LUMPS AND BUMPS SURGERY OSCE PRESENTATION

A short notes on the LUMPS and BUMPS that happen in the human body . The various characteristics of them all and how to easily diagnose or different one type from another

1. LUMPS AND BUMPS
Lipoma
It is a cluster of fat cells, which have become over-active to form a palpable
mass (never turn malignant).
Hx:
Age: all ages not common in children.
Symptoms:
swelling
If it is pedunculated will interfere with movement
3-hard & painful b/c of fat necrosis
Ulceration with repetitive friction.
Development: grow slowly over many years & rarely regress.
Multiplicity: often multiple.
Exam:
Position: anywhere where there is fat most common in subcutaneous tissues of
upper limbs (forearm).
Color: normal skin color but when stretch it have glazed, transparent
appearance. The veins that crossing the lipoma visible as faint blue streaks.
Tenderness: not tender
Shape: spherical or hemispherical
Size: all sizes
Surface: smooth & bosselated (due to fat lobules)
Edge: irregular curves with slip sign

2. Composition: soft solid jelly-like fat, transilluminate & do not fluctuate
Relations: subcutaneous one not usually attached superficially or deeply & can
move in all directions
LN: should not be enlarged
Local tissues: normal
Regional exams-lymph nodes, blood supply and nerve supply
Sebaceous cysts
If the mouth of the sebaceous gland blocked, the gland becomes distended by
its secretion & this form sebaceous cyst
Hx:
Age: all ages rarely before adolescence, most commonly in early adulthood &
middle age
Duration: take a long duration (slowly growth)
Symptoms:
Lump commonly in the scalp (scratched when the patient combing his hair) &
genitalia
Enlarged rapidly & become painful when infected
As the discharge hardens, it forms a sebaceous horn
Infection of the cyst wall forms a boggy, painful discharging swelling = Cocks
’
peculiar tumor
Fate: regress or even disappear
Multiplicity: commonly multiple
Exam:

3. Position: in the hairy parts of the body (common in scalp, scrotum, neck,
shoulders & the back)
Color: as normal skin
Tenderness: not tender (pain & tenderness indicate infection)
Temperature: normal & increase when the cyst inflamed
Shape: tense & spherical
Surface: smooth
Edge: well define & easily feel
Composition: hard, not fluctuated, dull in percussion, not have fluid thrill & not
compressible or pulsate
LN: should not enlarge
Complication: infection, rupture, calcification & cocks peculiar tumor
’
Tx: - excision
If infected do the drainage then the excision
Dermoid cysts
Is a cyst deep to the skin lined by the skin can be congenital or acquired occur
in skin containing hair & sebaceous gland
Congenital dermoid :
Hx:
Age: Noticed at birth but more often in a few years later
Symptoms: cosmetic disfiguration usually in head & neck, rarely become big &
rarely become infected
Multiplicity: not usually multiple

4. Exam:
Position: At any point in the mid-line of the trunk (commonly along the lines of
fusion of ophthalmic & maxillary facial process (external angle of the eye)
Shape & size: ovoid or spherical & 1-2 cm in diameter
Surface: smooth
Composition: soft, fluctuate, only transilluminate if contain clear fluid, large
cysts conduct a fluid thrill & dull to percussion, not pulsatile, compressible or
reducible
Relations: deep to the skin & not attach to the skin or deep structures
Acquired implantation Dermoid cysts :
“ “
Hx:
There is a history of small deep cut or stab injury
Symptom : small & tense swelling , occur in areas subjected to repeated trauma
may be painful & tender & may interfere with the grip & touch if it is on the
fingers .
Exam:
Position: commonly found beneath skin liable to injury (fingers) & rarely in
surgical incisions
Shape & size: spherical smooth & small (0.5 1) cm in diameter
–
Composition: Hard & tense
Relation:
Overlying skin is often scared
May be tethered to the deep aspect of the scar
Deeper structures should be normal & freely mobile over them

5. LN: normal
Complications: Rarely become infected
Differential diagnosis: sebaceous cyst
Tx: - excision
If in scalp: do x-ray 1
st
to see if there is communication with underlying
intracranial tissue => if there is no communication do excision
Ganglion
It is a cystic, myxomatous degeneration of fibrous tissue caused by B . Tumor or
trauma
Hx:
Age: in all ages but majority present between 20-60 but rarely in children
Duration: grow very slowly
Symptom: lump that cause disfiguring but not painful
Persistence: does not connect with or empty into a joint
Exam:
Position: anywhere but commonly present near the capsule of the joint (90%
arise on the dorsal & ventral surfaces of the wrist joint & hand)
Shape & surface: spherical with smooth surface & some are multilocular & feel
like a collection of cyst
Composition: soft or hard solid masses with gelatinous material within them &
most of them fluctuate
Reducibility: may slip away between deeper structures when pressed but its
content not reduced into the joint

6. Relations: usually attached to fibrous tissue from which they originate but not
to underlying tissue (should be freely mobile over them)
Local tissues: normal
Differential diagnosis:
Bursae (soft, the joint is normal)
cystic protrusions of the synovial cavity of arthritic joints (soft , the joint
abnormal)
lipoma
osteoma
Tx: excision
Neurofibroma
It is benign tumor contain a mixture of neural & fibrous element
If it is multiple, congenital & familial ---- Von Recklinghausens disease
’
Hx:
Age: usually at adult age
Symptoms: disfiguring, may be tender when it is related to a nerve trunk &
patient may get tingling sensation
Multiplicity: often multiple
Exam:
Position: anywhere but forearms most often affected
Shape & size: usually fusiform & a few cm in length
Composition: firm rubber & dull to percussion
Relations: normal & it is mobile within subcutaneous tissues

7. Kaposi sarcoma
Is cutaneous sarcoma associated with HIV infection, immune-compromised
patient
Hx:
Symptoms: painless nodules or plaques, dark in color, beneath the skin & 1
st

appear in the legs
Exam:
Sites: lower extremities
Shape: hemispherical
Color: dark red
Tenderness: painless
Relations: overlying skin may ulcerate
Tx: biopsy for confirm the dx the radiotherapy