Peripheral cholangiocarcinoma with endoluminal tumor thrombus in main bile duct mimicking a Klatskin tumor.

BACKGROUND: Peripheral cholangiocarcinoma with endobiliary thrombus could be confused with Klatskin tumor, eventually leading to inappropriate therapeutic decision. CASE REPORT: A 56-year-old man presented with an obstructive jaundice. Preoperative magnetic resonance imaging (MRI) showed a segment 7 liver tumor associated with a complete stop at the biliary bifurcation compatible with a Klatskin tumor. Surgical exploration revealed that biliary obstruction was caused by endobiliary tumor-related thrombus. A right hepatectomy was performed, allowing complete endobiliary thrombus extraction. At pathology, a T2N0 intrahepatic cholangiocarcinoma was demonstrated. No adjuvant chemotherapy was given and currently, 22 months after surgery, the patient remains disease free. DISCUSSION: This case underlines the fact that intraductal growth of peripheral cholangiocarcinoma does not represent a contraindication for surgical treatment. MRI could be useful to differentiate such presentation of peripheral cholangiocracinoma from Klatskin tumor and orientate the surgical treatment.