Multiple osteolytic lesions - metastases from signet cell carcinoma - stomach

This 56-years old man, with mild bone pain, but otherwise well-preserved and asymptomatic, was found to have extensive osteolytic lesions on MRI and plain radiographs. A biopsy was attempted at another hospital, but was inconclusive.

Using a Cook 18G co-axial gun canula system, biopsies were obtained from two sesions, one in the sacrum and one in the ilium. There was clear fluid obtained from both lesions, so the walls of both lesions were biopsied.

The eventual diagnosis was of metastases from signet cell carcinoma, probably from the stomach - a gastric mass was found on endoscopy.