Abstract

Rajasekharan C.* and Akhil Krishna

ABSTRACT

A 55 year old female was referred to the outpatient services for severe tiredness, loss of weight, bone pains, headache and low grade fever of 2 months duration with provisional diagnosis of multiple myeloma. Upon examination she was, pale, febrile with tenderness on multiple ribs. There was no axillary or other lympadenopathy. Examinations of systems were unremarkable. Thyroid and were breast were normal. Xray skull AP and lateral views revealed multiple, round, and purely lytic diffuse osteolytic "punchedout”lesions affecting theskull”raindropskull"(figure.1.Panel.A,B)[1]and the x-ray chest was showing the ribs multiple osteolytic lesions in the ribs.Liver function tests showed mild elevation of enzymes and alkaline phospatase was 176u/litre and mildly deranged renal function tests. Urine bencejones proteins were negetive and serum electrophoresis normal. Ultrasound scan abdomen, Computerised scan abdomen, chest, Oesophago gastroduodenoscopy, mammography were normal. Bone marrow revealed adenocarcinoma (figure.2.Panel.A).Magnetic Resonance Imaging (MRI) guided stereotaxic large core needle biopsy from a doubtful site on left breast showed infiltrating ductal carcinoma (figure.2.Panel.B).