A Metachronous Gastric Metastasis from Intrahepatic Cholangiocarcinoma

We report a case of a 68-year-old woman, who underwent extended right hepatectomy with extrahepatic bile duct resection for intrahepatic cholangiocarcinoma (ICC). Histopathological examination showed a mass-forming type of ICC and no lymph node metastasis. Adjuvant chemotherapy with gemcitabine and cisplatin was performed for 6 months after operation, and S-1 was administered intermittently from 11 months after operation, because the serum CA19-9 level was elevated without imaging evidence of recurrence. She presented with nausea and vomiting 32 months after operation. Upper gastrointestinal endoscopy showed pyloric stenosis. Enhanced CT showed a circumferential submucosal thickening of the pyloric wall. Distal gastrectomy was performed, and we considered a diagnosis of gastric cancer or metastatic gastric cancer from ICC. Histological findings of the gastric lesion were compatible with metastasis of ICC. Immunohistochemical staining of CK19 and CA19-9 were positive in both the primary and metastatic lesions. To the best of our knowledge, this is the first case of metachronous gastric metastasis from ICC.