Differential Diagnosis for a 45-year-old with a Bump on the Groin

• Single most likely diagnosis:
  • Inguinal hernia: This is a common condition where tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles, often presenting as a bulge or bump in the groin area.
• Other Likely diagnoses:
  • Lipoma: A benign tumor made up of fat tissue that can appear as a lump under the skin, including in the groin area.
  • Cyst (e.g., epidermoid or sebaceous cyst): These are closed capsules or sac-like structures that can form under the skin, often filled with a cheesy or semi-solid material, and can appear as bumps.
  • Lymphadenopathy (enlarged lymph nodes): Can be due to various causes including infections, autoimmune diseases, or malignancies, and may present as bumps in the groin area.
  • Folliculitis or abscess: Infections of the hair follicles or skin that can cause bumps, especially if they become infected and form an abscess.
• Do Not Miss diagnoses:
  • Testicular cancer (if the bump is in the scrotum and not clearly a hernia): Although less common, testicular cancer can present as a lump in the testicle and is critical to diagnose early.
  • Melanoma or other skin cancers: While less likely, any new or changing skin lesion, especially if pigmented, should be evaluated for the possibility of skin cancer.
  • Lymphoma: Enlarged lymph nodes in the groin could be a sign of lymphoma, a type of cancer that starts in cells called lymphocytes.
• Rare diagnoses:
  • Pseudoaneurysm or vascular malformation: Abnormalities of the blood vessels that can present as a lump or mass, though this would be less common in the groin without a history of trauma or surgery.
  • Neurofibroma: A type of benign nerve tumor that can appear as a lump under the skin, including in the groin area, more commonly in individuals with neurofibromatosis.
  • Soft tissue sarcoma: A rare type of cancer that can appear as a lump or mass in the soft tissues, including muscles, tendons, fat, and blood vessels.