title: 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.
authors.affiliation: Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Sam A
authors.initials: SA
authors.lastname: MacKenzie
authors.affiliation: Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Joaquim Stanislas Olivier
authors.initials: JS
authors.lastname: Goffin
authors.affiliation: University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK.
authors.forename: Conor
authors.initials: C
authors.lastname: Rankin
authors.affiliation: Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Carter
mesh_terms: D001650:Bile Duct Neoplasms / Q000188:drug therapy / Q000473:pathology*; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000188:drug therapy / Q000473:pathology*; D018450:Disease Progression; D004358:Drug Therapy; D005260:Female; D005269:Femur / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D010166:Palliative Care; D016896:Treatment Outcome