PMC7784099_01
MRI of the hip revealed that there were extensive marrow signal abnormalities of left pubic bone with mild expansion seen in sacrum predominantly left side seen at axial plane (above) and coronal plane (below). The findings were suggestive of primary or metastatic bone disease or other metabolic bone disorder like PDB.
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Her Xray of the hip revealed diffuse sclerotic left pelvic bone and Magnetic Resonance Imaging (MRI) of the hip revealed extensive marrow signal abnormalities at the left pelvic bone (Figure1).
CE CT of thorax revealed that there was a spiculated lung nodule in the superior segment of left lower lobe, adjacent to the left oblique fissure, measuring 2.6 x 1.8 x 2.5 cm (AP x W x CC) associated with thickening of the adjacent left oblique fissure.
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As part of workup of bony lesion in adult to rule out possibility of secondary malignancy, contrast enhanced computed tomography of thorax, abdomen and pelvis (CECT-TAP) were performed which revealed a spiculated lung nodule at the left lower lung lobe, suggestive of lung malignancy (Figure 2).
Histopathologic examination of the left iliac bone showed (A) thickening and disorganized trabecular pattern (H & E, 40x). (B) Cement lines along the coarsened and enlarged trabeculae are characteristically seen. The marrow was calcified and replacement of the marrow space by fibrous tissue was seen (H & E, 40x).
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The histopathology result of bone biopsy of the left iliac bone was later reported as Paget's disease of the bone (Figure 3).
Lung biopsy showed moderately differentiated adenocarcinoma. (A), (B) There were 2 fragments of fibrocollagenous tissue and alveolar tissue displaying infiltration by tumour cells in small cluster, glandular and single cell pattern (H & E, 10x, 20x) (C) The tumour cells exhibit moderate pleomorphism with hyperchromatic nuclei and moderate amount of eosinophilic cytoplasm (H & E, 40x) (D) Immunohistochemistry study shows the tumour cells are positive for transcription factor (TTF-1) (10x).
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A CT guided biopsy of the lung mass was done later which revealed adenocarcinoma of the lung (Figure 4).
(A)
F-FDG PET/CT revealed that there was a hypermetabolic lung mass (SUV max 7.3) measuring 2.7x2.1x3.7cm at left lower lobe of the lung corresponded to the hypodense lesion at CT scan. There was a new hypermetabolic activity in patchy areas of lucency and sclerosis of the right side of sacral bone, right ilium, bodies of L3-L5 and right lamina of L5. (B)
F-FDG PET/CT revealed that there was diffuse sclerosis of the left hemi pelvis (ilium, ischium and pubic bone) with minimal metabolic activity in keeping with PDB.
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There was also diffuse sclerosis of the left hemi pelvis (ilium, ischium and pubic bone) with minimal metabolic activity in keeping with PDB (Figure 5A and B).