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Strange Lump Turns Out to be “Nothing”

April 22, 2011
4 inch wide, 6 inch long and 2 inch deep , firm lump under this dog's skin on the spine of the shoulderblade

Nasty Shoulder Lump

A Strange, Nasty Lump Just Suddenly Appears

“Doc, I’m so worried, this lump just appeared. It doesn’t seem to bother her, but it’s huge!” said Tiffany, the 3-year-old Labrador-Ridgeback mixed-breed dog’s mom.

“Let’s not panic,” said Doc Truli. “First, we’ll examine the lump, then perform an aspirate to see what it’s made of.”

The lump felt semi-soft.  It was long and oval-shaped.  Under the surface, Doc could feel the connective tissue of the supraspinatus (pronounced supra-spin-at-us) muscle, the muscle that lives on the top half of the shoulder-blade above the spine of the shoulder-blade.  That lump was attached to some deep connective tissue structures!

An 18 gauge, 1 1/4 inch needle attached to a leur-lock 6 cc syringe cut easily into the lump.  The plunger pulled back to suck cells into the vacuum space in the barrel of the syringe, created by the plunger pressure and the expansion of the empty space in the syringe.  A drop of serosanguinous, light cherry-red watery blood tinged the plastic syringe barrel.

“You didn’t get anything?” said Tiffany’s mom.  Everyone thinks that…

Doc Truli removed the needle, pulled back on the barrel, filling the syringe with air, then replaced the needle and lined the bevelled tip up with a glass microscope slide.  A quick push on the plunger and the blood spot and a tiny sample of fluid with cells sprayed in a fan shape onto the slide.

“A few minutes to dry, fix, and stain, then a look under the microscope and we’ll have a name for that lump,” said Doc Truli.

The lump contains a mixed inflammatory infiltrate and red blood cells.  The cells looked like a mix of immune cells, typical of inflammation after injury.  A needle aspirate diagnosis is never 100% accurate because the cells are sprayed onto the slide, they are not aligned in the pattern of layers from inside the body.  The most accurate understanding of a lump is obtained from a biopsy sample – a surgical sample kept as a lump and prepared and analyzed at the laboratory.

Tru Philosophical Thought

The reason a diagnosis is only definitive with a biopsy sample is because of the way a diagnosis is defined and solidified in modern medicine.  The physical, visual look and characteristics under the microscope define the mass or lump.

While that may be obvious, other cultures may define the biological behavior as a diagnosis.  Or the emotional effect on the body.  Chinese medicine deals with energy patterns.  Homeopathic practice does not require a name for a disease in order to treat the patient.

Therefore, a diagnosis, or definition of a mass in Western medicine, is defined by the histological microscopes features.  Perhaps if we explored other definitions of a mass, we would not need biopsies and invasive procedures in order to help patients.

Tiffany’s lump shrunk over 4 weeks.  Her body circulation broke down the inflammation and absorbed the swollen fluid-filled tissues.  This time, the lump was not cancer, but a “sports injury” from playing way too rough with her dog friends!

Further Reading

When a Fat Bump Goes Bad

Chocolate Lab Lump is a Bloody Hematoma

Quirky Lump Problem

Visit VirtuaVet’s Lumps and Bumps Category for more stories & pictures!

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