Marked gastric uptake of Tc-99m methylene diphosphonate (MDP) in a patient with myeloma and hypercalcemia

A 59-year-old man presented with a 7-month history of increasing left shoulder pain. The initial plain films showed near absence of the left scapula and scattered lucent changes in the left humerus. A CT scan confirmed the presence of widespread lytic bony lesions, with a large soft-tissue mass centered around the left scapula. An isotope bone scan demonstrated marked uptake of MDP in the stomach and nasal mucosa. Further laboratory investigations revealed marked hypercalcemia and the presence of Bence-Jones protein in the urine. An ultrasound-guided biopsy of the soft-tissue mass confirmed the diagnosis of multiple myeloma.