Bone scintigraphy in an uncommon presentation of metastatic lung carcinoma

A 66-year-old male smoker with a history of peptic ulcer disease had hemoptysis and weight loss. Bronchoscopy revealed a tumor in the right main bronchus. Thoracic CT scan showed a right hilar mass with tumor extension into the esophagus. Biopsy of the tumor confirmed squamous cell carcinoma. The patient underwent radical radiotherapy plus adjuvant chemotherapy. Four months later, left maxillary pain with local swelling and loosening of teeth developed, which progressed despite parenteral antibiotic therapy. A bone scan revealed diffuse symmetric increase in tracer accumulation throughout the maxilla. CT scan showed extensive palatal destruction by tumor. Maxillary biopsy confirmed squamous cell carcinoma with histologic features consistent with metastasis from the primary lung carcinoma.