Klatskintumor

Klatskin
tumor during ERC. The patient lies on his stomach obliquely, so that the left side of image corresponds to the patient"s left side. In the left and right biliary system, a wire is placed, which is required for the subsequent insertion of stents to drain bile. Both parts were injected with contrast through a tube. The lack of contrast in the area of the confluence is clearly visible, where the wires run parallel.
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ERC: stents
placed in the left and right bile duct. At the right, the contrast that has been given before is already well-drained, making the bile ducts clearly recognizable due to the intruding air.
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CT and MR
imaging of primary biliary cholangitis: a pictorial review. A 54-year-old male with HBV (hepatitis B virus) infection. Moderate hyperintensity nodule with a poorly defined boundary was observed in the T2WI image in the hilar region of the liver (arrow) (a); a nodular lesion adjacent to the portal venous confluence and the right branch shows marked enhancement on the PVP image (arrow) (b); and the MRCP image shows abrupt interruptions without tapering presented in the hepatic hilar bile ducts (arrow) with vine-like dilatation of the intrahepatic bile ducts (c). Pathological confirmation after surgical resection: cholangiocarcinoma of the hilar
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Klatskin tumor is a term that was traditionally given to a hilar (perihilar) 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.

Epidemiology

They are thought to account for up to 25% of all cholangiocarcinomas .

Pathology

Classification

Prognostic staging is defined by the TNM system: perihilar cholangiocarcinoma (staging).

The Bismuth-Corlette system is an anatomic classification well known by surgeons used for preoperative assessment.

Radiographic features

For general imaging features of a cholangiocarcinoma, refer to the main article.

Ultrasound

The presence of a hilar mass with obstruction would raise concern on ultrasound. The reported echotexture according to one study :

  • increased echogenicity relative to surrounding liver ~80%
  • reduced echogenicity ~20%
  • mixed echogenicity ~2%

Ultrasound may also show an intraluminal mass extending into the bile duct and in a small proportion of cases (4%), there may also be evidence of bile duct wall thickening.

CT

CT demonstrates the intrahepatic biliary radical dilatation. The tumor mass itself is ill-defined and usually invisible, but hilar necrotic lymph nodes or hepatic metastatic deposits can be identified.

MRI/MRCP

MRCP with its 3D capability is superior to CT to delineate the degree and location of the biliary tree stricture. It is the gold standard method for diagnosis of hilar cholangiocarcinoma. Shouldering and abrupt tapering at the stricture site suggests the diagnosis. Identifying the exact location and involvement can help in preoperative classification.

History and etymology

It is named after Gerald Klatskin (1910-86), American pathologist, New York.

Differential diagnosis

Imaging differential considerations include:

See also

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Klatskintumor:
biliäre
Papillomatose
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