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Age / Sex : 87 / M
Age/Sex: 87/M
C.C.: Large painless masses in bilateral periscapular area
1) What is your impression?
Courtesy : Wan Tae Kim, MD, MD., Seoul Veterans Hospital
Diagnosis: elastofibroma dorsi
Discussion
Findings:
1) Sonogram shows a poorly defined right back mass at the inferior angle of the scapula with interspersed linear echoes.
2) Axial and coronal noncontrast CT scan shows bilateral lentiform masses with attenuation values similar to those of the neighboring muscles and linear interspersed hypodense areas, suggesting fatty streaks within the mass.
3) Axial spin echo T1-weighted MR image shows a intermediate signal intensity mass lesion in the right chest wall with interspersed lines of high signal intensity consistent with fat.
4) Axial and coronal fast spin echo T2-weighted MR image shows the bilateral masses in the subscapular lesions with low signal intensity and linear high signal intensity strands.
5) After injection of gadolinium, moderate enhancement of the mass was detected.
Differential Diagnosis:
Extraabdominal desmoid, Fibroma, Metastasis, Liposarcoma, Hematoma
Diagnosis: Elastofibroma dorsi
Discussion:
Elastofibroma dorsi is a rare, benign, soft tissue tumor of the periscapular area. This disease entity was first reported in 1961 by Järvi and Saxén. The greater majority of elastofibromas occur in the infrascapular or subscapular region beneath the rhomboid major and latissimus dorsi muscle. Elastofibroma occurs chiefly in older individuals with mean age of 70years. The lesion occurs more frequently in women with a ratio as high as 13: 1. Elastofibroma dorsi is a slow growing tumor of the connective tissue. It has been suggested that elastofibroma is a chronic reactive process between and the chest wall and the scapula, caused by repeated mechanical friction. But, recent studies suggest an abnormal neoelastogenesis rather than a degeneration of the preexisting elastic fibers as the main pathogenetic factor. The sonographic appearance of elastofibroma dorsi consists of arrays of interspersed linear or curvilinear hypoechoic strands against an echogenic background. MRI is the imaging modality of choice, as it clearly shows the characteristic layered pattern of fibrous tissue and fatty tissue. The dense fibrous connective tissue shows intermediate signal intensity on T1-weighted images and relatively low signal intensity on T2-weighted images nearly identical to that generated by the skeletal muscle. The foci of interspersed fatty tissue shows high signal intensity on T1-weighted images and intermediate signal intensity on T2-weighted images. The elastic stain shows dark brown to black elastic fibers with an elongated or globular appearance and serrated margins.
References:
1. Järvi OH, Saxén AE. Elastofibroma dorsi. Acta Pathol Microbiol Scand Suppl 1961;144:83-84
2. Brandser EA, Goree JC, El-Khoury GY. Elastofibroma dorsi : prevalence in an elderly patient population as revealed by CT. AJR Am J Roentgenol 1998;171:977-980
3. Nagamine N, Nohara Y, Ito E. Elastofibroma in Okinawa. A clinicopathologic study of 170 cases. Cancer 1982;50:1794-1805
4. Naylor MF, Nascimento AG, Sherrick AD, McLeod RA. Elastofibroma dorsi: radiologic findings in 12 patients. AJR Am J Roentgenol 1996;167:683-687
5. Soler R, Requejo I, Pombo F, Sáez A. Elastofibroma dorsi : MR and CT findings. Eur J Radiol 1998;27:264-267
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