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Computed tomography of the chest, abdomen, and pelvis.
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A repeat CT chest, abdomen, and pelvis revealed multiple lytic lesions in the left clavicle, with possible fracture, as well as in the sacrum and ilium (Fig. 1).
Immunohistochemistry of bone marrow aspirate.
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The immunohistochemistry (Fig. 2 and Table 2) was positive for synaptophysin, pancytokeratin, patchy chromogranin, CDX2, and villin, the combination of which supported the diagnosis of metastatic, high-grade, poorly differentiated neuroendocrine carcinoma (NEC) favoring a gastrointestinal pancreaticobiliary origin, invading the majority of the bone marrow.