60-pound tumor misdiagnosed as obesity for over a decade until chance discovery

For 12 years, doctors misdiagnosed an adult male patient with obesity until they detected a 60-pound malignant tumor as the cause of his expanding waistline.^[]

“My stomach kept getting bigger. I went from doctor to doctor,” Kraut said.^[] “I lost so much weight with the change in diet and Ozempic that my face and arms were very thin. Only my stomach was huge. The doctor even said that I was malnourished.”

Diagnosing his expanding waistline

Kraut began having health problems in 2011 with his stomach expanding. He was diagnosed with type 2 diabetes and obesity the following year. A doctor detected the tumor 12 years later when preparing Kraut for the gastric sleeve operation. The doctor palpated Kraut’s stomach, finding a hard surface not indicative of fat, and sent Kraut for a CT scan, which revealed the huge tumor.

Two weeks later, doctors diagnosed Kraut with a rare fatty tumor comprising multiple smaller cancerous areas encased in fat. The cancer had metastasized to his right kidney.

The tumor type was not disclosed. However, the National Cancer Institute notes that liposarcoma is “a rare type of cancer that begins in fat cells.”^[] These tumors usually form in the subcutaneous fat or deep soft tissues of the abdomen or leg. They remain painless and grow slowly but may metastasize, as in Kraut’s case.

The pervasiveness of weight bias

This wasn’t the first time something like this has happened. Another case study, recently published in Clinical Case Reports, reported on a 100-pound tumor found in a patient who was also initially misdiagnosed with severe obesity.^[] As the case study authors noted, “obesity results in higher risk of some cancers while obesity stigma affects patients’ quality of care.”

The authors describe obesity stigma as “social devaluation and denigration due to excess body weight,” and they acknowledge that obesity stigma on the part of healthcare professionals may have contributed to the late cancer diagnosis. They also noted that bias on the part of primary care physicians means they are likely to consider patients with obesity noncompliant, resulting in spending less time with them during consultations.

Fatima Cody Stanford, MD, an obesity specialist at Massachusetts General Hospital, who was not involved in the case report, said that weight bias is a “major threat to the health of our public,” in a YouTube video from Scientific American.^[]

She suggested that obesity stigma is linked to a lack of understanding by physicians, other healthcare providers, and the general population, who think obesity is a lifestyle choice. “This is completely false. There are over 100 factors that are linked to body size,” Dr. Stanford said. “The biggest factor is genetics.”^[]

A similar case 

The patient in the Clinical Case Reports article was a 53-year-old woman who had a 19-year history of severe obesity.^[] She was referred for bariatric evaluation, which revealed abdominal obesity. She had no abdominal or pelvic pain or vaginal bleeding, and she did not report a change in bowel movements. Tests revealed an elevated Ca 19.9, but other tumor markers appeared normal. A CT scan showed a large, non-metastasized intraperitoneal abdominal mass.

For Kraut, who was misdiagnosed with obesity, doctors removed his tumor last year, but it had caused significant damage to his small intestine. His right kidney was removed due to the metastasis.^[] “I have to go to the oncologist twice a year because I still have tumor tissue inside me that is growing. I was told that it cannot be removed because it is connected to several organs,” he said.