This document summarizes a case report of an elastofibroma, a benign soft tissue lesion most commonly found in elderly women. A 61-year-old female presented with a slowly growing 12 cm mass in her right infrascapular region. Surgery was attempted but margins were positive due to infiltration into chest wall. Microscopic examination found collagenized fibrous tissue with mature adipose tissue and elastic fibers. Special histochemical staining with Verhoeff's stain clearly identified the elastic fibers, leading to the precise diagnosis of elastofibroma. This case highlights the importance of conventional histochemistry techniques in reaching an accurate diagnosis.

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Elastofibroma: A Soft Tissue Infiltrative Lesion Revealing the Importance of
Conventional Histochemistry
Article · December 2017
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Aydin, Cli Med Cas Stu Rev 2017, 1(2): 53-55
Clinical Medical Case Studies and Reviews
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Open Access Case Report
Citation: Aydin NE (2017) Elastofibroma: A Soft Tissue Infiltrative Lesion Revealing the Importance of Conventional Histochemistry. Cli Med Cas Stu Rev 1(2):
53-55.
Copyright: © 2017 Aydin NE. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: November 16, 2016; Accepted: December 20, 2017; Published: December 26, 2017
Elastofibroma: A Soft Tissue Infiltrative Lesion Revealing
the Importance of Conventional Histochemistry
Introduction
Elastofibroma is an unusual lesion that is most
commonly encountered in elderly persons, arising
mainly from the connective tissue between inferior
scapular region and the chest wall [1,2]. Most of the
patients are in the sixth and seventh decades of life and
only rare pediatric cases have been described and the
overwhelming majority of the cases are female, many
patients give a history of intensive and repetitive manual
labor and in autopsies, changes in the subcapsular
thoracic fascia similar to elastofibroma were found in
people over 55 years [3]. Here an elastofibroma case
which mimicked a soft tissue malignancy during surgical
excision is presented.
Case Presentation
A61-year-oldfemalepatientpresentedwithapainless
softtissuemassthathasbeenslowlygrowingforaboutfive
years. The mass was about 12 cm in greatest dimension,
located at the right infrascapular area reaching the
thoracic cage anteriorly. The clinical impression was of a
benign mass since it was mobile in physical examination
and superficial. A total excision was attempted with a
diagnosis of “fibrolipoma” but the surgeon was discerned
about its infiltrative anterior borders with the thoracic
ribs and the anterior surgical margins were dissected
Nasuhi Engin Aydin1,2
*
1
Izmir Katip Celebi University, Faculty of Medicine, Cigli, Izmir 35620, Turkey
2
Ataturk Hospital, Department of Pathology, Basin Sitesi, Karabaglar, Izmir 35360, Turkey
*Corresponding author: Dr. Nasuhi Engin Aydin, Fatih Cad. Alp Sitesi B blok No.12 Yalova, 77200, Turkey, Tel: +90-546-615-
7058, E-mail: nasuhiengin@gmail.com
Abstract
Elastofibroma is a peculiar superficial soft tissue infiltrative lesion forming a mass mimicking malignancy clinically. The pathologic
diagnosis is straight forward with conventional elastic tissue stains. Here a demonstrative case in a 61-year-old woman with a soft
tissue mass located at the right infrascapular area infiltrating the periost of thoracic ribs anteriorly is presented. In an era of diagnostic
immunohistochemistry procedures being overwhelmingly used in surgical pathology this is a good example that conventional
histochemistry is still a good adjunct in reaching precise diagnosis in particular circumstances.
Keywords: Elastofibroma, Histochemistry, Soft tissue mass
Figure 1: Low power view of the microscopic section showing
fibrous tissue intermingled with mature adipose cells (lower area
shows surgical margin painted with blue dye), (hematoxylin and
eosin ×40).
with cauterization. Postoperatively the clinical diagnosis
was “soft tissue malignancy” with incomplete excision.
Pathologic features
The surgical excision consisted of two pieces of solid,
fibrofatty tissues hard in consistency, 8 and 4.2 cm in
greatest dimensions with alternating white and yellow
areas. The microscopic sections revealed a mixture of
collagenized hypocellular fibrous tissue with variably
sized mature adipose tissue (Figure 1 and figure 2).

3. Citation: Aydin NE (2017) Elastofibroma: A Soft Tissue Infiltrative Lesion Revealing the Importance of Conventional Histochemistry. Cli Med Cas Stu Rev
1(2): 53-55.
CMCSR Page 54 of 55
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There were occasional scattered fibroblasts without
mitotic activity. There were dark eosinophilic somewhat
swollen fibers in routine hematoxylin and eosin stain
which looked different than the nearby collagen fibers
(Figure 3). Masson’s trichrome staining revealed that
these peculiar fibres were quite distinct from the nearby
collagen fibers (Figure 4). The exact nature of these fibers
with swollen appearance was discerned by elastic tissue
stain utilizing Verhoeff’s elastic tissue histochemistry
revealing black elastic fibers widely dispersed in the
lesion (Figure 5 and figure 6). A precise histopathological
diagnosis of “elastofibroma” was made.
Discussion
Elastofibroma is a peculiar soft tissue mass forming
lesion most commonly encountered in elderly persons
with most of the cases being above 60 years of age
having a female predominance, arising mainly from the
connective tissue between inferior scapular region and
the chest wall [1,2]. A history of intensive and repetitive
manual labor is reported in the majority and in a series
of 235 autopsies, changes in the subcapsular thoracic
fascia similar to elastofibroma were found in 24.4 % of
females and 11.2 % of males above 55 years of age [3].
Another postmortem study revealed elastofibroma in
Figure 2: Intermediate power view showing a predominance of
hypocellular collagenized tissue component (hematoxylin and
eosin ×100).
Figure 3: High power view showing peculiar darkly eosinophilic
swollen fibers amidst a homogeneous hyalinized collagenous
tissue background with scattered fibroblasts (hematoxylin and
eosin ×400).
Figure 4: Broad fibers contrasting with the blue staining
homogeneous appearing hyalinized collagenous tissue
background (Masson’s trichrome stain ×400).
Figure 5: Black elastic fibers scattered in the collagenous fibrous
tissue can be seen clearly with histochemistry (Verhoeff’s elastic
tissue stain ×100).
Figure 6: Elastic fibers have beaded appearance and/or
irregular borders in high power view (Verhoeff’s elastic tissue
stain ×400).

4. Citation: Aydin NE (2017) Elastofibroma: A Soft Tissue Infiltrative Lesion Revealing the Importance of Conventional Histochemistry. Cli Med Cas Stu Rev
1(2): 53-55.
CMCSR Page 55 of 55
www.usepg.org
13 % of elderly patients and pre-elastofibroma like
morphological changes (degenerated elastic fibres) in 81
% [4]. A clinicopathologic study of 170 peculiar cases in
Okinawa, Japan revealed a genetic predisposition leading
to high numbers of familial clustering unique to this
geographical area, [5]. The usual presentation is that of
a slowly growing, mass rarely causing pain, tenderness,
limitation of motion, or scapular snapping. Most
elastofibroma arise from the connective tissue between
the lower scapula and the chest wall with attachment to
the periosteum and ligaments in the region of the sixth,
seventh, and eighth ribs, [6-8]. The mass is ill-defined,
oblong or spherical, firm, ranging from 5 to 10 cm with
a variegated cut surface showing yellow adipose tissue
between gray-white fibrous areas, sometimes with
cystic change [1,2]. Frequently, the surgeon is concerned
about the possibility of a sarcoma due to the infiltrative
irregular margins, [6,7]. On microscopic examination,
there is a mixture of intertwining swollen, eosinophilic
collagen and elastic fibers associated with occasional
fibroblasts, small amounts of interstitial mucoid material,
and some aggregates of mature adipose tissue. The
elastic fibers have a degenerated, beaded appearance
and special histochemical stains for elastic tissue
reveal branched and unbranched elastic fibers having
central dense cores with irregular or serrated margins.
The majority of investigations suggest this lesion is
a degenerative phenomenon (pseudotumor) with of
excessive formation of collagen and abnormal elastic
fibers. Frictions between the inferior edge of the scapula
and the underlying chest wall have been implicated for
this pathologic elastogenesis [3,4]. Elastofibroma is a
benign lesion that is best treated by conservative excision
and local recurrence has been uncommon in reported
series of cases [6-8]. This presented case which had
positive surgical margins anteriorly near the thoracic
ribs has not experienced any recurrence for a follow up
period of two years.
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