Elastofibroma dorsi: prospects of complex clinical and radiological diagnostics (CT and MRI) in diagnosis (a case study)

Objective. To systematize modern concepts of the etiology, diagnosis, and management of patients with elastofibroma of the back, and to illustrate the features of the diagnostic process based on the analysis of literature data and a clinical case.

Materials and methods. An analysis of scientific literature dedicated to elastofibroma was conducted. A detailed clinical observation of a 65-year-old female patient with bilateral asymptomatic masses in the subscapular region was also presented. Diagnosis involved clinical examination, magnetic resonance imaging (MRI), computed tomography (CT), and histological examination after biopsy.

Results. The clinical case demonstrated the difficulties of radiological diagnostics: according to MRI data, a malignant process (fibrosarcoma) was suspected, whereas the CT picture, considering the typical location and structure, suggested elastofibroma. The final diagnosis was established only after histological examination, which revealed fragmented elastic fibers (“globules”) and fibrous tissue without signs of atypy. Taking into account absence of symptoms, the patient was recommended a wait-and-see approach with dynamic observation. The literature analysis confirmed that modern radiological methods (ultrasound, CT, MRI) play a key role in diagnostics, revealing pathognomonic signs, and surgical treatment is indicated only in the presence of symptoms.

Conclusion. Elastofibroma is a rare benign formation, often requiring differential diagnostics with malignant soft tissue tumors. The most informative diagnostics methods are CT and MRI, but verification is only possible histologically in complex cases. In asymptomatic cases, dynamic observation is the method of choice, as the disease lacks potential for malignant transformation. The presented case study emphasizes the importance of an integrated approach combining anamnestic data, radiological methods, and morphological examination.

1. Boldin BV, Tsukan VYu, Dizengof IM, Sergeev AA, Kolesova SI, Kobzarev DA. Elastofibroma: a literature review and clinical case. Ambulatornaya khirurgiya = Ambulatory Surgery. 2023;20(2):202-208. (In Russ.). DOI: https://doi.org/10.21518/akh2023-030

2. Vinokurov AS, Yudin AL, Uchevatkin AA, Yumatova EA. Radiation diagnostics of elastofibroma. Medical Visualization. 2016(3):136-141.

3. Freixinet J, Rodríguez P, Hussein M, Sanromán B, Herrero J, Gil R. Elastofibroma of the thoracic wall. Interact Cardiovasc Thorac Surg. 2008;7:626-628. DOI: https://doi.org10.1510/icvts.2007.174722

4. Brandser EA, Goree JC, El-Khoury GY. Elastofibroma dorsi: prevalence in an elderly population as revealed by CT. Am J Roentgenol 1998;171:977-980. DOI: https://doi.org/10.2214/ajr.171.4.9762978

5. Jarvi OH, Lansimies P.H. Subclinical elastofibromas in the scapular region at autopsy series. Acta Pathol. Microbiol. Scand. 1975;83:87-108. DOI: https://doi.org/10.1111/j.1699-0463.1975.tb01361.x

6. Nagamine N, Nohara Y, Ito E. Elastofibroma in Okinawa: a clinicopathologic study of 170 cases. Cancer. 1982;50:1794-1805. DOI: https://doi.org/10.1002/1097-0142(19821101)50:9<1794: aid-cncr2820500925>3.0.co;2-l

7. Naylor MF, Nascimento AG, Sherrick AD, McLeod RA. Elastofibroma dorsi: radiologic findings in 12 patients. Am. J. Roentgenol. 1996;167:683-687. DOI: https://doi.org/10.2214/ajr.167.3.8751681

8. Blumenkrantz Y, Bruno GL, González CJ, Namías M, Osorio AR, Parma P. Characterization of Elastofibroma Dorsi with 18FDG PET/CT: a retrospective study. Rev. Esp. Med. Nucl. 2011;30(6):342-345. DOI: https://doi.org/10.1016/j.remn.2011.01.006

9. Braham E, Hergli I, Boudaya MS, Ismail O, AyadiKaddour A, Kilani T, El Mezni F. Elastofibroma of scapula: a case report and literature review. Ann Transl Med. 2013;1(3):31. DOI: https://doi.org/10.3978/j.issn.2305-5839.2013.05.01

10. Karrakchou B, Yaikoubi Y, Chairi MS, Jalil A. Elastofibroma dorsi: case report and review of the literature. Pan African Medical Journal. 2017;28:34. DOI: https://doi.org/10.11604/pamj.2017.28.34.13675

11. Vastamäki M. Elastofibroma scapulae. Clin. Orthop. Relat. Res. 2001:404-408.

12. Kourda J, Ayadi-Kaddour A, Merai S, Hantous S, Miled KB, Mezni FE. Bilateral elastofibroma dorsi. a case report and review of the literature. Orthop Traumatol Surg Res. 2009;95:383- 387. DOI: https://doi.org/10.1016/j.otsr.2009.05.002

13. Falidas E, Arvanitis D, Anyfantakis G, Pazidis A, Koukouli, Miltiadou D, Koronaiou A. Painful elastofibroma dorsi: a report of a case and a brief review of the literature. Case Rep Orthoped. 2013:794247. DOI: https://doi.org/10.1155/2013/794247

14. Di Vito A, Scali E, Ferraro G. Mignogna C, Presta I, Camastra C, Donato G, Barni T. Elastofibroma dorsi: a histochemical and immunohistochemical study. Eur J Histochem. 2015;59(1):2459. DOI: https://doi.org|10.4081/ejh.2015.2459

15. Hammoumi ME, Qtaibi A, Arsalane A, El Oueriachi, Kabiri el H. Elastofibromadorsi: clinicopathological analysis of 76 cases. Korean J Thorac. Cardiovasc Surg. 2014;47:111-116. DOI: https://doi.org/10.5090/kjtcs.2014.47.2.111

16. Nagano S, Yokouchi M, Setoyama T, Sasaki H, Shimada H, Kawamura I, Ishidou Y, Setoguchi T, Komiya S. Elastofibroma dorsi: surgical indications and complications of a rare soft tissue tumor. Molecular Clin Oncol 2014;2(3):421-424. DOI: https://doi.org/10.3892/mco.2014.257

17. Tokur M, Kurul CI, Gönül II, Memiş L. Exercise-induced elastofibroma dorsi. Eurasian J. Pulmonol. 2014;16:47-49. DOI: https://doi.org/10.5152/ejp.2014.78055

18. Oueslati S, Douira-Khomsi W, Bouaziz MC, Zaouia K. Elastofibroma dorsi: A report on 6 cases. Acta Orthop Belg. 2006;72(2):237-342.

19. Briccoli A, Casadei R, Di Renzo M, Favale L, Bacchini P, Bertoni F. Elastofibroma dorsi. Surg. Today. 2000;30:147-152. DOI: https://doi.org/10.1007/PL00010063

20. Kastner M, Salai M, Fichman S, Heller S, Dudkiewicz I. Elastofibroma at the scapular region. Isr. Med. Assoc. J. 2009;11:170-172.

21. Goyal P, Gandhi D, Gupta S, Kumar SLiY, Olsavsky TD, Gupta N, Goyal P. Elastofibroma dorsi. Proceedings (Baylor University Medical Center). 2017;30(3):340-342. DOI: https://doi.org/10.1080/08998280.2017.11929641

22. Cavallasca JA, Sohn DI, Borgia AR, Maliandi Mdel R, Musuruana JL. Elastofibroma dorsi: review of 4 cases. Reumatol. Clin. 2012;8(6):358-360. DOI: https://doi.org/10.1016/j.reumae.2012.06.002

23. Ochsner JE, Sewall SA, Brooks GN, Agni R. Best cases from the AFIP: Elastofibroma dorsi. Radiographics. 2006;26(6):1873-1876. DOI: https://doi.org/10.1148/rg.266055184

24. Kransdorf MJ, Meis JM, Montgomery E. Elastofibroma: MR and CT appearance with radiologic-pathologic correlation. AJR. 1992;159(3):575-579. DOI: https://doi.org/10.2214/ajr.159.3.1503030

25. Pilge H, Hesper T, Holzapfel BM, Prodinger PM, Straub M, Krauspe R. Elastofibroma: clinical results after resection of a rare tumor entity. Orthop Rev (Pavia). 2014;6(2):5329. DOI: https://doi.org/10.4081/or.2014.5329

26. Jena A, Mutheeswaraiah Y, Chowhan AK, Rukmangadha N, Kumaraswamy MR. Hibernoma – an unusual presentation. J. Clin. Sci. Res. 2013;2:105-107. DOI: https://doi.org/10.15380/2277-5706.JCSR.12.074

27. Grayson JW, Wallace JC. A case report and discussion of hibernomas: pathology, genetics, diagnosis, and treatment. Am. J. Clin. Med. 2012;9(3):151-153.

28. Santosh D, Suresh P, Venkatanarasimha N. Infrascapular abnormalities: location-specific fat-containing chest wall lesions. AJR Am J Roentgenol. 2012;198(5):W510-1. DOI: https://doi.org/10.2214/AJR.11.8167

29. Karakurt O, Kaplan T, Gunal N, Gulbahar G, Kocer B, Han S, Dural K, Sakinci U. Elastofibroma dorsi management and outcomes: review of 16 cases. Interact Cardiovasc Thorac Surg. 2014;18(2):197-201. DOI: https://doi.org/10.1093/icvts/ivt442

30. Daigeler A, Vogt PM, Busch K, Pennekamp W, Weyhe D, Lehnhardt M, Steinstraesser L, Steinau HU, Kuhnen C. Elastofibroma dorsi – differential diagnosis in chest wall tumours. World J Surg Oncol. 2007;5:15. DOI: https://doi.org/10.1186/1477-7819-5-15

31. Prete PE, Henbest M, Michalski JP, Porter RW. Intraspinal elastofibroma. A case report. Spine (Phila Pa 1976). 1983;8(7):800-802. DOI: https://doi.org/10.1097/00007632-198310000-00019

32. Deutsch GP. Elastofibroma dorsalis treated by radiotherapy. Br J Radiol. 1974;47(561):621-623. DOI: https://doi.org/10.1259/0007-1285-47-561-621