Low back pain (LBP) is one of the most important health conditions that can affect human with physical and psychosocial changes. Nonspeci c LBP, de ned as self-limiting and which exact cause cannot be determined, is common among older adults. Besides, lumbar disc herniation should be the rst diagnosis that comes to mind in between 40-60 years-old patients with clinical ndings of radiculopathy with LBP.However, in order not to miss important causes such as malignancy that can cause LBP, the patient's anamnesis should be deepened, and physical examination should be performed carefully. We reported the case of a 53-year-old woman with anaplastic carcinoma of the pancreas (APC) where the initial symptom was LBP accompanied by radiculopathy and diagnosed by tru-cut biopsy from the sacral metastatic soft tissue mass, which was speci ed by the advanced imaging. APC is a rare cancer, and the survival time of the patients is quite short due to its rapid spread and resistance to chemotherapy and radiotherapy. Based on this case, clinicians should evaluate the patient detailly, prefer further imaging when necessary, and discuss the case with musculoskeletal radiologists when there are diagnostic problems, which will reduce the possibility of overlooking the underlying serious causes of LBP.
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