Right Groin Mass and Joint Pain: Possible Causes and Next Steps

Right groin mass + bilateral shoulder/knee/hip joint pain?

Hello, doctor.
I am a 59-year-old female housewife.
From 2018 to 2019, I occasionally experienced dull pain in my right lower abdomen at night (at most once a month), which resolved after urination.
Around October 2019, I began to experience pain in both knees, a tight sensation in both shoulders, and pain in both hip joints, particularly worsening when standing up after sitting for a long time.
In May of this year, I was diagnosed with multiple osteoarthritis and cervical disc herniation at the C4-C5 level (the doctor mentioned tendonitis, possibly due to household chores, and recommended heat therapy for my neck and cervical traction).
X-rays confirmed that both shoulders, knees, and hip joints were normal, with no cartilage damage.

I experienced abdominal pain three times on March 31, April 25, and June 17, all occurring after breakfast, starting with bloating that gradually turned into dull pain, which resolved by noon.
During the abdominal pain on June 17 (with no diarrhea and one episode of vomiting), I discovered a mass near the right lower abdomen close to the groin, which is elongated and confirmed to be internal.
Pressing on it during abdominal pain causes discomfort, but it is not painful otherwise.
It does not feel hard like a stone, and I perceive it as more swollen than the left side.
The mass does not move, and I usually do not feel it.
I notice more pain in the right hip joint compared to the left when walking.
Urination is normal, and blood tests are normal, with Free T4 at 1.24 and TSH at 1.586.
Recently, I weighed myself and found that I have lost 2.5 kg compared to last year, now weighing 47.5 kg (I forgot to record the weight loss over the past few months).
Additionally, abdominal and vaginal ultrasounds and a Pap smear revealed a 1.3 cm uterine fibroid.

Could this possibly be a lymphatic issue? Is there a chance it could be a malignant tumor? Which specialty should I consult? Thank you! Currently, I am taking: Celebrex 200 mg, Dorsiflex 200 mg, and Methycobal (Mecobalamin 250 µg).

Lan, 50~59 year old female. Ask Date: 2020/07/12

Dr. Chen Sirong reply Oncology

Lan / 59 years old / Female
Regarding the issue of a mass in the right lower groin:
1.
You have already undergone abdominal and pelvic ultrasound, so you have seen a doctor.
2.
You should have had the doctor you consulted examine it! What did the doctor say? If there are any issues, the doctor should continue to monitor or follow up.
If there are no problems, self-observation is sufficient.
3.
I also encounter a few patients who do not believe the doctor when they say there is no problem, and they end up paying out of pocket for a CT scan, which also shows no issues! Some asymmetry is normal and can occur.
If the mass continues to grow, you should definitely return to the doctor for further examination.
If you are still concerned, you may consider getting a CT scan at your own expense.
4.
If you wish to see another doctor, general surgery or obstetrics and gynecology are both options.
Wishing you peace and joy,
Taoyuan Hospital
Chen Si-Rong

Reply Date: 2020/07/12

More Info

Based on your description, it seems that you are experiencing a combination of joint pain, particularly in the hips, knees, and shoulders, along with a concerning mass in the right groin area. Given your medical history and the recent findings from your ultrasound and other tests, let's break down the potential causes and next steps.

Possible Causes
1. Osteoarthritis: You mentioned a diagnosis of multiple osteoarthritis, which can cause joint pain and stiffness, especially after prolonged periods of inactivity (like sitting). This condition is common in older adults and can lead to inflammation and pain in the affected joints.

2. Groin Mass: The mass you described near your right groin could be several things. Given that it is not hard and does not move, it might be a benign condition such as a lipoma (a fatty tumor) or a lymph node enlargement. However, the fact that it is painful when pressed could indicate inflammation or infection.

3. Lymphatic Issues: You raised a question about whether this could be related to lymphatic issues. Lymphadenopathy (swollen lymph nodes) can occur due to infections, inflammatory conditions, or malignancies. Given your symptoms and the location of the mass, it is worth considering this possibility.

4. Malignancy: While the likelihood of a malignant tumor cannot be completely ruled out, especially given your age and the presence of a mass, the characteristics you described (soft, non-mobile) are more suggestive of a benign process. However, further evaluation is necessary to rule out any serious conditions.

5. Referred Pain: The pain in your right hip could be referred pain from the groin mass or from your existing osteoarthritis. Sometimes, pain in one area can manifest in another due to nerve pathways.

Next Steps
1. Consultation with a Specialist: Given the complexity of your symptoms, it would be prudent to consult with a specialist. An orthopedic surgeon could evaluate your joint issues, while a general surgeon or gastroenterologist might be more appropriate for the groin mass. If there are concerns about lymphatic issues, a hematologist or oncologist may also be involved.

2. Imaging Studies: While you have already undergone ultrasound, further imaging such as a CT scan or MRI of the abdomen and pelvis could provide more detailed information about the mass and its relationship to surrounding structures.

3. Biopsy: If the mass remains concerning after imaging, a biopsy may be necessary to determine its nature definitively. This is particularly important if there is any suspicion of malignancy.

4. Monitoring Symptoms: Keep track of any changes in your symptoms, such as increased pain, changes in the mass, or new symptoms like weight loss or changes in appetite. These could provide important clues to your healthcare provider.

5. Medication Review: Continue taking your prescribed medications (Celebrex, Dorsiflex, and Methylcobalamin) as directed. Discuss with your doctor if you feel they are adequately managing your pain or if adjustments are needed.

Conclusion
Your symptoms warrant a thorough evaluation to determine the cause of the groin mass and the joint pain. While there are several potential explanations, including benign conditions, it is essential to rule out any serious issues. Consulting with the appropriate specialists and possibly undergoing further imaging or a biopsy will help clarify the situation. Please ensure you communicate all your symptoms and concerns during your next medical appointment to facilitate a comprehensive assessment.

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