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Benign lesion in common hepatic duct simulating Klatskin Tumor: a case report
Apresentação do caso
Male, 58 years old patient presented with weight loss, fever, jaundice, fecal acolia, choluria and pruritus. Full abdomen Nuclear Magnetic Resonance revealed expansive formation in the hepatic hilum, with iso-signal on T1 and heterogeneous hypersignal on T2, defining bile duct dilation, for which the main diagnostic hypothesis was Klatskin tumor. Associated with this finding, multiple hepatic lesions were suggestive of neoplastic implants and lymph node enlargement in the hepatic hilum and retroperitoneum.
Due to great clinical suspicion of Klatskin tumor, the patient was hospitalized for biopsy and clearance of bile duct. However, the histopathological result revealed only inflammatory lesions, a result of infection. Therefore, the patient was treated with antibiotics, evolving with clinical improvement and total regression of image findings - including the supposed neoplastic implants, which were hepatic abscesses.
Klatskin tumor is a rare pathology that develops from epithelial cells at the confluence of the common hepatic duct, with high mortality rates, and must be considered as a differential diagnosis of cholestatic syndromes, since the typical clinical picture is caused by obstruction of the biliary tract. Imaging exams are integral for identifying the disease, and in this case, the clinic and imaging exams were very characteristic of this type of tumor, however, the diagnosis was only confirmed after the biopsy result, which showed that it was a benign alteration - an infectious process - simulating symptoms and image findings expected in patients with Klatskin tumor.
This report shows the importance of characteristics related to changes in imaging exams, as well as the need for confirmatory biopsy, to the diagnosis of patients with cholestatic syndrome due to a lesion, be it benign or malignant, causing obstruction of the biliary tract.
Benign lesion; Klatskin tumor; Hepatic duct.
KARINA LÍLIAN GOMES MOREIRA, GABRIEL NUNES MELO CORREIA, LEVY DOMINGOS CANTO, FRANCISCO DE PAULA ROCHA AGUIAR NETO, ESTHER CECIN MAMERE, FRANCISCO DE ASSIS CAVALCANTE JUNIOR, LYGIA MARIA COSTA SOARES REGO