Given the history of oropharyngeal SCC and multiple lesions the lesion easiest to biopsy (the shoulder mass) was sampled.

Importance of this case is to recognize the features of pathological fracture on the initial plain film. Initial report (not given here) identified the fractures only.

Ultrasound was used to guide biopsy rather than as a diagnostic tool. If there was a change that the lesion was a primary bone tumor the biopsy tract would have been marked with carbon.