Rapidly aggravated skeletal muscle metastases from an intrahepatic cholangiocarcinoma

Figure 1 Computed tomography, magnetic resonance cholangiopancreatography, and positron-emission tomography-computed tomography showing an intrahepatic cholangiocalcinoma in the liver at first diagnosis. A: Computed tomography axial scan shows an ill-defined, low-attenuation mass in segments S1 and S5 of the liver; B: Contrast-enhanced, T1-weighted, axial image shows the 6-cm, peripherally enhanced mass in segments S1, S5, and S8; C and D: In the positron-emission tomography-computed tomography images, an area of strong hypermetabolism is noted (arrows), corresponding to the 6-cm soft tissue mass in the liver (maximum standardized uptake value, 10.4).

Figure 2 Histopatholgic findings. A and C: Liver shows a poorly differentiated cholangiocarcinoma. (hematoxylin and eosin, x 40, x 400); B: Skeletal muscle tissue shows metastasis of a poorly differentiated cholangiocarcinoma (hematoxylin and eosin, x 40); D and E: Neoplastic glands were positive in cytokeratin 7 and cytokeratin 19 staining (immunostain, x 400).

Figure 3 Thoracolumbar spine magnetic resonance imaging and positron-emission tomography-computed tomography images show multiple skeletal metastases in a whole body scan after 3 mo of palliative radiochemotherapy from first diagnosis. A and B: T2-weighted, axial images show ill-defined, high signal intensity masses in the psoas and paraspinal muscles; C and D: Positron-emission tomography-computed tomography (PET-CT) images show multiple masses with hypermetabolism in the paravertebral area, left upper arm, bilateral periscapular area, anterior and posterior chest walls, bilateral psoas muscles, lower anterior abdominal wall, bilateral gluteal muscles, and both proximal thigh muscles; E and F: Follow-up PET-CT images show aggravated multiple muscle metastasis after 3 and 7 mo of gemcitabine-cisplatin combination chemotherapy.