A case of isolated metastasis to right level II cervical lymph node from intrahepatic cholangiocarcinoma

Cervical lymphadenopathy is a common reason for referral to the Otolaryngology – Head & Neck Surgery clinic. The differential diagnosis is broad, and can include infectious, traumatic, anatomical, and neoplastic etiologies. Cervical lymph nodes are the primary site of metastasis for head and neck cancers, but have also been implicated in other forms of cancer, including primary tumors of the lung, gastrointestinal tract, and breast. The current case report outlines the diagnosis of metastatic intrahepatic cholangiocarcinoma, originally presenting as an isolated level II neck mass in an otherwise asymptomatic patient. Diagnosis was completed using a combination of radiological imaging, biopsy, and tumor biomarkers. This case report is the first with isolated metastasis to the level II nodal group from intrahepatic cholangiocarcinoma in an otherwise asymptomatic patient, and is the first to describe the specific treatment utilized in such a case. Neck mass evaluation is a common consult for all otolaryngologists. This case highlights the importance of both maintaining a broad differential when evaluating neck masses and when searching for a cancer with unknown primary.