A Subcutaneous Tumour on the Posterior Neck: A Quiz

A 51-year-old healthy Japanese man presented with a 1-year history of a subcutaneous asymptomatic tumour, 6×5 cm in size and gradually increasing, on the posterior neck.The patient had undergone cupping therapy on the shoulder and neck for alleviating stiffness once a week for 20 years.On physical examination an elastic, hard, immobile mass with no tenderness or redness was palpable on the posterior neck (Fig. 1A) and a rounded purpura was observed on the shoulder, possibly caused by the cupping therapy.Laboratory test results including blood count, biochemistry and coagulation were within normal limits.Magnetic resonance imaging (MRI) showed a well-circumscribed, rounded solid mass, with homogeneous intermediate signal intensity (isointense to muscle) on T1-weighted images (T1-WI) (Fig. 1B) and inhomogeneous mild high signal intensity involving sporadic scattered low signal intensity areas inside on T2weighted images (T2-WI) (Fig. 1C) and short T1 inversion recovery (STIR) (Fig. 1D).

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