Chief complaint-severepain in lower back and upper thighs
History- 1)carcinoma breast three years back, followed by surgery, chemotherapy and radiotherapy.
2)on Tamoxifen from 3 years
3)osteoporosis from last 7 years
Investigations-
1)year 2009-severe osteopenia with maximum bone loss of 21% on L3 and spine, ribs, trunk, arms with more on left side
2)year2012-fnac- invasive duct carcinoma, right breast
ER+,PR+,,hercep test-score "0"
3)year 2015-X-ray ,
MRI shows-focal altered marrow intensity lesions seen in b/l pelvic bones , sacrum ,and left upper femoral shaft consistent with metastasis in present clinical context
, PET scan - shows metabolically active ill defined lytic destructive lesions are seen in post cortex shaft of left femur,rt inf pubic Ramus, b/l iliac bones ,sacrum ,D5,7,11 and L1,4 sternum, rt 3,5,7 post ribs with mid rt para vertebral soft tissue lesion at D7 level- likely metastasis