Lung adenocarcinoma presents with diffuse bone metastasis

Abstract

A 62-year-old man that smoked 15 packs a year presented to our hospital with 3-month persistent pain in the upper back. He had no cancer history, and the blood tests were unremarkable. Whole body positron emission tomography (PET) computed tomography (CT) scanning revealed a mass at the right lower lung lobe, enlargement of mediastinal lymph node, metastatic spread in the liver, and multiple bone metastasis throughout the body including the ribs, spine, pelvis, femur, and humerus. Interestingly, his PET-CT image demonstrated contrast in almost his entire skeletal system like a skeleton ghost (Figure 1). A CT-guided biopsy was performed to obtain samples from the primary lung lesions and metastatic bone lesions. The histopathological diagnosis of both tissues demonstrated adenocarcinoma of lung origin, characterized by positive expression of TTF-1, CK7, and Napsin A and negative expression of