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What could a lump in my back be?

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Practicing since : 2004
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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 time, 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 a 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 3 months ago and although the urologist wasn't specifically looking for a lump in that area, he didn't notice anything abnormal.

I should also mention that about 6 weeks ago I was diagnosed with acid refills 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.

I saw an immunologist regarding the state of my immune system and she has ordered a blood test to be taken at least 2 weeks after I finish my fluconazole treatment (I finished the treatment last week). I also indicated the lump on my back to her, which she lightly palpitated and said was most likely a lipoma.

However, I've also been to an orthopedist regarding the lump. An x-ray didn't show any abnormalities in my spine and he has ordered an MRI but didn't want to speculate about what it could be until he has the MRI.

Finally, to complete my health round-up, at around the same time I noticed the lump, I noticed a small area of mild eczema at the base of my skull (really only a bit of reddish skin with 1 or 2 very small pumps that I thought were pimples) that had never been there before and that I pointed out to the immunologist as well. In addition, in the last day there developed a small area (cca. 1x1cm) at the base of my skull on the left side about 3cm behind my earlobe that is slightly reddish and tender when pressed, but is otherwise not bothersome. About a month ago I had the same on the right back side of my skull, but it went away after a week.

So, while I'm waiting to take my immunology blood tests and have the MRI, I have some questions that I hope you can help me with so I understand as much as possible about what may or may not be going on with me:

1) Since esophageal candidiasis is linked to lymphoma, my first thought is: could the lump on my back be lymphoma? (I have not had any systemic symptoms, no fever, night sweats, weight loss, fatigue)

2) What are the other possibilities that it could be? Lipoma? Liposarcoma? Hernia?

3) Would the presence of eczema along with everything else indicate anything?

4) Is there anything else I should be looking out for?

Thank you for your reply!
Thu, 3 May 2012 in Cancer
Answered by Dr. Indranil Ghosh 59 minutes later

Thanks for posting your query in detail. I have noted it down.

1. Could the lump on my back be lymphoma?
My Answer: Based on your description of the lump, it does not seem to be due to lymphoma. You need not be worried.

2) What are the other possibilities that it could be? Lipoma? Liposarcoma? Hernia?
My Answer: I agree with your doctor. The description is suggestive of lipoma. The location, absence of associated symptoms(rightly pointed by you) and it's morphological description does not favor the diagnosis of hernia or liposarcoma or any other tumour.

MRI results will throw light on the nature of the lesion. Histopathological studies following FNAC or excision biopsy will clinch the diagnosis.

3) Would the presence of eczema along with everything else indicate anything?
My answer: The occurrence of eczema was probably incidental. It is not related to the current lump in the back.

4) Is there anything else I should be looking out for?
My answer: I suggest you to wait for the MRI results. Your doctor will probably opt for histopathological studies, if feasible as the next step. As suggested in my earlier reply, that will clinch the diagnosis.

Hope you find my answers adequate. I will be available for follow ups.

Above answer was peer-reviewed by
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