Gabriel Sara, MD

A 67-year-old man in relatively good health presented to the ED with abdominal pain, nausea and vomiting.

An 83-year-old female with a family history of breast cancer was diagnosed in 1992 with a right breast cancer that was hormone receptor-positive, infiltrating ductal carcinoma.

A 65-year-old woman with a past medical history significant for depression and anxiety disorder presented in 1991 with abdominal distension and increasing girth. Imaging studies revealed bilateral ovarian masses, and she underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy and debulking surgery for a stage IIb ovarian epithelial cell carcinoma.

A 32-year-old man with chronic low back pain presented with acute worsening of back pain to his medical doctor. He was referred to an orthopedic surgeon who requested an MRI of his spine revealing disc disease at L5/S1 and splenomegaly.

Our patient is a 59-year-old man with a history of diabetes and HIV infection. He also has diffuse large B-cell lymphoma, which was diagnosed after presenting with low back pain and having found a bulky left upper quadrant mass. He received etoposide, prednisone, vincristine, doxorubicin and cyclophosphamide (EPOCH) chemotherapy for six cycles followed by involved field radiation to the bulky retroperitoneal mass.

An 89-year-old woman presented to our institution after a mechanical fall. She had a remote history of breast cancer with left breast mastectomy in 1978. She also had degenerative joint disease and underwent right hip replacement in 1994. She complained of progressive left hip pain for the past three months and has been using a walker at home. Examination revealed left hip erythema and tenderness with limited range of motion. The rest of the examination was otherwise unremarkable.

A 36-year-old healthy woman presented after several months of right hip pain not improved with physical therapy. Magnetic resonance image of the lumbar spine and pelvis revealed a compression fracture of the L2 vertebrae and abnormal signal enhancement of L4 and L5. Biopsy of the right iliac crest showed carcinoma of epithelial origin. Immunostains were not helpful in further characterizing the tumor. Full staging workup revealed bone only disease of the axial skeleton without a primary site of origin. The patient was treated with two cycles of chemotherapy for carcinoma of unknown primary site and palliative radiation to several painful bony lesions.