Fig. 1

A 66-year-old man who visited our hospital for hemoptysis. a Chest X-ray showed right costo-phrenic angle blurring. b Chest CT scan showed a 4 cm-sized mass. Squamous cell carcinoma was diagnosed by bronchoscopic biopsy. c At the time of diagnosis, the stage was T3N2M0. d At follow-up, WBBS was performed at 20 months of diagnosis, and hot-uptake was observed at the 2nd Lumbar body, left distal femur diaphysis and right distal tibia diaphysis. e The osteolytic lesions are observed in the lateral cortex of the left femur diaphysis and lateral cortex of right tibia diaphysis, suggesting skeletal metastases. f In chest X-ray, the haziness was increased at the right mid and lower lung field. g Curettage, flexible intramedullary nailing, plate fixation and bone cementing were performed on the right distal tibia diaphysis metastasis. Interlocking intramedullary nailing was performed on the left femur distal diaphysis metastasis. Additional postoperative radiation therapy was performed, and chemotherapy was continued. h Ten months after surgery, there was a slight increase in the size of the osteolytic lesions around the surgical sites, but full weight bearing without pain was possible. i The patient expired from pneumonia associated with lung cancer