A case of metachronous intrahepatic cholangiocarcinoma after curative surgery for extrahepatic cholangiocarcinoma

Abstract

A 69-year-old man, who had undergone extrahepatic bile duct resection for extrahepatic cholangiocarcinoma (papillary adenocarcinoma, pStage IA) 11 years ago presented with fever. He was admitted and diagnosed as acute cholangitis and liver abscess. After resolving with antibiotic therapy, further evaluation was needed due to an elevated tumor marker. Contrast-enhanced CT images revealed a 35-mm mass in segment IV of the liver, which was involving the left branch of portal vain and middle hepatic vein. He was diagnosed as metachronous intrahepatic cholangiocarcinoma, and underwent left lobectomy and left caudate lobectomy with middle hepatic vein resection. Pathological examination revealed well differentiated adenocarcinoma and no evidence of any vascular infiltration. Final diagnosis was Stage II intrahepatic cholangiocarcinoma, and no recurrence was confirmed under 3 years follow-up. Multiple primary cancers of intrahepatic and extrahepatic cholangiocarcinoma were rare; however, it should be noted that a careful follow-up is needed in patients after curative surgery for cholangiocarcinoma, especially in patients with newly onset cholangitis, for early diagnosis of recurrent or metachronous cholangiocarcinoma.