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Hard lump on back, MRI, back discomfort, esophageal candidiasis. Lymphoma?

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General Surgeon
Practicing since : 1980
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I have written to you before on this matter, but will summarize my history again:

About 1 month ago I discovered a hard, disc-shaped lump in my mid-back, about 3cm to the left of my spine at L2-3. The lump is not visible but can be felt upon palpitation. It feels oval shaped, cca. 2x3cm in size. It is very firm and feels like it's attached to the underlying muscle and the skin moves easily over it (i.e. it's not attached to the skin). It feels well-differentiated from the surrounding tissue with a defined edge. It does not seem to move and is not in any way tender or painful. However, pressing firmly on the lump produces pain and soreness in the area directly underneath and around the lump.

I also have lower back discomfort on the same side as the lump, starting from the area of the lump down to the top of my buttock and diagonally inward towards my groin. The discomfort is worst when I'm sitting with bad posture or in uncomfortable seats (such as a car seat). There is no discomfort when I stand or walk or lie on my back. Lying on my right side (the side opposite the lump) causes some discomfort. There are also times, e.g. shaving, washing dishes, when I'm slightly bent over that my back on the same side will "give way" (sort of snap out from under me). I have had isolated instances of discomfort in this same spot for years, but in the last months it has become more consistent and pretty much continuous. I discovered the lump about 1 month ago, but don't know how long it's been there. However, I did have an ultrasound of my kidneys during a prostate exam about 4 months ago and although the urologist wasn't specifically looking for a lump in that area, he didn't notice anything abnormal.

I have seen an orthopedist about my back and he was uncertain about what it was. He ordered an MRI, which he said did not show any serious problems. However, he also said that the MRI didn't show the lump, so he has contacted an MRI specialist to review the results, so I decided I'd also like a second opinion.

I should also mention that about 2 months ago I was diagnosed with acid reflux and esophageal candidiasis. The candidiasis had no obvious underlying cause (i.e. I'm HIV negative, negative for diabetes, have not been on antibiotics, have not used any asthma sprays, etc.). My CBC came back normal although my CRP was 5.51 mg/l (although I did have a soar throat and productive cough as well as a small infected cut in my nose at the time of the blood test). I was prescribed omeprazol for the reflux and a 3-week course of fluconazole for the candidiasis.

That being said, is there a way I can attach the MRI image files and x-rays for you to have a look at them? What could be the cause of my back discomfort? What about the lump? Since there is a link between esophageal candidiasis and lymphoma, and a link between lymphoma and lower back pain, I would like to be especially certain.
Posted Sat, 14 Apr 2012 in Back Pain
Answered by Dr. Rajinder Bajoria 3 hours later

Nice to see you again.

I am happy the way you have described your lump. Nothing can be better than this.     

Painless, non tender, invisible but palpable, oval, hard, non mobile, not adherent to over lying skin lump in the back of at the level of L2-L3 vertebrae, 3cms from spinous processes suggests something subcutaneous and / or muscular in origin. As it is well differentiated and well defined and suggests the benign nature of it. So I would like to assure about it. The possibility of it being cancer is nearly zero.

MRI has failed to detect the lesion. In routine we expect MRI or CT scan to catch all lesions or lump more than one cm if specifically order for. Such lumps you have would not be picked by them as they are subcutaneous or originating from connective tissue like muscle.

There are certain possibilities like neurofibroma, neuromyofibroma or cysticercosis of muscles. All these are benign and treatable. As all these are well defined, well circumscribed, painless. Mostly they are firm to hard in consistency .

FNAC or Excisional biopsy clinch the diagnosis for such lumps. You should consider to ask your doctor about it to prove the benign nature of it.

Back pain- A bad posture is the first thing that is causing the problem. You should avoid all the movements or postures that cause the pain. You can choose to apply TIGER BALM over the pain. Hot packs are helpful too. If these reduce the pain, my above reason makes lot of sense.

When a person has lymphoma we look for oesophageal candidiasis and not the other way. Oesophageal Candidiasis can be because of several other reasons. Back pain and Lymphoma are related in the same way. Your back pain should not be linked to either oesophageal candidiasis or the conditions that you mentioned.

‘Hope I have answered your query, “Wish you Good Health and trouble free speedy recovery”

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