Klatskin tumour is a term that was traditionally given to a hilar cholangiocarcinoma, occurring at the bifurcation of the common hepatic duct. Typically, these tumours are small, poorly differentiated, exhibit aggressive biologic behaviour, and tend to obstruct the intrahepatic bile ducts.
They are thought to account for up to 25% of all cholangiocarcinomas 1.
For general imaging features of a cholangiocarcinoma refer to main article.
The presence of a hilar mass with obstruction would raise concern on ultrasound. The reported echotexture according to one study was 5:
- 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 demonstrates the intrahepatic biliary radicle dilatation. The tumour mass itself is ill-defined and usually invisible however hilar necrotic lymph nodes or hepatic metastatic deposits could be identified. MRCP with its 3D capability is superior to CT to delineate the degree and location of the biliary tree stricture.
The gold standard method for diagnosis of hilar cholangiocarcinoma. Shouldering and abrupt tapering at the stricture site suggest the diagnosis. Identifying the exact location and involvement can help in preoperative classification.
Determine the exact location of the tumour mass and can be used in the preoperative assessment. The Bismuth-Corlette system is one classification:
- type I: the lesion is limited to the common hepatic duct distal to the confluence of right and left ducts
- type II: the tumour involves the confluence of right and left hepatic ducts
- type III: the tumour involves one of the hepatic ducts
- type IV: the tumour invades the right and left hepatic ducts and hence it becomes unresectable
For more discussion on staging see "cholangiocarcinoma staging".
History and etymology
It is named after Gerald Klatskin (1910-86), American pathologist, New York.
Imaging differential considerations include:
- biliary inflammatory pseudotumour: can be indistinguishable on imaging 6
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