How do you manage a patient with cervical cancer who has FDG uptake in bilateral ischial tuberosities with lytic areas on CT correlate, and also has a history suspicious for untreated polymyalgia rheumatica with chronic symptoms in the same anatomic locations?

I would be very interested in the opinion of a rheumatologist regarding the etiology of the lytic disease in the ischial tuberosities. A decision should be made on whether to biopsy one of these lesions. My suspicion is that it is unrelated to cervical cancer, but that possibility needs to be consid...

The question raises the concern for paraneoplastic PMR, an interesting subject in and of itself. Standard texts reference this relationship, especially in relation to multiple myeloma and Waldenström’s macroglobulinemia. One study (Muller et al., PMID 23842460) reports a 69% risk of the diagnosis of...

I agree with starting with a biopsy given the history and potential for non-oncologic reasons for FDG uptake. I think I (and you) want the patient to not have metastatic disease, but it is worth making a good-faith attempt to 'prove it' in this scenario.

If biopsy is negative, treat the pelvis with ...

In this clinical scenario, lytic lesions in the ischial tuberosities require us to assume they are due to metastatic disease. This does not rule out the possibility of concurrent PMR. Although PMR can sometimes be isolated to the hip girdle area, I would seek additional information. For example, doe...