Anterior Mediastinal Lymph Node Metastasis of Intrahepatic Cholangiocarcinoma: A Case Report and Literature Review.

Introduction: Intrahepatic cholangiocarcinoma (ICC) is the second most common liver malignant tumor with a poor prognosis. Lymph node (LN) metastasis is found in 15% of ICC at the time of initial diagnosis. However, the LN metastasis to the anterior mediastinum is extremely rare. Herein, we report a case of anterior mediastinal LN metastasis of ICC.

Case presentation: The patient is a 74-year-old man who had surgery for cervical esophageal cancer. During follow-up, a low-density hepatic tumor and swollen LNs in the anterior mediastinum were detected. The tumor of the liver was diagnosed as ICC by needle biopsy. Excisional biopsy of the LN was performed and the diagnosis was metastasis of ICC. Because the prognosis of the patient with ICC Stage IVB is poor, the patient received 8 courses of chemotherapy. Although the new lesion appeared next to the main tumor, these tumors were located in the left liver. In addition, it was difficult for the patient to continue the chemotherapy due to the renal dysfunction. Hepatectomy with lymphadenectomy was performed. The patient survives without recurrence for 9 months after surgery. This is the first report of anterior mediastinal metastasis of ICC without any other organ involvement.

Conclusions: Metastasis to the anterior mediastinum of hepatic tumor can be explained by the system that lymphatic fluid running under the capsule of the liver drains to the anterior mediastinal LNs through the coronary ligament. Metastasis of ICC to mediastinal LNs can occur when the tumor is located at the surface of the liver. Excisional biopsy is effective in determining the accurate disease stage and the treatment strategy.