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JAMA Surgery Clinical Challenge
October 2014

Firm Flank Mass Decreasing in Size After Pregnancy

Author Affiliations
  • 1Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
  • 2Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
  • 3Department of Oncology, Johns Hopkins Hospital, Baltimore, Maryland
JAMA Surg. 2014;149(10):1089-1090. doi:10.1001/jamasurg.2014.1632

A woman in her mid-30s pregnant with twins at 13 weeks’ gestation presented with a tender right-flank mass, which she noticed after falling and sustaining trauma to the area 1 week previously. Medical history was significant for a total thyroidectomy for papillary thyroid cancer 7 years before as well as a strong family history of malignant breast cancer on the maternal side and colon and liver cancer on the paternal side.

Physical examination revealed an 8 × 8-cm, tender, firm posterior right-flank mass that was mobile but fixed to the abdominal wall musculature. Laboratory examination revealed no abnormalities. Ultrasonography demonstrated a hypoechoic lesion measuring 3.3 × 3.6 cm with internal echoes and no significant flow (Figure 1A). A noncontrast magnetic resonance image (MRI) revealed this to be a well-circumscribed T2 hyperintense lesion with diffuse surrounding soft tissue edema within the adjacent muscular and subcutaneous tissues abutting the posterior margin of the right chest wall and external oblique muscle at the level of the T11 to T12 intercostal space (Figure 1B and C).

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