PMC7468612_01
Lumbar CT, left sagittal (a) and coronal (b) planes. A destructive lesion causing pathological fracture of the L4 vertebral body with mild adjacent soft tissue thickening. No abnormal soft tissue in the spinal canal was identified.
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Given his lower back pain and CRAB features, a spine X-ray as well as a lumbar CT were done, which showed lytic lesions in the L4 vertebral body (Figure 1).
CT neck, transverse plane. A 2.8 x 2.6 cm complex nodule in the left lobe of the thyroid. On further examination by way of a thyroid ultrasound, the lesion was further characterized and described as an echo poor mass showing lobulated margins and coarse internal calcification, highly suspicious for malignancy.
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A pan CT showed a 2.8 cm x 2.6 cm complex left lobe thyroid nodule concerning for malignancy (Figure 2).
Bone marrow trephine biopsy, H&E x 10. Bony trabecular remodelling and paratrabecular fibrosis are present. The bone marrow biopsy is otherwise normocellular and shows trilinear hematopoiesis.
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His normocellular bone marrow biopsy showed marked paratrabecular fibrosis (Figure 3).
Enlarging Howship lacunae populated by osteoclasts. These enlarge and transect the bone marrow trabeculae forming swaths of intertrabecular fibrosis (lower row, right panel).
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This stemmed from enlarging Howship lacunae, which effectively bisected the trabeculae (Figure 4).
CD 138 and kappa and lambda stains show presence of polytypic plasma cells.
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In addition, CD138, kappa and lambda stains showed polytypic plasma cells (Figure 5).