eMedicine Specialties > Dermatology > Benign Neoplasms

Elastofibroma: Differential Diagnoses & Workup

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Sonja Stander, MD, Staff Physician, Department of Dermatology, University-Hospital Muenster, Germany; Thomas Schwarz, MD, Vice Chairman, Professor, Department of Dermatology, University of Kiel, Germany
Contributor Information and Disclosures

Updated: Jul 21, 2009

Differential Diagnoses

Lipomas

Other Problems to Be Considered

Extra-abdominal fibromatosis
Sarcoma
Subcutaneous metastasis
Lipoma17

Workup

Imaging Studies

  • Elastofibromas have a typical sonographic appearance consisting of arrays of linear strands against an echogenic background.18 However, in some cases, the ultrasound pattern of an elastofibroma dorsi may be very similar to the surrounding muscular tissue, and neither a clear cleavage surface nor a specific vascular pattern can be seen. In these cases, the elastofibroma may be very difficult to distinguish from surrounding tissue.19
  • Chest wall radiographic findings are usually normal; however, elevation of the scapula from the chest wall has been detected in a few cases.20
  • CT scanning and MRI reveal a lenticular, unencapsulated, soft tissue mass with skeletal muscle attenuation interspersed with strands of fat attenuation.21,22,23 Small elastofibromas may be difficult to visualize on CT scans or MRIs, but they can be enhanced by the use of gadolinium. Its characteristic location (periscapular region) and specific imaging appearance on ultrasound images, CT scans, and MRIs facilitates accurate diagnosis.24 Noninvasive techniques, especially MRI, and histologic assessment are closely correlated, so that sometimes a biopsy can be avoided.25
  • Incidental detection of bilateral elastofibroma dorsi with F-18 fluorodeoxyglucose positron emission computed tomography scanning has been described.26

Procedures

  • A biopsy specimen should be obtained from the affected area. The surgical excision should be large and should include skin, subcutaneous fatty tissue, and, if necessary, deeper tissue. A shave or punch biopsy is not sufficient.

Histologic Findings

The tumor grossly appears as an ill-defined mass with a white or gray-white, glistening surface.

Upon light microscopy, elastofibromas are dermal unencapsulated tumors composed of branched and unbranched elastic fibers, eosinophilic collagen bundles, and scattered fatty tissue. The elastic fibers have a degenerated, beaded appearance or are fragmented into small globules or droplets arranged in a linear pattern. The epidermis is usually unaffected. The interspersed spindle or stellate cells show a fibroblastlike appearance and were almost consistently positive for vimentin and frequently positive for CD34 and lysozyme immunohistochemically.2 The CD105-positive vessels in elastofibromas appear to reflect active neovascularization.27

At an ultrastructural level, the elastic fibers appear as an irregular granular or fibrillary aggregation of electron-dense, amorphous material surrounded by microfibrils and collagen fibers. Collagen fibers are commonly incorporated within the elastic material.

Immunohistochemically, elastofibromas stain positively for vimentin but negatively for smooth muscle actin, S-100, desmin, and p53.28

Because of their densely fibrous nature, hypocellularity may be observed in fine-needle aspiration biopsy specimens of elastofibromas; thus, diagnostic material may be overlooked. The smears show evidence of mature adipocytes, fibroblasts, collagen fibers, globular bodies, and characteristic braidlike or fernlike structures, revealing degenerative elastic fibers. Careful evaluation of the background of the smears coupled with full knowledge of the clinical and radiological findings, including those from MRIs, is required to establish the correct diagnosis; therefore, a skin biopsy is preferable.

More on Elastofibroma

Overview: Elastofibroma
Differential Diagnoses & Workup: Elastofibroma
Treatment & Medication: Elastofibroma
Follow-up: Elastofibroma
References
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References

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Further Reading

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Keywords

elastofibroma, elastofibroma dorsi, connective-tissue tumor, connective tissue tumor, elastogenesis

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Sonja Stander, MD, Staff Physician, Department of Dermatology, University-Hospital Muenster, Germany
Disclosure: Nothing to disclose.

Thomas Schwarz, MD, Vice Chairman, Professor, Department of Dermatology, University of Kiel, Germany
Thomas Schwarz, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Kathryn Schwarzenberger, MD, Associate Professor of Medicine, Division of Dermatology, University of Vermont College of Medicine; Consulting Staff, Division of Dermatology, Fletcher Allen Health Care
Kathryn Schwarzenberger, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, American Dermatological Association, Dermatology Foundation, Medical Dermatology Society, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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