Klatskin tumor is a term that was traditionally 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.
They are thought to account for up to 25% of all cholangiocarcinomas 1.
For general imaging features of a cholangiocarcinoma refer to the 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 tumor 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 tumor 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 the right and left ducts
- type II: the tumor involves the confluence of the right and left hepatic ducts
- type III: the tumor involves one of the hepatic ducts
- type IV: the tumor 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 pseudotumor: can be indistinguishable on imaging 6
- hepatic tuberculosis 8
- autoimmune cholangitis 9
- benign fibrosing disease at the hepatic confluence 10
- hepatocellular carcinoma 11
- gallbladder carcinoma (invading the bile duct) 12
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- 2. Smout JL, Bellemans MA, Van herreweghe W. Klatskin tumors: radiological and imaging findings in eleven patients. J Belge Radiol. 1991;74 (3): 177-81. - Pubmed citation
- 3. Vogl TJ, Schwarz WO, Heller M et-al. Staging of Klatskin tumours (hilar cholangiocarcinomas): comparison of MR cholangiography, MR imaging, and endoscopic retrograde cholangiography. Eur Radiol. 2006;16 (10): 2317-25. doi:10.1007/s00330-005-0139-4 - Pubmed citation
- 4.Chen HW, Pan AZ, Zhen ZJ et-al. Preoperative evaluation of resectability of Klatskin tumor with 16-MDCT angiography and cholangiography. AJR Am J Roentgenol. 2006;186 (6): 1580-6. doi:10.2214/AJR.05.0008 - Pubmed citation
- 5. Yeung EY, Mccarthy P, Gompertz RH et-al. The ultrasonographic appearances of hilar cholangiocarcinoma (Klatskin tumours). Br J Radiol. 1988;61 (731): 991-5. doi:10.1259/0007-1285-61-731-991 - Pubmed citation
- 6. Knowlton JQ, Taylor AJ, Reichelderfer M et-al. Imaging of biliary tract inflammation: an update. AJR Am J Roentgenol. 2008;190 (4): 984-92. doi:10.2214/AJR.07.3033 - Pubmed citation
- 7.Pauls S, Juchems MS, Brambs HJ. Radiological diagnosis of Klatskin's tumour. Radiologe. 2005;45 (11): 987-8, 990-2. doi:10.1007/s00117-005-1271-5 - Pubmed citation
- 8. R Arora, A Sharma, P Bhowate, et al. Hepatic tuberculosis mimicking Klatskin tumor: A diagnostic dilemma. (2008) Indian Journal of Pathology and Microbiology. 51 (3): 382. doi:10.4103/0377-4929.42517 - Pubmed
- 9. A Shingina, D Owen, C Zwirewich, B Salh. Autoimmune cholangitis mimicking a klatskin tumor: a case report. (2011) Journal of Medical Case Reports. 5 (1): 485. doi:10.1186/1752-1947-5-485 - Pubmed
- 10. PC Verbeek, DJ Leeuwen van, LT Wit de, JW Reeders, NJ Smits, A Bosma, K Huibregtse, MN der Heyde van. Benign fibrosing disease at the hepatic confluence mimicking Klatskin tumors. (1992) Surgery. 112 (5): 866. Pubmed
- 11. Menias CO, Surabhi VR, Prasad SR, et al. Mimics of cholangiocarcinoma: spectrum of disease. (2008) Radiographics : a review publication of the Radiological Society of North America, Inc. 28 (4): 1115-29. doi:10.1148/rg.284075148 - Pubmed
- 12. Senthil Kumar, M. P., Marudanayagam, R.. Klatskin-Like Lesions. (2012) HPB Surgery. 2012: 107519. doi:10.1155/2012/107519 - Pubmed