LAUSR

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).