Klatskin tumor - Bismuth type 2

Case contributed by Dr Domenico Nicoletti

Presentation

Right upper quadrant pain.

Patient Data

Age: 80 years
Gender: Male

Concentric wall thickening, stenosing, with enhancement, of the proximal portion of the main bile duct, extended cranially at the confluence of hepatic ducts with associated discrete dilatation of the intrahepatic bile ducts. There are modest signs of arterialization the hepatic circulation in the second segment. The common bile duct is not dilated. Liver without focal lesions. In the pancreas are appreciable numerous cystic lesions in continuity with the main pancreatic duct referable to IPMN of secondary ducts. It should be noted pancreas divisum with Santorinicele. The Wirsung duct is not dilated.

Photo

Histological report

Case Discussion

Klatskin tumors arise at the level of the bifurcation of the hepatic ducts, usually between the 5th and 7th decade of life, more frequent in males. Jaundice is the main symptom. Other signs are abdominal pain and weight loss. There are frequent regional lymph node metastases. In 90% of cases, Klatskin tumors are sporadic, even if they have been associated with certain risk factors, including primary sclerosing cholangitis, secondary sclerosing cholangitis, chronic carriers of typhoid, parasitic infections (Opisthochis viverrini and Clonorchis sinensis), exposure to thorotrast and cysts of the bile duct, causing chronic biliary inflammation.

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