On past medical history, the patient had a benign lump removed from the right breast in the 1980s. She does not smoke. On oncologic examination, the patient does not appear chronically ill or cachectic. There is a mass, which is firm and nontender, in the left breast laterally which measures about 4 x 4 cm. On musculoskeletal examination, the right hip has a very restricted range of motion. Although the patient to walk, she is very great difficulty placing any weight on the right leg. She can sit, but she cannot lay back without bending the knee up because extending the right hip is very painful. From the flexed position, the hip can be gently abducted without too much pain. No masses palpable along the proximal femur or in the distal femur near the knee. Plain films show a lytic, permeative, destructive lesion that seemed to be centered in the cortex of the right femur just below the lesser trochanter. Part of the cortex is damaged. There is poorly defined lytic process extending into the intertrochanteric area and down the proximal portion of the femur for 8 or 10 cm. An MRI shows a permeative destructive lesion in the same location proximal right femur, with no soft tissue mass. The bone scan shows multiple abnormal areas of tracer uptake, the proximal femur as a large area of abnormal uptake, there are at least two lesions in the ribs, there are multiple scattered lesions in the right distal femur, and there is one lesion in the pelvis.