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

Abstract

Cholangiocarcinoma is an aggressive tumor of the hepatic biliary system and it commonly spreads to the regional lymph nodes, liver and lungs. However, bone metastasis from cholangiocarcinoma is rare compared with other tumors. We herein present the case of a 61-year-old Asian woman who presented with pain in the right scapular area. Magnetic resonance imaging revealed bone destruction and an adjacent soft tissue mass at the right scapula. The findings on computed tomography imaging were compatible with cholangiocarcinoma. Bone biopsy was performed and the diagnosis of cholangiocarcinoma with bone metastasis was confirmed. The survival time was 10 months, despite administration of palliative radiotherapy and chemotherapy. Therefore, bone metastasis from cholangiocarcinoma should be considered as a differential diagnosis in patients who present with an osteolytic bone lesion and a liver mass.

Keywords: biliary tract neoplasm; bone metastasis; cholangiocarcinoma.

Figure 1.

(A) Magnetic resonance imaging examination of the right shoulder showing destruction of nearly the entire right scapula, with an adjacent extraosseous soft tissue mass encasing the neurovascular bundle. (B) Bone scintigraphy revealed multiple bone metastases to the skull, mid-cervical vertebrae, T4, L1-2 and L4-5 vertebrae, pelvis, left proximal femur, right scapula, right humerus, proximal right forearm, lateral aspect of the right 8th rib and posterior aspect of the right 9th rib. (C) A computed tomography scan of the whole abdomen revealed an ill-defined hypodense lesion at hepatic segment 7/6 with subcapsular retraction, compatible with cholangiocarcinoma.

Figure 2.

A histological examination of the scapular mass revealed bone invasion by neoplastic cells arranged in cords and glandular formations, with a desmoplastic stromal reaction, resembling metastatic adenocarcinoma. Hematoxylin and eosin staining; magnification, ×200.