case_images: PMC7468612_01
case_images: Lumbar CT, left sagittal (a) and coronal (b) planes. A destructive lesion causing pathological fracture of the L4 vertebral body with mild adjacent soft tissue thickening. No abnormal soft tissue in the spinal canal was identified.
case_images: CRIHEM2020-8815841.001.jpg
case_images: PMC7468612_01_CRIHEM2020-8815841.001.jpg
case_images: fig1
case_images: Given his lower back pain and CRAB features, a spine X-ray as well as a lumbar CT were done, which showed lytic lesions in the L4 vertebral body (Figure 1).
case_images: CT neck, transverse plane. A 2.8 x 2.6 cm complex nodule in the left lobe of the thyroid. On further examination by way of a thyroid ultrasound, the lesion was further characterized and described as an echo poor mass showing lobulated margins and coarse internal calcification, highly suspicious for malignancy.
case_images: CRIHEM2020-8815841.002.jpg
case_images: PMC7468612_01_CRIHEM2020-8815841.002.jpg
case_images: fig2
case_images: A pan CT showed a 2.8 cm x 2.6 cm complex left lobe thyroid nodule concerning for malignancy (Figure 2).
case_images: Bone marrow trephine biopsy, H&E x 10. Bony trabecular remodelling and paratrabecular fibrosis are present. The bone marrow biopsy is otherwise normocellular and shows trilinear hematopoiesis.
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case_images: PMC7468612_01_CRIHEM2020-8815841.003.jpg
case_images: fig3
case_images: His normocellular bone marrow biopsy showed marked paratrabecular fibrosis (Figure 3).
case_images: Enlarging Howship lacunae populated by osteoclasts. These enlarge and transect the bone marrow trabeculae forming swaths of intertrabecular fibrosis (lower row, right panel).
case_images: CRIHEM2020-8815841.004.jpg
case_images: PMC7468612_01_CRIHEM2020-8815841.004.jpg
case_images: fig4
case_images: This stemmed from enlarging Howship lacunae, which effectively bisected the trabeculae (Figure 4).
case_images: CD 138 and kappa and lambda stains show presence of polytypic plasma cells.
case_images: CRIHEM2020-8815841.005.jpg
case_images: PMC7468612_01_CRIHEM2020-8815841.005.jpg
case_images: fig5
case_images: In addition, CD138, kappa and lambda stains showed polytypic plasma cells (Figure 5).