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Shoulder mass biopsy - Medium 1-3 cm
Biopsy
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Tissue biopsy of shoulder lesion.
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Shoulder Mass Biopsy - Medium 1-3 cm
- Why is it done?
- To obtain tissue samples from a palpable shoulder mass measuring 1-3 cm for histopathological examination and diagnosis
- To differentiate between benign and malignant lesions of the shoulder region
- To identify specific pathological entities including lipomas, cysts, sarcomas, metastatic lesions, or inflammatory conditions
- When imaging studies (ultrasound, MRI, or CT) show indeterminate or suspicious findings
- To establish a definitive diagnosis for treatment planning and prognostic assessment
- Typically performed after imaging workup has characterized the lesion as indeterminate or potentially malignant
- Normal Range
- Biopsy results are reported as histopathological findings rather than numerical values
- Normal/Benign Result: Tissue showing characteristics of benign pathology (lipoma, benign cyst, fibromas, or normal adipose/muscle tissue)
- Negative Result: No evidence of malignancy, infection, or significant pathology detected on microscopic examination
- Positive Result: Presence of malignant cells, specific infectious organisms, or abnormal cellular architecture consistent with disease
- Inconclusive/Non-diagnostic: Insufficient tissue obtained or artifacts present preventing definitive interpretation
- Units: Histological grade (for malignancies), specific organism identification (if infectious), and descriptive tissue characterization
- Interpretation
- Benign Lesions:
- Lipoma - mature fatty tissue with thin fibrous capsule; generally requires no further treatment
- Ganglion cyst - benign mucoid/myxoid material; often managed conservatively or surgically if symptomatic
- Hemangioma - vascular lesion with benign vascular channels; usually no intervention needed
- Malignant Lesions:
- Soft tissue sarcoma - high-grade or low-grade malignant tumor requiring urgent staging and oncologic treatment
- Lymphoma - primary or secondary lymphoid malignancy requiring systemic therapy consideration
- Metastatic carcinoma - indicates disseminated malignancy and affects staging/treatment decisions
- Factors Affecting Interpretation:
- Specimen adequacy - insufficient sampling may yield non-diagnostic results requiring rebiopsy
- Biopsy technique - core needle biopsy generally more reliable than fine needle aspiration for 1-3 cm lesions
- Location within lesion - sampling from margin vs center may affect diagnostic yield
- Tissue fixation and processing artifacts can complicate interpretation
- Immunohistochemical staining may be needed for definitive classification of malignancies
- Associated Organs
- Primary Organ Systems Involved:
- Musculoskeletal system - soft tissues, muscle, bone involvement
- Lymphatic system - if lymphoma or lymph node involvement
- Vascular system - hemangiomas or vascular malformations
- Conditions Associated with Abnormal Results:
- Soft tissue sarcomas - liposarcoma, fibrosarcoma, leiomyosarcoma, synovial sarcoma
- Lymphoproliferative disorders - lymphoma, leukemia involvement
- Metastatic disease - secondary involvement from lung, breast, melanoma, or other primary malignancies
- Benign lesions - lipomas, ganglion cysts, fibromas, hemangiomas
- Infectious processes - tuberculosis, fungal infections, atypical infections
- Potential Complications of Abnormal Results:
- Malignancy requires aggressive treatment potentially including surgery, radiation, or chemotherapy
- Disease dissemination risk if malignancy is high-grade or aggressive variant
- Functional morbidity from wide surgical excision required for sarcomas
- Metastatic spread may necessitate systemic therapy with significant side effects
- Follow-up Tests
- If Benign Diagnosis Confirmed:
- Clinical follow-up examination at 4-6 weeks post-biopsy to assess healing
- No imaging follow-up typically needed if benign lipoma or other clearly benign entity
- If Malignancy Diagnosed:
- CT chest/abdomen/pelvis for staging and metastatic workup
- MRI shoulder for precise local staging and surgical planning
- PET-CT scan if sarcoma or lymphoma suspected
- Oncology consultation for treatment planning
- Consideration for sentinel lymph node biopsy if indicated by histology
- If Non-diagnostic/Inconclusive:
- Repeat core needle biopsy with imaging guidance (ultrasound or CT)
- Excisional biopsy if repeat core biopsy remains non-diagnostic
- Advanced imaging (MRI or CT) for lesion characterization
- Ongoing Monitoring:
- Physical examination every 3 months for first 2 years if malignancy treated
- Imaging surveillance (MRI or CT) at 3, 6, and 12 months post-treatment
- Long-term surveillance for recurrence and metastatic disease
- Fasting Required?
- No - Fasting is not required for shoulder mass biopsy
- Special Instructions:
- Wear loose, comfortable clothing that allows easy access to shoulder region
- Shower/bathe before procedure but arrive with clean, dry skin
- Continue regular medications unless specifically instructed otherwise
- Medications to Avoid:
- Hold aspirin and NSAIDs for 5-7 days prior to procedure to reduce bleeding risk
- Avoid anticoagulants (warfarin, apixaban, rivaroxaban) - coordinate with prescribing physician
- Stop clopidogrel/ticlopidine 5-7 days before procedure if possible
- Pre-procedure Preparation:
- Local anesthesia will be administered; notify provider of anesthetic allergies
- Arrange for friend or family to drive post-procedure if sedation used
- Plan to rest arm for 24 hours post-biopsy; avoid heavy lifting and strenuous activity
- Keep biopsy site clean and dry; follow wound care instructions provided
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