Klatskin tumour

Case contributed by Dr Wajeeha Zagham

Presentation

Presented with painless jaundice & hyperbilirubinemia

Patient Data

Age: Mid 50s
Gender: Female
CT

Lesion noted in segment 4. ?significance

MRI

Report summary as follows:

Intrahepatic duct dilatation & dilatation of right (8 mm) & left hepatic (10 mm) ducts. Stenosis noted to at the junction of the hepatic ducts. Distal CBD (6 mm) appears normal while the stenosed ducts have a beaked appearance. There is no underlying pancreatic mass and a normal branching pattern of the common hepatic artery. Noted is sludge within a distended gallbladder (4.4 cm) with multiple stones. No findings to indicate acute cholecystitis. Segment III lesion demonstrates rim enhancement. No other lesion in the liver. The spleen, adrenal glands & kidneys are normal

Case Discussion

The operation report included the following findings: Cholangiocarcinoma from extrahepatic bile duct adhered to right hepatic artery, portal vein and gallbladder. Metastatic disease on liver (one single 2 cm metastasis in segment III), lymphovascular invasion.

Pathology findings correlated with op report. 

This case highlighted the difficulty in characterising liver lesions. This patient underwent a lengthy surgical procedure for what was determined to be metastatic disease. 

Hepatic metastases tend to show mild to moderate high intensity signal on T2W imagine & low signal on pre-contrast T1. Cystic & necrotic metastases show T2 increase signal (commonly in neuroendocrine tumours and sarcoma). Some liver metastases may demonstrate T1 hyperintensity particularly if fat-containing or melanin/methemoglobin/protein containing (such as melanoma).

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Case information

rID: 46254
Case created: 29th Jun 2016
Last edited: 16th Jul 2016
Inclusion in quiz mode: Included

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