Klatskin-Like Lesions

Kumar, Manoj; Marudanayagam, R.

doi:10.1155/2012/107519

Cited by 19 publications

(9 citation statements)

References 112 publications

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“…In extremely rare cases, this cholangitis has been reported to present as a Klatskin tumour on radiology,8 as in our case, where a characteristic lesion resembling a Klatskin tumour was seen. Imaging modalities such as CT, positron emission tomography scan and MRI have not been found useful in differentiating a hilar cholangiocarcinoma from IgG4 cholangitis with high certainty 8.…”

Section: Discussionsupporting

confidence: 68%

“…Imaging modalities such as CT, positron emission tomography scan and MRI have not been found useful in differentiating a hilar cholangiocarcinoma from IgG4 cholangitis with high certainty 8. However, as in our case, the concurrent involvement of the pancreas should raise a high suspicion of an autoimmune aetiology for the lesion as opposed to a neoplastic one.…”

Section: Discussioncontrasting

confidence: 56%

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Autoimmune pancreatitis mimicking Klatskin tumour on radiology

2015

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Autoimmune pancreatitis (AIP) is categorised into two distinct types, AIP type 1 and 2. Although there can be multisystem involvement, rarely, the cholangitis associated with AIP can present radiologically in a manner similar to that of Klatskin tumour. We present the case of a 65-year-old man who was almost misdiagnosed with a Klatskin tumour because of the similarity in radiological features of the two aforementioned clinical entities. The patient presented with a history of jaundice, pruritus and abdominal pain, and work up showed deranged liver function tests, elevated cancer antigen 19-9 levels and positive antinuclear antibodies. CT scan of the abdomen showed findings suggestive of Klatskin tumour but due to diffuse enlargement of the pancreas and surrounding low-attenuation halo found on a closer review, a diagnosis of AIP was performed. The patient was started on standard corticosteroid therapy and responded well, with complete resolution of the radiological findings.

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Section: Discussionsupporting

confidence: 68%

Section: Discussioncontrasting

confidence: 56%

Autoimmune pancreatitis mimicking Klatskin tumour on radiology

2015

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“…Radiological features include diffuse or segmental narrowing of the intrahepatic and/or extrahepatic bile duct associated with bile duct wall thickening . Although the utility of elevated serum IgG4 concentrations (>140 g/L) can be highly suggestive of IgG4‐SC, it is not regarded pathognomonic as approximately 30% of patients have normal serum IgG4 concentrations . Other sensitive but not specific serological markers include hypergammaglobulinaemia, hyper IgG, antinuclear antibody, rheumatoid factor and peripheral eosinophilia .…”

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confidence: 99%

“…Other sensitive but not specific serological markers include hypergammaglobulinaemia, hyper IgG, antinuclear antibody, rheumatoid factor and peripheral eosinophilia . While co‐presentation with autoimmune pancreatitis commonly occurs, IgG4‐SC can occur as isolated biliary disease and can manifest as either a diffuse sclerosing cholangitis or a hilar pseudotumourous mass . Enlargement of the salivary or lacrimal gland, retroperitoneal fibrosis or renal lesion may also be noted on presentation .…”

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confidence: 99%

“…Enlargement of the salivary or lacrimal gland, retroperitoneal fibrosis or renal lesion may also be noted on presentation . Given the unreliability of imaging modalities and brush cytology in distinguishing hepatic strictures, preoperative histological analysis is desired, through either Vater's ampulla biopsy, liver needle biopsy or bile duct biopsy, with more than 10 IgG4‐positive plasma cells used as the diagnostic threshold …”

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confidence: 99%

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IgG4-related sclerosing cholangitis: the cholangiocarcinoma mimic

et al. 2013

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A 51-year-old woman presented with a 3-week history of painless obstructive jaundice on a background of diet-controlled type 2 diabetes mellitus and significant weight loss. There was no history of inflammatory bowel disease. Physical examination revealed cachexia and jaundice. Relevant blood tests showed bilirubin, 56 μmol/L; alkaline phosphatase 1069 IU/L; gamma-glutyamyltransferase, 1114 IU/L; raised carbohydrate antigen 19-9 level, 213 kU/L; and normal carcinoembryonic antigen level, 2.1 ng/mL.Ultrasound showed common hepatic duct wall thickening and second-order duct involvement bilaterally (Fig. 1). Computed tomography (CT) scan revealed intrahepatic duct dilatation and a hilar stricture suspicious for a Klatskin-type cholangiocarcinoma (CCa) (Fig. 2). Magnetic resonance cholangiopancreatography reported an irregular, enhancing soft-tissue mass at the porta hepatitis ( Fig. 1). Staging laparoscopy revealed no evidence of hepatic or peritoneal metastasis. Percutaneous transhepatic cholangiogram and temporary biliary stent decompression was performed and subsequently right portal vein embolization to stimulate preoperative left lobe hypertrophy.An open extended right hepatectomy including segment 4B was undertaken. Operative findings included no demonstrable left lobe involvement or vascular invasion on intraoperative ultrasound. Extended lymphadenectomy was complicated by a pancreatic capsule injury, repaired intraoperatively.Histopathology did not confirm carcinoma of the stricture but features of immunoglobulin G4 (IgG4) autoimmune-related disease, with plasma cells in the wall of the gallbladder (>50 per high power field), with the majority being IgG4 positive. Sections of the left hepatic duct showed marked dilatation and chronic inflammation throughout the wall consisting of plasma cells and lymphocytes with scanty neutrophils and eosinophils (Fig. 3). Immunoglobulin levels were unremarkable (IgG level 11.4 g/L and IgG4 level 11.5 g/L).One week post-operatively, the patient developed abdominal distension with leucocytosis. CT scan revealed a pancreatic fistula with acute fluid collection and a reactive pancolitis, which required endo-Fig 1. Ultrasound reported (a) the presence of a mass (44 mm × 32 mm) at the porta hepatitis and (b) thickening of the biliary duct wall. Magnetic resonance imaging cholangio-pancreatogram reported (c) dilatation of the right and left hepatic ducts to the level of the porta hepatitis with (d) evidence of a soft-tissue mass in keeping with a hilar cholangiocarcinoma.Fig. 2. Initial computed tomography scan reveals (a) collapse of the common bile duct and (b) dilatation of the left intrahepatic duct.Fig. 3. Macroscopical analysis of the resected surgical specimen revealed (a) a white firm area at the hilum of the liver (arrows), involving the biliary ductal system and adherent to the wall of the gallbladder and extending into the intrahepatic biliary tributaries. (b) Immunohistochemical staining revealed large numbers of IgG4-positive plasma cells (40× original magnification)...

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Hilar/Perihilar Cholangiocarcinoma (Klatskin Tumor)

Zimmermann¹

2016

Tumors and Tumor-Like Lesions of the Hepatobiliary Tract

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Klatskin-Like Lesions

Cited by 19 publications

References 112 publications

Autoimmune pancreatitis mimicking Klatskin tumour on radiology

Autoimmune pancreatitis mimicking Klatskin tumour on radiology

IgG4-related sclerosing cholangitis: the cholangiocarcinoma mimic

Hilar/Perihilar Cholangiocarcinoma (Klatskin Tumor)

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