Peculiar thousand leaves soft-tissue mass: Elastofibroma dorsi.

Elastofibroma dorsi is an uncommon benign soft-tissue tumor with uncertain pathogenesis (Medicina (Kaunas), 2021; 57, 370). Surgical excision is the therapeutic option for symptomatic patients. A pathological study confirms the diagnosis after surgery. The prognosis is excellent with extremely rare recurrence cases (Anticancer Res, 2021, 41, 2211).

CLINICAL IMAGE

A 63‐year‐old female patient presented with a five‐year history of right subscapular mass causing pain and discomfort. Physical examination revealed a mass, inferior to the right scapular spine (Figure 1A). Magnetic resonance imaging showed a well‐defined, not encapsulated mass, alternating layers of fibrous tissue isointense to muscle in T1‐ and T2‐weighted sequences, and layers of fat tissue hyperintense in T1‐ and T2‐weighted sequences (Figure 1B). These findings were compatible with elastofibroma. The patient underwent total surgical excision of the mass (Figure 1C,D). The resected specimen measured 10 × 8.5 × 3 cm and was rubbery in consistency (Figure 2A). The cut surface showed gray or whitish fibrous tissue with variable intervening streaks of yellow fatty tissue conferring a “thousand leaves” gross appearance (Figure 2B). Histopathological examination revealed a poorly circumscribed proliferation of fibrocollagenous tissue containing a large number of abnormal elastic fibers and dispersed, bland‐appearing spindle cells, admixed with adipose tissue (Figure 2C). The elastic fibers are coarse, eosinophilic, and fragmented into linearly arranged globular or serrated disk‐like structures, simulating beads on a string (Figure 2D). The final pathological diagnosis was elastofibroma. The histological differential diagnoses of elastofibroma include desmoid fibromatosis and fibrolipoma. , The postoperative course was uncomplicated. No adjuvant treatment was planned for this patient.

FIGURE 1

(A) Clinical photograph of elastofibroma dorsi. Examination of the patient reveals a bulging palpable mass, inferior to the right scapular spine (white arrow). (B) Magnetic resonance image of elastofibroma dorsi. Axial T1‐weighted image shows a heterogeneous soft‐tissue mass with a signal intensity approximately equal to that of skeletal muscle, interlaced with areas of signal intensity similar to that of fat. (C) Surgical resection of elastofibroma dorsi. (D) Macroscopic view of the excised mass from the patient: Elastofibroma is regularly shaped, non‐encapsulated

FIGURE 2

(A) Macroscopic appearance of the subscapular elastofibroma removed from our patient. The tumor was a poorly circumscribed mass showing white soft to rubbery areas admixed with adipose tissue. (B) The cut surface of elastofibroma dorsi demonstrates a variegated appearance with an admixture of gray‐white fibrous tissue and intervening yellow fat conferring a “thousand leaves” appearance. (C) Histological findings of elastofibroma dorsi. The lesion is composed of fibrocollagenous tissue containing eosinophilic elastic fibers and scattered fibroblasts with a variable amount of mature adipose tissue (hematoxylin and eosin stain, original magnification 200×). (D) Histological findings of elastofibroma dorsi. Thick or coarse eosinophilic elastic fibers arranged in beaded strings or globules. (Hematoxylin and eosin, magnification 400×)

CONFLICT OF INTEREST

None declared.

AUTHOR CONTRIBUTIONS

Dr Faten LIMAIEM prepared, organized, wrote, and edited all aspects of the manuscript. Dr Faten LIMAIEM prepared all of the histology figures in the manuscript. Dr Seifeddine BACCOUCH and Dr Mohamed HAJRI participated in the conception and design of the study, the acquisition of data, analysis and interpretation of the data. All authors contributed equally to preparing the manuscript and participated in the final approval of the manuscript before its submission.

ETHICAL APPROVAL

All procedures performed were in accordance with the ethical standards. The examination was made in accordance with the approved principles.

CONSENT

Published with written consent of the patient.