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Posterior Fossa Tumor Excision Tips

10 Signs You Might Be Suffering From Brain Tumor!

Dr. Satyajit Das 89% (79 ratings)
DNB NEUROSURGERY, M.B.B.S.
Neurosurgeon, Durgapur
10 Signs You Might Be Suffering From Brain Tumor!

A tumor is formed due to the uncontrolled proliferation of living cells. Generally, the cells in the human body continuously die and are replaced by new cells. Some cells are replaced frequently, like intestinal lining and skin, while some like nerve cells live longer and may not be replaced once they die. Natural cell death is mediated by genetic information and the body’s bio-chemical signals. In the case of a tumor, some cells develop genetic mutations, and stop responding to the ‘cell-death’ signals. They do not die and continue to grow to form a mass, stealing nutrients and oxygen from surrounding tissue. Brain tumor can arise from any of the many types of cells in the brain or its covering. These can be benign (less harmful), or malignant (rapidly growing). These tumours cause harm by following methods: 

  1. A rapidly growing tumor mass can press on normal brain tissue and damage them in the enclosed space of skull. 
  2. Stealing food and oxygen from surrounding normal tissue thereby harming them. 
  3. Increase the brain pressure and reducing its blood supply. 
  4. Secrete harmful substances causing cerebral oedema. 
  5. Some tumours like certain Pituitary tumours can secrete hormones abnormally and cause hormonal imbalance

Symptoms of Brain Tumour: 

  1. Headache: New onset regular headaches, without any history of having such frequent headaches in past, which becomes worse because of other pressure related activities, such as sneezing, coughing, exercising might be a possible symptom of brain tumour and issues related to such sudden and frequent headaches should be taken up with the doctor without any further delay. If headache is associated with nausea or drowsiness, it is to be taken seriously. 
  2. Seizures: Seizures or convulsions (fits) are amongst the most common symptoms of brain tumour, which might be limited to a particular body part or the whole body. It may manifest as frank convulsive movements of the limbs, twitching of one side of face, or may cause subtle and transient behavioral changes. New onset seizures in young people must be evaluated to rule out brain tumours. 
  3. Numbness in arms/legs: Numbness in parts of the body may be caused by a tumour affecting the sensory tracts. 
  4. Balancing problems: Poor coordination and balancing problems may arise as a prominent symptom for brain tumour affecting the hindbrain. 
  5. Memory problems: Lack of concentration and memory loss may be the only symptoms for the presence of tumour in the frontal or temporal lobes. 
  6. Nausea or vomiting: Nausea or vomiting might be the symptoms of many other possible health issues, but a headache associated with nausea and/or vomiting is a characteristic symptom of raised brain pressure. Such symptoms should be evaluated to rule out a brain tumor and should not be ignored. 
  7. Facial paralysis: weakness of one half of face, like deviation of mouth, drooling of saliva from one corner of mouth, inability to close eyelids etc. may be due to facial paresis caused by a brain tumor in the opercular area or in the CP angle. Such symptoms need to be investigated for a tumor. 
  8. Change in vision: A person suffering from brain tumor might also experience changes in the vision, dizziness, blurry vision, among other sight related issues. 
  9. Change in speech: Sudden inability to speak or understand speech may be due to tumors of the dominant hemisphere of the brain.
  10.  Hearing problems: hearing problems and other hearing related disorders might have the brain tumor of posterior fossa or temporal lobe as a possible reason. 

Diagnosing a brain tumour may include one or more of many tests, including CT scan, Magnetic Resonance Imaging (MRI), PET scan and biopsy. One should never ignore the symptoms discussed above and should visit a doctor, preferably a Neurosurgeon as early as possible. Brain tumors are easier to treat if diagnosed early. Certain small tumors can be treated with radiation alone. If surgery is required, smaller tumors diagnosed early have greater chance of cure. If you wish to discuss about any specific problem, you can consult a Neurosurgeon.

3121 people found this helpful

Tumors And Cancer

Dr. Swarup Kumar Ghosh 89% (82 ratings)
MD - Bio-Chemistry, MF Homeo (London), DHMS (Diploma in Homeopathic Medicine and Surgery), BHMS
Homeopath, Kolkata
Tumors And Cancer

Tumors vary in their composition, but they all arise primarily, from deficiency in kali mur, which cause an excess of fibrin in the system. Occsionally this fibrin collects in masses, a tumor results. Sometimes these tumors contain only fibrin, their cure is very diffcult, as there are no blood vessels in them, consequenty no method of introducing kali mur (bio), into them to unite with the fibrin. In other case they are filled with fat, still others with water and other liquids. In all case, however, kali mur. Is the chief remedy, with such other cell- salts as suppuration, other complications may call for. The cause of cancer has so far not been discovered, but all present evidence point to the fact that the cancer cannot begin to grow until the vitality of the tissues surrounding in is lowered. It is therefore evident that the logical method of preventing cancer is to maintain the normal vitality of the tissues by watching for any symptoms of lacking cell - salts, replacing them as soon as possible. This same rule also holds goods after a cancer has become established the administration of whatever cell - salts the symptoms show to be lacking should be continued even where surgical, electrical, or other forms.

Bio treatment
Kali sulp, calc fluor, kali phos, natr. Mur, ferrum phos, calc phos, silicea, natr phosh.
 

1 person found this helpful

Treatment Of Lipoma (Fatty Tumor)!

Dr. Hiral Kumar Rakholiya 88% (1658 ratings)
BHMS
Homeopath, Ahmedabad

When anybody develops lipoma ----they usually consult a surgeon. Homeopathy is usually not thought as an option for lipomas as it is considered as a pure surgical disorder.

But do you know homeopathy can be effective for treatment of lipoma:

  • Homeopathic remedies can prevent formation of new lipoma formation.

  • Growth of existing lipomas can be arrested

  • The size of the existing lipomas can also be reduced (the lipoma is softened and flattened, so that it becomes less noticeable).

  • In relieving the pain and discomfort associated with a lipoma

The results with homeopathic treatment are better if treatment is started earlier - just after the diagnosis. The newly diagnosed lipoma treated with homeopathy in initial stages, can disappear completely. Treatment with homeopathic remedies is slow and continuous process.

According to homeopathy any illness is caused due to disharmony within your body. And the symptoms are just an expression of this disturbance. Hence the imbalance needs to be treated rather than the symptoms of the disease. Hence homeopathy, considers removal of lipoma by surgery as removal of the expression of the disease and not treatment of the cause or disease itself.  Hence recurrence of the lipoma can occur.

Homeopathy treatment aims to cure the cause of lipoma in you and not just treat the existing lipomas by improving the immune system. About 22 homoeopathic remedies are effective for treatment of lipomas. No one single homeopathic remedy is effective for everyone with lipoma. Correct choice of remedy is important to provide lasting relief. Understanding and correct judgment therefore becomes important on the part of the homeopathic doctor. The homeopathic doctor after taking a detailed history and examining you will prescribe any medication.

Some of the homeopathic remedies which are effective for treatment of lipoma include Calc ars, Calc carb, Calc flour, Lapis alb, Radium brom, Silicea, Spigelia and Thuja.

Homeopathic remedies are prescribed primarily with the intention to:

  • prevent formation of new lipoma.

  • Arrest the growth of existing lipomas

  • Reduce the size of the existing lipomas (the lipoma is softened and flattened, so that it becomes less noticeable).

  • Relieve the pain and discomfort associated with a lipoma

Surgery may be considered if homeopathic remedies are not effective in relieving the pain or discomfort associated with the lipoma or for cosmetic reasons. However, lipomas have a tendency to recur after excision.

Advantages of homeopathy for treatment of lipoma It is completely non-invasive

  • Homeopathic remedies are safe for all age groups

  • It is almost free of any side effects.

  • These remedies can be used even after surgical excision of a lesion

 

1 person found this helpful

Tumor - Which Type Of Biopsy Will Help?

Dr. Preetham Raj 91% (10 ratings)
MBBS, MS - General Surgery
General Surgeon, Bangalore
Tumor - Which Type Of Biopsy Will Help?

A tumor may be defined as an abnormal unwanted growth of tissue in any part of the body. This word need not immediately cause panic because the tumor may or may not cause a health threat. There are three types of tumors:

  1. Benign tumor: This is a noncancerous type of tumor. In our body, new cells are formed while the old ones called dead ones are disposed by our immune system. When this disposal of cells does not occur, the remaining dead cells form a lump, which is called a benign tumor. They are not dangerous since, they do not contain harmful fluids and do not spread. A person suffering from a benign tumor in the brain may have frequent headaches.
  2. Pre-malignant tumor: It is an initial disorder, or an earlier symptom of cancer manifestation. The inclination of this medical condition is that it will progressively become precarious. This is so because it is capable of conquering neighboring tissues and spreading as well. Leukoplakia is a form of premalignant cancer. They evolve as thick white patches inside the cheeks or on gums below the tongue. These patches are very difficult to be scraped off from the mouth. They are caused mainly due to chewing tobacco and smoking, and ff left untreated can expand.
  3. Malignant tumor: These are the cancerous tumors, in which cells multiply abnormally and rapidly. They are unstable and travel along bloodstream, circulatory system and lymphatic system to other parts of the body. Sarcomas and carcinomas are the most common types of malignant tumors. While the former is related to connective tissues the latter is related to organs and glands.

The most common procedure to name the type of cancer is to refer to their site of origin. Adenocarcinoma, refers to cancer in the adenoid glands. Similarly, a benign tumor of fatty tissue is called lipoma, where as a malignant tumor in the same area is referred to as liposarcoma.

What is a biopsy? How does it relate to a tumor?
A Biopsy is a medical procedure practised by qualified medical practitioners. This procedure helps in identifying the type of tumor within a patient. It aids the doctor to conclude the type of treatment to be given to any patient. This procedure is a definite diagnosis to the identification of cancer. A Biopsy is the removal of a sample of the abnormal, unwanted tissue for laboratory examination. Biopsies are of different types, and they may be performed using ultrasound, CT scan or MRI depending on where the tumor is.

  1. Excisional biopsy: In this method the entire lump of excess tissue is removed.
  2. Incisional biopsy: Here a sample of the abnormal tissue is removed surgically.
  3. Needle aspiration biopsy: Here the sample is extracted with the help of a needle.

After extraction, the tissue layers are sent to pathological departments to check their composition, and cause of disease.

In case you have a concern or query you can always consult an expert & get answers to your questions!

3645 people found this helpful

Fibroid Tumours- How Can it Be Treated?

Motherhood 88% (259 ratings)
Speciality Birthing Care
Gynaecologist, Bangalore
Fibroid Tumours- How Can it Be Treated?

Fibroid tumour is the abnormal cell growth in the uterus and they are mostly benign. Fibroids usually affect women in the age bracket of 30 - 40. Fibroid tumours are of three types, depending on their location:

  1. Submucosal fibroids: The tumour develops under the lining of the uterus
  2. Intramural fibroids: The growth is found amongst the muscles in the wall of the uterus
  3. Subserosal fibroids: The growth develops on the wall of the uterus right in the pelvic cavity111939

Causes behind it
The exact cause of fibroids in not known clearly. But certain factors have been discovered that might influence their formation. These factors include:

  1. Hormones: Progesterone and estrogen are the hormones responsible for recreating the uterine lining during every menstrual cycle. These hormones might trigger the formation of tumour.
  2. Family history: If any member in your family; your mother, grandmother or sister has/had fibroids in their uterus, you may also develop it.
  3. Pregnancy: Your body produces excessive progesterone and estrogen when you are pregnant, which may cause an increase in the size of a pre-existing small fibroid. Myomectomy can be done by giving incision on the abdomen or by laparoscopy depending on the size and location of the fibroids.

Signs You are suffering from it

  1. Heavy bleeding along with blood clots during or between your periods
  2. Lower back or pelvic pain
  3. Elevated menstrual cramping
  4. Frequent urination
  5. Pain during sex
  6. Longer than normal periods
  7. Bloating or pressure in lower abdomen
  8. Enlargement or swelling of the abdomen

How it can be treated?
Your doctor will formulate the right treatment depending on your age, the mass of the fibroids and your overall health. Your doctor may choose a combination of treatment to cure your fibroids, and they include:

  1. Medication: Gonadotropin releasing hormones (GnRH) agonists, birth control pills and ibuprofen (anti-inflammatory medicine) are prescribed. GnRH agonists reduce the level of progesterone and estrogen in your uterus.
  2. SurgeryMyomectomy and hysterectomy are two common surgical procedures to treat fibroids. Myomectomy is performed by removing the fibroids only by making an incision on the abdomen. But hysterectomy completely removes the uterus. The latter is reserved for serious cases.
  3. Non-invasive surgery: Forced ultrasound surgery, myolysis (shrinking fibroids with laser or electric current), cryomyolysis (fibroids are frozen) and endometrial ablation (an instrument uses heat, hot water, microwaves or electric current to destroy fibroids) are some non-invasive surgical procedures.

In case you have a concern or query you can always consult an expert & get answers to your questions!

4342 people found this helpful

Tumor Biopsy - Things You Should Know About It

Dr. Kanwaljit Chahl 88% (349 ratings)
Membership of the Royal College of Surgeons (MRCS), MS - General Surgery, MBBS
General Surgeon, Mohali
Tumor Biopsy - Things You Should Know About It

A tumor may be defined as an abnormal unwanted growth of tissue in any part of the body. This word need not immediately cause panic because the tumor may or may not cause a health threat. There are three types of tumors:

  1. Benign tumor: This is a noncancerous type of tumor. In our body, new cells are formed while the old ones called dead ones are disposed by our immune system. When this disposal of cells does not occur, the remaining dead cells form a lump, which is called a benign tumor. They are not dangerous since, they do not contain harmful fluids and do not spread. A person suffering from a benign tumor in the brain may have frequent headaches.
  2. Pre-malignant tumor: It is an initial disorder, or an earlier symptom of cancer manifestation. The inclination of this medical condition is that it will progressively become precarious. This is so because it is capable of conquering neighboring tissues and spreading as well. Leukoplakia is a form of premalignant cancer. They evolve as thick white patches inside the cheeks or on gums below the tongue. These patches are very difficult to be scraped off from the mouth. They are caused mainly due to chewing tobacco and smoking, and if left untreated can expand.
  3. Malignant tumor: These are the cancerous tumors, in which cells multiply abnormally and rapidly. They are unstable and travel along bloodstream, circulatory system and lymphatic system to other parts of the body. Sarcomas and carcinomas are the most common types of malignant tumors. While the former is related to connective tissues the latter is related to organs and glands.

The most common procedure to name the type of cancer is to refer to their site of origin. Adenocarcinoma, refers to cancer in the adenoid glands. Similarly, a benign tumor of fatty tissue is called lipoma, where as a malignant tumor in the same area is referred to as liposarcoma.

What is a biopsy? How does it relate to a tumor?
A Biopsy is a medical procedure practised by qualified medical practitioners. This procedure helps in identifying the type of tumor within a patient. It aids the doctor to conclude the type of treatment to be given to any patient. This procedure is a definite diagnosis to the identification of cancer. A Biopsy is the removal of a sample of the abnormal, unwanted tissue for laboratory examination. Biopsies are of different types, and they may be performed using ultrasound, CT scan or MRI depending on where the tumor is.

  1. Excisional biopsy: In this method the entire lump of excess tissue is removed.
  2. Incisional biopsy: Here a sample of the abnormal tissue is removed surgically.
  3. Needle aspiration biopsy: Here the sample is extracted with the help of a needle.

After extraction, the tissue layers are sent to pathological departments to check their composition, and cause of disease.

3061 people found this helpful

Klatskin Tumour - Understanding It In Detail!

MD, MBBS
Oncologist, Ernakulam
Klatskin Tumour - Understanding It In Detail!

A fifty-four years old Marwari patient from Assam presented with progressive jaundice and intermittent episodes of abdominal pain for three months. CT scan of abdomen showed a small (1.5 x 1.5 cm) mass in the bifurcation of common bile duct which is causing biliary tract obstruction and hence jaundice. Portal nodes were not enlarged and there was no lesion in the liver parenchyma. At presentation, serum bilirubin level was high (14.7 mg/dl). Endoscopic biopsy and brushing cytology was adenocarcinoma and clinic-radiological diagnosis was ‘Klatskin tumour’. 

  • Metallic stenting was done to relieve jaundice and after stenting serum bilirubin level came down rapidly. PET scan showed increased uptake in the biliary duct region mass without any sign of metastasis. He was evaluated and planned for treatment with robotic radiosurgery. He was treated using robotic radiosurgery (CyberKnife) with high precision radiotherapy technique after fiducial placement (gold seeds) near the tumour. After one year, the patient had no obvious complain, liver function (no jaundice) was normal and CT scan evaluation showed completed resolution of the mass.  
  • Klatskin tumour is an uncommon tumour that arises from the bifurcation of common bile duct in the abdomen (duct that drains bile from liver). Patients usually present with progressive (increasing) persistent jaundice followed by pain in the upper abdomen. Surgical excision is the mainstay of treatment. However, surgery is not possible in majority of the patients owing to the location of the tumour, high jaundice and medical condition. Chemotherapy may not be an optimal option in majority of the patients as they present with high jaundice. Majority of such patients with poor medical condition are treated with only supportive care and prognosis is dismal (survival for a few months only).
  • Patients with metallic stent have relief from jaundice but unfortunately in a few weeks time, the stent gets blocked with tumour growth. Patients again present with high jaundice and have severely impaired quality of life. They complain of severe itching of entire body, loss of appetite and succumb due to impaired liver function from high jaundice/obstruction. The treatment is to have a longer ‘jaundice-free period’ which in turn improves quality of life and possibly survival function as well.  
  • Stereotactic body radiation therapy’s high dose radiation ‘sterilizes’ the metallic stent and bile duct region. It is assumed that with radiation therapy, blockage of bile duct and stent is delayed and patients have longer jaundice-free period.In Klatskin tumour, CyberKnife allows to deliver high dose of radiation in a short duration to the target without significant morbidity. If you wish to discuss about any specific problem, you can consult an Oncologist.
3107 people found this helpful

Brain Tumor Surgery

Dr. Manish Vaish 86% (77 ratings)
IFAANS, DNB (Neurosurgery), MBBS
Neurosurgeon, Ghaziabad
Brain Tumor Surgery

Although surgery is considered to be the first step of treatment in any form of tumor, but its feasibility depends upon the type, size and location of the tumor. It is not necessary that every kind of brain tumor might require surgery.

Indications of Brain Tumor Surgery

  • Diagnosis of the type of tumor by taking a sample of the tumor for laboratory examination
  • Complete resection of tumor
  • Removal of the tumor as much as possible to slow down its growth and improve the symptoms
  • Remove the tumor in order to help other treatment
  • Provide direct access for other forms of treatment like chemotherapy, radiotherapy etc.
  • To relieve pressure caused by tumor on surrounding structures

Types of Brain Tumor Surgery: The different types of surgery that are performed in cases of brain tumor include the following:

Craniotomy: Craniotomy is the most commonly performed procedure to remove brain tumor along with a piece of bone. The removed bone is replaced and the tumor is sent for histopathology (biopsy). The surgery is performed using a high end microscope by any of the following techniques:

  • Extended bifrontal craniotomy
  • "Eyebrow" craniotomy (supraorbital craniotomy)
  • "Keyhole" craniotomy (retro-sigmoid craniotomy)
  • Orbitozygomatic craniotomy
  • Translabyrinthine craniotomy

Shunt: A narrow piece of flexible tube with a pressure regulated valve in between is called a shunt. This is used to relieve the intracranial pressure caused by obstruction of the natural brain fluid, Cerebrospinal fluid (CSF) pathway by tumor mass. The procedure involves insertion of a drainage system into the brain to remove or drain excess of blocked fluid into the peritoneal cavity.

Stereotactic surgery: This surgery is done by creating a three dimensional image called stereotaxy using computers. It aims to find out the location and position of the tumor. In fact it can also be done to aid tumor removal, implant radiation pellets or for other treatments.

Embolization: It is a procedure used to reduce the amount of blood supply to a tumor by blocking the blood flow in the selected arteries. It is generally performed before the main surgery.

Endoscopy and endoscope assisted surgery: Endoscope is a tool, which helps to closely visualize the tissue through small openings in difficult to reach areas. This tool can be used in various brain surgeries to precisely reach the target location without damaging the adjacent structures.

Adjuvant modalities to improve outcome: In addition to above mentioned surgeries, following surgeries may also be performed in relation to brain tumor treatment:

  • Laser surgery
  • Photodynamic laser surgery
  • Ultrasonic aspiration
  • Fluorescence guided surgery (FGS)
  • Electrophysiological monitoring
4265 people found this helpful

Can You Treat Fat-Swelling Tumours Or Lipoma With Homeopathy?

Dr. Sanket Gupta 90% (85 ratings)
BHMS, MD-Homeopathy, PGPC - Preventive Cardiology
Homeopath, Delhi
Can You Treat Fat-Swelling Tumours Or Lipoma With Homeopathy?

Lipoma can be clearly understood as that fat tumour – like protrusion on your hands, which disappears when we put a finger on it. This is a very benign tumour that occurs in the body. It is caused due to the accumulation of fat cells. In most cases, these tumours are painless, although, these might be pain causing too.

Furthermore, the most common parts of the body where this growth develops are the hands, shoulders, neck and upper limbs. Lipoma can be treated with the help of homeopathic medicines. In case you find a lipoma growth anywhere in your body, the best option is to seek professional help. Some of the common homeopathic treatments that can cure lipoma are:

  1. Calcarea Carb: This is the best medicine to treat lipoma in those who are overweight. A few symptoms and tests need to be performed on the patient before administering this medicine. The three parameters which are assessed before prescribing this medicine are excessive sweating through the head, sensitivity to cold air and special eating habits like craving for a particular kind of food. Apart from these three parameters, which are the main ones to be checked, it is also seen if the patient suffers from constipation and acidity. If these symptoms match with that of the patient, then Calcarea Carb is prescribed for treating lipomas.

  2. Sulphur: The next in line to treat lipoma would be sulphur. In fact, sulphur and Calcarea Carb are mostly at par with each other. However, it remains to be seen which medicine suits who depending on the constitutional make of the person. Those patients with high intake of sweets in their diet, excessive sweating, sensitivity towards heat and dislike towards bathing are the best candidates for administering Sulphur for treating lipoma.

  3. Belladonna: Though lipoma is usually painless, at times it can be painful too. In such situations, the pain is aggravated on touching the lump. Belladonna not only helps in subsiding the pain but also in dissolving the lump fully.

  4. Thuja: This helps in dissolving any fatty lumps developing anywhere in the body. In case the patient suffers from high cholesterol, then this is the best medicine to be administered.

Lipoma is a very common condition, which develops in people due to the formation of a fatty lump. It is a condition which needs to be treated immediately, but with effective treatments, it can completely disappear.

5109 people found this helpful

How Homeopathy Can Help Treat Fat Swelling Tumour?

Dr. Shruti Modak 87% (10 ratings)
BHMS
Homeopath, Bangalore
How Homeopathy Can Help Treat Fat Swelling Tumour?

Lipoma can be clearly understood as that fat tumour – like protrusion on your hands, which disappears when we put a finger on it. This is a very benign tumour that occurs in the body. It is caused due to the accumulation of fat cells. In most cases, these tumours are painless, although, these might be pain causing too.

Furthermore, the most common parts of the body where this growth develops are the hands, shoulders, neck and upper limbs. Lipoma can be treated with the help of homeopathic medicines. In case you find a lipoma growth anywhere in your body, the best option is to seek professional help. Some of the common homeopathic treatments that can cure lipoma are:

 

 

  1. Calcarea Carb: This is the best medicine to treat lipoma in those who are overweight. A few symptoms and tests need to be performed on the patient before administering this medicine. The three parameters which are assessed before prescribing this medicine are excessive sweating through the head, sensitivity to cold air and special eating habits like craving for a particular kind of food. Apart from these three parameters, which are the main ones to be checked, it is also seen if the patient suffers from constipation and acidity. If these symptoms match with that of the patient, then Calcarea Carb is prescribed for treating lipomas.

  2. Sulphur: The next in line to treat lipoma would be sulphur. In fact, sulphur and Calcarea Carb are mostly at par with each other. However, it remains to be seen which medicine suits who depending on the constitutional make of the person. Those patients with high intake of sweets in their diet, excessive sweating, sensitivity towards heat and dislike towards bathing are the best candidates for administering Sulphur for treating lipoma.

  3. Belladonna: Though lipoma is usually painless, at times it can be painful too. In such situations, the pain is aggravated on touching the lump. Belladonna not only helps in subsiding the pain but also in dissolving the lump fully.

  4. Thuja: This helps in dissolving any fatty lumps developing anywhere in the body. In case the patient suffers from high cholesterol, then this is the best medicine to be administered.

Lipoma is a very common condition, which develops in people due to the formation of a fatty lump. It is a condition which needs to be treated immediately, but with effective treatments, it can completely disappear.

4908 people found this helpful
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