multiple myeloma with severe pelvic pain

Chief complaint A 59 y/o female presents with severe pain in the pelvis and the sacrum. She described pain as 9 out of 10. History She has h/o multiple myeloma and she was treated with radiotherapy for mediastinal tumor 1 year back. Examination Physical examination revealed a hard supraclavicular tumor of 3*3.5 cm in size. Investigations Laboratory reports shows Hb: 9.9 g/dl, platelet count of 15 × 10 9/l, WBC: 3.5× 109 cells/l Which investigations should be performed? Treatment What should be done now?

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Ultrasound of Supraclavicular mass and biopsy Hematological investigations for MM . FDG PET CT can clearly show the extent of spread of malignant process . Multiple myeloma can sometimes present as solid tumour.

To above investigations add bone marrow biopsy

PET scan

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