The Case of the Author With an Aching Groin Mass

Albert B. Lowenfels, MD 

Disclosures

May 29, 2013

The Case

The patient was a 57-year-old writer who complained of a large, uncomfortable mass or "tumor" in his left groin. It first appeared as an asymptomatic lump when he was 24 years old; at that time, he consulted a surgeon, who was unsure of the diagnosis and asked the patient to return for another visit. However, the swelling caused so few symptoms that the patient waited more than 30 years before consulting another surgeon.

The mass increased in size during this time, but it only became symptomatic in the few months before the patient's death. When walking became increasingly difficult, the patient consulted several prominent surgeons, who had various opinions about the nature of the mass, but they all agreed that the swelling was most likely related to accumulated fluid, for which they recommended drainage. The patient agreed, and his surgeons removed about 4 liters of fluid, resulting in a dramatic shrinkage of the mass. Unfortunately, the fluid reaccumulated rapidly, and his surgeons removed an equal amount of fluid about 2 weeks later.

The patient's health continued to deteriorate, walking became very difficult, and he became febrile. After a final tapping, which removed about 6 liters of liquid, the patient developed generalized abdominal pain that was partially relieved by morphine, became anorexic, and died about 2 months after the initial onset of symptoms. An autopsy was performed.

Medical History

The patient had many childhood diseases that interfered with his schooling. As he grew older, his health gradually improved to the extent that he became an officer in the armed services. As an adult, he enjoyed robust health, except for several episodes of gout and a single attack of what appeared to be thrombophlebitis at age 53 years.

Family History

His mother died during childbirth while the patient was young, and his father died when the patient was in his 30s. His several siblings all died during infancy. There were no known familial illnesses.

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