J Korean Rheum Assoc.  2010 Mar;17(1):81-85. 10.4078/jkra.2010.17.1.81.

A Case of Ankylosing Spondylitis with Spinal Metastasis of Cholangiocarcinoma

• Sohn IW
• Bang SY
• Kim D
• Kim TH

• KMID: 2201998
• DOI: http://doi.org/10.4078/jkra.2010.17.1.81

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.

Keyword

Ankylosing spondylitis; Cholangiocarcinoma; Back pain

MeSH Terms

Adult
Back Pain
Bone Diseases
Cholangiocarcinoma
Discitis
Humans
Low Back Pain
Neoplasm Metastasis
Spondylitis, Ankylosing

Figure

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  Fig. 1. Pelvis AP shows the erosive change and sclerosis of the bilateral sacroiliac joints.

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  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.

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  Fig. 3. Spiral computed tomography (CT) revealed a huge liver mass (A) Arterial phase (B) Portal phase.

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  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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