Es va derivar un home de 62 anys al nostre hospital per a l'examen d'un tumor hepàtic en el lòbul hepàtic esquerre. Tenia diabetis mellitus i una infecció prèvia pel virus de l'hepatitis B. Els resultats de les proves de laboratori per a l'antigen carcinoembrionari (CEA) i l'antigen carbohidrat 19-9 (CA 19-9) no van ser destacables. Les exploracions per tomografia computada (CT) de l'abdomen i la ressonància magnètica potenciada en àcid gadoxètic (EOB-MRI) van revelar un tumor hipovascularitzat, de 30 mm de mida en el segment hepàtic 2 (S2), i sense engrandiment dels ganglis limfàtics regionals. Es va realitzar una biòpsia hepàtica per a l'anàlisi del tumor. Un examen histopatològic va mostrar un adenocarcinoma. En la immunohistoquímica, les cèl·lules del carcinoma van ser positives per a la citoqueratina 7 (CK7), CA 19-9, i EMA, i negatives per a CK20, a-fetoproteïna, i factor de transcripció tiroïdal 1 (TTF-1). Es va diagnosticar al pacient un tipus de ICC que formava una massa (MF). Es va realitzar una secció lateral esquerra, amb dissecció de ganglis limfàtics regionals al llarg de les artèries hepàtiques dreta, esquerra i mitjana i la branca superior de l'artèria gàstrica esquerra. L'examen histopatològic va mostrar un adenocarcinoma moderadament diferenciat en el segment hepàtic S2, amb una metàstasi de gangli limfàtic al voltant de la vena porta en el lligament hepatoduodenal i la invasió de la branca superior de la vena porta en el tumor principal. Hi havia dues metàstasis intrahepàtiques en el mateix S2 al voltant del tumor principal. Segons la vuitena edició del sistema d'estadificació TNM de la Unió Internacional per al Control del Càncer [], l'estadi patològic de la ICC va ser pT2pN1M0pStageIIIB. El curs postoperatori va ser sense incidents, i el pacient va ser donat d'alta el desè dia postoperatori. Tot i que se li va recomanar la quimioteràpia adjuvant perquè hi havia una alta possibilitat de recurrència del carcinoma, es va negar a sotmetre-s'hi. Twelve months after surgery, liver lesions in S4/S8 and S7 were detected on CT scans. No other liver lesions were found using EOB-MRI. On positron emission tomography-computed tomography (PET-CT), abnormal fluorodeoxyglucose (FDG) uptake was observed only in hepatic tumors, and extrahepatic lesions were not detected. Neither CEA nor CA 19-9 was elevated. The patient wanted a second opinion on treatment other than surgery and chemotherapy. After observation for 3 months, the size of two recurrent liver tumors was slightly larger compared with that observed 3 months ago. However, without developing any other lesions, he underwent a partial hepatectomy for each lesion. A pathological examination of both resected tumors revealed moderately differentiated adenocarcinoma in the center of the tumors, which was similar to that of previous ICC. At the margin of the tumors, poorly differentiated adenocarcinoma was detected. On immunohistochemistry, the carcinoma cells were positive for CK 7 and negative for CK 20 and TTF-1. Histopathological features were similar to those of the previous ICC; therefore, the patient was diagnosed with recurrence of ICC. He was discharged on the seventh postoperative day. Although the adjuvant chemotherapy was repeatedly recommended to him, he refused to undergo the therapy after the repeat hepatectomy. Four years and four months after the repeat hepatectomy, CT scans showed multiple nodes in S4 and S10 of the left lung and in S1 of the right lung. On PET-CT, FDG uptake was observed only in S4 of the left lung. After observation for 3 months, the size and number of tumors did not change. Therefore, wedge resection of the left upper lobe and sectionectomy of S10 of the left lung were performed. The histopathological findings of the resected lung nodules were compatible with metastatic ICC. On immunohistochemistry, the carcinoma cells were positive for CK 7 and negative for CK 20 and TTF-1. The nodule noted in S1 of the right lung was too small to be diagnosed for metastasis; therefore, it was not resected. After pulmonary resection, He was treated with gemcitabine (1000 mg/m2) and cisplatin (25 mg/m2) which were infused on day 1 and day 8. This regimen was repeated at 21-day intervals for 6 months. After chemotherapy, the size of the nodule in S1 of the right lung increased gradually. One year and ten months after the pulmonary resection, we confirmed that there were no other metastatic lesions and we performed a wedge resection of S1 of the right lung. Histopathological findings were compatible with metastatic ICC. On immunohistochemistry, the carcinoma cells were positive for CK 7 and negative for CK 20 and TTF-1. The patient is alive without evidence of disease 8 years after the initial surgery and 8 months after the last pulmonary resection.