J Korean Soc Radiol.  2017 Oct;77(4):217-221. 10.3348/jksr.2017.77.4.217.

Intrahepatic Cholangiocarcinoma Initially Presented as a Distant Metastatic Lymph Node without Demonstrable Hepatic Mass: A Case Report

• Kwon LM
• Ha HI
• Kim MJ
• Lee K
• Kwon MJ

• KMID: 2392117
• DOI: http://doi.org/10.3348/jksr.2017.77.4.217

Abstract

This report describes a rare case of intrahepatic cholangiocarcinoma, initially presented as a distant metastatic lymph node without demonstrable hepatic mass, in a 37-year-old man. Initially, a solitary cystic mass around the common hepatic artery was detected; two years later, a mass-forming intrahepatic cholangiocarcinoma developed in the left lobe of the liver. The cystic mass showed no change in shape and size for two years, which was then confirmed as a distant metastatic lymph node of cholangiocarcinoma after surgery. This was an extraordinary clinical manifestation of the intrahepatic cholangiocarcinoma, which presented as a cavity lymphadenopathy with unknown primary site, in addition to favorable clinical course with stable size and shape for 2 years. After literature reviews, we discuss in this paper the possible mechanism of cancer of unknown primary in intrahepatic cholangiocarcinoma, and the prognostic factors involved.

MeSH Terms

Adult
Bone Cysts
Cholangiocarcinoma*
Hepatic Artery
Humans
Liver
Lymph Nodes*
Lymphatic Diseases
Neoplasm Metastasis
Prognosis

Figure

• 

  Fig. 1 Intrahepatic cholangiocarcinoma in a 37-year-old man, initially presented as a distant metastatic lymph node without demonstrable hepatic mass. A. Contrast-enhanced CT scan shows a 2.7-cm well-defined cystic mass (arrow) around the common hepatic artery, with no demonstrable hepatic mass. B. After two years, follow up contrast enhanced CT scan reveals a presumed cystic mass around the common hepatic artery without interval change (arrow). However, an approximately 4.5-cm hepatic mass (arrowheads) is newly identified. C. The newly identified cystic mass shows intermediate signal intensity on axial T2-weighted MR image (arrow). D. The newly identified cystic mass shows focally eccentric enhancing wall thickening on contrast-enhanced axial T1-weighted MR image (arrowheads). E. The gross specimen photograph of the cystic mass shows cavitary mass with irregularly thickened wall, and having internal hemorrhage. F. Photomicrograph (hematoxylin and eosin staining, × 100) of the cystic mass confirms the necrotic and hemorrhagic change of metastatic lymph node.

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