title: Klatskin-mimicking lesions: still a diagnostical and therapeutical dilemma?
abstract: OBJECTIVE
  The preoperative as well as the intraoperative differentiation between Klatskin-mimicking lesions and malignant bile duct tumors at hilar bifurcation is still challenging. Our intention was to review the preoperative diagnostics including preoperative CA19-9 and bilirubin serum levels to compare benign and malignant tumors.
  
  
  METHODS
  We analyzed our prospectively established bile duct tumor database. From 1999 to 2008, 238 patients suspicious for hilar cholangiocarcinoma underwent surgery. In 24 patients the postoperative histological diagnosis showed a Klatskin-mimicking lesion. The histological report from 20 out of the 24 patients showed a chronic inflammatory transformation of the bile ducts. The histology of two patients showed a primary sclerosing cholangitis and the histological examination of the two remaining patients diagnosed a sarcoidosis of the extrahepatic bile duct.
  
  
  RESULTS
  Reassessment of preoperative diagnostics did not deliver any change of interpretation of the tumors' dignity compared to how it had been assessed preoperatively. Also, preoperative CA19-9 serum levels do not show a statistically reliable differentiation between benign or malignant dignity.
  
  
  CONCLUSIONS
  Current diagnostics cannot differentiate malignant from benign tumor masses in the hepatic hilum with the necessitated reliability. Therefore surgical resection of suspect hilar tumors is still the only appropriate therapy.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital of Essen, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Juntermanns
authors.forename: Gernot Maximilian
authors.initials: GM
authors.lastname: Kaiser
authors.forename: Henning
authors.initials: H
authors.lastname: Reis
authors.forename: Fuat Hakan
authors.initials: FH
authors.lastname: Saner
authors.forename: Sonia
authors.initials: S
authors.lastname: Radunz
authors.forename: Spiridon
authors.initials: S
authors.lastname: Vernadakis
authors.forename: Matthias
authors.initials: M
authors.lastname: Heuer
authors.forename: Hilmar
authors.initials: H
authors.lastname: Kuehl
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Juergen
authors.initials: J
authors.lastname: Treckmann
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D001663:Bilirubin / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003937:Diagnosis, Differential; D005260:Female; D006500:Hepatic Duct, Common; D006801:Humans; D018285:Klatskin Tumor / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged
chemical_list: D018395:CA-19-9 Antigen; D001663:Bilirubin