X ray of skull showing multiple lesions. The diagnosis is?

(B) Multiple myeloma[?]MULTIPLE MYELOMA:Most common primary malignant neoplasm in adults.Disseminated form - scattered, axial skeleton predominant site; vertebrae (50%), distribution correlates with normal sites of red marrow).Solitary form - vertebrae > pelvis > skull > sternum > ribs.Spinal Plasma Cell Myeloma - sparing of posterior elements, paraspinal soft-tissue mass with extradural extension, scalloping of anterior margin of vertebral bodies.Generalized osteoporosis with accentuation of trabecular pattern.Punched out appearance of widespread osteolytic areas with endosteal scalloping & uniform size, Diffuse osteolysis, Expansile osteolytic lesions in ribs, pelvis, long bones, Soft-tissue mass adjacent to bone destruction.Sclerosis may occur after chemotherapy, radiotherapy, fluoride administration.Sclerotic form of multiple myeloma is associated with Polyneuropathy,Organomegaly, Endocrine abnormalities, M-protein, Skin changes.Other Options[?]Paget's disease (Osteitis Deformans):Multiple chronic skeletal disease due to paramyxoviral infection causes resorption and bone formation.The newly formed bone is abnormally soft with disorganized trabecular pattern ("mosaic pattern") causing deformity.-Active phase: Osteolytic phase (aggressive bone resorption with lytic lesions).-Inactive phase: Quiescent phase (| bone turnover with skeletal sclerosis).-Mixed pattern is common (lytic & sclerotic phases coexist).Skull - Inner & outer table thickening & Skull becomes larger (Soldier's helmet), diploic widening, osteoporosis circumscripta, "cotton wool" appearance, sclerosis of base of skull, Facial bones are usually not affectedLong bones - "Candle flame" or "Blade of grass" lysis results fracturePelvis - protrusio acetabulae, thickened trabeculaeSpine - Upper cervical, low dorsal, midlumbar vertebral involvement, "picture frame vertebra" (bone-within-bone), "ivory vertebra", ossification of spinal ligaments, paravertebral soft tissue, disk spaces. Bone scan - Increased uptake.[?]Eosinophilic granuloma = most benign variety of LCH localized to bone.Location: bone (in children) or lung (in adults)Sites: Mostly diaphyseal; epiphyseal lesions are uncommon; Expansile lytic lesion with ill-defined / sclerotic edges; Endosteal scalloping, widening of medullary cavity; Cortical thinning, intracortical tunneling; Erosion of cortex + soft-tissue mass; Laminated periosteal reaction (frequent), may show interruptions; May appear rapidly within 3 weeks; Lesions respect joint space + growth plate.Prognosis: Excellent with spontaneous resolution of bone lesions in 6-18 months.[?]Osteomyelitis:Acute Osteomyelitis: Initial X-rays often normal (as long as 10 days), localized soft-tissue swelling, area of bone destruction (lags 7-14 days behind pathologic changes)-Involucrum (new bone formation), periosteal reaction (develops after 20 days), sequestrum (detached dead bone appears dense radiologically), cloaca formation.-Chronic Osteomyelitis: Thick irregular sclerotic bone with radiolu- cencies, elevated psriosteum, chronic draining sinus.-Sclerosing Osteomyelitis of Garre -- Focal bulge of thickened cortex (sclerosing periosteal reaction)Brodie Abscess: Subacute pyogenic osteomyelitis (smouldering indolent infection), Central area of lucency surrounded by dense rim of reactive sclerosis.BONE SCANS (local in radiopharmaceutical uptake (positive within 24-72 hours))Ga-67 scans - 100% sensitivity; increased uptake 1 day earlier than for Tc-99m MDP (Gallium helpful for chronic osteomyelitis)Static Tc-99m diphosphonate - 83% sensitivityThree-phase skeletal scintigraphy - 92% sensitivity, 87% specificityPhase: 1: Radionuclide angiography (profusion phase of regional blood flow); 2: "blood pool" images; 3: "bone uptake"WBC-scan--In-111-labeled leukocytes - best agent for acute infections--Tc-99m labeled leukocytes - preferred over in 111-leukocyte imaging especially in extremities.--WBC scans have largely replaced gallium imaging for acute osteomyelitis.