Differential Diagnosis for a 25-year-old Male with a Red Pedunculated Mass on the Central Spine

• Single most likely diagnosis:
  • Hemangioma: This is a common benign vascular tumor that can appear as a red, tender, and bleeding mass. The pedunculated nature and location on the spine are consistent with this diagnosis. Hemangiomas can be dense and may resemble a hematoma but are more likely to be a distinct mass.
• Other Likely diagnoses:
  • Pyogenic granuloma: A benign vascular lesion that can appear as a red, bleeding, and tender mass. It often grows rapidly and can be pedunculated.
  • Lipoma: Although typically not red or bleeding, a lipoma can become inflamed or traumatized, leading to these symptoms. The density of the mass could be consistent with a lipoma.
  • Neurofibroma: A benign nerve sheath tumor that can present as a pedunculated mass. While not typically red or bleeding, neurofibromas can become irritated or traumatized, leading to these symptoms.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
  • Malignant tumor (e.g., sarcoma): Although rare, a malignant tumor such as a sarcoma could present as a rapidly growing, bleeding mass. Early diagnosis and treatment are crucial for survival.
  • Angiosarcoma: A rare and aggressive malignant vascular tumor that can present as a red, bleeding mass. It is essential to consider this diagnosis due to its poor prognosis if left untreated.
• Rare diagnoses:
  • Glomus tumor: A rare benign vascular tumor that can appear as a red, tender, and bleeding mass. Glomus tumors are typically found under the fingernails but can occur in other locations.
  • Kaposi's sarcoma: A rare malignant vascular tumor that can present as a red, bleeding mass. It is often associated with immunocompromised states, such as HIV/AIDS.