A 42-year-old male presented to the emergency department with multiple complaints that had developed over the past month. He first noticed a painful mass on his left shoulder, and then more tender lumps began appearing on his abdomen, back, and neck. He had also been experiencing sharp abdominal, back, neck, hip, and extremity pains that subsequently forced him to quit his weekly recreational basketball games. He reported multiple positives in his review of systems, including night sweats, intermittent diarrhea and constipation, nausea and vomiting, and a weight loss of 20 lbs.
The patient was informed of the concern for metastatic disease. He was admitted for pain control, further evaluation, and management. An ultrasound-guided biopsy of the nodule on his right flank was performed (Figure 4). The oncology service evaluated the patient and diagnosed a poorly differentiated non-small cell cancer with neuroendocrine features and unknown primary source. An endoscopic retrograde cholangiopancreatography with stent placement relieved his biliary obstruction. A single treatment of radiation therapy was directed at a painful metastatic lesion on his right proximal humerus.
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