case_images: PMC4531608_01
case_images: Clubbing of fingers.
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case_images: Physical examination at presentation was normal except for tenderness of both the lower extremities and clubbing of the fingers (Figure 1).
case_images: (A) Bone scan shows diffusely increased uptake along the cortical portions of both lower extremities. (B) Left tibia and fibular X-ray films demonstrate diffuse cortical thickening (arrows).
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case_images: The plain radiograph of both lower legs showed cortical thickening along the shaft of the tibia and the bone scan revealed diffusely increased uptake along the cortex of both lower extremities (Figure 2).
case_images: Chest PA view shows left mediastinal bulging (arrows).
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case_images: In order to find the possibility of the secondary HOA, we performed a chest radiograph, which revealed a left mediastinal bulging mass (Figure 3).
case_images: At carinal level, chest CT scan shows a heterogeneous enhancing mass (arrows) with pericardial effusion in anterior mediastinum.
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case_images: The chest CT scan confirmed the presence of a soft tissue density mass in the anterior mediastinum with pericardial effusion (Figure 4).
case_images: Irregular nests of malignant tumor cells with some necrotic area. Tumor cells show poorly differentiated appearance with hyperchromatic and irregular nuclei and moderate amount of eosinophilic cytoplasm. Mitotic figures are frequently seen (Hematoxylin & Eosin, x200).
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case_images: Microscopic examination showed irregular nests of poorly differentiated malignant cells with hyperchromatic and irregular nuclei (Figure 5).