Fibroma pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2], Simrat Sarai, M.D. [3]

Overview

On gross pathology, polypoid lesion which is usually small, are characteristic findings of oral fibroma. On microscopic histopathological analysis, fibrous stroma, collagen bundles, prominent vessels, and overlying squamous mucosa with hyperkeratosis and focal ulceration are characteristic findings of oral fibroma. On gross pathology, well circumscribed, metaphyseal lesion, and fragments of white-grey rubbery tissue are characteristic findings of chondromyxoid fibroma. On microscopic histopathological analysis, spindle cells or stellate cells in a myxoid or chondroid stroma, lobules with hypocellular centers and hypercellular peripheries, giant cells in a hypercellular periphery, and scattered calcifications are characteristic findings of chondromyxoid fibroma. On gross pathology, fleshy, fibrous, yellow or tan-brown lesion with variable areas of haemorrhage are characteristic findings of non-ossifying fibroma. On microscopic histopathological analysis, spindle cells without cytologic atypia are arranged in a storiform pattern, scattered chronic inflammatory cells and benign giant cells, foam cells and hemosiderin deposition, and mitoses are characteristic findings of non-ossifying fibroma. On gross pathology, discrete mass that is well delineated from surrounding bone, tan-white, rubbery cut surface, firm to gritty and no encapsulation are characteristic findings of ossifying fibroma. On microscopic histopathological analysis, haphazardly distributed lamellated bony spicules on a background of fibrous stroma, a zonal architecture with a center of immature bone surrounded by more mature lamellar bone, and central spicules of woven bony trabeculae are lined by a layer of osteoblasts are characteristic findings of ossifying fibroma.[1][2]

Pathophysiology

Type of fibroma Location Gross pathology Microscpoic pathology Genetics and Immunohistochemistry Associated conditions
Ovarian Fibroma [3][4][5][6][7][8][9][10]
  • None
Oral Fibroma [11][12][13]
  • None
Chondromyxoid fibroma [14][15][16][17][18][19][20][21][22]
  • Well circumscribed, metaphyseal lesion, and fragments of white-grey rubbery tissue are noted
  • None
Uterine fibroma [23][24][25][26][27][28][29][30][31][32][33]
  • Round, well circumscribed (but not encapsulated), solid nodules that are white or tan, and show whorled appearance
Ossifying Fibroma [34][35][36][37][38][39][40]
  • Discrete mass that is well delineated from surrounding bone, tan-white, rubbery cut surface, firm to gritty and no encapsulation
  • They comprise of haphazardly distributed lamellated bony spicules on a background of fibrous stroma
  • The lesion has a zonal architecture with a center of immature bone surrounded by more mature lamellar bone.
  • The central spicules of woven bony trabeculae are lined by a layer of osteoblasts. The background is a loose and storiform fibrous tissue.
Non-ossifying Fibroma [41][42][43]
  • Clonal rearrangements in chromosomes 1, 3, 4, 11, and 14 are noted in NOFs (non-ossifying fibroma) of bone
Desmoplastic Fibroma [44][45][46][47][48][49][50]
  • Strong positive for the adhesion protein β-Catenin
  • Weak positive labelling for S-100
  • No positive stain for the proliferation marker Ki67
  • No associated conditions
Pleural Fibroma [51][52][53][54][55][56][57][58][59][60][61][62]
  • Composed of irregularly arranged fascicles comprising of spindle cells with collagen separation.
  • They originate from submesothelial mesenchymal cells.
  • Myxoid or cystic degeneration can occur.
  • Recurrent somatic fusions of the two genes, STAT6, located at chromosomal region 12q13, have been identified in pleural fibromas.
Cardiac Fibroma [63][64][65][66][67][68][69][70][71][72]
  • Well defined, solitary, intramyocardial lesions with smooth margins and usually large, with a mean diameter of ~5 cm
  • None
Renal Medullary Fibroma [73][74][75]
  • Small, and white well circumscribed nodule in medulla typically less than 3mm are characteristic findings of renal medullary fibroma
  • Small polygonal/stellate cells
  • Abundant loose/myxoid stroma
  • Entrapped renal tubules may be present
  • None
  • No associated conditions
Cemento-ossifying Fibroma [76][77][78][79][80][81][82][83][84][85]
  • Solid, sessile or pedunculated mass, which is often ulcerated, and generally has a diameter of less than 2 cm are characteristic findings of cemento-ossifying fibroma.
  • Cemento -ossifying tumors are composed of fibrous tissue, calcified tissue resembling bone and/or cementum.
  • The bone-like component is predominant reminiscent of woven bone and is found in more 'mature' lesions.
  • In some instances, this entity has been divided into cementifying fibroma and ossifying fibroma depending on the relative amounts of the tumor's constituent tissues.
  • Surface ulceration is common
  • None
  • No associated conditions
Desmoplastic Fibroblastoma [86][87][88][89][90][91]
  • FOSL1 gene is involved in the pathogenesis of desmoplastic fibroblastoma, llq 12 breakpoint described as being characteristic.
  • Beta-catenin -ve
  • Positive in desmoid-type fibromatosis
  • Desmin negative
  • S-100 negative
  • CD34 negative
  • MSA positive
  • Alpha-SMA positive
  • No associated conditions
Elastofibroma [92][93][94][95][96][97][98]
  • I'll defined, nonencapsulated, rubbery, firm, white lesion with interspersed fat and with moderate demarcation to surrounding tissue are characteristic findings of elastofibroma.
  • The tumors can be quite large (up to 20 cm), although most are around 5 cm.
  • No associated conditions
Sclerotic Fibroma [99][100][101][102][103][104][105][106][107]
  • Skin, may be solitary or multifocal
  • Well-delineated but unencapsulated mass of densely collagenized, hypocellular fibrous tissue with a storiform pattern, and prominent clefts between collagen bundles are characteristic findings of elastofibroma.
Giant cell fibroma [108][109][110][111][112][113][114][115]
  • None
  • No associated conditions
Peripheral Odontogenic Fibroma [116][117][118][119][120] Firm, slowly growing, sessile, and nodular growth of the gingiva are characteristic findings of peripheral odontogenic fibroma.
  • None
  • No associated conditions

Gross Pathology and Microscopic Pathology

Type of fibroma Gross image Microscopic image
Ovarian fibroma
Ed Uthman, MD [CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0)],https://upload.wikimedia.org/wikipedia/commons/0/04/Fibroma_of_the_Ovary.jpg,https://commons.wikimedia.org/wiki/File:Fibroma_of_the_Ovary.jpg
Histopathology of ovarian fibroma showing benignspindle cellproliferation,Boujoual M, Hakimi I, Kouach J, Oukabli M, Moussaoui DR, Dehayni M. Large twisted ovarian fibroma in menopausal women: a case report. Pan Afr Med J. 2015;20:322. Published 2015 Apr 6. doi:10.11604/pamj.2015.20.322.5998,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4491469/
Oral fibroma
Fibroma of oral mucosa,Klaus D. Peter, Gummersbach, Germany [CC BY 3.0 de (https://creativecommons.org/licenses/by/3.0/de/deed.en)],https://upload.wikimedia.org/wikipedia/commons/c/c5/Fibroma.jpg,https://commons.wikimedia.org/wiki/File:Fibroma.jpg
Librepath [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)],https://upload.wikimedia.org/wikipedia/commons/d/db/Oral_fibroma_--_low_mag.jpg,https://commons.wikimedia.org/wiki/File:Oral_fibroma_--_low_mag.jpg
Chondromyxoid fibroma
arahkayb [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)],https://upload.wikimedia.org/wikipedia/commons/a/a6/Bone_ChondromyxoidFibroma_Calcium_MP_PA.JPG,https://commons.wikimedia.org/wiki/File:Bone_ChondromyxoidFibroma_Calcium_MP_PA.JPG
Uterine fibroma
Hic et nunc [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)],https://upload.wikimedia.org/wikipedia/commons/f/f7/Uterine_fibroids.jpg,https://commons.wikimedia.org/wiki/File:Uterine_fibroids.jpg
Calicut Medical College [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)],https://upload.wikimedia.org/wikipedia/commons/e/ea/Leiomyoma_Uterus_40x.jpg,https://commons.wikimedia.org/wiki/File:Leiomyoma_Uterus_40x.jpg
Ossifying Fibroma
Histopathologicaly, this lesion is characterized by spindle cell proliferation packed with globular cementum droplets and round/ovoid fragments of woven bone. These spindle cells appear benign and associated with psammomatoid cementum droplets and some woven bone and consistent with aggressive ossifying fibroma, psammomatous type IV,Alghonaim Y, ALRashed ALHumaid S, Arafat A. Aggressive ossifying fibroma of right ethmoidal sinus: A case report. Int J Surg Case Rep. ;53:513–516. doi:10.1016/j.ijscr.2017.12.026,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6290393/
Cardiac fibroma
Jha NK, Kiraly L, Tamas C, et al. Large cardiac fibroma and teratoma in children- case reports. J Cardiothorac Surg. 2015;10:38. Published 2015 Mar 22. doi:10.1186/s13019-015-0242-9,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373309/
Fibroblast cells in fascicles with abundant collagen fiber,Heidari A, Sabzi F, Faraji R. Right atrial fibroma in an adult patient. Ann Card Anaesth. 2018;21(1):65–67. doi:10.4103/aca.ACA_121_17,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791493/
Giant cell fibroma
Pebbly appearance in right retromolar region,Sabarinath B, Sivaramakrishnan M, Sivapathasundharam B. Giant cell fibroma: A clinicopathological study. J Oral Maxillofac Pathol. 2012;16(3):359–362. doi:10.4103/0973-029X.102485,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519210/
Artifactual spacing was observed surrounding the giant cells,Sabarinath B, Sivaramakrishnan M, Sivapathasundharam B. Giant cell fibroma: A clinicopathological study. J Oral Maxillofac Pathol. 2012;16(3):359–362. doi:10.4103/0973-029X.102485,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519210/
Peripheral odontogenic fibroma
Baiju CS, Rohatgi S. Peripheral odontogenic fibroma: A case report and review. J Indian Soc Periodontol. 2011;15(3):273–275. doi:10.4103/0972-124X.85674,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200026/
Baiju CS, Rohatgi S. Peripheral odontogenic fibroma: A case report and review. J Indian Soc Periodontol. 2011;15(3):273–275. doi:10.4103/0972-124X.85674,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200026/
Elastofibroma
The typical location for bilateral elastofibroma dorsi in prone position and with slightly abducted arm,Sarici IS, Basbay E, Mustu M, et al. Bilateral elastofibroma dorsi: A case report. Int J Surg Case Rep. ;5(12):1139–1141. doi:10.1016/j.ijscr.2014.10.032,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275815/
High Power slide showing elastic fibres (pink areas) which confirms the diagnosis of elastofibroma. (Altered elastic fibres in a collagenous matrix),Pillay Y, Sabarathnam R. Elasto fibroma Dorsi: a case report of bilateral tumours and excision of the symptomatic lesion in a male patient. J Surg Case Rep. 2017;2017(11):rjx206. Published 2017 Nov 7. doi:10.1093/jscr/rjx206,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5691368/
Desmoplastic fibroblastoma
Grewal R, Natter P, Makary R, Silliman J. Desmoplastic fibroblastoma of the left upper arm. BMJ Case Rep. 2018;2018:bcr2017221738. Published 2018 Jan 26. doi:10.1136/bcr-2017-221738,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786997/
Renal medullary fibroma
Renal medullary fibroma showing a firm grayish yellow calcified tumor (black arrow), renal hilum (white arrow),Kumar S, Choudhary GR, Nanjappa B, Bal A. Benign medullary fibroma of the kidney: a rare diagnostic dilemma. J Clin Imaging Sci. 2013;3:43. Published 2013 Oct 29. doi:10.4103/2156-7514.120776,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3823390/
H&E stain showing bland spindle-shaped cells occurring singly within a loose stromal matrix (black arrow) and separated by thick collagen bundles (white arrow),Kumar S, Choudhary GR, Nanjappa B, Bal A. Benign medullary fibroma of the kidney: a rare diagnostic dilemma. J Clin Imaging Sci. 2013;3:43. Published 2013 Oct 29. doi:10.4103/2156-7514.120776,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3823390/
Pleural fibroma
Single multi nodular encapsulated pale white firm piece of tissue,Hassan S, Husain SS, Anwar MA, Saeed S. Pleural Fibroma; A meandering path to surgical removal. Pak J Med Sci. 2015;31(1):236–238. doi:10.12669/pjms.311.5517,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386196/

Pathophysiology

Physiology

The normal physiology of [name of process] can be understood as follows:

Pathogenesis

  • The exact pathogenesis of [disease name] is not completely understood.

OR

  • It is understood that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
  • [Pathogen name] is usually transmitted via the [transmission route] route to the human host.
  • Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
  • [Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
  • The progression to [disease name] usually involves the [molecular pathway].
  • The pathophysiology of [disease/malignancy] depends on the histological subtype.

Genetics

[Disease name] is transmitted in [mode of genetic transmission] pattern.

OR

Genes involved in the pathogenesis of [disease name] include:

  • [Gene1]
  • [Gene2]
  • [Gene3]

OR

The development of [disease name] is the result of multiple genetic mutations such as:

  • [Mutation 1]
  • [Mutation 2]
  • [Mutation 3]

Associated Conditions

Conditions associated with [disease name] include:

  • [Condition 1]
  • [Condition 2]
  • [Condition 3]


Type of fibroma Location Gross pathology Microscpoic pathology Genetics and Immunohistochemistry Associated conditions
Ovarian Fibroma [3][4][5][6][7][8][9][10]
  • None
Oral Fibroma [11][12][13]
  • None
Chondromyxoid fibroma [14][15][16][17][18][19][20][21][22]
  • Well circumscribed, metaphyseal lesion, and fragments of white-grey rubbery tissue are noted
  • None
Uterine fibroma [23][24][25][26][27][28][29][30][31][32][33]
  • Round, well circumscribed (but not encapsulated), solid nodules that are white or tan, and show whorled appearance
Ossifying Fibroma [34][35][36][37][38][39][40]
  • Discrete mass that is well delineated from surrounding bone, tan-white, rubbery cut surface, firm to gritty and no encapsulation
  • They comprise of haphazardly distributed lamellated bony spicules on a background of fibrous stroma
  • The lesion has a zonal architecture with a center of immature bone surrounded by more mature lamellar bone.
  • The central spicules of woven bony trabeculae are lined by a layer of osteoblasts. The background is a loose and storiform fibrous tissue.
Non-ossifying Fibroma [41][42][43]
  • Clonal rearrangements in chromosomes 1, 3, 4, 11, and 14 are noted in NOFs (non-ossifying fibroma) of bone
Desmoplastic Fibroma [44][45][46][47][48][49][50]
  • Strong positive for the adhesion protein β-Catenin
  • Weak positive labelling for S-100
  • No positive stain for the proliferation marker Ki67
  • No associated conditions
Pleural Fibroma [51][52][53][54][55][56][57][58][59][60][61][62]
  • Composed of irregularly arranged fascicles comprising of spindle cells with collagen separation.
  • They originate from submesothelial mesenchymal cells.
  • Myxoid or cystic degeneration can occur.
  • Recurrent somatic fusions of the two genes, STAT6, located at chromosomal region 12q13, have been identified in pleural fibromas.
Cardiac Fibroma [63][64][65][66][67][68][69][70][71][72]
  • Well defined, solitary, intramyocardial lesions with smooth margins and usually large, with a mean diameter of ~5 cm
  • None
Renal Medullary Fibroma [73][74][75]
  • Small, and white well circumscribed nodule in medulla typically less than 3mm are characteristic findings of renal medullary fibroma
  • Small polygonal/stellate cells
  • Abundant loose/myxoid stroma
  • Entrapped renal tubules may be present
  • None
  • No associated conditions
Cemento-ossifying Fibroma [76][77][78][79][80][81][82][83][84][85]
  • Solid, sessile or pedunculated mass, which is often ulcerated, and generally has a diameter of less than 2 cm are characteristic findings of cemento-ossifying fibroma.
  • Cemento -ossifying tumors are composed of fibrous tissue, calcified tissue resembling bone and/or cementum.
  • The bone-like component is predominant reminiscent of woven bone and is found in more 'mature' lesions.
  • In some instances, this entity has been divided into cementifying fibroma and ossifying fibroma depending on the relative amounts of the tumor's constituent tissues.
  • Surface ulceration is common
  • None
  • No associated conditions
Desmoplastic Fibroblastoma [86][87][88][89][90][91]
  • FOSL1 gene is involved in the pathogenesis of desmoplastic fibroblastoma, llq 12 breakpoint described as being characteristic.
  • Beta-catenin -ve
  • Positive in desmoid-type fibromatosis
  • Desmin negative
  • S-100 negative
  • CD34 negative
  • MSA positive
  • Alpha-SMA positive
  • No associated conditions
Elastofibroma [92][93][94][95][96][97][98]
  • I'll defined, nonencapsulated, rubbery, firm, white lesion with interspersed fat and with moderate demarcation to surrounding tissue are characteristic findings of elastofibroma.
  • The tumors can be quite large (up to 20 cm), although most are around 5 cm.
  • No associated conditions
Sclerotic Fibroma [99][100][101][102][103][104][105][106][107]
  • Skin, may be solitary or multifocal
  • Well-delineated but unencapsulated mass of densely collagenized, hypocellular fibrous tissue with a storiform pattern, and prominent clefts between collagen bundles are characteristic findings of elastofibroma.
Giant cell fibroma [108][109][110][111][112][113][114][115]
  • None
  • No associated conditions
Peripheral Odontogenic Fibroma [116][117][118][119][120] Firm, slowly growing, sessile, and nodular growth of the gingiva are characteristic findings of peripheral odontogenic fibroma.
  • None
  • No associated conditions
Type of fibroma Gross image Microscopic image
Ovarian fibroma
Ed Uthman, MD [CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0)],https://upload.wikimedia.org/wikipedia/commons/0/04/Fibroma_of_the_Ovary.jpg,https://commons.wikimedia.org/wiki/File:Fibroma_of_the_Ovary.jpg
Histopathology of ovarian fibroma showing benignspindle cellproliferation,Boujoual M, Hakimi I, Kouach J, Oukabli M, Moussaoui DR, Dehayni M. Large twisted ovarian fibroma in menopausal women: a case report. Pan Afr Med J. 2015;20:322. Published 2015 Apr 6. doi:10.11604/pamj.2015.20.322.5998,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4491469/
Oral fibroma
Fibroma of oral mucosa,Klaus D. Peter, Gummersbach, Germany [CC BY 3.0 de (https://creativecommons.org/licenses/by/3.0/de/deed.en)],https://upload.wikimedia.org/wikipedia/commons/c/c5/Fibroma.jpg,https://commons.wikimedia.org/wiki/File:Fibroma.jpg
Librepath [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)],https://upload.wikimedia.org/wikipedia/commons/d/db/Oral_fibroma_--_low_mag.jpg,https://commons.wikimedia.org/wiki/File:Oral_fibroma_--_low_mag.jpg
Chondromyxoid fibroma
arahkayb [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)],https://upload.wikimedia.org/wikipedia/commons/a/a6/Bone_ChondromyxoidFibroma_Calcium_MP_PA.JPG,https://commons.wikimedia.org/wiki/File:Bone_ChondromyxoidFibroma_Calcium_MP_PA.JPG
Uterine fibroma
Hic et nunc [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)],https://upload.wikimedia.org/wikipedia/commons/f/f7/Uterine_fibroids.jpg,https://commons.wikimedia.org/wiki/File:Uterine_fibroids.jpg
Calicut Medical College [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)],https://upload.wikimedia.org/wikipedia/commons/e/ea/Leiomyoma_Uterus_40x.jpg,https://commons.wikimedia.org/wiki/File:Leiomyoma_Uterus_40x.jpg
Ossifying Fibroma
Histopathologicaly, this lesion is characterized by spindle cell proliferation packed with globular cementum droplets and round/ovoid fragments of woven bone. These spindle cells appear benign and associated with psammomatoid cementum droplets and some woven bone and consistent with aggressive ossifying fibroma, psammomatous type IV,Alghonaim Y, ALRashed ALHumaid S, Arafat A. Aggressive ossifying fibroma of right ethmoidal sinus: A case report. Int J Surg Case Rep. ;53:513–516. doi:10.1016/j.ijscr.2017.12.026,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6290393/
Cardiac fibroma
Jha NK, Kiraly L, Tamas C, et al. Large cardiac fibroma and teratoma in children- case reports. J Cardiothorac Surg. 2015;10:38. Published 2015 Mar 22. doi:10.1186/s13019-015-0242-9,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373309/
Fibroblast cells in fascicles with abundant collagen fiber,Heidari A, Sabzi F, Faraji R. Right atrial fibroma in an adult patient. Ann Card Anaesth. 2018;21(1):65–67. doi:10.4103/aca.ACA_121_17,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791493/
Giant cell fibroma
Pebbly appearance in right retromolar region,Sabarinath B, Sivaramakrishnan M, Sivapathasundharam B. Giant cell fibroma: A clinicopathological study. J Oral Maxillofac Pathol. 2012;16(3):359–362. doi:10.4103/0973-029X.102485,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519210/
Artifactual spacing was observed surrounding the giant cells,Sabarinath B, Sivaramakrishnan M, Sivapathasundharam B. Giant cell fibroma: A clinicopathological study. J Oral Maxillofac Pathol. 2012;16(3):359–362. doi:10.4103/0973-029X.102485,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519210/
Peripheral odontogenic fibroma
Baiju CS, Rohatgi S. Peripheral odontogenic fibroma: A case report and review. J Indian Soc Periodontol. 2011;15(3):273–275. doi:10.4103/0972-124X.85674,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200026/
Baiju CS, Rohatgi S. Peripheral odontogenic fibroma: A case report and review. J Indian Soc Periodontol. 2011;15(3):273–275. doi:10.4103/0972-124X.85674,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200026/
Elastofibroma
The typical location for bilateral elastofibroma dorsi in prone position and with slightly abducted arm,Sarici IS, Basbay E, Mustu M, et al. Bilateral elastofibroma dorsi: A case report. Int J Surg Case Rep. ;5(12):1139–1141. doi:10.1016/j.ijscr.2014.10.032,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275815/
High Power slide showing elastic fibres (pink areas) which confirms the diagnosis of elastofibroma. (Altered elastic fibres in a collagenous matrix),Pillay Y, Sabarathnam R. Elasto fibroma Dorsi: a case report of bilateral tumours and excision of the symptomatic lesion in a male patient. J Surg Case Rep. 2017;2017(11):rjx206. Published 2017 Nov 7. doi:10.1093/jscr/rjx206,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5691368/
Desmoplastic fibroblastoma
Grewal R, Natter P, Makary R, Silliman J. Desmoplastic fibroblastoma of the left upper arm. BMJ Case Rep. 2018;2018:bcr2017221738. Published 2018 Jan 26. doi:10.1136/bcr-2017-221738,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786997/
Renal medullary fibroma
Renal medullary fibroma showing a firm grayish yellow calcified tumor (black arrow), renal hilum (white arrow),Kumar S, Choudhary GR, Nanjappa B, Bal A. Benign medullary fibroma of the kidney: a rare diagnostic dilemma. J Clin Imaging Sci. 2013;3:43. Published 2013 Oct 29. doi:10.4103/2156-7514.120776,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3823390/
H&E stain showing bland spindle-shaped cells occurring singly within a loose stromal matrix (black arrow) and separated by thick collagen bundles (white arrow),Kumar S, Choudhary GR, Nanjappa B, Bal A. Benign medullary fibroma of the kidney: a rare diagnostic dilemma. J Clin Imaging Sci. 2013;3:43. Published 2013 Oct 29. doi:10.4103/2156-7514.120776,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3823390/
Pleural fibroma
Single multi nodular encapsulated pale white firm piece of tissue,Hassan S, Husain SS, Anwar MA, Saeed S. Pleural Fibroma; A meandering path to surgical removal. Pak J Med Sci. 2015;31(1):236–238. doi:10.12669/pjms.311.5517,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386196/

References

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