Dr. Jared Gardner conducts a dermatopathology teaching session with residents focusing on fibrohistiocytic and spindly skin lesions. Case 1 is identified and diagnosed as Elastofibroma Dorsi. Microscopically, while it appears as nondescript fibrous tissue with intermingled fat on H&E, the crucial diagnostic feature seen on elastic stain (VVG) is the presence of distinctive, thick, beaded, and bunched-up elastic fibers. The video emphasizes the differential appearance of these fibers based on whether they are viewed in longitudinal section (pipe-cleaner/beaded) or cross-section (florets/flowers). Clinically, this benign lesion is overwhelmingly found on the back near the inferior tip of the scapula, often recognized radiographically, and typically only removed if symptomatic.
Elastofibroma Dorsi: A Pathology Case Review
0:08 Introduction: Dr. Jared Gardner introduces a teaching session for dermatology and pathology residents focused on fibrohistiocytic and spindly skin lesions.
0:31 Case 1 Image Analysis (Elastic Stain): The initial slide shown is a special stain (elastic fiber stain, likely Verhoeff-Van Gieson or VVG), not standard H&E. The resident notes the "beaded elastic fiber appearance" (1:04).
1:25 Diagnosis: The lesion is diagnosed as an Elastofibroma Dorsi.
1:31 H&E Appearance: On standard H&E, the lesion is described as "very boring," appearing as non-descript pink collagen/fibrous tissue with low cellularity and intermingled adipose tissue (1:36–1:46).
2:01 Key Microscopic Features: Even on H&E, the diagnostic feature—beaded, bunched-up collagen/elastic fibers—can be seen. These are likened to "pipe cleaner" brushes.
2:24 VVG Stain Detail: A crisper image using the elastic stain (VVG) is shown, highlighting the longitudinal cuts of the elastic fibers (beaded appearance) and the cross-sectional view, where the fibers look like "little flowers or florets" (2:30–2:38).
2:41 Characteristic Location: The vast majority of cases occur on the back, specifically near the inferior tip of the scapula, often linked to the motion and rubbing of the scapula against the rib cage.
2:58 Clinical Recognition: The lesion is usually recognized radiographically or by orthopedic surgeons. It is only removed if it becomes large or causes symptoms.
3:14 Key Takeaway: Elastofibroma Dorsi is highly site-specific (dorsi/scapular tip) and defined microscopically by its unique elastic fiber morphology.