Metastatic Cholangiocarcinoma in the Absence of Jaundice Presenting with Neck Swelling in District Hospital

Introduction: Cholangiocarcinoma is a malignancy arising from biliary epithelium with incidence rate of less than 2 in 100000. It is the second most common primary liver malignancy. Cholangiocarcinoma usually presents with jaundice with or without abdominal pain. In advanced cholangiocarcinoma, it is extremely rare for cervical swelling to be the initial complaint and presentation.
Case Presentation: A 69-year-old male with underlying diabetes mellitus presented to surgical clinic with painful neck cervical swelling for 1 month with no other associated symptoms. Blood investigations were within normal range. Contrast enhanced computer tomography showed multiple enlarged lymph nodes over the axilla, mediastinal and supraclavicular with small hypodense lesion identified at Segment IV of the liver. Excision biopsy of left supraclavicular was performed which revealed metastatic adenocarcinoma. Immunohistochemistry study with an elevated Ca 19.9 tumour marker confirmed the diagnosis of metastatic cholangiocarcinoma.
Conclusion: Metastatic cholangiocarcinoma presenting with neck swelling in the absence of jaundice is a rare occurrence and confer diagnostic challenge especially in district hospital. Availability of immunohistochemical study is of paramount important in establishing the diagnosis.