There is a hard lump under the ribs

A hard lump under the ribs may be caused by a sebaceous cyst. The main cause of the disease is the congestion of sebaceous gland excretion disorders. It is difficult to determine whether it is a sebaceous cyst based on a single symptom. We need to first understand the disease, and then combine it with other characteristics of the disease to make a comprehensive judgment before we can draw a conclusion. Now let’s look at the situation of sebaceous cysts.

Clinical manifestations

Sebaceous cysts protrude from the surface of the skin and are prone to occur in areas rich in sebaceous glands, such as the scalp, face, chest and back, and most of them grow slowly. When there is no concurrent infection, patients generally have no symptoms. The tumors are spherical, single or multiple, and vary in size, ranging from a few millimeters to nearly 10 centimeters. It is of medium hardness and elasticity, protruding from the skin surface, adhered to the skin, not easy to push, with a smooth surface and no sense of fluctuation. There is a needle-head-sized umbilicus-like opening in the center, which is blue-black in color and shaped like a needle-head acne. Squeezing can produce tofu dregs or noodle mud-like contents, which are sebum and broken sebaceous gland cells, often with a rancid odor. It is extremely rare for sebaceous cysts to become cancerous, but they are prone to secondary infection. If infection occurs, inflammatory reactions such as redness, swelling, heat, and pain may occur. The cyst may rupture and temporarily disappear under external force, but it will form scars and is prone to recurrence.

Differential Diagnosis

It should be differentiated from dermoid cyst, epidermoid cyst, subcutaneous lipoma, etc.

1. Dermoid cyst

It is a congenital cyst formed by the skin cell primordium that deviates from its original position. It is located subcutaneously, not adhered to the skin but tightly adhered to the base tissue. It often grows near the midline of the body, and is prone to occur around the eye sockets, root of the nose, occipital region and floor of the mouth. It is a hamartoma.

2. Epidermoid cyst

Also known as traumatic epidermal cyst. It is a cyst containing keratin in the dermis, which is mostly caused by trauma (especially puncture) that implants the epidermis into the dermis. There is often keratin hyperplasia on the surface of the tumor, and it is prone to occur in parts that are susceptible to trauma and compression, such as the hands, ankles, and feet.

3. Subcutaneous lipoma

Lipoma is flat and lobed, located under the skin. If you push the local skin along both sides of the tumor with your fingers, an orange peel-like sign may appear.

treat

The most commonly used radical cure is surgical resection under local anesthesia. Sebaceous cysts are small tumors on the body surface. The surgery is simple and can be performed in an outpatient clinic. The cyst should be removed as completely as possible without leaving any cyst wall, otherwise it is prone to recurrence. Since sebaceous cysts mostly occur on the face, the cosmetic effect should be considered during surgical excision. A small incision can be used to remove the sebaceous cyst on the face and neck, and the skin can be sutured without tension to avoid the growth of scars and achieve a beautiful effect.

Antibiotics should be used appropriately if there is infection before surgery and to control inflammation after surgery. Sebaceous cysts that have been infected should be surgically removed after the infection is controlled. For patients whose local infection cannot be controlled or has been complicated by abscess, incision and drainage should be performed.

CO2 laser and electro-ion minimally invasive methods are considered to be good methods for treating cysts without concurrent infection. They are particularly suitable for the treatment of sebaceous cysts on the face due to their simple operation, small incision, little bleeding, no need for sutures, almost no scars, and low recurrence rate.