Brief Answer:
Usually benign but cancer needs to be excluded.

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in detail.
A single lemon sized swelling in the gluteal region needs to be shown to a surgeon to make a probable clinical diagnosis.

In my experience, small soft to firm swellings below the skin, which are painless, most likely fit into the diagnosis of neurofibroma or lipoma which are benign.

Rarely it can be a cancer swelling like soft tissue sarcomas which is firm to hard and is adherent to underlying muscles.

A neurofibroma is an usually benign tumor containing nerve and fibrous elements which is soft to firm and painless to start with and with progressive increase in size over time, it can infiltrate a nerve and then cause pain.

A lipoma is very soft and slips under the skin and clinical examination usually confirms it.

A rare possibility is soft tissue sarcoma which usually produces no signs and symptoms in its early stages. As the tumor grows, it becomes hard and may cause a noticeable lump or swelling and pain, if it presses on nerves or muscles.

Surgeons usually make a preliminary diagnosis easily with clinical examination. If required they may ask for an imaging investigation like ultrasound scan, CT scan or MRI scan. This will show the size, extent and origin of the swelling. Any increased blood flow and whether it is lipoma (fat containing), neurofibroma or soft tissue sarcoma will also be known.

Depending on the clinical and imaging diagnosis, if there is doubt of a cancer like features, the surgeon might ask for a pathological examination like FNAC or biopsy to confirm that diagnosis and then removal of tumour if required. If there is no pain or risk of cancer then removal is not recommended.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Consult surgeon, lemon sized cancer can be cured.

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

If you are sitting for long periods and this lemon sized swelling has appeared in the gluteal cleft and has recently become tender, then there is a condition called pilonidal cyst which can be the diagnosis.

About pilonidal cysts,
1. These cysts usually occur when hair punctures the skin and then becomes embedded and the gluteal cleft is the commonest location. If a pilonidal cyst becomes infected, the resulting abscess is often extremely painful. The cyst can be drained through a small incision or removed surgically.

2. Pilonidal cysts most commonly occur in young men, and the problem has a tendency to recur. People who sit for prolonged periods of time.

However, consulting a surgeon is most important to confirm the probable diagnosis.

As mentioned earlier, even in the worst case scenario, even if it is a cancer then treatment and cure is surely possible at the present size.

Please consult the surgeon at the earliest.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
X ray done to assess calcification and bones.

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

If your doctor has examined you and concluded that it is benign then it must be one. The MRI is needed to know the exact size, extent of the mass and its plane of origin and the relation with adjacent structures. The type of benign mass can also be commented upon.

The X ray is being ordered to know if there is any calcification in the mass or associated bone destruction in the region due to the mass. This is routinely done in most patients.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Please find details below.

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

I have worked in a cancer institute for years. Hopefully it should not involve the underlying bone. If it is adherent to the muscles and soft tissues then it is completely curable even being a cancer.

In benign cases also you might have to stay for a day if the tumor has deeper attachments with the underlying muscles. If it is only limited to the skin and fat layers then an out patient procedure might be offered.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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