{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:14:52Z","timestamp":1788869692877,"version":"build-2803163510"},"reference-count":15,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,22]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>A man in his late 40s presented with progressive chest pain, cough and dyspnoea. Imaging revealed left lung collapse with pleural involvement. Thoracoscopic pleural biopsy confirmed pulmonary adenocarcinoma by immunohistochemistry. Staging fluorodeoxyglucose positron emission tomography-CT demonstrated nodal disease and unexpectedly diffuse marrow uptake with widespread lytic lesions involving the axial and appendicular skeleton, raising concern for a haematological malignancy. Serum protein electrophoresis revealed no monoclonal band, arguing against plasma cell dyscrasia. CT of the brain demonstrated multiple lytic calvarial lesions without parenchymal involvement, an unusual pattern in lung adenocarcinoma. The patient was diagnosed with stage IV lung adenocarcinoma with extensive skeletal metastases. Owing to poor performance status and advanced disease, the patient was managed with the best supportive care and died 5\u2009months after diagnosis. This case highlights that lung adenocarcinoma may rarely present with diffuse marrow involvement and highlights the importance of histopathological correlation when imaging mimics haematological disease.<\/jats:p>","DOI":"10.1136\/bcr-2026-274087","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T11:55:18Z","timestamp":1788868518000},"page":"e274087","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Diffuse skeletal and bone marrow metastases mimicking plasma cell dyscrasia in advanced lung adenocarcinoma"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2331-9703","authenticated-orcid":false,"given":"Shivam","family":"Garg","sequence":"first","affiliation":[{"name":"Department of Pulmonary Medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruchi","family":"Dua","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajshree","family":"Koirala","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Upendra","family":"Panday","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"2026090804551279000_19.9.e274087.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2014.07.020"},{"key":"2026090804551279000_19.9.e274087.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12890-025-03702-0","article-title":"Risk factors of bone metastasis in lung adenocarcinoma","volume":"25","author":"Cao","year":"2025","journal-title":"BMC Pulm Med"},{"key":"2026090804551279000_19.9.e274087.3","first-page":"1","article-title":"Differential diagnosis of diffuse bone marrow uptake on 18F-FDG PET\/CT","volume":"2","author":"Hapkido","year":"2016","journal-title":"Int J Clin Biomed Res"},{"key":"2026090804551279000_19.9.e274087.4","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1097\/01.rlu.0000242685.55001.67","article-title":"Diffuse bone marrow uptake on F-18 FDG PET in patients with myelodysplastic syndromes","volume":"31","author":"Inoue","year":"2006","journal-title":"Clin Nucl Med"},{"key":"2026090804551279000_19.9.e274087.5","doi-asserted-by":"crossref","first-page":"103051","DOI":"10.1016\/j.ctrv.2025.103051","article-title":"Bone metastases in NSCLC: Modern paradigms in management and supportive care","volume":"142","author":"Minuti","year":"2026","journal-title":"Cancer Treat Rev"},{"key":"2026090804551279000_19.9.e274087.6","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1928.01140040002001"},{"key":"2026090804551279000_19.9.e274087.7","doi-asserted-by":"crossref","first-page":"53","DOI":"10.4103\/0971-5851.51446","article-title":"Multiple myeloma mimicking bone metastasis in a patient of carcinoma breast","volume":"29","author":"Hingmire","year":"2008","journal-title":"Indian J Med Paediatr Oncol"},{"key":"2026090804551279000_19.9.e274087.8","doi-asserted-by":"crossref","first-page":"515","DOI":"10.4066\/AMJ.2013.1859","article-title":"Compressive myeloradiculopathy from bony metastasis as the initial presentation of poorly differentiated adenocarcinoma stomach - a case report","volume":"6","author":"Basheer","year":"2013","journal-title":"Australas Med J"},{"key":"2026090804551279000_19.9.e274087.9","doi-asserted-by":"crossref","DOI":"10.1007\/s12308-025-00652-8","article-title":"Where are the immunoglobulins? 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