A 71-year-old male is brought to the ER after sustaining a motor vehicle crash. During routine trauma workup, a CT of the thorax is performed, and you are consulted regarding a lesion on the posterior chest wall. An MRI is also available for you to review, which demonstrates a soft-tissue mass on the posterior chest wall deep to the scapula with no particularly defining characteristic features. On interview, he denies recent pain in this area. He denies weakness or sensory changes in the upper extremity.
Which of the following lesions is found almost exclusively between the scapula and chest wall?
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Desmoid tumor
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Chordoma
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Atypical lipoma
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Elastofibroma
Discussion
The correct answer is (D). Elastofibroma is a slow-growing, reactive lesion found almost exclusively between the scapula and chest wall. It can present as a slowly enlarging mass that sometimes causes pain with shoulder movement but is often an incidental finding on imaging performed for another reason.
A needle biopsy is performed, which confirms the diagnosis. What is the best recommended treatment at this time?
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Marginal resection
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Wide resection and radiation
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Observation
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Neoadjuvant chemotherapy followed by resection
Discussion
The correct answer is (C). Elastofibroma is a slow-growing, benign lesion that can be observed if asymptomatic. There is no malignancy potential. Excision is reserved for symptomatic lesions, which usually cause pain in the area with shoulder motion.
Objectives: Did you learn...?
Understand the clinical features of Elastofibroma? Potential treatment options for Elastofibroma?
