Differential Diagnosis for Painless Chest Wall Lump

The patient's presentation with a painless chest wall lump, a history of dysgerminoma (a type of ovarian cancer), and previous Quantiferon TB test results that are not indicative of active tuberculosis infection, guides the differential diagnosis. The lack of a clearly distinguishable mass on CT and ultrasound adds complexity to the diagnosis.

• Single Most Likely Diagnosis

  • Lipoma: Given the description of the lump as feeling like swelling and being located below the clavicle, a lipoma is a plausible diagnosis. Lipomas are common, benign tumors composed of fat tissue, and they can occur almost anywhere in the body. They are usually painless, soft, and mobile, which aligns with the patient's symptoms.

• Other Likely Diagnoses

  • Fibroma or Other Benign Tumors: Similar to lipomas, other benign tumors such as fibromas could present as painless lumps. The location and characteristics of the lump could also suggest other benign growths.
  • Lymphadenopathy: Although the imaging did not clearly show a mass, lymphadenopathy (enlarged lymph nodes) could present as a lump, especially in someone with a history of cancer. However, the absence of other symptoms and the specific location might make this less likely.
  • Hematoma or Seroma: Given the history of cancer and potential for surgical interventions, a hematoma or seroma (collections of blood or fluid, respectively) could be considered, especially if there was any recent trauma or procedure in the area.

• Do Not Miss Diagnoses

  • Metastasis: Although the patient is in remission from dysgerminoma, the possibility of metastasis from the original cancer or a new primary cancer cannot be overlooked. Metastatic disease can present in almost any location, including the chest wall.
  • Sarcoma: Soft tissue sarcomas are rare but can present as a painless lump. Given the patient's history of cancer, it's essential to consider this possibility, although it is less likely.
  • Infection (including Tuberculosis): Despite the previous Quantiferon TB test results suggesting a low likelihood of M. tuberculosis complex infection, any infection, including tuberculosis, could potentially cause a lump, especially if it involves the lymph nodes or forms an abscess.

• Rare Diagnoses

  • Neurofibroma: Part of the spectrum of neurofibromatosis type 1, these benign nerve sheath tumors can present as lumps but are less common.
  • Desmoid Tumor: A rare type of benign tumor that can occur in the chest wall, desmoid tumors are known for their potential to grow and cause local destruction, despite being non-metastasizing.
  • Other Rare Tumors: Including but not limited to schwannomas, leiomyomas, or other soft tissue tumors that are less common and might present with similar symptoms.