A 56-year-old man presented with bony pain. X-ray of skull showing which lesions in brain:
## **Core Concept**
The question pertains to the radiological findings in the skull of a patient presenting with bony pain. The lesions described are likely related to a systemic condition affecting bone. **Paget's disease of bone** and **multiple myeloma** are prime considerations in a differential diagnosis for lytic lesions in the skull.
## **Why the Correct Answer is Right**
The correct answer, , shows punched-out lytic lesions without sclerotic margins, which is characteristic of **multiple myeloma**. Multiple myeloma is a plasma cell neoplasm that can cause lytic bone lesions due to the production of osteoclast-activating factors by the malignant plasma cells. These lesions are typically "punched out," meaning they have sharp margins and lack reactive bone formation around them.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option does not describe the characteristic "punched-out" lesions seen in multiple myeloma.
- **Option B:** This option might represent a different kind of bone lesion but does not specifically suggest the lytic lesions characteristic of multiple myeloma.
- **Option D:** This option likely represents a different radiographic pattern, possibly more suggestive of blastic or sclerotic lesions, which are not typical for multiple myeloma.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that **multiple myeloma** can present with **bony pain**, **pathological fractures**, and **hypercalcemia**. The presence of **Bence Jones proteins** (light chains in urine) and **monoclonal spike** on serum protein electrophoresis are diagnostic clues. Remember, the CRAB criteria (Calcium elevation, Renal failure, Anemia, and Bone lesions) are often used to diagnose multiple myeloma.
## **Correct Answer: .**