Diffuse skeletal and bone marrow metastases mimicking plasma cell dyscrasia in advanced lung adenocarcinoma.
Shivam Garg, Ruchi Dua, Rajshree Koirala et al.
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Case in brief
A man in his late 40s presented with chest pain, cough, and dyspnoea. Imaging showed left lung collapse and pleural involvement, confirmed as pulmonary adenocarcinoma via thoracoscopic biopsy. Staging revealed diffuse bone marrow uptake and lytic lesions, initially suggesting a haematological malignancy. However, serum protein electrophoresis showed no monoclonal band. The patient was diagnosed with stage IV lung adenocarcinoma with extensive skeletal metastases and received supportive care, passing away five months later.
What made this case unusual
The case is notable for the diffuse bone marrow involvement and widespread lytic lesions, which are atypical presentations for lung adenocarcinoma and initially raised concerns for plasma cell dyscrasia.
Diagnostic / clinical pearl
Clinicians should consider the possibility of diffuse skeletal metastases in lung adenocarcinoma, especially when imaging findings mimic haematological malignancies, and ensure histopathological correlation.
Why it matters
This case underscores the importance of recognizing atypical metastatic patterns in lung cancer, which can lead to misdiagnosis and inappropriate management.