PMC10050980_01
Plain radiography reveals altered bone structure of the proximal tibial diaphysis as well as decreased surrounding soft tissue transparency
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F1
Plain radiography did not detect any pathology, although decreased soft tissue transparency around the proximal tibia was seen (Figure 1).
Pathologic fracture of proximal tibial diaphysis
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F2
She was brought to our emergency department, where a pathologic fracture of the proximal tibial diaphysis was diagnosed on X-ray, just at the level of the prior incision (Figures 2 A, B).
External bone fixation of left tibia
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F3
The patient underwent emergency surgery, and osteosynthesis was achieved by means of external bone fixation (Figure 3).
A - Coronal plane of MSCT - osteolytic tibial lesion, B - Axial plane of MSCT - osteolytic lesion in the diaphysis of the left tibia covering almost all the diameter of the bone in this site, C - Axial plane of abdominal MSCT showing rectal mass
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F4
MSCT of the abdomen, thorax, and lower extremities was obtained and revealed rectal tumour with no signs of metastases apart from the osteolytic lesion in the fractured left tibia (Figures 4 A-C).
Endoscopic finding of the rectal tumour
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F5
Furthermore, a colonoscopy was done, and a circular mass in the upper rectum, about 12 cm from the anal verge, was found (Figure 5).
Histological finding of metastatic CRC in the tibia with preserved bone beds (HE 100x)
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F6
At the marginal parts of the tumour the bone beds were preserved (Figure 6).
Histological finding of metastatic CRC in the tibia with positive immunohistochemical reaction to CK8 (100x)
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F7
Tumour cells showed a positive immunohistochemical reaction to CK8, CK20, BER EP4, and CDX2 (Figures 7-10) and a negative reaction to CK7 (Figure 11, Table I).
Histological finding of metastatic CRC in the tibia with positive immunohistochemical reaction to CK 20 (100x)
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F8
Tumour cells showed a positive immunohistochemical reaction to CK8, CK20, BER EP4, and CDX2 (Figures 7-10) and a negative reaction to CK7 (Figure 11, Table I).
Histological finding of metastatic CRC in the tibia with positive immunohistochemical reaction to BER EP 4 (100x)
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F9
Tumour cells showed a positive immunohistochemical reaction to CK8, CK20, BER EP4, and CDX2 (Figures 7-10) and a negative reaction to CK7 (Figure 11, Table I).
Histological finding of metastatic CRC in the tibia with positive immunohistochemical reaction to CDX2 (100x)
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F10
Tumour cells showed a positive immunohistochemical reaction to CK8, CK20, BER EP4, and CDX2 (Figures 7-10) and a negative reaction to CK7 (Figure 11, Table I).
Histological finding of metastatic CRC in the tibia with negative immunohistochemical reaction to CK8 CK7 (100x)
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F11
Tumour cells showed a positive immunohistochemical reaction to CK8, CK20, BER EP4, and CDX2 (Figures 7-10) and a negative reaction to CK7 (Figure 11, Table I).