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An unusual subcutaneous lump

An 82-year-old white woman presented with a slightly sore, lumpy area under the skin on the left lower abdomen, which had developed over a few weeks. There was no history of trauma or any other lumps. The patient had ulcerative colitis, hypothyroidism, Raynaud’s syndrome, osteoporosis and asthma. She had developed immune thrombocytopenia 13 years previously, and had been successfully treated with cyclophosphamide. There was a family history (the patient’s father) of colon cancer and pernicious anaemia. The patient was taking levothyroxine, raloxifine and inhalers for asthma. On examination, a solitary, nontender, firm subcutaneous mass, measuring 80 · 50 mm, was seen on the left lower lateral abdominal wall (Fig. 1). The overlying skin was normal, and not fixed to the lump. There was no weight loss, fatigue, bone pain, epistaxis or lymphadenopathy, and the systemic examination was normal. Laboratory investigations showed that the patient had normal results for full blood count, erythrocyte sedimentation rate (ESR), renal function (creatinine 55 lmol ⁄ L; normal range 50–90 lmol ⁄ L), liver function and serum calcium. Complement levels were normal. Serum protein electrophoresis did not show any paraprotein. Cryoproteins and urinary Bence–Jones proteins were not detected. In 1997, a bone-marrow aspirate had been taken to investigate thrombocytopenia, and had not shown an excess of plasma cells or malignancy. A biopsy was taken from the centre of the mass for examination. Histopathological findings