Presentation
Pain and swelling of the right eye with proptosis. Pain and numbness in the left jaw.
Patient Data
Numerous lytic lesions within the skull and calvarium, many of these associated with epidural extension.
Additionally, there is a mass arising from the right orbital roof, extending to the right orbit and the right anterior cranial fossa. This results in proptosis.
Right orbital roof has been replaced by an expansile, T1 hypointense/T2 slightly hyperintense lesion that demonstrates nodular marginal enhancement. Mass effect on adjacent right frontal lobe and globe causing right exophthalmos.
T1/T2 isointense, enhancing lesions are seen throughout the calvarium. Many of these involve both the inner and outer tables and extend to the epidural space.
Case Discussion
This patient had further imaging, including a CT of the chest, abdomen, and pelvis with contrast, and a PET-CT. Multiple hepatic lesions were found, as well as multiple lytic bone lesions involving the spine and ribs.
Core biopsy of the liver mass suggested intrahepatic cholangiocarcinoma (ICC) as the primary malignant tumor, and the numerous extrahepatic lesions were consistent with extensive bone metastases, involving the skull, spine, and ribs.
ICC is the second most common primary liver cancer and is more invasive with a higher metastasis rate compared to hepatocellular carcinoma. Studies show that around 11% of patients with ICC develop bone metastases, and their outcome is worse in comparison to patients with liver involvement only 1.
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