Greetings. I am only asking this question here because my regular
doctor is out of town for several days, and the physician covering her
caseload was not very helpful at all.

Question summary: I have an unexplained firm mass protruding from my
belly, and while I'm waiting for my medical care professionals to get
back to me with test results and referrals and such, it would really
help my peace of mind to get some independent info on what could
possibly be causing such a phenomenon.

The background info: I am a 50-year-old woman, obese, but in the midst
of a medically-supervised weight loss regimen run by my HMO. I have
lost 60 pounds since the end of January, and in the process I have
revealed a sizeable, relatively firm mass protruding from my belly,
which apparently had been previously camoflaged by fat. The mass is
fairly symmetrical, centered around and slightly above my navel; about
6 inches in diameter and protruding a couple of inches from the
surrounding flesh. It seems to be in the fat tissue itself--i.e.,
outside the wall of my abdominal muscles.

There is hardly ever any pain associated with this mass, except for a
couple of  months ago where it almost felt like I had a muscle pull in
the abdominal muscles around and under the mass. In fact, it felt for
all the world like I had strained my belly button, if such a thing is
poassible. This pain took a couple of days to resolve, but otherwise
there's been nothing.

After reporting the problem to my regular physician--who thought it
might be a hernia--I underwent an abdominal CT scan earlier this week,
and a bunch of bloodwork a couple of weeks ago. The substitute doctor
was dreadfully unhelpful in explaining what the CT scan meant (she
wasn't looking at the scan itself, just reading a text report from the
techs who performed it) and refused to speculate on what the mass
might be, except to say something rather confusing to me about
fibroids, which I thought only occurred within the uterus. The
sub-doctor did tell me that all of my bloodwork was absolutely normal,
including a blood test that can flag for possible cancer activity.

I do have referrals in process to GYN and surgery specialists for
further examination and biopsy, and my regular physician gets back
late next week, but in the meantime I would really like to get some
more helpful information on what this mass might possibly
be--especially, things it could be other than cancer, which would be
really reassuring to know.

I am aware that *unexplained* weight loss is a strong symptom of
cancer. However, I have been *deliberately* working on weight loss
through a program of my HMO, and have been losing at a relatively
normal rate of 2.5 pounds a week (on a nutritionally balanced plan),
and I've proven to myself that if I don't stick to the plan my weight
loss does stop, so I'm relatively sure I don't have to worry on that
score. Also, I have generally been feeling pretty healthy--not tired
or run-down in any way; in fact, due to the weight loss I've been able
to enjoy greater physical activity and some light exercise.

I do suffer from other health conditions, some of which might have
something to do with the unexplained mass, some of which probably have
nothing to do with it, but I'll list them anyway, just for
thoroughness' sake. These conditions include: GERD; hypertension;
gout; osteoarthritis; hemmorrhoids/anal fissure with occasional
bleeding (bright red blood). Other medical history details which may
or may not have to do with things: I have no personal history of
cancer, though my mother did die of breast cancer. I am well into
perimenopause, and have never borne children. My periods, when they
happen, tend to be heavy, with flooding and profound cramps, but as of
now I haven't been diagnosed with fibroids. I do not take (and would
like to avoid taking) hormone replacement therapy.

So--forgive the long data dump, but that's everything I can think of
right now that might be pertinent to my problem. Any help would be
vastly appreciated.

Hello Oedipamassive,

  I can understand your apprehension at the appearance of this mass.
Be aware that we can?t diagnose you online, but can only provide some
information about periumbilical masses. This list is not a
comprehensive list, as there causes numerous to numerous to liast that
?could? fit your description. This is a list of some possibilities,
ranging from the ?simply benign? to the more serious type of malady. I
certainly hope in your case that you suffer from a benign cause.



?An abdominal mass can be a sign of an abscess, a problem with a blood
vessel (such as an aneurysm), an enlarged organ (such as the liver,
spleen, or kidney), a tumor, or an accumulation of feces.?

Many of these do not fit your description, but some do.
?	Abdominal aortic aneurysm can cause a pulsating mass around the navel. 
?	Bladder distention (urinary bladder over-filled with fluid) can
cause a firm mass in the center of the lower abdomen above the pelvic
bones, and in extreme cases can extend as far up as the navel.
?	Cholecystitis can cause a very tender mass that is felt below the
liver in the right-upper quadrant (occasionally).
?	Colon cancer can cause a mass almost anywhere in the abdomen. 
?	Crohn's disease or bowel obstruction can cause multiple tender,
sausage-shaped masses anywhere in the abdomen.
?	Diverticulitis can cause a mass that is usually located in the
left-lower quadrant.
?	Gallbladder tumor can cause a moderately tender, irregularly shaped
right-upper quadrant mass.
?	Hydronephrosis (fluid-filled kidney) can cause a smooth,
spongy-feeling mass in one or both sides or toward the back (flank
area).
?	Kidney cancer can sometimes cause a mass in the abdomen. 
?	Liver cancer can cause a firm, lumpy mass in the right upper quadrant. 
?	Liver enlargement (hepatomegaly) can cause a firm, irregular mass
below the right rib cage (right costal margin), or on the left side in
the stomach area (epigastric).
?	Neuroblastoma, a malignant tumor often found in the lower abdomen,
that primarily occurs in children and infants.
?	Ovarian cyst can cause a smooth, rounded, rubbery mass above the
pelvis in the lower abdomen.
?	Pancreatic abscess can cause a mass in the upper abdomen in the epigastric area. 
?	Pancreatic pseudocyst can cause a lumpy mass in the upper abdomen in
the epigastric area.
?	Renal cell carcinoma can cause a smooth, firm, nontender mass near
the kidney (usually only affects one kidney).
?	Spleen enlargement (splenomegaly) -- the edge of an enlarged spleen
may sometimes be felt in the left-upper quadrant.
?	Stomach cancer can cause a mass in the left-upper abdomen in the
stomach area (epigastric) if the cancer is large.
?	Uterine leiomyoma (fibroids) can cause a round, lumpy mass above the
pelvis in the lower abdomen (occasionally can be felt if the fibroids
are large).
?	Volvulus can cause a mass anywhere in the abdomen. 
?	Ureteropelvic junction obstruction can cause a mass in the lower abdomen.
http://www.nlm.nih.gov/medlineplus/ency/article/003274.htm




Umbilical Hernia
================
?An umbilical hernia appears in the belly button. A periumbilical
hernia is similar to an umbilical hernia, but occurs next to the belly
button.
A person with a hernia often feels pain, pressure or burning, or a
feeling that something has given way.?
http://www.webmd.com/hw/health_guide_atoz/sth149784.asp

Periumbilical Hernia
http://www.vandenberg.af.mil/~MDG/handouts/Pg224.pdf





Hepatic Lesion
==============
?The ligamentum teres hepatis (edit: Also called falciform
ligament)connects the umbilicus to the left lobe of the liver, and
thus a hepatic lesion can spread through the ligament to the umbilicus
and the anterior abdominal wall. We present a case of hepatoma of the
left lobe which extended to the rectus abdominis muscle through the
ligamentum teres.?
http://www.springerlink.com/(vuhwt3jwrfasq02vmccixez2)/app/home/contribution.asp?referrer=parent&backto=issue,24,83;journal,88,97;linkingpublicationresults,1:100116,1

Illustrations
http://www.fotosearch.com/illustration/falciform-ligament.html



Sister Mary Joseph Nodules
==========================
?Sister Mary Joseph nodules are metastatic deposits in the
periumbilical area. The purpose of this review is to demonstrate
umbilical anatomy, discuss modes of metastatic spread, the various
imaging appearances and their relevance to the radiologist.?
http://bjr.birjournals.org/cgi/content/abstract/72/864/1230

?Sister Mary Joseph first noticed that a 'nodule' in the umbilicus was
often associated with advanced malignancy. She drew William James
Mayo?s attention to this sign and he published an article about it in
1928, referring to is as the "pants button umbilicus". In 1949 the
English surgeon Hamilton Bailey (1894-1961), in his famous textbook
"Physical Signs in Clinical Surgery", in 1949 coined the term "Sister
Joseph's nodule" for an umbilical metastasis.?
http://www.whonamedit.com/doctor.cfm/2984.html


I wish I could tell you more. Try to be patient and relaxed while you
wait for your doctor to review all your test results to get a clear
clinical picture of your problem. Congratulations on your weight loss!
I personally know how hard that is!

I wish you the best! If anything is unclear, please request an Answer
Clarification, and allow me to respond, before you rate.

Sincerely, Crabcakes

Search Terms
=============
Periumbilical mass
Abdominal mass