A long-term survival case of metachronous para-aortic lymph node metastasis from intrahepatic cholangiocarcinoma, staining in the early phase with chronic virus-related hepatitis

Lymph node metastasis is one of the most serious prognostic factors in patients with intrahepatic cholangiocarcinoma. Furthermore, treatment of recurrent intrahepatic cholangiocarcinoma is difficult. We report a rare case of long-term survival in a patient who had metachronous para-aortic lymph node metastasis from intrahepatic cholangiocarcinoma. A 70-year-old man was followed up after endoscopic mu-cosal resection for esophageal cancer and referred to our section with space-occupying lesion of the liver. Computed tomography (CT) demonstrated a 3.0-cm-diameter tumor located in S6, which was hy-perattenuated in the early phase. Tumor cells were heptitis B antigen positive. He underwent partial hepatectomy under a preoperative diagnosis of hepatocellular carcinoma. The histopathological diagnosis was intrahepatic cholangiocarcinoma. At 16 months after the first operation, CT showed a swollen lymph node behind the inferior vena cava. After the second operation, we diagnosed metachronous para-aortic lymph node metastasis of intrahepatic cholangiocarcinoma. At 26 months after the first operation, a swollen lymph node around the celiac artery was found. He underwent a third operation at another institution. The histopathological findings were moderately differentiated adenocarcinoma, which was the same as the previously resected tumors. The patient is still alive without recurrence 3 years after the third resection and over 5 years after the first operation.