She presented to the emergency department a year later complaining of nausea, vomiting, and weight loss (6.3 kg [14 lb]). On physical examination, she was anicteric, afebrile, and normotensive with no hepatomegaly. Her workup included a white blood cell count of 3800 cells/μL (normal range, 4-11 cells/μL [to convert to ×109/L, multiply by 0.001]), a hemoglobin level of 7.6 g/dL (normal range, 12-16 g/dL [to convert to grams per liter, multiply by 10.0]), a creatinine level of 1.3 mg/dL (normal range, 0.7-1.5 mg/dL [to convert to micromoles per liter, multiply by 88.4]), normal albumin and liver enzyme levels, and a normal coagulation profile. Imaging studies included magnetic resonance imaging of the abdomen, CT angiography, a chest CT scan, a bone scan, and ultrasonography, all of which had negative results. She subsequently underwent a positron emission tomographic/CT scan (Figure 1).