Elastofibroma dorsi is an uncommon benign lesion. Negamine et al.
described a series of 170 patients from Okinawa. Genetic predisposition was
reported with 32% of the 170 patients having a family history of elastofibroma.
All the larger series of elastofibroma reported in the literature showed
elastofibroma was commoner in females. In our series, it was commoner in males (80%).
Elastofibroma typically occurs in the subscapular or infrascapular
region. It is also reported to occur in other sites like the axilla, ischial
tuberosity, greater trochanter, posterior elbow, stomach, rectum, omentum, eye,
], and foot. The site of occurrence was in the typical infrascapular
region in our series.
Malghem et al. [9
] in their review article on imaging study findings in
elastofibroma dorsi noted the considerable disagreement about the need for
obtaining a biopsy. In our series, the patients presented to the soft tissue
sarcoma clinic. Trucut biopsy was performed at the time of consultation to
obtain a definitive histological diagnosis. A series of 235 autopsies by
Jarvi and Lansimies [10
] found features of elastofibroma in the subscapular thoracic fascia
in 29 of 119 (24%) females and 10 of 89 males (11%), all aged 58 or more. Giebel
et al. [11
] in a series of 100 autopsies
found elastofibroma in 13 patients—10 males and 3
females. Naylor et al. [2
] reported in their series of 12 patients that the
tumour was bilateral in all the 9 patients in whom both sides of the chest was
imaged and this indicated the benign nature of the swelling eliminating the
need for biopsy.
Briccoli et al. [12
] reported in their series of 9 patients that the
tumour was bilateral in 3 patients (33%) and all of the 9 patients underwent
surgical excision. Vastamaki [13
] reported in a series of 5 patients that the
diagnosis was clinical based on the presence of firm subscpular mass with long
history. In our series, elastofibroma was unilateral in 13 patients (87%) and
bilateral in 2 patients (13%). If there was a definitive radiological diagnosis
with typical clinical presentation in asymptomatic patients, we deferred biopsy
Following clinical, radiological, and/or histological diagnosis, the
patient was offered an informed choice: 11 of our patients opted for excision of the
swelling and 4 patients opted for nonoperative treatment. Elastofibroma occurs
after the 5th decade and the mean age in our series was 68.9 years consistent with
other reported series. Large (> 5
cm) soft tissue swellings deep to the deep
fascia strongly raise the possibility of a soft tissue sarcoma in this age
]. The average maximum dimension of the lesion was 7
cm. We had a low
threshold to biopsy these lesions unless there was great confidence based on
clinical and radiological grounds that the lesion was benign. This is reflected
by the number of biopsies in our series.
The radiological and histological findings have been well described in
various papers (Naylor et al. [2
], Zembsch et al.
], Malghem et al. [9
Hayes et al. [15
Our series is the largest surgical series for this rare condition. The
question of necessity for surgery for this benign lesion in an elderly
population is legitimate. Informed choice should be offered to the patients,
for various reasons surgery may or may not be chosen by the patient. If surgery
was the preferred option, our series has shown that curative marginal resection
can be performed safely in this age group. The periscapular region is highly
vascular and the incidence of post operative haematoma should be borne in mind.
There were no reported recurrences or other complications.