Carcinoma of unknown primary radiologically presenting as myeloma
Author(s): Cheena Garg, Shiwani Gupta and Ashish Bansal
Abstract: An elderly male patient presented with complains of bone pain with lower backache and on initial investigation was found to be mildly anaemic with raised erythrocyte sedimentation rate, C reactive protein, mild hypercalcemia and mildly raised serum creatinine levels. On imaging studies multiple bony lytic lesions were seen predominantly in axial skeleton. A provisional diagnosis of multiple myeloma was made and he was further investigated for M proteins and bone marrow abnormalities. Serum and Urine examination were negative for paraproteins but bone marrow showed clusters of atypical epithelial cells pointing towards metastatic carcinoma, primary site/origin of which remain unknown despite using immunohistochemical markers along with PET (Positron Emission Tomography) scan favoring a diagnosis of Carcinoma of Unknown Primary (CUP). This report suggest that Carcinoma of unknown primary must be considered as a differential diagnosis in elderly patient with multiple skeletal lesions and equivocal findings of hypercalcemia, abnormal renal function, anaemia and bone lesions and avoid the diagnostic pitfall of labeling these patients as of Multiple Myeloma.
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