Elastofibroma dorsi is a rare benign soft-tissue tumor composed predominantly of elastic and fibrous connective tissue. It typically develops in the subscapular region, between the scapula and the chest wall, and is often asymptomatic. Although the exact cause of elastofibroma dorsi is not fully understood, its development appears to be associated with repetitive mechanical stress involving the shoulder girdle, chronic microtrauma, and prolonged friction or pressure between the scapula and the chest wall. The condition is frequently bilateral.Diagnostic TestsThe diagnosis of elastofibroma dorsi is based on a combination of clinical examination and imaging studies, with biopsy required only in selected cases. On physical examination, the physician may identify a palpable, usually non-tender mass in the subscapular region, which may become more prominent during forward movement of the shoulder and scapula. Imaging studies, particularly Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) (Figure 1), are used to confirm the presence of the lesion, assess its size and anatomical relationships, and evaluate the surrounding tissues. Biopsy is not routinely required when clinical and radiological findings are typical. However, tissue sampling may be indicated when imaging findings are atypical or raise suspicion of a malignant soft-tissue tumor.TreatmentIn many cases, elastofibroma dorsi does not require active treatment, particularly when the lesion is small, asymptomatic, and does not cause functional impairment. Surgical treatment may be considered when the lesion becomes large or symptomatic, causes significant discomfort or pain, or interferes with normal shoulder and scapular movement. Surgery is performed under general anesthesia and consists of complete excision of the lesion through a subscapular incision, with careful preservation of the surrounding muscles and other anatomical structures (Figure 2).Post-operative course The usual post-operative hospital stay is approximately 4-5 days, with particular attention paid to pain management and wound care. Potential complications include bleeding, surgical-site infection, and post-operative seroma formation. Bleeding and infection are relatively uncommon, whereas seroma formation is more frequent, particularly after the removal of large lesions. When clinically indicated, a post-operative seroma may require one or more percutaneous aspirations. In selected cases, microbiological analysis of the aspirated fluid and antibiotic therapy may also be necessary.Patients may occasionally be discharged with a subfascial drain in place. The drain can subsequently be removed once the daily volume of fluid has decreased to an appropriate level. Patients are generally followed closely during the first month after surgery. A further surgical follow-up visit is recommended approximately three months after the procedure, usually accompanied by an ultrasound examination of the soft tissues in the scapular region.In conclusion, elastofibroma dorsi is a rare benign soft-tissue tumor that requires an individualized approach to management. Accurate diagnosis based primarily on clinical assessment and imaging allows patients with typical asymptomatic lesions to be managed conservatively, while surgical excision can provide effective treatment for symptomatic or functionally limiting lesions. Author: Dr. Fabio Davoli, head of General & Thoracic Surgery Unit, IRCCS Rizzoli Orthopaedic Institute.Scheda revisionata il: 13 novembre 2023.

Lipomas are benign tumors made up of fatty tissue. In the chest, they most commonly develop within the subcutaneous tissues of the chest wall, although they may occasionally arise deeper, between or within muscle layers.They are among the most common benign soft-tissue tumors. Lipomas usually grow slowly, are soft and mobile, and are generally painless. Although they are usually harmless, they may cause cosmetic concerns, discomfort or, particularly when they become large or develop in deeper locations, compression of nearby structures and functional problems.DiagnosisThe diagnosis of a chest lipoma usually begins with a clinical examination. The doctor may identify a soft, mobile and generally painless mass beneath the skin.Imaging examinations, such as ultrasound or magnetic resonance imaging (MRI), may be used to confirm the fatty nature of the mass, assess its size and location, and evaluate its relationship with surrounding structures, particularly muscles and the deeper tissues of the chest wall.In selected cases, especially when imaging shows atypical features or when the mass is large, deep or rapidly growing, a biopsy may be required to distinguish a simple lipoma from an atypical lipomatous tumor or other soft-tissue tumors.TreatmentSmall, asymptomatic lipomas with typical clinical and imaging features do not always require surgical treatment. Depending on their characteristics, clinical observation and periodic imaging may be appropriate.Surgical removal may be recommended when a lipoma causes pain or discomfort, increases in size, interferes with daily activities, causes a significant cosmetic problem, or when its clinical or imaging characteristics do not allow a confident diagnosis.Surgery is also frequently considered for particularly large or deep lipomatous masses (Figure 1), for which complete assessment is important to exclude an atypical lipomatous tumor or other diagnoses.During surgery, the aim is to remove the mass completely while preserving the function and appearance of the surrounding chest wall as much as possible. The risk of recurrence after complete removal of a simple lipoma is generally low.Depending on the size, depth and location of the mass, surgery may be performed under local or general anesthesia. Hospital stay is usually short and, in selected cases, the procedure can be performed on a day-surgery basis.Overall, chest lipomas are benign tumors composed predominantly of fatty tissue. Clinical assessment and appropriate imaging usually allow an accurate diagnosis, while surgery provides definitive treatment when indicated. Management should always be tailored to the characteristics of the individual patient and the specific lesion.What Are Atypical Lipomatous Tumors of the Chest?Atypical lipomatous tumors (ALTs) are fatty tumors that differ from simple lipomas in their biological behavior and microscopic characteristics.Compared with simple lipomas, they may be larger, deeper and more closely associated with muscles and other structures of the chest wall. On imaging, they may also have a more complex or irregular appearance (Figure 2).When an atypical lipomatous tumor is suspected, MRI is particularly useful for defining its extent and relationship with the surrounding anatomical structures. A biopsy is generally required before surgical treatment in order to establish the diagnosis and plan the most appropriate surgical approach.The management of atypical lipomatous tumors may require a multidisciplinary approach involving surgeons, radiologists, pathologists and oncologists. Accurate assessment of their anatomical characteristics and biological behavior is important in determining the optimal treatment strategy.Surgical excision is generally the treatment of choice for atypical lipomatous tumors of the chest wall. The objective is complete removal of the tumor while preserving, whenever possible, the function and stability of the chest wall.Unlike simple lipomas, atypical lipomatous tumors have a greater tendency to recur locally after surgery. In addition, although their metastatic potential is very low in the absence of dedifferentiation, long-term follow-up is important because these tumors may occasionally undergo dedifferentiation into a more aggressive form.After surgical excision, regular follow-up is therefore recommended. The type and frequency of imaging examinations will depend on the location and characteristics of the tumor, the surgical margins and the definitive histological findings, and may be determined within a multidisciplinary setting. Author: Dr. Fabio Davoli, Head of the General and Thoracic Surgery Unit, Rizzoli Orthopedic Institute.Scheda revisionata il: 13 novembre 2023.

OverviewOsteosarcoma, a type of bone cancer, most often spreads to the lungs. Osteosarcoma mostly affects children, teenagers, and young adults. Early detection and treatment are important to improve outcomes. At the Rizzoli Orthopaedic Institute, lung surgeons, orthopaedic surgeons and cancer specialists work together to provide personalized care. They use both traditional open surgery and minimally invasive techniques, depending on the patient’s needs.How Common Are Lung Metastases?Osteosarcoma is the most frequent bone cancer in young people. The lungs are the most common place where the cancer can spread.About 20–30 % of patients have lung metastases when they are first diagnosed.Up to 40–50 % may develop lung metastases later.How Are Lung Metastases Diagnosed?Doctors use imaging tests to find lung metastases:Chest X-ray is often the first step.CT scan of the chest is more detailed and can detect even small nodules.PET/CT scan helps check if cancer has spread to other parts of the body.Usually, these tests are enough to confirm lung metastases.Treatment OptionsTreatment usually combines chemotherapy with surgery to remove all visible lung tumors. If surgery is not possible, stereotactic radiotherapy may be used to control the tumors.Surgery (Metastasectomy)Surgery is recommended if:There are a limited number of lung tumors,Cancer has not spread outside the lungs, andThe patient has responded well to chemotherapy.The goal is to remove all lung tumors and achieve a disease-free state.Surgical TechniquesOpen chest surgery (thoracotomy) allows the surgeon to carefully feel the entire lung to find small tumors that may not show on scans.Wedge resection means removing the tumor along with a small piece of healthy lung tissue.Sometimes a larger section of the lung (lobectomy) may be needed. Complete removal of a lung (pneumonectomy) is very rare.Minimally invasive surgery (VATS) uses small incisions and a camera. It usually works best for patients with a few easily accessible tumors.  Prognosis and Follow-UpThe outlook depends on:How many tumors are in the lungs,How well the patient responds to chemotherapy, andWhether all tumors can be completely removed.Patients who have all lung metastases successfully removed have a much better chance of long-term survival. Regular follow-up is essential to detect any new tumors early.Possible ComplicationsSurgery can cause bleeding, lung infection, or breathing difficulties.Chemotherapy can cause side effects such as low blood counts, kidney problems, or heart effects.Radiotherapy to the lungs may cause inflammation of the lung tissue, cough, or shortness of breath.Careful monitoring and rehabilitation help reduce risks and support recovery.Rizzoli Institute ExperienceThe Thoracic Surgery Unit at the Rizzoli Institute has extensive experience treating lung metastases from bone cancers. The team has performed over 1,000 lung surgeries for sarcoma patients, combining years of expertise with the latest techniques. Even though minimally invasive surgery is now available, open surgery is often preferred in osteosarcoma to make sure all tumors are found and removed.ConclusionsSurgery to remove all lung metastases remains the most important treatment for long-term survival in osteosarcoma patients. Thanks to multidisciplinary care and decades of experience, the Rizzoli Institute is one of Europe’s leading centers for treating lung metastases from bone cancers.Figure 1Diagram showing three ways surgeons can remove lung tumors: a small section of the right upper lobe, right lower lobe, or left upper lobe is taken out to remove the tumor while keeping as much healthy lung as possible. Download Patient-Friendly PDFs in Spanish, French, Portuguese, and RussianThis section provides downloadable PDFs in Spanish, French, Portuguese, and Russian, offering patient-friendly information on lung metastases from osteosarcoma. If you would like more information or wish to contact a specialist, please write to the Head of Thoracic Surgery at the Rizzoli Institute: fabio.davoli@ior.itMetástasis pulmonares por osteosarcoma: información para paziente. Este documento explica de manera sencilla qué son las metástasis pulmonares en el osteosarcoma, cómo se diagnostican y las opciones de tratamiento disponibles para los pacientes.Métastases pulmonaires de l’ostéosarcome: informations pour les patients. Ce document explique de façon simple ce que sont les métastases pulmonaires de l’ostéosarcome, comment elles sont diagnostiquées et quelles sont les options de traitement pour les patients.Metástases pulmonares do osteossarcoma: informações para paziente. Este documento explica de forma clara o que são as metástases pulmonares do osteossarcoma, como são diagnosticadas e as opções de tratamento disponíveis para os pacientes.Лёгочные метастазы остеосаркомы: информация для пациентов. В этом документе простыми словами объясняется, что такое лёгочные метастазы при остеосаркоме, как они диагностируются и какие существуют варианты лечения для пациентов BibliographyHigh grade osteosarcoma of the extremities metastatic to the lung: long-term results in 323 patients treated combining surgery and chemotherapy, 1985-2005. Briccoli A, Rocca M, Salone M, Guzzardella GA, Balladelli A, Bacci G. Surg Oncol. 2010 Dec;19(4):193-9.Surgery for lung metastases in Ewing’s sarcoma of bone. Briccoli A, Rocca M, Ferrari S, Mercuri M, Ferrari C, Bacci G. Eur J Surg Oncol. 2004: 30, 63–67