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Table of Contents
CASE REPORT
Year : 2018  |  Volume : 15  |  Issue : 3  |  Page : 175-176

Klatskin tumor (hilar cholangiocarcinoma)


Department of Radiology, St. John's Medical College, Bengaluru, Karnataka, India

Date of Web Publication10-Sep-2018

Correspondence Address:
Reddy Ravikanth
Department of Radiology, St. John's Medical College, Bengaluru - 560 034, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_16_18

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  Abstract 


Klatskin tumor is a term that was given to a hilar cholangiocarcinoma, occurring at the bifurcation of the common hepatic duct. Typically, these tumors are small, poorly differentiated, exhibit aggressive biologic behavior, and tend to obstruct the intrahepatic bile ducts. Here, we present the multidetector computed tomography findings in a case of hilar cholangiocarcinoma.

Keywords: Hilar cholangiocarcinoma, Klatskin tumor, multidetector computed tomography


How to cite this article:
Ravikanth R, Pinto DS. Klatskin tumor (hilar cholangiocarcinoma). Apollo Med 2018;15:175-6

How to cite this URL:
Ravikanth R, Pinto DS. Klatskin tumor (hilar cholangiocarcinoma). Apollo Med [serial online] 2018 [cited 2019 Oct 22];15:175-6. Available from: http://www.apollomedicine.org/text.asp?2018/15/3/175/240936




  Introduction Top


Hilar cholangiocarcinoma is a rare malignant tumor arising from the epithelium of the bile ducts. Surgery is still the only chance of potentially curative treatment in patients with perihilar cholangiocarcinoma and should be tailored optimally according to the location, size, and vascular invasion of the tumors. Accurate diagnosis and staging of these tumors is, therefore, critical for optimal management.

Portal venous involvement in cholangiocarcinoma is encasement and narrowing of the vessel more than luminal invasion, which is usually the pattern of venous involvement by hepatocellular carcinoma.


  Case Report Top


A 60-year-old elderly woman with a history of jaundice, pruritus, dull-aching pain in the right quadrant, and weight loss presented to the emergency department. On examination, vitals were stable. Tenderness was elicited in the right hypochondrial region with hepatomegaly. Blood test showed aspartate aminotransferase 65 U/L, alanine aminotransferase 97 U/L, direct bilirubin 18 mg/dl, total bilirubin 24 mg/dl, and alkaline phosphatase 269 U/L. Imaging workup included contrast-enhanced multidetector computed tomography (MDCT) abdomen. MDCT revealed hepatomegaly with an ill-defined lesion at the biliary confluence showing contrast enhancement in the portal venous and delayed contrast phases [Figure 1]a and [Figure 1]b. Severe intrahepatic biliary radicle dilatation was seen with no portal or hepatic venous thrombosis [Figure 1]c. The findings were suggestive of Klatskin tumor. Diagnosis was confirmed with histologic examination of the surgically resected specimen.
Figure 1: (a) Axial contrast-enhanced computed tomography image demonstrating hepatomegaly with intrahepatic biliary radicle dilatation. (b) Axial contrast-enhanced computed tomography delayed-phase imaging showing ill-defined mass lesion at the confluence of right and left biliary ducts within the porta hepatis. (c) Reformatted coronal contrast-enhanced computed tomography image showing hilar cholangiocarcinoma with extensive proximal intrahepatic biliary radicle dilatation. No portal or hepatic venous thrombosis seen

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  Comments Top


With MDCT, biliary tumors can be correctly identified in nearly 100% of patients.[1] On ultrasound and CT, extrahepatic cholangiocarcinomas can easily be detected because the tumor occludes the bile duct and thus causes dilatation of the proximal bile ducts.[2] MDCT provides better anatomic detail in depicting vascular and extrahepatic invasion and to rule out liver and lymph node metastasis. Further progress in preoperative staging of Klatskin's tumor can be achieved with delayed contrast-enhanced CT scans which improve the detection of tumor proximally beyond second-order bile ducts. Surgical exploration of these patients should be undertaken only when preoperative examination has shown a potential for curative resection because the risks of palliative surgery for malignant obstructive jaundice are high with surgical mortality rates of 20%–30%.[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zech CJ, Schoenberg SO, Reiser M, Helmberger T. Cross-sectional imaging of biliary tumors: Current clinical status and future developments. Eur Radiol 2004;14:1174-87.  Back to cited text no. 1
    
2.
Baron RL, Stanley RJ, Lee JK, Koehler RE, Melson GL, Balfe DM, et al. A prospective comparison of the evaluation of biliary obstruction using computed tomography and ultrasonography. Radiology 1982;145:91-8.  Back to cited text no. 2
    
3.
Whelton MJ, Petrelli M, George P, Young WB, Sherlock S. Carcinoma at the junction of the main hepatic ducts. Q J Med 1969;38:211-30.  Back to cited text no. 3
    


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