Rare progression of cholangiocarcinoma: distal femoral metastasis

Abstract

Cholangiocarcinoma (CCA) is a rare cancer of the bile duct epithelial cells, with metastases to long bones rarely reported. We present the case of a woman aged 61 years, diagnosed with CCA 6 years previously. She presented with right thigh discomfort, rapidly progressing to immobility with severe pain. Radiological investigations revealed a lytic lesion in her right distal femur, most likely a metastatic deposit, at high risk of pathological fracture. This was managed with an en bloc resection and implantation of a distal femoral replacement. Pathology specimens from theatre confirmed metastatic CCA. Despite sustaining a subsequent fractured neck of femur on the operative side, she recovered well from surgery, with minimal pain and improved mobility on discharge. She restarted palliative chemotherapy. This case illustrates the option of definitive major surgery for the management of metastatic bone disease. As in this case, this can lead to improved symptom control and quality of remaining life.

Bone metastasis from cholangiocarcinoma mimicking osteosarcoma: A case report and review literature

“…Only five cases of metastasis to the appendicular skeleton from CCA have been reported in the literature to date ( Table I). The most commonly reported sites of bone metastasis are the humerus, fibula and femur (8)(9)(10)(11)(12). To the best of our knowledge, this is the first report of a scapular metastasis from CCA to date.…”

Pathological Clavicle Fracture: Initial Presentation of Intrahepatic Cholangiocarcinoma

“…ICC is a rare tumor and results in early mortality. Five-year survival in patients undergoing surgical resection is less than 5% [13][14]. Metastasis in the ICC is mostly lymphatic to the regional lymph nodes and hematogenously to the organs such as the lungs, adrenal gland, brain, and peritoneum [1,8].…”

“…Karanjia et al reported a case with distal fibular metastasis secondary to ICC [12]. MacKenzie et al treated distal femoral metastasis with en bloc resection and tumor prosthesis in a patient with known ICC [14]. Chindaprasirt et al presented an ICC case with scapular bone and surrounding soft metastasis [15].…”

Paraparesis and Disseminated Osteolytic Lesions Revealing Cholangiocarcinoma: A Case Report

“…Few cases of bone metastasis from CCA are described in the literature, and the most commonly reported sites were the humerus, the fibula, the femoral bone [ 8 ], and the scapula [ 9 - 11 ]. In our case, multiple osteolytic lesions with a malignant aspect were discovered in the coxal bone, the sacrum, and the left proximal femoral region, as well as in the calvarium and spine.…”