{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:02:34Z","timestamp":1756425754038,"version":"3.44.0"},"reference-count":7,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,5,23]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:p>Radiological evidence of lytic bone lesions has a wide differential diagnosis including metastatic bone disease, multiple myeloma, primary bone cancers and infection. Here, we present the case of a woman in her 80s found to have lytic bone lesions associated with an IgA paraproteinaemia who was thus presumed to have a diagnosis of multiple myeloma. However, bone marrow biopsy results were indicative of monoclonal gammopathy of undetermined significance. She was subsequently referred to the \u2018carcinoma of unknown primary (CUP) team\u2019, and ultimately diagnosed with metastatic breast cancer following a repeat trephine biopsy. A range of conditions may present with lytic bone lesions and these differentials must be suitably investigated even in the presence of paraproteinaemia. Early CUP team involvement is pivotal to ensure appropriate clinical management and patient support.<\/jats:p>","DOI":"10.1136\/bcr-2022-254016","type":"journal-article","created":{"date-parts":[[2023,6,22]],"date-time":"2023-06-22T21:21:30Z","timestamp":1687468890000},"page":"e254016","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Metastatic breast cancer and monoclonal gammopathy of undetermined significance resembling multiple myeloma"],"prefix":"10.1136","volume":"16","author":[{"given":"Paula","family":"Muehlschlegel","sequence":"first","affiliation":[{"name":"Oncology, University College London Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roopinder","family":"Gillmore","sequence":"additional","affiliation":[{"name":"Oncology, Royal Free London NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabine","family":"Pomplun","sequence":"additional","affiliation":[{"name":"Histopathology, cytopathology, University College London Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,6,22]]},"reference":[{"key":"2025082723434735000_16.6.e254016.1","unstructured":"National Insititute for health and care excellence . Metastatic malignant disease of unknown primary origin in adults: diagnosis and management. 2010. Available: https:\/\/www.nice.org.uk\/guidance\/cg104\/chapter\/1-Guidance"},{"key":"2025082723434735000_16.6.e254016.2","unstructured":"Subramanian S , Viswanathan VK . Lytic Bone Lesions. StatPearls Publishing, 2022."},{"key":"2025082723434735000_16.6.e254016.3","first-page":"004","article-title":"Metastatic bone disease: pathogenesis and therapeutic options: up-date on bone metastasis management","volume":"15","author":"D\u2019Oronzo","year":"2019","journal-title":"J Bone Oncol"},{"key":"2025082723434735000_16.6.e254016.4","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2006.054627"},{"key":"2025082723434735000_16.6.e254016.5","doi-asserted-by":"crossref","first-page":"19266","DOI":"10.1038\/s41598-021-98803-1","article-title":"Monoclonal Gammopathy of undetermined significance is associated with prostate cancer in a population-based cohort study","volume":"11","author":"Hornung","year":"2021","journal-title":"Sci Rep"},{"key":"2025082723434735000_16.6.e254016.6","doi-asserted-by":"publisher","DOI":"10.4081\/oncol.2017.321"},{"key":"2025082723434735000_16.6.e254016.7","doi-asserted-by":"crossref","unstructured":"Liu D , Wu J , Lin C , et al . Breast subtypes and prognosis of breast cancer patients with initial bone metastasis: A population-based study. Front Oncol 2020;10. doi:10.3389\/fonc.2020.580112","DOI":"10.3389\/fonc.2020.580112"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-254016","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:43:58Z","timestamp":1756363438000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-254016"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6]]},"references-count":7,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6,22]]},"published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1136\/bcr-2022-254016"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-254016","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2023,6]]}}}