Elastofibroma Dorsi
F. Ghalamkarpour MD
Department of Dermatology, Shahid Beheshti University, Bou Ali Hospital, Tehran, Iran
Elastofibroma dorsi is a rare pseudo-tumor that results from repeated trauma, almost exclusively in the connective tissue between the edge of the scapula and the chest wall. It is a degenerative benign neoplasm occurring usually in elderly women with the clinical appearance of a malignant tumor. Elastofibroma is very rarely reported in literature. Herein we report on a 70-year-old woman with two plaques of elastofibroma presenting in two unusual sites of body; one on the right breast with an unusual shape and another over the back, on the same side.
Case Report
A 70-year-old woman was hospitalized for evaluation of two purplish plaques which had been expanding slowly for a period of three years.
Physical examination revealed sharply defined, indurated plaques; one beneath the areola of the right breast involving the whole lower border in an irregular arcuate shape (Fig. 1). Another plaque was seen on the lower border of right scapula. The patient complained of tenderness with pressure. She had no history of trauma or local mechanical pressure. Her past medical history was unremarkable. She was married and had two children. Other physical examination and laboratory studies were normal.
A punch biopsy was performed on both lesions. Histologic examination with H&E stain revealed a normal epidermis and papillary dermis with increased collagen and elastic fibers. In some areas among the thick collagen bundles, elastic fibers showed a fragmented appearance with small eosinophilic globules. Staining with Orcein-Gimsa showed increased elastic fibers in some areas. They were beaded and broken into round pieces, while in other areas they were wavy or arranged in a linear manner (Fig. 2).
Total excision was recommended to the patient but she refused and left without treatment.
Discussion
Elastofibroma dorsi was first reported by Jarvi and Saxen in 1959.1-4 Since then, a few isolated cases and small series have been been reported, some based on autopsy findings. Its true incidence is not known. This benign though malignant looking process usually presents as a firm, ill defined mass4,5 not attached to the overlying epidermis. However, an unusual ulcerating case has also been reported.5 The lesions extend very slowly and are usually seen in elderly woman who have a history of hard labor or trauma.3 With a tendency to occur between the lower edge of scapula and chest wall, it was called elastofibroma dorsi.4 Involvement of other sites of mechanical pressure such as fingers, greater trochanter,3 feet, infraolecranon region, ischial tuberosity6,7 and in visceral sites have been also reported.8
The origin of elastofibroma is a subject of controversy. Elastotic degeneration of collagen fibers has been suggested as a possible cause.9,10 Some believe that fibroblasts are responsible for this slightly abnormal elastogensis.11 Fukuda et al came to the conclusion that the eosinophilic material are true fibers.12
Local mechanical pressure leading to vascular damage is an important factor in the development of this tumor.5 Elastofibroma is capable of infiltrating muscle and bone.5 Diagnosis is usually based on histological examination. However, many cases are diagnosed at autopsy.
Light microscopy shows a tumoral mass consisting of eosinophilic collagen and elastic fibers with occasional fibroblasts.2 Elastic fibers are beaded and broken into small globules with a linear arrangement.2,4 With the use of elastin stain, branched and unbranched fibers of 20 to 30 m m in diameter are seen which have a dense central core and a serrated margin.2,3
Total excision is the treatment of choice.3 In this report we present an unusual case of elastofibroma dorsi. In our patient the plaques were located on the breast and scapula simultaneously; one having an unusual arcuate shape. Although this condition is normally associated with trauma or hard labor, there was no such history of in this case.
References
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