Lumbar and left femur x-ray images were negative for bony pathology. He was given NSAIDS for pain and a home exercise program. He was referred to a sports chiropractor for soft tissue mobilization.
Within weeks, he presented with severe low back pain and urinary frequency. CT abdomen and pelvis revealed two large soft tissue masses. One was suprapubic, posterior to the distal rectus sheath and displaced the bladder. Case Photo #1 The other involved abductor muscles and was anterior to the pubic ramus. Case Photo #2 There was left inferior pubic ramus periostitis and sclerosis without obvious destruction. Suspicion increased for malignancy.
Needle core biopsies were positive for a high grade round cell malignancy. Staging imaging, including PET, showed bony metastasis to the cervical and thoracic spine with extension into the epidural space causing mild cord compression.
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