Dr. Pepe’s Diploma Casebook: Case 77 – SOLVED!


Dear Friends,

Today I am presenting images of a 72-year-old man with pain in the sternum. Check the images below, leave your thoughts in the comments section and come back on Friday for the answer.

1. Metastases
2. Chondrosarcoma
3. Osteomyelitis
4. Any of the above



Click here for the answer

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    21 Responses to : Dr. Pepe’s Diploma Casebook: Case 77 – SOLVED!

    1. shekhar khanpara says:


    2. genchi bari italia says:

      …metastasi….c’è un’altra immagine, simile e più piccola inferiormente… l’ilo di sx mostra una formazione solida sospetta per cr ilare… complimenti x il triplete….saluti alla prossima finale !

    3. gaborini says:

      lack of calcification or surrounding soft tissue swelling goes against, although does not completely rule out chondrosarcoma and osteomyelitis, respectively. Metastasis is the most probable diagnosis.

    4. Borsuk says:

      I think correct answer is 4- any of the above.
      There is finding in a middle part of sternum with scalloping of endosteum and defects in cortical layer and little of soft tissue occupation nearby.
      Any of possible diagnosis could be found in this age group and could provoke pain.
      Maybe chondrosarcoma is little less possible because of lack of calcification- but it isn’t patognomonic.


      4.any of the above

    6. Dr. Pepe says:

      Four answers and three choices. Good!

    7. gus says:

      i say any of the above but my first choice is metastasis.
      The patient has gynecomastia, pericardiac fat deposition and parasternal lymph nodes .
      i can see pericardial calcification on the level of sternal mass on sagital view.

    8. Fares says:

      Lucent lesions of the sternum should be considered malignant until proven otherwise.
      For the age of patient we consider metastasis as first DD.

    9. Iffat Rehman says:

      Mets in this age group unless proven otherwise…

    10. All answers are posible in this case.

    11. mahendra says:

      Metastasis is the first possibility

    12. Ahmed Abdelwahed says:

      I think I will go for Mets (age group)
      lack of chindroid matrix mineralization can somehow exclude chondrosarcoma
      while absence of adjacent soft tissues significant inflammatory reaction is not In the favour of osteomyelitis

    13. Jose M Negron Soto says:

      Lytic lesion in the body of the sternum: DDx metastatic lesion, myeloma/plasmacytoma, lymphoma, infection (osteomyelitis).

    14. Osama says:

      any of the above

    15. Sana says:


    16. Kathy says:

      Metástasis si te best choice.

    17. Baroth says:

      1. Metastases

    18. Dr. Pepe says:

      Dear friends, I believe most of you are right. Although any of the conditions is possible, metastases should be the most likely diagnosis.
      See differential diagnosis tomorrow, as well as other processes.
      Have a nice weekend.
      Special mention to Genchi Bari: no more football until August!

    19. PABLO REYES says: