B-cell lymphoma mimicking multiple myeloma.

A 75-year-old white male presented with a one-month history of pain in the left shoulder. Early laboratory data revealed hypercalcemia. Extensive skeletal survey was remarkable for multiple lytic lesions in skull, right scapula, right humerus and left iliac crest. A bone marrow biopsy of the left iliac crest did not show evidence of plasma cell dyscrasia. A computed tomographic scan (CT) of the abdomen revealed a right renal mass and multiple lesions in the liver. A CT-guided biopsy of liver showed lymphoma cells strongly positive for CD19 and CD20 stains: findings consistent with B-cell lymphoma. Our case illustrates that B-cell lymphomas can clinically present in a fashion that mimics multiple myeloma in the form of hypercalcemia, renal failure and lytic bone lesions.