56 Year old male with known chronic obstructive pulmonary disease presented with altered sensorium, headache and vomiting. Ill defined sclerotic lesions involving vertebrae,sternum, Bilateral scapula,pelvic bones and femoral heads seen on CT scan.Patient has grade I Prostatomegaly with normal serum PSA and high serum alkaline phosphatase. Bone marrow trephine biopsy was done to investigate pancytopenia.

Biopsy was hypocellular as per age with thickening  of bony trabeculae.The trabeculae had scalloped appearance due to increased resorption bays containg large osteoclasts and  replacement of marrow spaces by vascular connective tissue. Plasma cells, lymphocytes and macrophages were seen within the connective tissue.