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Forum Name: Miscellaneous Cancer Topics

Question: Lump in area of xiphoid and costal margin


 dlb - Wed Jan 10, 2007 11:09 pm

I am a 52 year old cauc. male. Diagnosed as diabetic type 2 several months ago, I began a very strict diet, daily vigorous exercise, and weight loss going from 250 pounds to 175 pounds. Recent A1c and glucose tolerance tests now in normal range. Having lost significant weight, I became aware of a hard mass over xiphoid area and in costal margin - I am not mistaking this for a "normal" protrusion - it is hard, fixed, lump about 1 inch in diameter. There is no pain, no pain on palpitation of it, no skin irritation or redness or other swelling, nor history of injury/trauma to this area. I had a routine chest xray in June 2006 and this was not mentioned in the report. I had lumbar surgery in Sept 2006 (my second) and an anterior cervical disectomy in 2002. Current daily medications are 50 mg Cozaar, 145 mg Tricor, 40 mg Zocor, 37.5 Effexor, 1000 IU Vitamin D, Multi-vitamin, 4800 mg Omega-3. BP, Cholesterol all under excellent control. Overall health very good since weight loss and daily vigorous exercise. Recent colonoscopy normal, family history of breast cancer in mother and maternal grandmother. This lump is not in soft breast tissue however but is in costal angle near or covering xiphoid. Do I need biopsy? Will see my internist in 2 weeks and was wondering before then what it might be. I am not excessively worried about it, but?
 Dr. Wafaa Abdel-Hadi - Thu Jan 11, 2007 3:35 pm

Dear dIb,

Is it in the right or left costal area?! Do you drink Alcohol? you can ask your internist for an abdominal ultrasound and liver function tests, in addition to LDH blood test. That would be very beneficial...no need for biopsy.

Best regards,
 dlb - Thu Jan 11, 2007 3:57 pm

It is slightly on the right (my right) of center. I have had liver tests done with the LDL?HDL tests and liver is fine. I am a non-smoker and non-drinker - never have used either. I am not sure about needing an abdominal ultrasound - the bump is higher up - about 2 inches below a horizontal line connecting the nipples - it is not in my abdominal area. (?)
 Dr. Wafaa Abdel-Hadi - Fri Jan 12, 2007 3:16 pm

Dear dIb,

The anatomy of the liver extends roughly from your right mid cage (5th costal space and goes down to almost 2-3 fingers below the costal margins depending on your size, weight or if you have fatty liver it gets bigger...and horizontally it passes beyond the xiphoid process.

The next step is for your internist to examine it and if it is hard and fixed as you say, he'll see if it is lying on a rib or not (that's to say if it is bony in origin or not) will either do a CT scan of the chest followed by a simple needle biopsy or the other way around. Your internist will determine which to start with,according to clinical examination.

And by the way LDH is not HDL....and has got nothing to do with your lipid profile...It is an enzyme in the body gives us an idea about certain inflammations that are going on especially with the lymph nodes.

Best of luck,
 dlb - Fri Jan 12, 2007 11:16 pm

Thanks for the additional information. I believe, as does my wife who is a nurse practitioner, that the lump is hard and fixed and bony in nature. I appears to be lying on a rib junction. Regarding LDH, I misunderstood. The only liver tests I have done are those associated with checking the effects of the tricor and zucor - I would have to review recent lab work to see if the LDH evaulation was done - I doubt it. I see my internist next week and trust her greatly - this give me better understanding and I appreciate your feedback. I try to be an informed patient - "doing my homework" as it were - and try and take responsibility for maintaining my health. Thanks for the consultative help. dlb

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