CASE
The patient is a 63-year-old Jamaican female. She presented to the general surgery clinic for evaluation of a large protuberant mass extending from her right flank and buttock.
History The patient reported having numerous growths on her skin that first developed when she was in her 20s. She first noticed this mass approximately 3 years ago, stating that it had grown significantly in recent months. The patient denied pain at the site of the enlarging mass; however, activities of daily living (ADLs) had become increasingly difficult because of its size.
She reported no fever, chills, weight loss, or fatigue. She also denied significant vision changes, focal neurologic deficits, or radiculopathy.
The patient's medical history was significant for hypertension and hyperlipidemia. She recently underwent surgical removal of a cataract from her left eye with no complications. She has no further surgical history. Family history is significant for a sister with similar cutaneous masses.
Physical examination The patient was a pleasant, thin, black female who appeared older than her stated age. She was alert and oriented ×3, and vital signs were within normal limits. Multiple café-au-lait spots and pedunculated masses of various sizes were present over most of her body; the largest measured 40×30 cm and extended from the right lumbar region (Figure 1). No evidence of freckling in the armpits or groin was noted. Extraocular movements were intact with no visual acuity deficits present on examination. Motor, sensory, and cranial nerves were grossly intact. The patient ambulated with moderate difficulty secondary to the weight of the mass. Cardiovascular, respiratory, GI, and GU examination findings were unremarkable. CT with contrast of the right lower extremity showed a large, pedunculated mass on the posterolateral aspect of the thigh, which was uniform in texture and demonstrated soft tissue attenuation. No neurovascular structures were contained within the mass, and no changes were seen in the underlying muscular and bony structures
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