Journal of Digestive Cancer Research

Korean Society of Gastrointestinal Cancer Research (대한소화기암연구학회)
권호 표지

A Case of Klatskin Tumor Showing Slow Progression

  • Min Kyu Kang (Department of Internal Medicine, Yeungnam University College of Medicine) ;
  • Kook Hyun Kim (Department of Internal Medicine, Yeungnam University College of Medicine) ;
  • Joon Hyuk Choi (Department of Pathology, Yeungnam University College of Medicine) ;
  • Tae Nyeun Kim (Department of Internal Medicine, Yeungnam University College of Medicine)
  • Received : 2017.05.31
  • Accepted : 2017.06.14
  • Published : 2017.06.30
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Abstract

A 64-year-old man was admitted due to jaundice for 2 weeks. Radiologic findings revealed biliary stricture at the hepatic hilum with intrahepatic duct dilation suggesting Bismuth type IV Klatskin tumor. Jaundice improved spontaneously several days after hospitalization. Surgical treatment was considered but he only wanted to observe without specific treatment. Ten months later, he was re-admitted due to the recurrence of jaundice. Computed tomography (CT) showed no significant difference compared to previous results. Serum cancer antigen 19-9 and Immunoglobulin G4 were normal. Endoscopic forcep biopsy during endoscopic retrograde cholagiopancreatography (ERCP) revealed chronic inflammation. After steroid use under possible diagnosis of IgG4 related cholangiopathy, biliary stricture improved slightly. Four years later, he was hospitalized with the occurrence of acute cholangitis. Endoscopic retrograde biliary drainage was performed following endobiliary forcep biopsy. Pathology revealed well-differentiated adenocarcinoma at this time. Combined chemotherapy based on gemcitabine and cisplatin was performed. Six months later, CT revealed partial response.

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References

  1. Molina V, Sampson J, Ferrer J, et al. Klatskin tumor: Diagnosis, preoperative evaluation and surgical considerations. Cirugia Espanola (English Edition) 2015;93:552-560.
  2. Kim KH. The roles of endoscopic ultrasound in the diagnosis of pancreatobiliary cancer. Yeungnam University Journal of Medicine 2016;33:77-84.
  3. Kim KR, Kim JH, Park WK, et al. The effect of percutaneous bilateral metalic stent for hilar cholangiocarcinoma. Yeungnam University Journal of Medicine 2005;22:211-220.
  4. Senthil Kumar M, Marudanayagam R. Klatskin-like lesions. HPB Surgery 2012;2012.
  5. Kosuge T, Yamamoto J, Shimada K, Yamasaki S, Makuuchi M. Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Annals of surgery 1999;230:663.
  6. Ohtsuka M, Ito H, Kimura F, et al. Results of surgical treatment for intrahepatic cholangiocarcinoma and clinicopathological factors influencing survival. British journal of surgery. 2002;89:1525-1531.
  7. Guglielmi A, Ruzzenente A, Campagnaro T, et al. Patterns and prognostic significance of lymph node dissection for surgical treatment of perihilar and intrahepatic cholangiocarcinoma. Journal of Gastrointestinal Surgery 2013;17:1917-1928.
  8. Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD. Cholangiocarcinoma. The Lancet 2005;366:1303-1314.
  9. Farley DR, Weaver AL, Nagorney DM, editors. "Natural history" of unresected cholangiocarcinoma: patient outcome after noncurative intervention. Mayo Clinic Proceedings 1995:Elsevier.
  10. Berr F, editor Photodynamic therapy for cholangiocarcinoma. Seminars in liver disease; 2004: Copyright? 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.
  11. Valle J, Wasan H, Palmer DH, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. New England Journal of Medicine 2010;362:1273-1281.