Suggest treatment for lump on right bicep
(1) there is clearly a lump beneath the skin. It is hard, the size of a pea, appears moveable and on top of the muscle. The lump itself doesnt seem to hurt but the area around it tender when pressed. If nothing showed on the MRI (T2 without contrast), what could this lump be?
(2). The MRI is the gold standard even without contrast so should I stop worrying?
I saw the dermatologist. He said it wasnt his area because it appeared to be deeper than the surface of the skin. He thought it was a lipoma, ganglion cyst or enlarged lymph node (note i confirmed the radiologist view after this appt because it didnt make sense). The MRI didnt see any of that.
What else can it be? Can I at least be confident that it isnt a sarcoma/cancer as it should have shown on MR, correct?
I am also happy to send images from MR if helpful. They said they went 6 inches from humoral head and the lump is about 5 inches down. I cant interpret the images to confirm that they did in fact go 6 inches down.
I am requesting advice from ortho as the derm said the lump was deeper and needed to see an ortho surgeon.
This is not a cancer for sure.
Thank you for the query.
Sometimes we try to diagnose something simple with very advanced tools. In my opinion this is what has happen to you. If you palpate a lump right under the skin, and its movable, clearly such lump is benign. No doubt in that. And as it is movable, has nothing to do with a bone.
First test which you should have is simple soft tissue ultrasound. The lump would be seen in this test for sure.
MRI is very good test. But it has some limitation like every other tool and lump right under the skin can be invisible in this test.
Answering your questions:
1. This lump still can be a cyst or lipoma.
2. MRI rules any malignant thing in the bones or muscles, so really you should not be worried. And for sure this is not any sarcoma.
How about seeing general surgeon instead of orthopedist? Instead of thinking what exactly the lump is (you can never be sure), it should be removed and tested. If its right under the skin, such procedure should be easy and painless.
Hope this will help. Feel free to ask further questions.
I do not think this is any cancer.
Actually contrast is used to see the blood circulation. In case of tumors, the blood circulation is always ample so malignant tumor is filled with contrast.
But as MRI is very accurate test, even without contrast, some tumor should be seen. And in case of any doubts, radiologist would write that there some tumor but he can not determine its nature and MRI with contrast should be done.
Here we have a situation where they dont see anything at all.
My recommendation for you is to have soft tissue ultrasound at first. And I do not thing this is a cancer. Cancer grows constantly, has rough surface, and after some time becomes not movable. It simply infiltrates all surrounding tissues.
The radiologist saw nothing and said there was nothing to worry about. With your explanation on value of contrast that must be why even if the lump is small, and wouldnt be missed, correct?
Additionally your explanation that a tumor close to surface may not show up must explain it since there is clearly a lump. If i understand your initial response that doesnt mean cancer is missed but a benign lump/tumor may not show, correct.
I think the lump moves on top but does feel relatively fixed at bottom.
That said, 2 docs said it seemed movable.
Either way, it is small so that is positive. After our dialogue, i feel better but worse case it is likely early.
I forgot to note in my discussion with the ortho surgeon today. He told me to note if i start to see skin dimpling when looking for comcerning signs.
I dont know why i disnt mention it but i do notice dimpling on the skin above where the lump is located. I read that is a sign of a dermatofibroma thus good. Especially since they are usually small lumps like mone. After talking to him, I am now comcerned it may mean something bad. What are your thoughts?
Is the size of the lunp a good sign that, worse case, this is early stage?
Soft tissues ultrasound is different than regular one.
Such ultrasound is different as the doctor is focused on the soft tissues. He also must use different probe (linear instead of convex). Such probe allows to see any lump right under the skin (and also deeper if that's necessary).
In case of MRI, we give contrast not to see something. We give it to distinguish one tissue from another tissues (we contrast blood). As cancer cells multiply really fast, they need a lot of blood (much more than any other regular tissue). This makes cancerous tissue to have a lot of blood vessels. When you give a contrast, such tissue glows.
Cancer is not missed. It simply does not appear so superficially (except skin cancer which is not dangerous). Cancer, even if starts from the superficial tissues, grows deeply affecting and infiltrating all tissues.
If it were a cancer, something would appear in the MRI.
Dimpling is not a significant sign. It would be important, if it were a breast cancer.
Size is also not an important sign as long as you describe it as small or medium.
Thank you again.
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