A Case of Paraaortic Lymph Node Swelling Diagnosed as Metastasis from Intrahepatic Bile Duct Cancer following Laparoscopic Retroperitoneal Resection

Abstract

A 71-year-old woman who was incidentally detected to have an abnormality in an upper gastrointestinal series in a medical inspection was referred to the department of internal medicine. For the past 10 years from the age 56 to 66, she had been followed for a liver cystic tumor elsewhere, and the follow-up was terminated 5 years before. She was detected having a paraaortic lymph node swelling without any other primary malignancy through screening examinations. In order to make a definitive diagnosis, she was introduced to our department to resect the lymph node followed by pathological examination. She underwent a retroperitoneal laparoscopic resection for the lymph node swelling. She could resume oral ingestion on the next day and was discharged 4 days after the surgery uneventfully. Pathological findings showed that the lymph node swelling was metastasis from adenocarcinoma. Additional PET-CT examination revealed an abnormal uptake of FDG at the liver cystic tumor. She was referred to her previous doctor and chemotherapy was started under the definite diagnosis of paraaortic lymph node metastasis of intrahepatic bile duct cancer. We consider that laparoscopic retroperitoneal resection can be a promising approach for paraaortic lymph node biopsy.