A 72-year-old female patient presented to the hospital with complaint of abdominal pain, jaundice and pruritus. She also reported of losing 6 kgs of weight in 2 months. The patient was diagnosed with intrahepatic bile duct dilation because of cholangiocarcinoma.
A 72-year-old woman reported to the hospital with abdominal pain, jaundice and pruritus. The woman also reported that she had lost 6 kgs of weight in the last 2 months.
Laboratory studies of the patient showed direct bilirubin level of 14.3 mg per decilitre (normal range, 0.1 to 0.3), an alkaline phosphatase level of 223 U per litre, an aspartate aminotransferase level of 55 U per litre, and an alanine aminotransferase level of 56 U per litre. For further evaluation, magnetic resonance imaging (MRI) of the abdomen was performed which showed marked intrahepatic biliary ductal dilation. Imaging showed that the dilation tapered and cutoff near the hilum. In addition to this, a hepatic hilar mass with vessel involvement was also seen.
The findings on the MRI were consistent with the diagnosis of hilar colangiocarcinoma or Klatskin’s tumour.
Klatskin’s tumour refers to a hilar cholangiocarcinoma that occurs at the bifurcation of the common hepatic duct. These tumours are typically small and poorly differentiated. Moreover, show aggressive biologic behaviour and obstruct the intrahepatic bile ducts.
The patient underwent percutaneous transhepatic cholangiography with biliary drainage. To confirm the diagnosis, a specimen from the hilar mass was biopsied; histopathological evaluation of the biopsied specimen confirmed the diagnosis of cholangiocarcinoma or Klatskin’s tumour.
Imaging studies also showed that the lesions had metastasised to the lungs, with involvement of both the hepatic artery and the portal vein. The tumour was not resectable, therefore, the patient was put on palliative care.
Rossi, U. G., & Cariati, M. (2020). Intrahepatic Biliary Ductal Dilatation. New England Journal of Medicine, 382(4), 364-364.