PMC9644070_01
Imaging examination of the patient. Computed tomography images (upper image for axial, lower left for sagittal, and lower right for coronal, respectively) of the patient at the initial diagnosis (A, B). (A) CT scan showed a soft tissue mass (2.4 cm x 1.8 cm) and a pathologic fracture on the right humerus of the patient. (B) Chest CT showed a pulmonary mass in the left upper lobe. X-ray images after the first two surgeries (C, D). (C) X-ray image after the surgery for plate internal fixation on the right humerus. (D) X-ray image after the surgery for the right shoulder joint replacement. Computed tomography images (upper image for axial, lower left for sagittal, and lower right for coronal, respectively) before the surgery of shoulder disarticulation (E, F). (E) CT scan showed the prosthesis of patient exposed out of right humerus. (F) Chest CT presented stable disease in the primary lung tumor.
fonc-12-1045458-g001.jpg
PMC9644070_01_fonc-12-1045458-g001.jpg
f1
A computed tomography (CT) scan revealed the evidence of a soft tissue mass and pathologic fracture on the right humerus ( Figure 1A ). At the same time, a pulmonary CT presented space-occupying lesions on her left upper lobe ( Figure 1B ). X-ray imaging after surgery is shown in  Figure 1C . Pathologic imaging is presented in  Supplementary Figure 1 . After the prognostic evaluation (more than 6 months) and the general condition assessment, in order to prevent pathologic fracture of the right humerus, the replacement of the right shoulder joint was performed ( Figure 1D ). The CT imaging is shown in  Figure 1E . The patient is still in follow-up with stable disease in his primary lung tumor after long-term systematic therapy ( Figure 1F ).
The timeline of the diagnosis and treatment course of the patient in the present case.
fonc-12-1045458-g002.jpg
PMC9644070_01_fonc-12-1045458-g002.jpg
f2
The pathological result was confirmed to be a metastatic adenocarcinoma with poor differentiation ( Supplementary Figure 2 ). The timeline of the diagnosis and treatment course of the patient is summarized in  Figure 2 .