What's Causing This Rapidly Growing, Golf Ball–Sized Mass?

Mark Davis, MD; Nandita Kakar


November 08, 2021

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 70-year-old man presents with a history of initial fullness in the left medial epitrochlear region that developed over approximately 2 months into a golf ball–sized mass. The mass is nontender, with no drainage. The overlying skin is normal, and the patient does not recall any trauma. He describes no other symptoms and denies fever, sweats, or weight loss, as well as any loss of muscular function or tingling, burning, or pain sensations of the left arm. The mass causes mild to no discomfort, and the patient is mainly concerned about its rapid progression.

He has a past medical history of familial hypercholesterolemia and gastroesophageal reflux disease (GERD) with esophagitis, which are managed with atorvastatin and omeprazole, respectively. He has never smoked tobacco or used alcohol or illicit substances. His surgical history includes a hernia repair and a tonsillectomy. He has a family history of heart disease and Alzheimer's disease.


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