case_images: PMC9552178_01
case_images: (A) One year after the left nephrectomy, two lung metastases were revealed by computed tomography. (B) Eight months later, a left humerus fracture with osteolytic change was revealed by X-ray. Magnetic resonance imaging (MRI) showed an extraskeletal mass at the fracture site (left: T1-weighted image, right: fat-suppressed T2-weighted image), and it was considered to be a pathological fracture due to bone metastasis.
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case_images: One year after the surgery, radiological examination revealed two lung metastases ( Figure 1A ), for which drug treatment was recommended, but the patient refused this. Magnetic resonance imaging (MRI) showed a mass lesion extending to the outside of the fracture site, which was considered a pathological fracture due to bone metastasis ( Figure 1B ).
case_images: (A) After four courses of ICI treatment, the pulmonary metastases had almost disappeared. (B) Furthermore, the tumor at the fracture site had shrunk remarkably and almost disappeared (MRI: gadolinium-enhancement).
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case_images: Figure 2A ), and the therapeutic effect was evaluated as a partial response (PR) based on the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Furthermore, the tumor at the pathological fracture site showed remarkable shrinkage ( Figure 2B ).
case_images: Postoperative X-ray.
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case_images: Finally, cement was added to the defect at the fracture site, and screw fixation of the nail was performed ( Figure 3 ).
case_images: (A) The soft tissue at the fracture site. (B) Histopathological examination showed no evidence of malignancy, and the bone healing process after the fracture was observed.
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case_images: Postoperatively, histopathological examination of the soft tissue at the fracture site and medullary cavity showed no evidence of malignancy, and bone healing after the fracture was observed ( Figure 4 ).