Tumorous swelling on the back

Abstract

A 29-year-old man with a painless mass on his back. History of the present illnessThe patient had noticed a painless mass over his right midback 2 years earlier. The mass had increased gradually in size. He had no history of fever, weight loss, anorexia, back pain, or similar lesions at any other site on his body. The overlying skin did not appear to be involved, and there was no history of any injury, injection, or surgical procedure on that site. There was no sensory loss or burning or tingling over or around the mass lesion, nor a history of chest pain, cough, hemoptysis, or breathlessness.Examination revealed a well-demarcated mass of moderate firmness that was approximately 7 ϫ 5 cm 2 in dimension. There was no erythema or tenderness to suggest inflammation. There was no spinal tenderness or gibbus, and scapular movements were not restricted. The remainder of the physical examination was unremarkable. Spine radiographs did not reveal any vertebral damage to suggest Pott's spine.Ultrasonography revealed a localized intramuscular abscess on the right scapular area. The patient was subsequently lost to followup for 1 year, during which time he underwent multiple incision and drainage procedures of the presumed abscess at other clinics. However, the lesion did not resolve. Cultures of the pus-like material exuded during abscess drainage were negative on several occasions.When the patient returned to our clinic, the mass had grown significantly in size and now occupied nearly twothirds of the right side of his back and the side of his trunk ( Figures 1A and B). The mass was firm, nontender, and nearly oblong, with few fluctuant areas. It was difficult to determine if the tumor was fixed to underlying structures, but the overlying skin was not tethered. Shoulder girdle movement and chest expansion were nearly normal. There were no enlarged regional lymph nodes. There was no fever and a complete review of systems was otherwise noncontributory. Medical historyThe patient had been diagnosed with dermatomyositis 7 years before presentation with the mass. His dermatomyositis had been characterized by polyarthritis, gradually progressive proximal muscle weakness, and ulcers over both elbows. There was no history of photosensitivity, malar rash, cough, dyspnea, dysphagia, or dysphonia. Examination had revealed a classic Gottron's sign over the dorsal surfaces of his metacarpal, proximal interphalangeal, and distal interphalangeal joints; punched out ulcers over both elbows; and proximal muscle weakness.The patient's muscle enzymes (creatine kinase, lactate dehydrogenase, and aspartate aminotransferase) were elevated more than 4-fold at presentation, accompanied by elevations in the erythrocyte sedimentation rate and C-reactive protein concentration. An enzyme immunoassay for antibodies to the human immunodeficiency virus was negative, as were assays for antinuclear antibodies and antiMi2 antibodies. Electrodiagnostic studies and the result of a muscle biopsy confirmed the diagnosis of dermatomyositis.The patient's elbow...

An Enormous Tumor in a Patient With Clinically Amyopathic Dermatomyositis

“…EICs greater than 5 cm are classified as giant EICs. 6 Similar to our patient, excision of the cyst resulted in no recurrence or changes in disease course of the underlying dermatomyositis. 5 To our knowledge, there has been one additional case report in the literature detailing the development of a giant calcified epidermal cyst in a patient with longstanding dermatomyositis who also had preceding cutaneous ulcerations.…”