Images of Memorable Cases: Cases 135, 136, 137 & 138 135 This 42-year-old woman had generalized lymphadenopathy, hepatosplenomegaly, and several hard, nonpainful, sternal masses. 136 This 60-year-old man had hematuria and a pulsatile sternal mass. 137 This 63-year-old man had a large, rounded, nontender, firm mass in the area of the right sternoclavicular joint. He was afebrile but had anemia, proteinuria, and renal insufficiency. 138 This 76-year-old woman presented with jaundice and a mass in the upper part of her sternum. 135. Hodgkin’s disease Involving the sternum. 136. Renal cell carcinoma Metastatic to the sternum. 137. Multiple myeloma With plasmacytoma involving the right sternoclavicular joint. 138. Pancreatic carcinoma Metastatic to the sternum. Most sternal masses represent metastases. The primary tumor is usually lymphoma, multiple myeloma, or carcinoma of the breast, kidney, or thyroid. Pulsation of the mass strongly suggests multiple myeloma or metastases from renal or thyroid carcinoma. Primary sternal tumors are almost always malignant and typically are chondrosarcomas. In some cases, sternal swelling signals infection (e.g., tuberculosis, coccidioidomycosis, aspergillosis, brucellosis, and staphylococcal or pseudomonal disease).