Year 2019 / Volume 111 / Number 2
Original
Klatskin tumors and “Klatskin-mimicking lesions”: our 22-year experience.

121-128

DOI: 10.17235/reed.2018.5749/2018

Konstantinos Tsalis, Styliani Parpoudi, Dimitrios Kyziridis, Orestis Ioannidis, Natalia-Antigoni Savvala, Nikolaos Antoniou, Savvas Symeonidis, Dimitrios Konstantaras, Ioannis Mantzoros, Manousos-Georgios Pramateftakis, Efstathios Kotidis, Stamatios Angelopoulos,

Abstract
Background and study purpose: Hilar cholangiocarcinoma, also known as Altemeier-Klatskin tumor, is a rare malignancy that arises in the confluence of the hepatic ducts of the porta hepatis. The prognosis is rather poor. Several lesions mimic these tumors and lead to a misdiagnosis, resulting in radical hepatic resections. These lesions are known as Klatskin-mimicking lesions. We present our experience with the diagnosis and treatment of pathological lesions that can mimic a perihilar cholangiocarcinoma and establish an algorithm of treatment Methods: For the current retrospective study, a prospectively established bile-duct tumor database was analyzed by selecting patients with a preoperative diagnosis of perihilar cholangiocarcinoma. Results: In the last 22 years (from January 1, 1996, to December 31, 2017), 73 patients who were referred to our tertiary center with a primary diagnosis of a Klatskin tumor were treated. All patients underwent a thorough evaluation before deciding upon the treatment. However, only 58 cases had a confirmed preoperative diagnosis of hilar cholangiocarcinoma in the final histopathological examination. The final diagnosis in 15 patients differed from the primary cause for referral and the lesions were regarded as Klatskin-mimicking lesions. Conclusions: Clinicians should always highly suspect Klatskin-mimicking lesions when they evaluate a patient for a possible hilar cholangiocarcinoma in order to avoid a misdiagnosis and propose a proper treatment.
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References
1. Hennedige TP, Neo WT, Venkatesh SK. Imaging of malignancies of the biliary tract- an update. Cancer Imaging 2014; 14: 14. (PMID: 25608662 DOI: 10.1186/1470-7330-14-14)
2. Altemeier WA, Gall EA, Zinninger MM, Hoxworth PI. Sclerosing carcinoma of the major intra hepatic bile ducts. AMA Arch Surg 1957; 75: 450– 461. (PMID: 13457619)
3. Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. Am J Med 1965; 38: 241–256. (PMID: 14256720)
4. Khan SA, Thomas HC, Davidson BR et al. Cholangiocarcinoma. Lancet, 2005; 366: 1303–1314. (PMID: 16214602 DOI: 10.1016/S0140-6736(05)67530-7)
5. Li J, Kuehl H, Grabellus F, Müller SP, Radunz S, Antoch G, Nadalin S, Broelsch CE, Gerken G, Paul A, Kaiser GM. Preoperative assessment of hilar cholangiocarcinoma by dual-modality PET/CT. J Surg Oncol 2008; 98: 438-443. (PMID: 18767120 DOI: 10.1002/jso.21136)
6. Verbeek PCM, van Leeuwen DJ, de Wit LT, Reeders JW, Smits NJ, Bosma A, Huibregtse K, van der Heyde MN. Benign fibrosing disease at the hepatic confluence mimicking Klatskin tumors. Surgery 1992; 112: 866-871. (PMID: 1332203)
7. Gerhards MF, Vos P, van Gulik TM, Rauws EA, Bosma A, Gouma DJ. Incidence of benign lesions in patients resected for suspicious hilar obstruction. Br J Surg 2001; 88: 48-51. (PMID: 11136309 DOI: 10.1046/j.1365-2168.2001.01607.x)
8. Knoefel WT, Prenzel KL, Peiper M Hosch SB, Gundlach M, Eisenberger CF, Strate T, Scheunemann P, Rogiers X, Izbicki JR. Klatskin tumors and Klatskin mimicking lesions of the biliary tree. Eur J Surg Oncol 2003; 29: 658- 661. (PMID: 14511613)
9. Juntermanns B, Kaiser GM, Reis H, Saner FH, Radunz S, Vernadakis S, Heuer M, Kuehl H, Paul A, Treckmann J. Klatskin-mimicking lesions: still a diagnostical and therapeutical dilemma? Hepatogastroenterology, 2011; 58: 265-269. (PMID: 21661379)
10. Makuuchi M, Thai BL, Takayasu K, Takayama T, Kosuge T, Gunvén P, Yamazaki S, Hasegawa H, Ozaki H. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 1990; 107: 521-527 (PMID: 2333592).
11. Nimura Y, Hayakawa N, Kamiya J, Kondo S, Shionoya S. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg 1990; 14: 535-545 (PMID: 2166381 DOI: 10.1007/BF01658686).
12. Zani S Jr, Pappas TN. Management of cholangiocarcinoma. In Cameron JL, Cameron AM. Current surgical therapy. 11th ed. Philadelphia: Elsevier Inc, 2014: 414-419
13. Lang H, Kaiser GM, Zöpf T, Sotiropoulos GC, Frilling A, Malagó M, Broelsch CE. Surgical therapy of hilar cholangiocarcinoma. (Article in German) Chirurg 2006; 77: 325-334. (PMID: 16568258 DOI: 10.1007/s00104-006-1177-4)
14. Mosconi S, Beretta GD, Labianca R, Zampino MG, Gatta G, Heinemann V.Cholangiocarcinoma. Crit Rev Oncol Hematol 2009; 69: 259–270. (PMID: 18977670 DOI: 10.1016/j.critrevonc.2008.09.008)
15. Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, Miyagawa S. Results of surgical resection for patients with hilar bile duct cancer: Application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg 2003; 238: 84-92. (PMID: 12832969 DOI: 10.1097/01.SLA.0000074984.83031.02)
16. Pichlmayr R, Weimann A, Klempnauer J, Oldhafer KJ, Maschek H, Tusch G, Ringe B. Surgical treatment in proximal bile duct cancer. A single center experience. Ann Surg 1996; 224: 628-638. (PMID: 8916878)
17. Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, Wex C, Lobeck H, Hintze R. Extended resections for hilar cholangiocarcinoma. Ann Surg 1999; 230:808-818. (PMID: 10615936)
18. Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BS J, Youssef BA M, Klimstra D, Blumgart LH. Staging, resectability, and outcome in 184 patients with hilar cholangicarcinoma. Ann Surg 2001; 234: 507-517. (PMID: 11573044)
19. Shaib Y, El-Serag HB: The epidemiology of cholangiocarcinoma. Semin Liver Dis 2004; 24:115–125. (PMID: 15192785 DOI: 10.1055/s-2004-828889)
20. Khan SA, Davidson BR, Goldin R, Pereira SP, Rosenberg WM, Taylor-Robinson SD, Thillainayagam AV, Thomas HC, Thursz MR, Wasan H; British Society of Gastroenterology. Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document. Gut 2002; 51:VI1–VI9. (PMID: 12376491)
21. Juntermanns B, Radunz S, Heuer M, Hertel S, Reis H, Neuhaus JP, Vernadakis S, Trarbach T, Paul A, Kaiser GM. Tumor markers as a diagnostic key for hilar cholangiocarcinoma. Eur J Med Res 2010; 15: 357-361. (PMID: 20947473)
22. Blechacz B, Komuta M, Roskams T, Gores GJ. Clinical diagnosis and staging of cholangiocarcinoma. Nat Rev Gastroenterol Hepatol 2011; 8: 512-522. (PMID: 21808282 DOI: 10.1038/nrgastro.2011.131)
23. Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, Madhusudan S, Iveson T, Hughes S, Pereira SP, Roughton M, Bridgewater J; ABC-02 Trial Investigators. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 2010; 362: 1273- 81. (PMID: 20375404 DOI: 10.1056/NEJMoa0908721)
24. Senthil Kumar MP, Marudanayagam R. Klatskin-like lesions. HPB Surg 2012; 2012: 107519. (PMID: 22811587 DOI: 10.1155/2012/107519)
25. Wetter LA, Ring EJ, Pellegrini CA, Way LW. Differential diagnosis of sclerosing cholangiocarcinomas of the common hepatic duct (Klatskin tumors). Am J Surg, 1991; 161: 57–63. (PMID: 1846276)
26. Koea J, Holden A, Chau K, McCall J. Differential diagnosis of stenosing lesions at the hepatic hilus. World J Surg 2004; 28: 466– 470. (PMID: 15085401 DOI: 10.1007/s00268-004-7034-z)
27. Digby KH. Common-duct stones of liver origin. Br J Surg, 1930; 17: 578–591.
28. Tsui WM, Chan YK, Wong CT, Lo YF, Yeung YW, Lee YW.. Hepatolithiasis and the syndrome of recurrent pyogenic cholangitis: clinical, radiologic, and pathologic features. Semin Liver Dis 2011; 31: 33-48. (PMID: 21344349 DOI: 10.1055/s-0031-1272833)
29. Lee JW, Han JK, Kim T, Kim YH, Choi BI, Han MC, Suh KS, Kim SW. CT features of intraductal intrahepatic cholangiocarcinoma. AJR Am J Roentgenol 2000; 175: 721- 725. (PMID: 10954456 DOI: 10.2214/ajr.175.3.1750721)
30. Wani NA, Robbani I, Kosar T. MRI of oriental cholangiohepatitis. Clin Radiol 2011; 66: 158-163. (PMID: 21216332 DOI: 10.1016/j.crad.2010.06.017)
31. Kim HJ, Kim JS, Joo MK, Lee BJ, Kim JH, Yeon JE, Park JJ, Byun KS, Bak YT. Hepatolithiasis and intrahepatic cholangiocarcinoma: A review. World J Gastroenterol 2015; 21: 13418-13431. (PMID: 26730152 DOI: 10.3748/wjg.v21.i48.13418)
32. Maggard MA, O’Connell JB, Ko CY. Updated population based review of carcinoid tumors. Ann Surg 2004; 240: 117-122. (PMID: 15213627)
33. Tsalis K, Vrakas G, Geroukis T, Cheva A, Roidos GN, Lazarides C. Primary neuroendocrine tumor of the extrahepatic biliary tree mimicking Klatskin tumor. J Gastrointestin Liver Dis 2010; 19: 341-342. (PMID: 20922208)
34. Tsalis K, Vrakas G, Vradelis S, Dimoulas A, Pilavaki M, Papaemmanouil S, Micheli A, Lazarides C, Kartalis G. Primary hepatic gastrinoma: Report of a case and review of literature. World J Gastrointest Pathophysiol, 2011; 2: 26-30. (PMID: 21607163 DOI: 10.4291/wjgp.v2.i2.26)
35. Oh HC, Kim MH, Lee KT, Lee JK, Moon SH, Song TJ, Eum J, Park DH, Lee SS, Seo DW, Lee SK. Clinical clues to suspicion of IgG4- associated sclerosing cholangitis disguised as primary sclerosing cholangitis or hilar cholangiocarcinoma. J Gastroenterol Hepatol 2010; 25: 1831–1837. (PMID: 21091993 DOI: 10.1111/j.1440-1746.2010.06411.x)
36. Zen Y, Nakanuma Y. IgG4 cholangiopathy. Int J Hepatol 2012; 2012: 472376. (PMID: 21994885 DOI: 10.1155/2012/472376)
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Tsalis K, Parpoudi S, Kyziridis D, Ioannidis O, Savvala N, Antoniou N, et all. Klatskin tumors and “Klatskin-mimicking lesions”: our 22-year experience. . 5749/2018


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Publication history

Received: 27/05/2018

Accepted: 04/09/2018

Online First: 13/11/2018

Published: 01/02/2019

Article revision time: 92 days

Article Online First time: 170 days

Article editing time: 250 days


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