case_images: PMC10890798_01
case_images: Case 1. MRI of the pelvis 7 months after nephrectomy showing the metastasis in the iliac bone. a Coronal. b, c Transverse images.
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case_images: F1
case_images: Right hip pain 7 months later prompted further imaging revealing an osteolytic process in the right supra-acetabular iliac bone (Fig. 1) and in the sternum (Fig. 2).
case_images: Transverse cut through the centre of the resected hip joint showing the necrotic centre (*) within the renal cancer metastasis surrounded by the intact pseudocapsule.
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case_images: Transarterial embolization followed by en bloc hip joint resection (Fig. 3) and reconstruction by a cementless LUMIC  (implantcast ) endoprosthesis (Fig. 4) was subsequently performed.
case_images: 3D-CT - reconstruction image (a), August 2011 10 days after resection of the metastasis and reconstruction with LUMIC  endoprosthesis. X-ray documentation (b) 12 years later June 2023.
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case_images: F4
case_images: Hip reconstruction is stable without signs of loosening (Fig. 4).
case_images: Pathology slides of the clear cell renal cell sternum metastasis: overview of renal cell carcinoma metastasis on the left side of the microphotograph with the sternal bone and cartilage on the right edge (a), classical clear cell carcinoma with low-grade nuclei devoid of prominent nucleoli (b), focal papillary pattern of clear cell carcinoma (c), partial spindle cell growth pattern (d). Standard haematoxylin/eosin staining. Overview field of view 5*3.3 mm, high power microphotographs with field of view 0.625*0.413 mm.
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case_images: An extralesional en bloc resection of the sternal metastasis followed 6 weeks later (histology findings proving metastasis of a clear cell renal metastasis are presented in Fig. 5).
case_images: PMC10890798_02
case_images: Case 2. CT-guided biopsy of the prostate sternum metastasis (2013) 3 years after prostatectomy (2010).
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case_images: F6
case_images: Score 3 + 4 = 7a). Secondary increase of prostate-specific antigen (PSA) levels from <0.1 ng/mL to 2.71 ng/mL was observed in 2013. 18F-Fluorocholine PET-CT revealed a solitary active sternal focus at the level of rib 5-7; biopsy (Fig. 6) confirmed prostate cancer metastasis.
case_images: Coronal and sagittal MRI of the sternum documenting the extent of the lesion in 2020.
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case_images: Again irradiation with 30 Gy applied by Cyber knife led to decreased PSA. 3 years later, in 2020, PSA increased to 2.01 ng/mL and a painful pathologic sternal fracture across the irradiated field (Fig. 7, 8) occurred.
case_images: 18F-PSMA PET - CT showing the extensive osteolysis of the sternum and the focal radionuclide uptake supporting prostate cancer tumour activity.
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case_images: F8
case_images: Again irradiation with 30 Gy applied by Cyber knife led to decreased PSA. 3 years later, in 2020, PSA increased to 2.01 ng/mL and a painful pathologic sternal fracture across the irradiated field (Fig. 7, 8) occurred.
case_images: Resected sternum segment distal to the level between 3rd and 4th ribs.
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case_images: F9
case_images: After wide resection of the sternum distal to the 3rd rib with tumour-free margins (Fig. 9) and proof of active metastasis (Fig. 10), PSA is normal at 3-year follow-up.