Every week we are presented with excellent opportunities to solve many patient's complaints--often times some they didn't even know who to seek help from.
All of these cases that we will post are actual patients, seen in our facility by our providers.
Clinical Information:
Patient is a 50-year-old male with a large soft tissue mass on the back side of his shoulder blade near the base of the neck. He reports having noticed this for the last several years but feels it may be increasing in size over the last several months. No other significant medical history otherwise.
Exam Findings:
Large soft tissue mass is noticed on the back of the shoulder. Mass is not painful to touch, but the patient reports feeling “pressure”. The mass overall is very compressible (squishy) and is mobile. There are no pulsations from the mass and there appears to be no abnormal skin changes or temperature changes adjacent to the mass.
Differential Diagnosis (DDx):
One of the most common superficial soft tissue masses by far is a benign lipoma and is in a classic locations at the hips/shoulders and displays benign features such as non-painful, mobile, non-aggressive growing mass. While lipomas are benign, in rare cases, they can transform into a malignant form known as a liposarcoma. Liposarcomas in general are not very common, but risk increases with age and the closer a lipoma is to the axial skeleton (spine, hips, shoulder, head) also increases the risk and in this case with a recent change in size should also be considered. Other conditions that can mimic these tumors are an abscess from an infection, sebaceous cyst, or malignant fibrous histiocytoma which is the most common malignant soft tissue tumor of the musculoskeletal system.
Imaging:
Like most conditions, imaging can be just as vital to helping chose a specific diagnosis. In this case, we were able to perform a diagnostic ultrasound of the mass and found the inside of the tumor had material consistent with adipose tissue (fat) and a thick capsule around it (indicating slow benign process) with no abnormal vascular changes in or around it (making an aggressive process like malignant tumor or infection less likely) which when combined with our clinical findings and DDx helps to confirm the mass as being a benign lipoma.
Lipoma background:
•Most common soft tissue tumor (2% of population).
•Most are found incidentally in people > 40 years old. Risk increases with age.
•Gold standard for imaging is MRI or diagnostic ultrasound.
•Most require no treatment unless locally painful or for cosmetic reasons.