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

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, The Hospital for Rheumatic Disease, Hanyang University College of Medicine, Seoul, Korea. thkim@hanyang.ac.kr

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

  • 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)


Reference

1). Hur JW., Kim TH. Pathogenesis of ankylosing spondylitis. J Korean Rheum Assoc. 2005. 12:163–72.
2). Yang CH., Jeong MK., Lee HJ., Lee YH., Yoon KY., Kim JS, et al. Multiple myeloma combined with ankylosing spondylitis. Korean J Med. 1985. 28:560–6.
3). Choi BY., Park YB., Lee JH., Ryu HJ., Lee EY., Lee YJ, et al. A case of ankylosing spondylitis accompanying sarcoidosis. J Korean Rheum Assoc. 2007. 14:251–5.
Article
4). Kim YN., Lee HE., Lee SH., Lee YA., Woo DH., Hwangbo Y, et al. Ankylosing spondylitis Associated with plasmacytoma. J Korean Rheum Assoc. 2005. 12:240–4.
5). Stone MA., Pomeroy E., Keat A., Sengupta R., Hickey S., Dieppe P, et al. Assessment of flares in ankylosing spondylitis disease activity using the flare illustration. Rheumatology. 2008. 47:1213–8.
6). Geusens P., Vosse D., Linden S. Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol. 2008. 19:335–9.
Article
7). Roodman GD. Mechanism of bone metastasis. N Engl J MED. 2004. 350:1655–64.
8). Brophy S., Calin A. Definition of disease flare in ankylosing spondylitis; the patients' perspective. J Rheumatol. 2002. 29:954–8.
9). Ozgocmen S., Godekmerdan A., Ozkurt-Zengin F. Acute phase response, clinical measures and disease activity in ankylosing spondylitis. Joint Bone Spine. 2007. 74:249–53.
10). Deyo RA., Weinstein JN. Low back pain. N Engl J Med. 2001. 344:363–70.
Article
11). Atlas SJ., Nardin RA. Evaluation and treatment of low back pain: an evidence based approach to clinical care. Muscle Nerve. 2003. 27:265–84.
12). Goh L., Suresh P., Gafoor A., Hughes P., Hickling P. Disease activity in longstanding ankylosing spondylitis- a correlation of clinical and magnetic resonance imaging findings. Clin Rheumatol. 2008. 27:449–55.
13). Coleman RE. Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev. 2001. 27:165–76.
Article
Full Text Links
  • JKRA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr