Pulmonary metastasis of distal cholangiocarcinoma with multiple cavities in bilateral lungs: A case report

Cholangiocarcinoma is a type of malignant tumor derived from the epithelium of the bile duct. Cases of cholangiocarcinoma metastasis to the lung are rare, especially those with imaging features of multiple cavities in bilateral lungs. Here, we report a case of a patient who had previously undergone radical resection of primary distal cholangiocarcinoma 18 months ago. Transbronchoscopic lung biopsy of the right lung and biopsy of the left supraclavicular lymph node were performed for pathology confirmation, as well as immunohistochemistry. Multiple cavity shadows in bilateral lungs and enlarged lymph nodes were found on the computed tomography (CT) scan obtained 18 months postoperatively. No obviously enlarged lymph nodes were observed under the carina and beside the aortic arch, whereas enlarged lymph nodes were found above the left clavicle. Biopsy of lung and supraclavicular lymph nodes confirmed metastatic adenocarcinoma. Immunohistochemistry showed that it originated from the digestive tract and had the same homology as cholangiocarcinoma (CK19 +, Villin +). Cholangiocarcinoma can be transferred to the lung and the left supraclavicular lymph nodes through the lymphatic pathway by characteristic jumping lymph node metastases. Diffuse cystic change is a specific CT manifestation of the lymphatic lung metastasis of cholangiocarcinoma.