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.