case_images: PMC9091406_01
case_images: (a and b) Plain radiographs (antero-posterior and lateral view) showing eccentric osteolytic lesion in distal femur with soft tissue involvement. (c and d) Immediate post-operative plain radiograph of the reconstructed intercalary defect, (e and f) 2 years follow-up post-operative plain radiograph.
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case_images: F1
case_images: The pre-operative radiograph showed an eccentric lytic lesion in the distal femur with moth-eaten appearance and involvement of surrounding soft tissue (Fig. 1). Post-operative plain radiograph was done (Fig. 1).
case_images: (a and b) MRI images showing a well marginated distal femoral lesion.
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case_images: F2
case_images: It was located 25 cm from the tip of the greater trochanter and 5 cm proximal to articular surface laterally and 3 cm medially (Fig. 2).
case_images: (a and b) Preoperative PET scan showing evidence of left nephrectomy with meta-static osteolytic lesion involving posteromedial femoral cortex of right side with associated FDG avid soft tissue component.
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case_images: F3
case_images: PET scan showed no other lesions in the body (Fig. 3).
case_images: Diagrammatic representation of pre-operative plan of margins for wide local resection.
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case_images: F4
case_images: Pazopanib before orthopedic consultation was sought, but the tumor showed no regression in its size. Pre-operative planning for resection of the tumor with the reconstruction of the intercalary defect with bone cement was done and exact margins of resection were decided (Fig. 4).
case_images: (a) Plane of resection with a cuff of surrounding muscles. (b and c) Skeletal defect after resection reconstruction with cement and plate. (c) The resected tumor mass (dimensions 16.5 x 7 x 5 cm).
case_images: JOCR-12-1-g005.jpg
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case_images: F5
case_images: Wide local excision of the tumor with its intact capsule, along with the cuff of surrounding vastus intermedius muscle was carried out (Fig. 5).
case_images: (a) 40x image of clear cell carcinoma showing pleomorphic cells with clear cyto-plasm and round nuclei. (b) Oil immersion view showing atypical mitotic figures and areas of angiogenesis.
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case_images: F6
case_images: Post-operatively, the histopathology report confirmed the diagnosis to be metastatic clear cell tumor of the right distal femur, consistent with metastatic RCC (Fig. 6).
case_images: Postoperative clinical picture showing satisfactory knee range of motion.
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case_images: F7
case_images: At 2 years follow-up the patient walks without support, with knee flexion up to 120 degrees without any complaints or complications (Fig. 7).
case_images: (a and b) Postoperative PET scan showing no metabolically active soft tissue mass lesion anywhere in the body except for mild soft tissue enhancement near surgical site probably due to post-operative soft tissue inflammation.
case_images: JOCR-12-1-g008.jpg
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case_images: F8
case_images: A follow-up PET scan did not show any active lesion in the body (Fig. 8).