lesions?

A 35-year-old woman comes in who had fallen while moving from her wheelchair to her bed. When she fell, she struck her head on a chair, lost her sense of direc-tion, and injured her left hip. She is complaining of rib pain that worsened with movement. Her medical his-tory includes recurrent bacterial infections. Physical ex-amination finds kyphosis of the thoracic spine but no other abnormalities. Laboratory findings include a nor-mocytic, normochromic anemia, Bence Jones protein-uria, and an M (for monoclonal) spike in the gamma globulin region on serum protein electrophoresis. Radiographic findings Lateral (Figure 1) and anteroposterior ([AP] Figure 2) radiographs of the skull display sharply defined mul-tiple round, punched-out lucent foci, with sparing of the inner table of bone. The lesions do not seem to have a sclerotic border. The mandible and cervical spine are also involved. Lumbar spine films (not included here) display extensive demineralization and severe com