A large back mass

1. PATIENT PRESENTATION

A 44‐year‐old male presented to the emergency department for evaluation of a back mass that had been growing insidiously for 7 years. He had previously been told it was a lipoma but was lost to follow‐up for several years. The mass had begun growing more rapidly over the year before presentation, when spontaneous drainage of clear fluid prompted medical evaluation. Figure 1, Panel A shows the 15 × 23 × 24 cm mass and associated skin necrosis located over his left upper back with the patient lying in the right lateral decubitus position. Computed tomography of the chest demonstrated a large mass with internal enhancing septations and areas of fat necrosis concerning for liposarcoma, which did not invade adjacent structures (Figure 1, Panel B). He was admitted to the hospital for surgical resection.

FIGURE 1.

A, Patient with large mass on posterior left shoulder, while laying in the lateral decubitus position. B, Sagittal CT scan of the patient's back mass, demonstraing calcifications and septations. CT: computed tomography

2. DIAGNOSIS: LIPOMA WITH FOCAL FAT NECROSIS

The resulting mass was histologically determined to be a lipoma with focal fat necrosis without evidence of malignancy. Malignant transformation of benign soft tissue tumors is extremely rare, and advanced radiological imaging can neither exclude nor definitively diagnose liposarcoma. ¹ The patient recovered well postoperatively and suffered no immediate complications from surgical removal.

CONFLICTS OF INTEREST

None.

Pettit N, Corson‐Knowles D. A large back mass. JACEP Open. 2021;2:e12511. 10.1002/emp2.12511