<s>[INST] I have a hard lump deep in my back. It s located about 2 inches below my posterior rib cage and 4 inches to the left of my spine. It is very tender. It feels hard to me and is not moving. I keep reading it s likely a lipoma but this seems to present differently. I ve seen lipomas before and this is different. The lump is at least an inch in length. I am only 38 years old. The lump has been there for at least 6 months but hasn t been bothersome until now. I appreciate any input. I m nervous it s something bad. Thank you. Gina [/INST] Hi Gina ! Good evening. I am Chat Doctor answering your query. It seems to be a tense cyst feeling hard with secondary infection giving rise to the painful sensation. Even though the swelling did not bother you so long, I would advise you to get it operated (excision biopsy) and send it for histopathology test. If I were your doctor, I would first prescribe you with a broad spectrum antibiotic, an anti-inflammatory Chat Doctor.  I hope this information would help you in discussing with your family physician/treating doctor in further management of your problem. Please do not hesitate to ask in case of any further doubts. Thanks for choosing Chat Doctor to clear doubts on your health problems. I wish you an early recovery. Chat Doctor. </s>