Bone lesions simulating multiple myeloma: unusual presentation of esophageal cancer

A Trail to Diagnosis—Finding the Primary Lesions of Bone Metastasis

This case reports an interesting case of hip pain. A 70-year-old male came to the hospital with lethargy and right hip pain. X-ray of the right hip was concerning for impending pathological fracture of right femur. Blood work was significant for hypercalcemia. He was managed with fluids, bisphosphates, and right hip arthroplasty. A bone biopsy was taken. His initial workup included an X-ray skeletal survey and computer tomography (CT) of the chest and abdomen to diagnose etiology of the right hip lesion. An X-ray skeletal survey showed multiple osteolytic bone lesions very suspicious for multiple myeloma. CT chest and abdomen did not show any concerning relevant findings. However, bone biopsy resulted as poorly differentiated adenocarcinoma of pancreatic or gastrointestinal origin. Magnetic resonance imaging (MRI) of the abdomen/pancreatic protocol was done, which showed normal pancreas and associated ducts. Later he underwent endoscopy showing stricture at the lower esophagus, whose biopsy confirmed the diagnosis of poorly differentiated adenocarcinoma with esophagus as primary site. Further staging workup was completed by positron emission tomography (PET) scan. It was stage four at the time of diagnosis. Right hip pain was secondary to bone metastasis from esophageal cancer (EC). The primary lesion was not noticeable on CT imaging despite the evident extensive metastasis, challenging the diagnosis. He was offered palliative radiation therapy for bone metastasis and associated pain. Unfortunately, he continued to have recurrent hospital admissions with other medical conditions, and his physical health declined rapidly. He died within a few months after diagnosis.

Occult Esophageal Squamous Cell Carcinoma Presenting with Multiple Bony Osteolytic Lesions Clinically Mimicking Multiple Myeloma: A Diagnostic Dilemma

Bone metastasis as an initial presentation of esophageal carcinoma is uncommon. In the absence of typical presentations like dysphagia, these cases may lead to diagnostic dilemmas both for the clinicians and pathologists. Here, we report a case of disseminated metastasis of esophageal squamous cell carcinoma to the bone in a 47-year-old female, who presented with multiple osteolytic lesions and clinically mimicking multiple myeloma. A detailed diagnostic work-up established the diagnosis of esophageal squamous cell carcinoma.

Phenotyping emphysema and airways disease: Clinical value of quantitative radiological techniques

The pathophysiology of chronic obstructive pulmonary disease (COPD) and Alpha one antitrypsin deficiency is increasingly recognised as complex such that lung function alone is insufficient for early detection, clinical categorisation and dictating management. Quantitative imaging techniques can detect disease earlier and more accurately, and provide an objective tool to help phenotype patients into predominant airways disease or emphysema. Computed tomography provides detailed information relating to structural and anatomical changes seen in COPD, and magnetic resonance imaging/nuclear imaging gives functional and regional information with regards to ventilation and perfusion. It is likely imaging will become part of routine clinical practice, and an understanding of the implications of the data is essential. This review discusses technical and clinical aspects of quantitative imaging in obstructive airways disease.