No significant laboratory findings.
X-rays of left shoulder revealed narrowing of space between the acromion and humeral head. MRI was obtained and revealed small left glenohumeral joint effusion, degenerative changes at acromioclavicular joint, and abnormal marrow signal in bones of left shoulder. Nuclear medicine bone scan revealed only degenerative changes.
Biopsy performed by Orthopedic Oncology described area as a large void in the bone and hypercellular bone marrow with megakaryocytic clustering. Pathologist was unable to provide definitive diagnosis. Bone marrow biopsy consisted predominantly of blood clot and small fragment of bone with crushed marrow, but the amount of hematopoietic elements present were insufficient for evaluation.
Patient later presented to ER for persistent and worsening left shoulder pain. CT of neck and chest revealed a left lung mass with mediastinal lymphadenopathy as well as a left supraclavicular soft tissue mass and adjacent adenopathy.
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