MacKenzie Sam A, Goffin Joaquim Stanislas Olivier, Rankin Conor, Carter Tom
Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK.
BMJ Case Rep. 2017 Mar 27;2017:bcr2016218616. doi: 10.1136/bcr-2016-218616.
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.
胆管癌（CCA）是一种罕见的胆管上皮细胞癌，很少有转移至长骨的报道。我们报告一例61岁女性病例，该患者6年前被诊断为CCA。她因右大腿不适就诊，病情迅速发展至无法活动并伴有剧痛。影像学检查显示其右股骨远端有一溶骨性病变，很可能是转移性病灶，有发生病理性骨折的高风险。对此采用了整块切除并植入远端股骨假体进行治疗。术中病理标本证实为转移性CCA。尽管术后手术侧随后发生了股骨颈骨折，但她术后恢复良好，出院时疼痛轻微且活动能力有所改善。她重新开始了姑息性化疗。该病例说明了对于转移性骨病可选择确定性的大手术治疗。就像本病例一样，这可以改善症状控制并提高剩余生命的质量。
