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__NOTOC__
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{{SI}}
{{SI}}
 
Elastofibroma dorsi {{CMG}}; {{AE}}{{ADS}}{{MA}}{{Ammu}}
Elastofibroma dorsi {{CMG}}; {{AE}}
 
{{SK}}elastofibroma dorsi  
{{SK}}elastofibroma dorsi  


==Overview==
==Overview==
Elastofibroma dorsi is a rare, slow growing, ill-defined [[soft tissue]] [[mass]] of the [[chest wall]]. It occurs most in the periscapular region.Elastofibroma was first discovered by Jarvi and Saxen, in 1961. Elastofibroma dorsi is a rare, slow growing, ill-defined [[soft tissue]] [[mass]] of the [[chest wall]]. It occurs most in the periscapular region. It is commonly located beneath [[latissimus dorsi]] and [[Rhomboid major muscle|rhomboid major muscles]] near to the [[Inferior angle of the scapula|inferior angle of the scapula.]] It is a benign [[neoplasm]] with clinical appearance of a [[malignant tumor]]. The exact pathogenesis of elastofibroma dorsi is not fully understood. It is thought that elastofibroma dorsi is the result of subclinical microtrauma, reactive [[hyperplasia]] of [[elastic fibers]] and increased production of [[fibrous tissue]]. The area between [[thoracic wall]] and [[scapula]] is the area of maximum and repeated friction and it was postulated as one of the reason of pathogenesis of elastofibroma. Elastofibroma often has bilateral location in the [[thoracic wall]]. On gross pathology, characteristic findings of elastofibroma include [[solitary]], poorly circumscribed, [[heterogeneous]], [[Soft tissue|soft-tissue]] mass. On microscopic [[histopathological]] analysis, characteristic findings of Elastofibroma include [[Eosinophilic]], beaded [[elastic fibers]] with Verhoeff's elastic stain. many fragmented fibers with appearance of beads on a string can be seen also. Elastofibroma dorsi must be differentiated from [[lipoma]], desmoid tumours, [[neurofibroma]] and [[liposarcoma]]. The [[prevalence]] of elastofibroma is approximately 11200 in men and 24400 in women per 100,000 individuals in each gender autopsies. Elastofibroma commonly affects elderly female and age can be ranging from 35-94 years. The  female to male ratio is approximately 2.1. The majority of elastofibroma cases are reported in Japan. The majority of patients with elastofibroma dorsi are asymptomatic. Elastofibroma may present with painless [[swelling]], pain (less than 10% of patients), scapular snapping, limitation of motion, clunking sensation in the shoulder [[adduction]]-[[abduction]] movement. Patients with elastofibroma usually appear normal and physical examination findings of Elastofibroma can include limited [[range of motion]] and [[swelling]]. An x-ray may be helpful in the diagnosis of elastofibroma and the findings include soft tissue density in the periscapular region. X-ray may be normal. CT scan may show a heterogenous [[soft tissue]] mass with poorly defined margins.Magnetic resonance imaging is the first diagnostic tool for diagnosis of elastofibroma dorsi. Findings on MRI suggestive of elastofibroma include solitary heterogeneous, poorly circumscribed, [[soft-tissue]] mass which is isointense to muscle in T1 and T2WI images.Positron emission tomography/computed tomography (PET/CT) may show low to moderate metabolic activity in these patients. PET/CT shows low-grade diffuse 18F [[fluorodeoxyglucose]] uptake. Needle aspiration biopsy confirms the diagnosis exclude [[sarcoma]]. Surgical resection is considered only in symptomatic cases.


==Historical Perspective==
==Historical Perspective==
Elastofibroma was first discovered by Jarvi and Saxen, in 1961.<ref name="pmid13789598">{{cite journal |vauthors=JARVI O, SAXEN E |title=Elastofibroma dorse |journal=Acta Pathol Microbiol Scand Suppl |volume=51(Suppl 144) |issue= |pages=83–4 |date=1961 |pmid=13789598 |doi= |url=}}</ref>
Elastofibroma was first discovered by Jarvi and Saxen, in 1961.<ref name="pmid13789598">{{cite journal |vauthors=JARVI O, SAXEN E |title=Elastofibroma dorse |journal=Acta Pathol Microbiol Scand Suppl |volume=51(Suppl 144) |issue= |pages=83–4 |date=1961 |pmid=13789598 |doi= |url=}}</ref><ref name="pmid11246542">{{cite journal| author=Järvi OH, Länsimies PH| title=Subclinical elastofibromas in the scapular region in an autopsy series. | journal=Acta Pathol Microbiol Scand A | year= 1975 | volume= 83 | issue= 1 | pages= 87-108 | pmid=1124654 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1124654  }}</ref>
 
The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
 
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
 
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
 
There have been several outbreaks of [disease name], including -----.
 
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].


==Classification==
==Classification==
There is no established system for the classification of [disease name].
There is no established system for the classification of elastofibroma.
 
OR
 
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
 
OR
 
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
 
OR
 
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
 
OR
 
If the staging system involves specific and characteristic findings and features:
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
 
OR
 
The staging of [malignancy name] is based on the [staging system].
 
OR
 
There is no established system for the staging of [malignancy name].


==Pathophysiology==
==Pathophysiology==
Elastofibroma dorsi is a rare, slow growing, ill-defined soft tissue mass of the chest wall. It occurs most in the periscapular region.It is commonly located beneath latissimus dorsi and rhomboid major muscles near to the inferior angle of the scapula. It is a benign neoplasm with clinical appearence of a malignant tumor. <ref name="pmid18407963">{{cite journal |vauthors=Freixinet J, Rodríguez P, Hussein M, Sanromán B, Herrero J, Gil R |title=Elastofibroma of the thoracic wall |journal=Interact Cardiovasc Thorac Surg |volume=7 |issue=4 |pages=626–8 |date=August 2008 |pmid=18407963 |doi=10.1510/icvts.2007.174722 |url=}}</ref>
*Elastofibroma dorsi is a rare, slow growing, ill-defined [[soft tissue]] [[mass]] of the [[chest wall]]. It occurs most in the periscapular region.
*It is commonly located beneath [[latissimus dorsi]] and [[Rhomboid major muscle|rhomboid major muscles]] near to the [[Inferior angle of the scapula|inferior angle of the scapula.]]
*It is a benign [[neoplasm]] with clinical appearance of a [[malignant tumor]].<ref name="pmid18407963">{{cite journal |vauthors=Freixinet J, Rodríguez P, Hussein M, Sanromán B, Herrero J, Gil R |title=Elastofibroma of the thoracic wall |journal=Interact Cardiovasc Thorac Surg |volume=7 |issue=4 |pages=626–8 |date=August 2008 |pmid=18407963 |doi=10.1510/icvts.2007.174722 |url=}}</ref>
*The exact pathogenesis of elastofibroma dorsi is not fully understood.
*It is thought that elastofibroma dorsi is the result of subclinical microtrauma, reactive [[hyperplasia]] of [[elastic fibers]] and increased production of [[fibrous tissue]].<ref name="pmid1417241">{{cite journal |vauthors=Machens HG, Mechtersheimer R, Göhring U, Schlag PN |title=Bilateral elastofibroma dorsi |journal=Ann. Thorac. Surg. |volume=54 |issue=4 |pages=774–6 |date=October 1992 |pmid=1417241 |doi= |url=}}</ref><ref name="pmid169615222">{{cite journal| author=Cota C, Solivetti F, Kovacs D, Cristiani R, Amantea A| title=Elastofibroma dorsi: histologic and echographic considerations. | journal=Int J Dermatol | year= 2006 | volume= 45 | issue= 9 | pages= 1100-3 | pmid=16961522 | doi=10.1111/j.1365-4632.2004.02550.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16961522  }}</ref>
*The area between [[thoracic wall]] and [[scapula]] is the area of maximum and repeated friction and it was postulated as one of the reason of pathogenesis of elastofibroma.<ref name="pmid169615222" />
*Another theory regarding pathogenesis includes genetic alteration using [[comparative genomic hybridization]](CGH).
*Hernandez ''et al'' found changes in [[DNA sequences|DNA-sequences]] in [[chromosomes]] 1p, 13q, 19p and 22q.<ref name="pmid20422214">{{cite journal| author=Hernández JL, Rodríguez-Parets JO, Valero JM, Muñoz MA, Benito MR, Hernandez JM et al.| title=High-resolution genome-wide analysis of chromosomal alterations in elastofibroma. | journal=Virchows Arch | year= 2010 | volume= 456 | issue= 6 | pages= 681-7 | pmid=20422214 | doi=10.1007/s00428-010-0911-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20422214  }}</ref>
*Nishio ''et al.'' noted an increase of [[DNA]] copies on [[X chromosome]]<nowiki/>s ' long arm using CGH.<ref name="pmid12165800">{{cite journal| author=Nishio JN, Iwasaki H, Ohjimi Y, Ishiguro M, Koga T, Isayama T et al.| title=Gain of Xq detected by comparative genomic hybridization in elastofibroma. | journal=Int J Mol Med | year= 2002 | volume= 10 | issue= 3 | pages= 277-80 | pmid=12165800 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12165800  }}</ref>
*Elastofibroma often has bilateral location in the [[thoracic wall]].<ref name="JenaPatnayak20163">{{cite journal|last1=Jena|first1=Amitabh|last2=Patnayak|first2=Rashmi|last3=Settipalli|first3=Sarla|last4=Nagesh|first4=N|title=Elastofibroma: An uncommon tumor revisited|journal=Journal of Cutaneous and Aesthetic Surgery|volume=9|issue=1|year=2016|pages=34|issn=0974-2077|doi=10.4103/0974-2077.178543}}</ref><ref name="SariciBasbay2014">{{cite journal|last1=Sarici|first1=Inanc Samil|last2=Basbay|first2=Elif|last3=Mustu|first3=Mehdi|last4=Eskut|first4=Burak|last5=Kala|first5=Ferhat|last6=Agcaoglu|first6=Orhan|last7=Akici|first7=Murat|last8=Ozkurt|first8=Enver|title=Bilateral elastofibroma dorsi: A case report|journal=International Journal of Surgery Case Reports|volume=5|issue=12|year=2014|pages=1139–1141|issn=22102612|doi=10.1016/j.ijscr.2014.10.032}}</ref>


The exact pathogenesis of elastofibroma dorsi is not fully understood. It is thought that elastofibroma dorsi is the result of subclinical microtrauma, reactive hyperplasia of elastic fibres and increased production of fibrous tissue. <ref name="pmid1417241">{{cite journal |vauthors=Machens HG, Mechtersheimer R, Göhring U, Schlag PN |title=Bilateral elastofibroma dorsi |journal=Ann. Thorac. Surg. |volume=54 |issue=4 |pages=774–6 |date=October 1992 |pmid=1417241 |doi= |url=}}</ref>
===Gross pathology===
On gross pathology, characteristic findings of elastofibroma include:<ref name="JenaPatnayak20163" />


Elastofibroma occurs predominantly on the right side. Only 10% of patients has bilateral involvement. <ref name="pmid1503030">{{cite journal |vauthors=Kransdorf MJ, Meis JM, Montgomery E |title=Elastofibroma: MR and CT appearance with radiologic-pathologic correlation |journal=AJR Am J Roentgenol |volume=159 |issue=3 |pages=575–9 |date=September 1992 |pmid=1503030 |doi=10.2214/ajr.159.3.1503030 |url=}}</ref>
* A [[solitary]], poorly circumscribed, [[heterogeneous]], [[Soft tissue|soft-tissue]] mass.
 
*Cut section are firm with grayish-white areas.
Elastofibroma often has bilateral location in the thoracic wall.<ref name="JenaPatnayak20163">{{cite journal|last1=Jena|first1=Amitabh|last2=Patnayak|first2=Rashmi|last3=Settipalli|first3=Sarla|last4=Nagesh|first4=N|title=Elastofibroma: An uncommon tumor revisited|journal=Journal of Cutaneous and Aesthetic Surgery|volume=9|issue=1|year=2016|pages=34|issn=0974-2077|doi=10.4103/0974-2077.178543}}</ref>
===Microscopic findings===
 
On microscopic [[histopathological]] analysis, characteristic findings of Elastofibroma include:<ref name="JenaPatnayak20163" /><ref name="pmid16961522">{{cite journal| author=Cota C, Solivetti F, Kovacs D, Cristiani R, Amantea A| title=Elastofibroma dorsi: histologic and echographic considerations. | journal=Int J Dermatol | year= 2006 | volume= 45 | issue= 9 | pages= 1100-3 | pmid=16961522 | doi=10.1111/j.1365-4632.2004.02550.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16961522  }}</ref>
OR
 
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
 
OR
 
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
 
OR
 
 
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
 
OR
 
The progression to [disease name] usually involves the [molecular pathway].
 
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.
 
On gross pathology, characteristic findings of elastofibroma include:<ref name="JenaPatnayak20164">{{cite journal|last1=Jena|first1=Amitabh|last2=Patnayak|first2=Rashmi|last3=Settipalli|first3=Sarla|last4=Nagesh|first4=N|title=Elastofibroma: An uncommon tumor revisited|journal=Journal of Cutaneous and Aesthetic Surgery|volume=9|issue=1|year=2016|pages=34|issn=0974-2077|doi=10.4103/0974-2077.178543}}</ref>
 
* A solitary, poorly circumscribed, heterogeneous, soft-tissue mass  
*Cut section are firm with grayish-white areas  
 
On microscopic histopathological analysis, characteristic findings of Elastofibroma include: <ref name="JenaPatnayak20162">{{cite journal|last1=Jena|first1=Amitabh|last2=Patnayak|first2=Rashmi|last3=Settipalli|first3=Sarla|last4=Nagesh|first4=N|title=Elastofibroma: An uncommon tumor revisited|journal=Journal of Cutaneous and Aesthetic Surgery|volume=9|issue=1|year=2016|pages=34|issn=0974-2077|doi=10.4103/0974-2077.178543}}</ref>
 
* Eosinophilic, beaded elastic fibers with Verhoeff's elastic stain
*Many fragmented fibers with appearance of beads on a string
*


*[[Eosinophilic]], beaded [[elastic fibers]] with Verhoeff's elastic stain.
*Many fragmented fibers with appearance of beads on a string.
===Gallery===
<gallery heights="175" widths="175">
File:1-s2.0-S2210261214002806-gr2 lrg.jpg| Bilateral Elastofibroma dorsi. Source:''Science direct(under creative commons)''<ref name="SariciBasbay2014">{{cite journal|last1=Sarici|first1=Inanc Samil|last2=Basbay|first2=Elif|last3=Mustu|first3=Mehdi|last4=Eskut|first4=Burak|last5=Kala|first5=Ferhat|last6=Agcaoglu|first6=Orhan|last7=Akici|first7=Murat|last8=Ozkurt|first8=Enver|title=Bilateral elastofibroma dorsi: A case report|journal=International Journal of Surgery Case Reports|volume=5|issue=12|year=2014|pages=1139–1141|issn=22102612|doi=10.1016/j.ijscr.2014.10.032}}</ref>
Image:Elastofibroma of mitral valve 001.jpg|Elastofibroma
File:1-s2.0-S2210261214002806-gr3 lrg.jpg| Bilateral Elastofibroma dorsi. Source:''Science direct(under creative commons)''<ref name="SariciBasbay2014">{{cite journal|last1=Sarici|first1=Inanc Samil|last2=Basbay|first2=Elif|last3=Mustu|first3=Mehdi|last4=Eskut|first4=Burak|last5=Kala|first5=Ferhat|last6=Agcaoglu|first6=Orhan|last7=Akici|first7=Murat|last8=Ozkurt|first8=Enver|title=Bilateral elastofibroma dorsi: A case report|journal=International Journal of Surgery Case Reports|volume=5|issue=12|year=2014|pages=1139–1141|issn=22102612|doi=10.1016/j.ijscr.2014.10.032}}</ref>
Image:Papillary fibroelastoma 001.jpg|Papillary Fibroelastoma: When located on the mitral valve, these tumors are usually on the anterior leaflet of the atrial surface.
</gallery>


==Causes==
==Causes==
Disease name] may be caused by [cause1], [cause2], or [cause3].
The cause of elastofibroma dorsi has not been identified. Subclinical microtrauma could be one of the reasons.<ref name="pmid1417241" />
 
<br />
The cause of elastofibroma dorsi has not been identified. Subclinical microtrauma could be one of the reasons. <ref name="pmid1417241" />  
 
OR
 
Common causes of [disease] include [cause1], [cause2], and [cause3].
 
OR
 
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
 
OR
 
The cause of elastofibroma dorsi has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].


==Differentiating Elastofibroma dorsi from Other Diseases==
==Differentiating Elastofibroma dorsi from Other Diseases==


Elastofibroma dorsi must be differentiated from desmoid tumours, neurofibroma and liposarcoma. <ref name="pmid185512042">{{cite journal |vauthors=Tetikkurt C, Tetikkurt S, Bayar N |title=Diagnosis of elastofibroma |journal=Can. Respir. J. |volume=15 |issue=4 |pages=217–8 |date=2008 |pmid=18551204 |pmc=2677955 |doi=10.1155/2008/638624 |url=}}</ref>
Elastofibroma dorsi must be differentiated from desmoid tumours, neurofibroma and liposarcoma.<ref name="JenaPatnayak20163" />


==Epidemiology and Demographics==
==Epidemiology and Demographics==
The prevalence of elastofibroma is approximately 11200 in men and 24400 in women per 100,000 individuals in each gender autopsies. <ref name="pmid1124654">{{cite journal |vauthors=Järvi OH, Länsimies PH |title=Subclinical elastofibromas in the scapular region in an autopsy series |journal=Acta Pathol Microbiol Scand A |volume=83 |issue=1 |pages=87–108 |date=January 1975 |pmid=1124654 |doi= |url=}}</ref>
*The prevalence of elastofibroma is approximately 11200 in men and 24400 in women per 100,000 individuals in each gender autopsies.<ref name="JenaPatnayak20163" />
 
*Elastofibroma commonly affects elderly female.<ref name="JenaPatnayak20163" />
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
*Elastofibroma commonly affects females ranging from 35-94 years.<ref name="JenaPatnayak20163" />
 
*Females are more commonly affected by elastofibroma than men. The  female to male ratio is approximately 2.1
OR
*The majority of elastofibroma cases are reported in Japan.<ref name="JenaPatnayak20163" />
 
In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
 
 
 
Patients of all age groups may develop [disease name].
 
OR
 
The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
 
OR
 
Elastofibroma commonly affects elderly female. <ref name="pmid27081248">{{cite journal |vauthors=Patnayak R, Jena A, Settipalli S, Nagesh N |title=Elastofibroma: An Uncommon Tumor Revisited |journal=J Cutan Aesthet Surg |volume=9 |issue=1 |pages=34–7 |date=2016 |pmid=27081248 |pmc=4812887 |doi=10.4103/0974-2077.178543 |url=}}</ref>
 
OR
 
[Chronic disease name] is usually first diagnosed among [age group].
 
OR
 
Elastofibroma commonly affects females ranging from 35-94 years. <ref name="pmid270812483">{{cite journal |vauthors=Patnayak R, Jena A, Settipalli S, Nagesh N |title=Elastofibroma: An Uncommon Tumor Revisited |journal=J Cutan Aesthet Surg |volume=9 |issue=1 |pages=34–7 |date=2016 |pmid=27081248 |pmc=4812887 |doi=10.4103/0974-2077.178543 |url=}}</ref>
 
 
 
There is no racial predilection to [disease name].
 
OR
 
Elastofibroma usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
 
 
 
affects men and women equally.
 
OR
 
Female are more commonly affected by elastofibroma than men. The  female to male ratio is approximately 2.1
 
 
 
The majority of elastofibroma cases are reported in Japan. <ref name="pmid7116305">{{cite journal |vauthors=Nagamine N, Nohara Y, Ito E |title=Elastofibroma in Okinawa. A clinicopathologic study of 170 cases |journal=Cancer |volume=50 |issue=9 |pages=1794–805 |date=November 1982 |pmid=7116305 |doi= |url=}}</ref>
 
OR
 
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].


==Risk Factors==
==Risk Factors==
There are no established risk factors for [disease name].
There are no established risk factors for elastofibroma.  
 
OR
 
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
 
OR
 
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
 
OR
 
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.


==Screening==
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].
There is insufficient evidence to recommend routine screening for elastofibroma.
 
OR
 
According to the [guideline name], screening for [disease name] is not recommended.
 
OR
 
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
Prognosis is generally excellent.
 
OR
 
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
 
OR
 
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.


==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
There are no established criteria for the diagnosis of elastofibroma.  
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
There are no established criteria for the diagnosis of [disease name].


===History and Symptoms===
===History and Symptoms===
The majority of patients with elastofibroma dorsi are asymptomatic. Elastofibroma may present with:<ref name="pmid2652048">{{cite journal |vauthors=Greenberg JA, Lockwood RC |title=Elastofibroma dorsi. A case report and review of the literature |journal=Orthop Rev |volume=18 |issue=3 |pages=329–33 |date=March 1989 |pmid=2652048 |doi= |url=}}</ref>
The majority of patients with elastofibroma dorsi are asymptomatic. Elastofibroma may present with:<ref name="pmid2652048">{{cite journal |vauthors=Greenberg JA, Lockwood RC |title=Elastofibroma dorsi. A case report and review of the literature |journal=Orthop Rev |volume=18 |issue=3 |pages=329–33 |date=March 1989 |pmid=2652048 |doi= |url=}}</ref>
* Painless swelling
* Painless [[swelling]]
* Pain ( less than 10% of patients)
* Pain (less than 10% of patients)
* Scapular snapping
* Scapular snapping
* Limitation of motion,  
* Limitation of motion,  
* Clunking sensation in the shoulder adduction-abduction movement<ref name="pmid25437657">{{cite journal |vauthors=Sarici IS, Basbay E, Mustu M, Eskut B, Kala F, Agcaoglu O, Akici M, Ozkurt E |title=Bilateral elastofibroma dorsi: A case report |journal=Int J Surg Case Rep |volume=5 |issue=12 |pages=1139–41 |date=2014 |pmid=25437657 |pmc=4275815 |doi=10.1016/j.ijscr.2014.10.032 |url=}}</ref>
* Clunking sensation in the shoulder [[adduction]]-[[abduction]] movement<ref name="pmid25437657">{{cite journal |vauthors=Sarici IS, Basbay E, Mustu M, Eskut B, Kala F, Agcaoglu O, Akici M, Ozkurt E |title=Bilateral elastofibroma dorsi: A case report |journal=Int J Surg Case Rep |volume=5 |issue=12 |pages=1139–41 |date=2014 |pmid=25437657 |pmc=4275815 |doi=10.1016/j.ijscr.2014.10.032 |url=}}</ref>
scapular snapping, limitation of motion, clunking sensation in the shoulder adduction-abduction movement., limitation of motion, clunking sensation in the shoulder adduction-abduction movement.
 
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].


===Physical Examination===
===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
*Patients with elastofibroma usually appear normal.
 
*Physical examination findings of Elastofibroma can include limited [[range of motion]] and [[swelling]] <ref name="pmid25437657">{{cite journal |vauthors=Sarici IS, Basbay E, Mustu M, Eskut B, Kala F, Agcaoglu O, Akici M, Ozkurt E |title=Bilateral elastofibroma dorsi: A case report |journal=Int J Surg Case Rep |volume=5 |issue=12 |pages=1139–41 |date=2014 |pmid=25437657 |pmc=4275815 |doi=10.1016/j.ijscr.2014.10.032 |url=}}</ref>
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Laboratory Findings===
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
There are no diagnostic laboratory findings associated with elastofibroma.
 
OR
 
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
OR
 
[Test] is usually normal among patients with [disease name].
 
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with [disease name].


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
There are no ECG findings associated with elastofibroma.
 
OR
 
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===X-ray===
===X-ray===
 
An x-ray may be helpful in the diagnosis of elastofibroma. Findings on an x-ray suggestive of elastofibroma include soft tissue density in the periscapular region. X-ray may be normal.<ref name="pmid18551204">{{cite journal |vauthors=Tetikkurt C, Tetikkurt S, Bayar N |title=Diagnosis of elastofibroma |journal=Can. Respir. J. |volume=15 |issue=4 |pages=217–8 |date=2008 |pmid=18551204 |pmc=2677955 |doi=10.1155/2008/638624 |url=}}</ref>
An x-ray may be helpful in the diagnosis of elastofibroma. Findings on an x-ray suggestive of elastofibroma include soft tissue density in the periscapular region. X-ray may be normal. <ref name="pmid18551204">{{cite journal |vauthors=Tetikkurt C, Tetikkurt S, Bayar N |title=Diagnosis of elastofibroma |journal=Can. Respir. J. |volume=15 |issue=4 |pages=217–8 |date=2008 |pmid=18551204 |pmc=2677955 |doi=10.1155/2008/638624 |url=}}</ref>


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].
There are no echocardiography/ultrasound findings associated with elastofibroma.
 
OR
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===CT scan===
===CT scan===
CT scan may be helpful in the diagnosis of elastofibroma dorsi. Findings on CT scan suggestive of elastofibroma dorsi include a heterogenous soft tissue mass with poorly defined margins. <ref name="pmid8998883">{{cite journal |vauthors=Hoffman JK, Klein MH, McInerney VK |title=Bilateral elastofibroma: a case report and review of the literature |journal=Clin. Orthop. Relat. Res. |volume= |issue=325 |pages=245–50 |date=April 1996 |pmid=8998883 |doi= |url=}}</ref>
CT scan may be helpful in the diagnosis of elastofibroma dorsi. Findings on CT scan suggestive of elastofibroma dorsi include a heterogenous [[soft tissue]] mass with poorly defined margins.<ref name="pmid8998883">{{cite journal |vauthors=Hoffman JK, Klein MH, McInerney VK |title=Bilateral elastofibroma: a case report and review of the literature |journal=Clin. Orthop. Relat. Res. |volume= |issue=325 |pages=245–50 |date=April 1996 |pmid=8998883 |doi= |url=}}</ref><ref name="pmid1503030">{{cite journal| author=Kransdorf MJ, Meis JM, Montgomery E| title=Elastofibroma: MR and CT appearance with radiologic-pathologic correlation. | journal=AJR Am J Roentgenol | year= 1992 | volume= 159 | issue= 3 | pages= 575-9 | pmid=1503030 | doi=10.2214/ajr.159.3.1503030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1503030  }}</ref>


===MRI===
===MRI===
Magnetic resonance imaging is the most useful diagnostic tool for diagnosis of elastofibroma dorsi. <ref name="pmid14648789">{{cite journal |vauthors=Domanski HA, Carlén B, Sloth M, Rydholm A |title=Elastofibroma dorsi has distinct cytomorphologic features, making diagnostic surgical biopsy unnecessary: cytomorphologic study with clinical, radiologic, and electron microscopic correlations |journal=Diagn. Cytopathol. |volume=29 |issue=6 |pages=327–33 |date=December 2003 |pmid=14648789 |doi=10.1002/dc.10381 |url=}}</ref>
*Magnetic resonance imaging is the most useful diagnostic tool for diagnosis of elastofibroma dorsi.<ref name="pmid15030302">{{cite journal| author=Kransdorf MJ, Meis JM, Montgomery E| title=Elastofibroma: MR and CT appearance with radiologic-pathologic correlation. | journal=AJR Am J Roentgenol | year= 1992 | volume= 159 | issue= 3 | pages= 575-9 | pmid=1503030 | doi=10.2214/ajr.159.3.1503030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1503030  }}</ref><ref name="pmid14648789">{{cite journal |vauthors=Domanski HA, Carlén B, Sloth M, Rydholm A |title=Elastofibroma dorsi has distinct cytomorphologic features, making diagnostic surgical biopsy unnecessary: cytomorphologic study with clinical, radiologic, and electron microscopic correlations |journal=Diagn. Cytopathol. |volume=29 |issue=6 |pages=327–33 |date=December 2003 |pmid=14648789 |doi=10.1002/dc.10381 |url=}}</ref>
 
*Findings on MRI suggestive of elastofibroma include solitary heterogeneous, poorly circumscribed, [[soft-tissue]] mass.<ref name="pmid15030303">{{cite journal| author=Kransdorf MJ, Meis JM, Montgomery E| title=Elastofibroma: MR and CT appearance with radiologic-pathologic correlation. | journal=AJR Am J Roentgenol | year= 1992 | volume= 159 | issue= 3 | pages= 575-9 | pmid=1503030 | doi=10.2214/ajr.159.3.1503030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1503030  }}</ref><ref name="pmid21655005">{{cite journal |vauthors=Go PH, Meadows MC, Deleon EM, Chamberlain RS |title=Elastofibroma dorsi: A soft tissue masquerade |journal=Int J Shoulder Surg |volume=4 |issue=4 |pages=97–101 |date=October 2010 |pmid=21655005 |pmc=3100815 |doi=10.4103/0973-6042.79797 |url=}}</ref>
Findings on MRI suggestive of elastofibroma include solitary heterogeneous, poorly circumscribed, soft-tissue mass.<ref name="pmid21655005">{{cite journal |vauthors=Go PH, Meadows MC, Deleon EM, Chamberlain RS |title=Elastofibroma dorsi: A soft tissue masquerade |journal=Int J Shoulder Surg |volume=4 |issue=4 |pages=97–101 |date=October 2010 |pmid=21655005 |pmc=3100815 |doi=10.4103/0973-6042.79797 |url=}}</ref>
*The lesion is isointense to muscle in T1 and T2WI images
 
The lesion is isointense to muscle in T1 and T2WI images  
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Other Imaging Findings===
===Other Imaging Findings===
 
Positron emission tomography/computed tomography (PET/CT) may be helpful in the diagnosis of elastofibroma. Findings on PET/CT suggestive of elastofibroma include low to moderate metabolic activity in these patients. PET/CT shows low-grade diffuse 18F [[fluorodeoxyglucose]] uptake.<ref name="pmid16100483">{{cite journal |vauthors=Patrikeos A, Breidahl W, Robins P |title=F-18 FDG uptake associated with Elastofibroma dorsi |journal=Clin Nucl Med |volume=30 |issue=9 |pages=617–8 |date=September 2005 |pmid=16100483 |doi= |url=}}</ref>
Positron emission tomography/computed tomography (PET/CT) may be helpful in the diagnosis of elastofibroma. Findings on PET/CT suggestive of elastofibroma include low to moderate metabolic activity in these patients. PET/CT shows low-grade diffuse 18F fluorodeoxyglucose uptake. <ref name="pmid16100483">{{cite journal |vauthors=Patrikeos A, Breidahl W, Robins P |title=F-18 FDG uptake associated with Elastofibroma dorsi |journal=Clin Nucl Med |volume=30 |issue=9 |pages=617–8 |date=September 2005 |pmid=16100483 |doi= |url=}}</ref>


===Other Diagnostic Studies===
===Other Diagnostic Studies===
 
Needle aspiration biopsy is helpful in the diagnosis of elastofibroma and exclude [[sarcoma]].<ref name="pmid18551204">{{cite journal |vauthors=Tetikkurt C, Tetikkurt S, Bayar N |title=Diagnosis of elastofibroma |journal=Can. Respir. J. |volume=15 |issue=4 |pages=217–8 |date=2008 |pmid=18551204 |pmc=2677955 |doi=10.1155/2008/638624 |url=}}</ref>
Needle aspiration biopsy is helpful in the diagnosis of elastofibroma and exclude sarcoma. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].


==Treatment==
==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Surgery===
===Surgery===
Surgical resection is considered only in symptomatic cases. <ref name="JenaPatnayak2016">{{cite journal|last1=Jena|first1=Amitabh|last2=Patnayak|first2=Rashmi|last3=Settipalli|first3=Sarla|last4=Nagesh|first4=N|title=Elastofibroma: An uncommon tumor revisited|journal=Journal of Cutaneous and Aesthetic Surgery|volume=9|issue=1|year=2016|pages=34|issn=0974-2077|doi=10.4103/0974-2077.178543}}</ref>
Surgical resection is considered only in symptomatic cases.<ref name="JenaPatnayak20163" />
 
Surgical intervention is not recommended for the management of [disease name].
 
OR
 
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for symptomatic patients.<ref name="pmid270812482">{{cite journal |vauthors=Patnayak R, Jena A, Settipalli S, Nagesh N |title=Elastofibroma: An Uncommon Tumor Revisited |journal=J Cutan Aesthet Surg |volume=9 |issue=1 |pages=34–7 |date=2016 |pmid=27081248 |pmc=4812887 |doi=10.4103/0974-2077.178543 |url=}}</ref>
 
OR
 
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
 
OR
 
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
 
OR
 
Surgery is the mainstay of treatment for [disease or malignancy].


===Primary Prevention===
===Primary Prevention===
There are no established measures for the primary prevention of [disease name].
There are no established measures for the primary prevention of elastofibroma.
 
OR
 
There are no available vaccines against [disease name].
 
OR
 
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
OR
 
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].


===Secondary Prevention===
===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].
There are no established measures for the secondary prevention of elastofibroma.
 
OR
 
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].


==References==
==References==
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__NOTOC__
{{SI}}
{{CMG}} {{AE}} {{Ammu}}
{{SK}}  Elastofibroma dorsi
==Overview==
Elastofibroma is an ill-defined fibroelastic tumor-like condition made up of enlarged and irregular [[elastic fibers]]. On gross pathology, ill defined, nonencapsulated, rubbery, and firm, white [[lesion]] with interspersed [[fat]] are characteristic findings of elastofibroma. On microscopic histopathological analysis, heavy dense bands of [[collagenous]] tissue dissected by fat and abnormal elastic fibers are characteristic findings of elastofibroma . The elastic fibers are usually quite large and are easily identified. The elastic fibers are coarse, thick, and darkly [[eosinophilic]], often fragmented into globules, creating a "string of pearls" or "pipe cleaner" appearance. Degeneration will cause the elastic fibers to appear as globules with a serrated or prickled edge.  Elastofibroma may be caused by either [[trauma]], genetic [[mutation]], or systemic [[enzyme]] defects. Elastofibroma must be differentiated from other diseases that cause soft tissue tumor such as: spindle cell [[lipoma]], [[nuchal]]-type [[fibroma]], and [[fibromatosis]] colli. Elastofibroma may also be diagnosed using [[biopsy]] and histochemistry. [[Surgery]] is the mainstay of therapy for elastofibroma.
==Pathophysiology==
* Elastofibroma, also called elastofibroma dorsi, is an ill-defined fibroelastic tumor-like condition made up of enlarged and irregular [[elastic fibers]]. <ref name="Chandrasekar">{{Cite journal | last1 = Chandrasekar | first1 = C. R. | last2 = Grimer | first2 = R. J. | last3 = Carter | first3 = S. R. | last4 = Tillman | first4 = R. M. | last5 = Abudu | first5 = A. | last6 = Davies | first6 = A. M. | last7 = Sumathi | first7 = V. P. | title = Elastofibroma Dorsi: An Uncommon Benign Pseudotumour | doi = 10.1155/2008/756565 | journal = Sarcoma | volume = 2008 | pages = 1 | year = 2008 | pmid = 18382611 | pmc =2276598 }}</ref> <ref name="Briccoli">{{Cite journal | last1 = Briccoli | first1 = A. | last2 = Casadei | first2 = R. | last3 = Di Renzo | first3 = M. | last4 = Favale | first4 = L. | last5 = Bacchini | first5 = P. | last6 = Bertoni | first6 = F. | title = Elastofibroma dorsi | journal = Surgery today | volume = 30 | issue = 2 | pages = 147–152 | year = 2000 | pmid = 10664338 | doi=10.1007/pl00010063}}</ref>
* The tumor develops very specifically in the [[subscapularis muscle|subscapular]] or infrascapular area, deep to the muscle, and can be attached to [[periosteum]] of ribs. It is usually between the [[shoulder blade]] and the lower neck, with rare tumors reported in the [[chest wall]]. <ref name="Chandrasekar">{{Cite journal | last1 = Chandrasekar | first1 = C. R. | last2 = Grimer | first2 = R. J. | last3 = Carter | first3 = S. R. | last4 = Tillman | first4 = R. M. | last5 = Abudu | first5 = A. | last6 = Davies | first6 = A. M. | last7 = Sumathi | first7 = V. P. | title = Elastofibroma Dorsi: An Uncommon Benign Pseudotumour | doi = 10.1155/2008/756565 | journal = Sarcoma | volume = 2008 | pages = 1 | year = 2008 | pmid = 18382611 | pmc =2276598 }}</ref> <ref name="Mortman">{{Cite journal | last1 = Mortman | first1 = K. D. | last2 = Hochheiser | first2 = G. M. | last3 = Giblin | first3 = E. M. | last4 = Manon-Matos | first4 = Y. | last5 = Frankel | first5 = K. M. | title = Elastofibroma Dorsi: Clinicopathologic Review of 6 Cases | doi = 10.1016/j.athoracsur.2006.11.050 | journal = The Annals of Thoracic Surgery | volume = 83 | issue = 5 | pages = 1894–1897 | year = 2007 | pmid = 17462431 | pmc = }}</ref> <ref name="Briccoli">{{Cite journal | last1 = Briccoli | first1 = A. | last2 = Casadei | first2 = R. | last3 = Di Renzo | first3 = M. | last4 = Favale | first4 = L. | last5 = Bacchini | first5 = P. | last6 = Bertoni | first6 = F. | title = Elastofibroma dorsi | journal = Surgery today | volume = 30 | issue = 2 | pages = 147–152 | year = 2000 | pmid = 10664338 | doi=10.1007/pl00010063}}</ref>
*The genetic mutation in has been associated alterations of short arm of [[chromosome 1]] with the development of elastofibroma.
*On gross pathology, ill defined, nonencapsulated, rubbery, and firm, white lesion with interspersed fat are characteristic findings of elastofibroma.
*On microscopic histopathological analysis, heavy dense bands of collagenous tissue dissected by fat and abnormal elastic fibers are characteristic findings of elastofibroma. The elastic fibers are often quite large and are easily identified. The elastic fibers are coarse, thick, and darkly [[eosinophilic]], often fragmented into globules, creating a "string of pearls" or "pipe cleaner" appearance. Degeneration will cause the elastic fibers to appear as globules with a serrated or prickled edge.
<gallery heights="175" widths="175">
Image:Elastofibroma of mitral valve 001.jpg|Elastofibroma
Image:Elastofibroma of mitral valve 002.jpg|Elastofibroma
Image:Papillary fibroelastoma 001.jpg|Papillary Fibroelastoma: When located on the mitral valve, these tumors are usually on the anterior leaflet of the atrial surface.
</gallery>
==Causes==
* Elastofibroma may be caused by either [[trauma]], genetic [[mutation]], or systemic [[enzyme]] defects.
==Differentiating Elastofibroma from other Diseases==
*Elastofibroma must be differentiated from other diseases that cause soft tissue tumor such as:
:*Spindle cell [[lipoma]]
:*Nuchal fibroma
:*Fibromatosis colli
==Epidemiology and Demographics==
* Elastoblastoma is a very rare disease.
===Age===
*Elastofibroma is more commonly observed among patients aged more than 50 years old.
===Gender===
*Females are more commonly affected with elastofibroma than males.
* The female to male ratio is approximately 5:1.
===Race===
*Elastofibroma usually reported more in individuals of the Japanese race.
==Risk Factors==
*Common risk factor in the development of elastofibroma is trauma.
== Diagnosis ==
=== Symptoms ===
*Symptoms of elastofibroma may include the following:
:*Swelling
:*Pain
=== Physical Examination ===
*Patients with elastofibroma usually appear normal.
*Physical examination may be remarkable for:
:*Slow growing, deep-seated, firm mass, often presenting bilaterally
:*Tenderness
=== Other Diagnostic Studies ===
*Elastofibroma may also be diagnosed using biopsy and histochemistry.
====Histochemistry====
* [[File:Elastofibroma_stained_with_elastic_stain_LDRT.tif|thumb|right|An elastic stain photomicrograph at high power highlighting the elastic fibers in black.]] The elastic fibers will be highlighted by a [[Weigert's elastic stain|Weigert]] or [[Van Gieson's|Van Gieson]] elastic stains. <ref name="Nakamura">{{Cite journal | last1 = Nakamura | first1 = Y. | last2 = Ohta | first2 = Y. | last3 = Itoh | first3 = S. | last4 = Haratake | first4 = A. | last5 = Nakano | first5 = Y. | last6 = Umeda | first6 = A. | last7 = Shima | first7 = H. | last8 = Tomoda | first8 = N. | title = Elastofibroma dorsi. Cytologic, histologic, immunohistochemical and ultrastructural studies | journal = Acta cytologica | volume = 36 | issue = 4 | pages = 559–562 | year = 1992 | pmid = 1636353}}</ref>
== Treatment ==
=== Surgery ===
*Surgery is the mainstay of therapy for  elastofibroma.
==References==
{{Reflist|2}}
[[Category:Oncology]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Medicine]]

Latest revision as of 20:59, 3 October 2019

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Elastofibroma dorsi Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]Mahda Alihashemi M.D. [3]Ammu Susheela, M.D. [4] Synonyms and keywords:elastofibroma dorsi

Overview

Elastofibroma dorsi is a rare, slow growing, ill-defined soft tissue mass of the chest wall. It occurs most in the periscapular region.Elastofibroma was first discovered by Jarvi and Saxen, in 1961. Elastofibroma dorsi is a rare, slow growing, ill-defined soft tissue mass of the chest wall. It occurs most in the periscapular region. It is commonly located beneath latissimus dorsi and rhomboid major muscles near to the inferior angle of the scapula. It is a benign neoplasm with clinical appearance of a malignant tumor. The exact pathogenesis of elastofibroma dorsi is not fully understood. It is thought that elastofibroma dorsi is the result of subclinical microtrauma, reactive hyperplasia of elastic fibers and increased production of fibrous tissue. The area between thoracic wall and scapula is the area of maximum and repeated friction and it was postulated as one of the reason of pathogenesis of elastofibroma. Elastofibroma often has bilateral location in the thoracic wall. On gross pathology, characteristic findings of elastofibroma include solitary, poorly circumscribed, heterogeneous, soft-tissue mass. On microscopic histopathological analysis, characteristic findings of Elastofibroma include Eosinophilic, beaded elastic fibers with Verhoeff's elastic stain. many fragmented fibers with appearance of beads on a string can be seen also. Elastofibroma dorsi must be differentiated from lipoma, desmoid tumours, neurofibroma and liposarcoma. The prevalence of elastofibroma is approximately 11200 in men and 24400 in women per 100,000 individuals in each gender autopsies. Elastofibroma commonly affects elderly female and age can be ranging from 35-94 years. The female to male ratio is approximately 2.1. The majority of elastofibroma cases are reported in Japan. The majority of patients with elastofibroma dorsi are asymptomatic. Elastofibroma may present with painless swelling, pain (less than 10% of patients), scapular snapping, limitation of motion, clunking sensation in the shoulder adduction-abduction movement. Patients with elastofibroma usually appear normal and physical examination findings of Elastofibroma can include limited range of motion and swelling. An x-ray may be helpful in the diagnosis of elastofibroma and the findings include soft tissue density in the periscapular region. X-ray may be normal. CT scan may show a heterogenous soft tissue mass with poorly defined margins.Magnetic resonance imaging is the first diagnostic tool for diagnosis of elastofibroma dorsi. Findings on MRI suggestive of elastofibroma include solitary heterogeneous, poorly circumscribed, soft-tissue mass which is isointense to muscle in T1 and T2WI images.Positron emission tomography/computed tomography (PET/CT) may show low to moderate metabolic activity in these patients. PET/CT shows low-grade diffuse 18F fluorodeoxyglucose uptake. Needle aspiration biopsy confirms the diagnosis exclude sarcoma. Surgical resection is considered only in symptomatic cases.

Historical Perspective

Elastofibroma was first discovered by Jarvi and Saxen, in 1961.[1][2]

Classification

There is no established system for the classification of elastofibroma.

Pathophysiology

Gross pathology

On gross pathology, characteristic findings of elastofibroma include:[8]

Microscopic findings

On microscopic histopathological analysis, characteristic findings of Elastofibroma include:[8][10]

Gallery

  • Bilateral Elastofibroma dorsi. Source:Science direct(under creative commons)[9]

    Bilateral Elastofibroma dorsi. Source:Science direct(under creative commons)[9]

  • Elastofibroma

    Elastofibroma

  • Bilateral Elastofibroma dorsi. Source:Science direct(under creative commons)[9]

    Bilateral Elastofibroma dorsi. Source:Science direct(under creative commons)[9]

  • Papillary Fibroelastoma: When located on the mitral valve, these tumors are usually on the anterior leaflet of the atrial surface.

    Papillary Fibroelastoma: When located on the mitral valve, these tumors are usually on the anterior leaflet of the atrial surface.

Causes

The cause of elastofibroma dorsi has not been identified. Subclinical microtrauma could be one of the reasons.[4]

Differentiating Elastofibroma dorsi from Other Diseases

Elastofibroma dorsi must be differentiated from desmoid tumours, neurofibroma and liposarcoma.[8]

Epidemiology and Demographics

  • The prevalence of elastofibroma is approximately 11200 in men and 24400 in women per 100,000 individuals in each gender autopsies.[8]
  • Elastofibroma commonly affects elderly female.[8]
  • Elastofibroma commonly affects females ranging from 35-94 years.[8]
  • Females are more commonly affected by elastofibroma than men. The female to male ratio is approximately 2.1
  • The majority of elastofibroma cases are reported in Japan.[8]

Risk Factors

There are no established risk factors for elastofibroma.

Screening

There is insufficient evidence to recommend routine screening for elastofibroma.

Natural History, Complications, and Prognosis

Prognosis is generally excellent.

Diagnosis

Diagnostic Study of Choice

There are no established criteria for the diagnosis of elastofibroma.

History and Symptoms

The majority of patients with elastofibroma dorsi are asymptomatic. Elastofibroma may present with:[11]

  • Painless swelling
  • Pain (less than 10% of patients)
  • Scapular snapping
  • Limitation of motion,
  • Clunking sensation in the shoulder adduction-abduction movement[12]

Physical Examination

  • Patients with elastofibroma usually appear normal.
  • Physical examination findings of Elastofibroma can include limited range of motion and swelling [12]

Laboratory Findings

There are no diagnostic laboratory findings associated with elastofibroma.

Electrocardiogram

There are no ECG findings associated with elastofibroma.

X-ray

An x-ray may be helpful in the diagnosis of elastofibroma. Findings on an x-ray suggestive of elastofibroma include soft tissue density in the periscapular region. X-ray may be normal.[13]

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with elastofibroma.

CT scan

CT scan may be helpful in the diagnosis of elastofibroma dorsi. Findings on CT scan suggestive of elastofibroma dorsi include a heterogenous soft tissue mass with poorly defined margins.[14][15]

MRI

  • Magnetic resonance imaging is the most useful diagnostic tool for diagnosis of elastofibroma dorsi.[16][17]
  • Findings on MRI suggestive of elastofibroma include solitary heterogeneous, poorly circumscribed, soft-tissue mass.[18][19]
  • The lesion is isointense to muscle in T1 and T2WI images

Other Imaging Findings

Positron emission tomography/computed tomography (PET/CT) may be helpful in the diagnosis of elastofibroma. Findings on PET/CT suggestive of elastofibroma include low to moderate metabolic activity in these patients. PET/CT shows low-grade diffuse 18F fluorodeoxyglucose uptake.[20]

Other Diagnostic Studies

Needle aspiration biopsy is helpful in the diagnosis of elastofibroma and exclude sarcoma.[13]

Treatment

Surgery

Surgical resection is considered only in symptomatic cases.[8]

Primary Prevention

There are no established measures for the primary prevention of elastofibroma.

Secondary Prevention

There are no established measures for the secondary prevention of elastofibroma.

References

  1. ↑ JARVI O, SAXEN E (1961). "Elastofibroma dorse". Acta Pathol Microbiol Scand Suppl. 51(Suppl 144): 83–4. PMID 13789598.
  2. ↑ Järvi OH, Länsimies PH (1975). "Subclinical elastofibromas in the scapular region in an autopsy series". Acta Pathol Microbiol Scand A. 83 (1): 87–108. PMID 1124654.
  3. ↑ Freixinet J, Rodríguez P, Hussein M, Sanromán B, Herrero J, Gil R (August 2008). "Elastofibroma of the thoracic wall". Interact Cardiovasc Thorac Surg. 7 (4): 626–8. doi:10.1510/icvts.2007.174722. PMID 18407963.
  4. ↑ 4.0 4.1 Machens HG, Mechtersheimer R, Göhring U, Schlag PN (October 1992). "Bilateral elastofibroma dorsi". Ann. Thorac. Surg. 54 (4): 774–6. PMID 1417241.
  5. ↑ 5.0 5.1 Cota C, Solivetti F, Kovacs D, Cristiani R, Amantea A (2006). "Elastofibroma dorsi: histologic and echographic considerations". Int J Dermatol. 45 (9): 1100–3. doi:10.1111/j.1365-4632.2004.02550.x. PMID 16961522.
  6. ↑ Hernández JL, Rodríguez-Parets JO, Valero JM, Muñoz MA, Benito MR, Hernandez JM; et al. (2010). "High-resolution genome-wide analysis of chromosomal alterations in elastofibroma". Virchows Arch. 456 (6): 681–7. doi:10.1007/s00428-010-0911-y. PMID 20422214.
  7. ↑ Nishio JN, Iwasaki H, Ohjimi Y, Ishiguro M, Koga T, Isayama T; et al. (2002). "Gain of Xq detected by comparative genomic hybridization in elastofibroma". Int J Mol Med. 10 (3): 277–80. PMID 12165800.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 Jena, Amitabh; Patnayak, Rashmi; Settipalli, Sarla; Nagesh, N (2016). "Elastofibroma: An uncommon tumor revisited". Journal of Cutaneous and Aesthetic Surgery. 9 (1): 34. doi:10.4103/0974-2077.178543. ISSN 0974-2077.
  9. ↑ 9.0 9.1 9.2 Sarici, Inanc Samil; Basbay, Elif; Mustu, Mehdi; Eskut, Burak; Kala, Ferhat; Agcaoglu, Orhan; Akici, Murat; Ozkurt, Enver (2014). "Bilateral elastofibroma dorsi: A case report". International Journal of Surgery Case Reports. 5 (12): 1139–1141. doi:10.1016/j.ijscr.2014.10.032. ISSN 2210-2612.
  10. ↑ Cota C, Solivetti F, Kovacs D, Cristiani R, Amantea A (2006). "Elastofibroma dorsi: histologic and echographic considerations". Int J Dermatol. 45 (9): 1100–3. doi:10.1111/j.1365-4632.2004.02550.x. PMID 16961522.
  11. ↑ Greenberg JA, Lockwood RC (March 1989). "Elastofibroma dorsi. A case report and review of the literature". Orthop Rev. 18 (3): 329–33. PMID 2652048.
  12. ↑ 12.0 12.1 Sarici IS, Basbay E, Mustu M, Eskut B, Kala F, Agcaoglu O, Akici M, Ozkurt E (2014). "Bilateral elastofibroma dorsi: A case report". Int J Surg Case Rep. 5 (12): 1139–41. doi:10.1016/j.ijscr.2014.10.032. PMC 4275815. PMID 25437657.
  13. ↑ 13.0 13.1 Tetikkurt C, Tetikkurt S, Bayar N (2008). "Diagnosis of elastofibroma". Can. Respir. J. 15 (4): 217–8. doi:10.1155/2008/638624. PMC 2677955. PMID 18551204.
  14. ↑ Hoffman JK, Klein MH, McInerney VK (April 1996). "Bilateral elastofibroma: a case report and review of the literature". Clin. Orthop. Relat. Res. (325): 245–50. PMID 8998883.
  15. ↑ Kransdorf MJ, Meis JM, Montgomery E (1992). "Elastofibroma: MR and CT appearance with radiologic-pathologic correlation". AJR Am J Roentgenol. 159 (3): 575–9. doi:10.2214/ajr.159.3.1503030. PMID 1503030.
  16. ↑ Kransdorf MJ, Meis JM, Montgomery E (1992). "Elastofibroma: MR and CT appearance with radiologic-pathologic correlation". AJR Am J Roentgenol. 159 (3): 575–9. doi:10.2214/ajr.159.3.1503030. PMID 1503030.
  17. ↑ Domanski HA, Carlén B, Sloth M, Rydholm A (December 2003). "Elastofibroma dorsi has distinct cytomorphologic features, making diagnostic surgical biopsy unnecessary: cytomorphologic study with clinical, radiologic, and electron microscopic correlations". Diagn. Cytopathol. 29 (6): 327–33. doi:10.1002/dc.10381. PMID 14648789.
  18. ↑ Kransdorf MJ, Meis JM, Montgomery E (1992). "Elastofibroma: MR and CT appearance with radiologic-pathologic correlation". AJR Am J Roentgenol. 159 (3): 575–9. doi:10.2214/ajr.159.3.1503030. PMID 1503030.
  19. ↑ Go PH, Meadows MC, Deleon EM, Chamberlain RS (October 2010). "Elastofibroma dorsi: A soft tissue masquerade". Int J Shoulder Surg. 4 (4): 97–101. doi:10.4103/0973-6042.79797. PMC 3100815. PMID 21655005.
  20. ↑ Patrikeos A, Breidahl W, Robins P (September 2005). "F-18 FDG uptake associated with Elastofibroma dorsi". Clin Nucl Med. 30 (9): 617–8. PMID 16100483.


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