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histiocytoﬁbroma (14). Enhancement of these tumors is usually substantial or heterogeneous due to neovascularization and
is signiﬁcantly higher than that of EFD (2, 11, 15). In general,
subscapular topography, bilateralism, and typical imaging features including FDG uptake pattern in the elderly are suﬃcient
for diagnosis of EFD, thus avoiding biopsies and unnecessary
surgical resection. Occasionally, image-guided biopsy is required
if doubt persists in oncologic patients after imaging exams.
Otherwise, stable patterns of 18F-FDG uptake and mass size
on follow-up PET-CT may virtually eliminate malignancy from
the diﬀerential diagnosis. If the lesion is asymptomatic, simple
observation suﬃces. Complete surgical resection may be considered in symptomatic patients or for esthetic reasons (≥5 cm)
(10, 15). Local tumor recurrence has been reported after incomplete excision (2, 16). As no cases of malignant transformation
have been described in the literature (17), there is no need for
follow-up with EFD.
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2.
3.
4.
5.

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Baylor University Medical Center Proceedings

Volume 30, Number 3
Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings July 2017
