A Case of Ankylosing Spondylitis with Spinal Metastasis of Cholangiocarcinoma

Il Woong Sohn; So Young Bang; Dam Kim; Tae Hwan Kim

doi:10.4078/jkra.2010.17.1.81

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Sohn, Bang, Kim, and Kim: A Case of Ankylosing Spondylitis with Spinal Metastasis of Cholangiocarcinoma

Original Article

J Korean Rheum Assoc 2010;17(1):81-85.

Published online: 23 March 2010

DOI: https://doi.org/10.4078/jkra.2010.17.1.81

A Case of Ankylosing Spondylitis with Spinal Metastasis of Cholangiocarcinoma

Il Woong Sohn, So Young Bang, Dam Kim, Tae Hwan Kim

Division of Rheumatology, Department of Internal Medicine, The Hospital for Rheumatic Disease, Hanyang University College of Medicine, Seoul, Korea

Received 25 September 200929 October 2009 Accepted 30 October 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Back pain is the most common symptom of ankylosing spondylitis (AS). The aggravation of back pain in AS patients is usually thought to be a flare-up of the disease activity. We report here on the case of a 31-year-old AS patient with low back pain. The lesions of this patient were unexpectedly diagnosed as metastatic spinal tumor due to cholangiocarcinoma. In a patient with AS, an acute aggravation of low back pain may be due to other pathologic conditions such as osteoporotic vertebral fracture, vertebral discitis and metastatic bone disease. Therefore, when a patient with AS presents with nonspecific low back pain, a physician should consider the above mentioned conditions.

Keywords: Ankylosing spondylitis, Cholangiocarcinoma, Back pain

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Fig. 1.

Pelvis AP shows the erosive change and sclerosis of the bilateral sacroiliac joints.

Fig. 2.

MRI of the lower spine shows multiple signal changes with heterogenous enhancement in the bone marrow of the thoracolumbar spine and sacrum (A) T2W fat suppressed image (B) T1W image with enhancement.

Fig. 3.

Spiral computed tomography (CT) revealed a huge liver mass (A) Arterial phase (B) Portal phase.

Fig. 4.

(A) Liver biopsy shows cholangiocarcinoma glands invading into the liver parenchyma (H&E stain, ×400) (B) The infiltrating tumor cells contained in the ductal lumen and the accompanying desmoplastic change of the stroma (H&E stain, ×400)

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