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Hard Lump On Chest. Diagnosed With Fat Deposit. Worried For Bone Cancer
Question: Hi, My son has a lump, hard round under his breast/top of rib cage on the left side. It is the size of a chestnut. He is 17. I took him to the pediatrician who called it a fatty deposit and promised me it was nothing to worry about. he did say to come back in two weeks anyway. make sure it does not get bigger. He saw it one week ago. My son has a friend who presented with a similar "mass" in the same region and it was sever bone cancer. I am worried. I think it should be biopsied. The pediatrician is well regarded and has been our doctor since my son was born and also for my now 21 year old daughter. He is very well know in Los Angeles where we live. and has been in practice for 30 years. My son discovered it just last week when he called it to my attention. We went to the doctor the next day. he said it hurt him. It was like it came out of nowhere. I did some research on line and only found info on calcium deposits. My son was concerned because he immediately thought of his friend. His friend had a mass in the left rib cage (he had it for a while and he knew it) and he ended up with stage 4 bone cancer. I think it should be biopsied. Our doctor indicated that it will go away on its own. The whole thing seems strange. I have never heard of a fatty deposit in the breast/rib cage area before and it feels like a lump.
Hi XXXXXXX,
Welcome to HCM!
I understand your concern esp in view of his friend's problem!
What I think (before you insist on biopsy) are the following points to consider.
1 we have to rule out inflammatory swellings - these are usually red,tender,indurated ( firm around the lump). Here biopsies are contraindicated.
2 A x- XXXXXXX of the chest or rather ultrasound of the lesion can help.
XRays do not help always because the front portion of the chest cage is made of cartilage. But bony lesions should show!
3 you have one more week to go before review - so just watch closely and if possible even measure the dimensions and see whether it s becoming smaller or bigger.
4 sometimes a doctor can detect by examination whether the lump is mobile or fixed .If mobile it is something under the skin and nothing to worry.
5 hormonal changes in boys can also cause some breast tissue development in boys that can persist up to 20 years of age . But this will be usually bilateral but can be asymmetrical.
6 costo chondritis of the rib will present with tenderness and swelling but will not be so localised.
As you mention that the doctor is an experienced one whom you usually trust, why don't you wait and watch for one more week till the review! He himself may suggest what to do.
Or you can express your concern and discuss with him at that time!!!
I have a gut feeling that it 's not something to worry about!!
(Of course seeing is better than hearing in medicine!!)
God bless
Good luck
Dr Uma
Welcome to HCM!
I understand your concern esp in view of his friend's problem!
What I think (before you insist on biopsy) are the following points to consider.
1 we have to rule out inflammatory swellings - these are usually red,tender,indurated ( firm around the lump). Here biopsies are contraindicated.
2 A x- XXXXXXX of the chest or rather ultrasound of the lesion can help.
XRays do not help always because the front portion of the chest cage is made of cartilage. But bony lesions should show!
3 you have one more week to go before review - so just watch closely and if possible even measure the dimensions and see whether it s becoming smaller or bigger.
4 sometimes a doctor can detect by examination whether the lump is mobile or fixed .If mobile it is something under the skin and nothing to worry.
5 hormonal changes in boys can also cause some breast tissue development in boys that can persist up to 20 years of age . But this will be usually bilateral but can be asymmetrical.
6 costo chondritis of the rib will present with tenderness and swelling but will not be so localised.
As you mention that the doctor is an experienced one whom you usually trust, why don't you wait and watch for one more week till the review! He himself may suggest what to do.
Or you can express your concern and discuss with him at that time!!!
I have a gut feeling that it 's not something to worry about!!
(Of course seeing is better than hearing in medicine!!)
God bless
Good luck
Dr Uma
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Good Morning, Dr. Uma,
Thank you for the reply.
Here is what I know as he is very private about me touching it and di not allow me into the exam room with the doctor the day we went. Thinks he is too grown up. Also has always had enlarged neck lymph nodes that have been biopsied over the years by a head and neck oncologist and they are nothing.
I did feel it though the first day which is when he became alarmed and actually went to the school nurse and called me in (i work in the same school and he was the one that asked to go to the doctor). The nurse felt it. I did not ask her as we went to the doctor.
This is what I felt.
1- No redness, swelling, inflammation.
2-hard, did not seem mobile although he had trouble locating it, but then he did.
3- not exactly the breast, but under a bit, but seems like where the breast ends and the rib cage begins.
4-it felt round as if it had a definite shape.
5- he will not let me touch it again.
says it is still there. Cannot see it if you look at him. Does not protrude. Got to find it.
6- has not complained about it hurting, but he might be scared.
7- has a pain in his back, localized in the right side, about the same level, off to the right of the spine, started on Monday, Feb 18 . He has asked me to massage it out. It has not gone away. I have felt nothing out of the ordinary beneath the skin. It is localized. Could be from his Monday boxing lesson.
8- He discovered the lump that we are speaking about on Wednesday, Feb 13 and called it to my attention on Feb 14 which is when I took him to doctor.
Thank you for additional feedback. He is graduating high school and has upcoming out of town trip with his school choir in April, and a graduation trip to Europ with his graduating class in July, and then off to college in August/Sept. I don't want any surprises. Worried is my middle name.
XXXXXXX
Thank you for the reply.
Here is what I know as he is very private about me touching it and di not allow me into the exam room with the doctor the day we went. Thinks he is too grown up. Also has always had enlarged neck lymph nodes that have been biopsied over the years by a head and neck oncologist and they are nothing.
I did feel it though the first day which is when he became alarmed and actually went to the school nurse and called me in (i work in the same school and he was the one that asked to go to the doctor). The nurse felt it. I did not ask her as we went to the doctor.
This is what I felt.
1- No redness, swelling, inflammation.
2-hard, did not seem mobile although he had trouble locating it, but then he did.
3- not exactly the breast, but under a bit, but seems like where the breast ends and the rib cage begins.
4-it felt round as if it had a definite shape.
5- he will not let me touch it again.
says it is still there. Cannot see it if you look at him. Does not protrude. Got to find it.
6- has not complained about it hurting, but he might be scared.
7- has a pain in his back, localized in the right side, about the same level, off to the right of the spine, started on Monday, Feb 18 . He has asked me to massage it out. It has not gone away. I have felt nothing out of the ordinary beneath the skin. It is localized. Could be from his Monday boxing lesson.
8- He discovered the lump that we are speaking about on Wednesday, Feb 13 and called it to my attention on Feb 14 which is when I took him to doctor.
Thank you for additional feedback. He is graduating high school and has upcoming out of town trip with his school choir in April, and a graduation trip to Europ with his graduating class in July, and then off to college in August/Sept. I don't want any surprises. Worried is my middle name.
XXXXXXX
Hi,
Thanks for all the details given very nicely!
You are absolutely justified in getting worried as a loving mother!!!
I think now more in favour of costochondritis !
It is a benign condition.
When on left side,sometimes mistaken for heart pain.
From your description I feel it is nothing serious.
Don't worry.
Wishing your son a very bright future!
Good luck
Dr Uma
Thanks for all the details given very nicely!
You are absolutely justified in getting worried as a loving mother!!!
I think now more in favour of costochondritis !
It is a benign condition.
When on left side,sometimes mistaken for heart pain.
From your description I feel it is nothing serious.
Don't worry.
Wishing your son a very bright future!
Good luck
Dr Uma
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr. Uma,
What is costochondritis?
Someone suggested to me , it might be a lipoma?
I got worried that it has something to do with my son taking Adderral. And he has complained of being tired and not being able to sleep of late. But that could be other things. His dad is getting divorced and the Adderral might have something to do with it.
I do pray it is nothing. I called the doctor today and I will take him back next week. He is going to be 18 in two weeks and I think he should have a major physical with blood work.
I will look forward to your last reply.
The more I think about where it is - on me -if I put my fingers right under my bra line in the very center of my chest between both breasts and then moved to the left a little - it is in the soft part about 2-3 inches to the left of the center about a half inch under the bra line. I also feel my rib there. my friend said the stomach is there also.
I just looked up Costochondritis. It is not that. There is nothing that says it presents as a definite lump with shape.
I wish it was that.
Thank you,
XXXXXXX
What is costochondritis?
Someone suggested to me , it might be a lipoma?
I got worried that it has something to do with my son taking Adderral. And he has complained of being tired and not being able to sleep of late. But that could be other things. His dad is getting divorced and the Adderral might have something to do with it.
I do pray it is nothing. I called the doctor today and I will take him back next week. He is going to be 18 in two weeks and I think he should have a major physical with blood work.
I will look forward to your last reply.
The more I think about where it is - on me -if I put my fingers right under my bra line in the very center of my chest between both breasts and then moved to the left a little - it is in the soft part about 2-3 inches to the left of the center about a half inch under the bra line. I also feel my rib there. my friend said the stomach is there also.
I just looked up Costochondritis. It is not that. There is nothing that says it presents as a definite lump with shape.
I wish it was that.
Thank you,
XXXXXXX
HiY
Yes,it is not a lump,but a prominence on the front end of the rib,in the cartilage ( you mentioned that it is difficult to see,does not protrude!)
Lipoma is a very benign swelling and should be in the space between ribs(intercostal space).
For diagnosing, localising whether it is from subcutaneous tissue in the inter coastal space or bone of the rib, or cartilage of the rib, is important. This can be done by the examining doctor by palpation ,by X-ray or ultrasound.
Adderral does not have any thing to do with it.
Yes I agree with you that he should get a compete checkup before his college including lipid profile.
I am sure it is nothing serious as you worry about and pray for you and your son to be healthy and happy.
Regards
Dr Uma
Yes,it is not a lump,but a prominence on the front end of the rib,in the cartilage ( you mentioned that it is difficult to see,does not protrude!)
Lipoma is a very benign swelling and should be in the space between ribs(intercostal space).
For diagnosing, localising whether it is from subcutaneous tissue in the inter coastal space or bone of the rib, or cartilage of the rib, is important. This can be done by the examining doctor by palpation ,by X-ray or ultrasound.
Adderral does not have any thing to do with it.
Yes I agree with you that he should get a compete checkup before his college including lipid profile.
I am sure it is nothing serious as you worry about and pray for you and your son to be healthy and happy.
Regards
Dr Uma
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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