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Anatomisch-pathologische Besonderheiten der Klatskin-Tumoren

Klassifikation, aktuelle molekularbiologische Aspekte, Prognosefaktoren

Pathological anatomical characteristics of Klatskin tumors

Classification, current molecular biological aspects, prognosis factors

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Zusammenfassung

Es handelt sich bei den Klatskin-Tumoren um eine Subgruppe der Gallengangkarzinome, die aufgrund ihrer besonderen Lokalisation eine chirurgische Herausforderung darstellt. Histomorphologisch zeigen Gallengangkarzinome keine lokalisationsabhängigen Unterschiede auch in Bezug auf ihre Vorläuferläsionen. Auch molekularbiologisch gibt es nur wenige Unterschiede. Wichtig für die Therapie und Prognoseabschätzung ist eine genau Diagnosestellung und bei Resektabilität eine standardisierte Aufarbeitung des Operationspräparats, um die Resektionsränder genau zu beurteilen. Ebenso wichtig ist eine regionäre Lymphknotendissektion. Molekularbiologisch sind bei dieser relativ seltenen Tumorerkrankung weitere Untersuchungen zu fordern, um eine individualisierte Therapie, wie sie derzeit für andere gastrointestinale Tumoren bereits durchgeführt wird, zu ermöglichen.

Abstract

Klatskin tumors are a distinct subgroup of cholangiocarcinomas which are a surgical challenge due to their special localization. Different localizations do not show great differences concerning histomorphology and precursor lesions. With respect to molecular alterations there are only small differences. Accurate clinical and histomorphological diagnosis is important for therapy and especially the prediction of prognosis as well as standardized processing of the resection specimen if the carcinoma is resectable. Additionally, accurate lymph node dissection is necessary. Concerning molecular markers further investigations are needed to develop individualized therapy regimes.

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Literatur

  1. Allen PJ, Reiner AS, Gonen M et al (2008) Extrahepatic cholangiocarcinoma: a comparison of patients with resected proximal and distal lesions. HPB 10:341–346

    Article  PubMed  Google Scholar 

  2. Anonymous (2003) General rules for surgical and pathological studies on cancers of biliary tract. Kanehara, Tokyo, Japan

  3. Benckert C, Jonas S, Cramer T et al (2003) Transforming growth factor beta 1 stimulates vascular endothelial growth factor gene transcription in human cholangiocellular carcinoma cells. Cancer Res 63:1083–1092

    PubMed  CAS  Google Scholar 

  4. Bismuth H, Corlette MB (1975) Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet 140:170–178

    PubMed  CAS  Google Scholar 

  5. Bosman FT, Carneiro F, Hruban RH (Hrsg) (2010) WHO classification of tumours of the digestive system. World Health Organization

  6. Deoliveira ML, Cunningham SC, Cameron JL et al (2007) Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg 245:755–762

    Article  PubMed  Google Scholar 

  7. Devaney K, Goodman ZD, Ishak KG (1994) Hepatobiliary cystadenoma and cystadenocarcinoma. A light microscopic and immunohistochemical study of 70 patients. Am J Surg Pathol 18:1078–1091

    Article  PubMed  CAS  Google Scholar 

  8. Endo K, Yoon BI, Pairojkul C et al (2002) ERBB-2 overexpression and cyclooxygenase-2 up-regulation in human cholangiocarcinoma and risk conditions. Hepatology 36:439–450

    Article  PubMed  CAS  Google Scholar 

  9. Esposito I, Schirmacher P (2008) Pathological aspects of cholangiocarcinoma. HPB 10:83–86

    Article  PubMed  CAS  Google Scholar 

  10. Gatto M, Alvaro D (2010) New insights on cholangiocarcinoma. World J Gastrointest Oncol 2:136–145

    Article  PubMed  Google Scholar 

  11. Jarnagin WR, Fong Y, Dematteo RP et al (2001) Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 234:507–517

    Article  PubMed  CAS  Google Scholar 

  12. Klatskin G (1965) Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. Am J Med 38:241–256

    Article  PubMed  CAS  Google Scholar 

  13. Kuroki T, Tajima Y, Matsuo K et al (2005) Genetic alterations in gallbladder carcinoma. Surg Today 35:101–105

    Article  PubMed  CAS  Google Scholar 

  14. Miller G, Socci ND, Dhall D et al (2009) Genome wide analysis and clinical correlation of chromosomal and transcriptional mutations in cancers of the biliary tract. J Exp Clin Cancer Res 28:62

    PubMed  Google Scholar 

  15. Munding J, Tannapfel A (2011) Anatomy of the liver. What does the radiologist need to know? Radiologe 51:655–660

    Article  PubMed  CAS  Google Scholar 

  16. Murakami Y, Uemura K, Sudo T et al (2011) Prognostic factors after surgical resection for intrahepatic, hilar, and distal cholangiocarcinoma. Ann Surg Oncol 18:651–658

    Article  PubMed  Google Scholar 

  17. Nakazawa K, Dobashi Y, Suzuki S et al (2005) Amplification and overexpression of c-erbB-2, epidermal growth factor receptor, and c-met in biliary tract cancers. J Pathol 206:356–365

    Article  PubMed  CAS  Google Scholar 

  18. Nakeeb A, Pitt HA, Sohn TA et al (1996) Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg 224:463–473

    Article  PubMed  CAS  Google Scholar 

  19. Rashid A, Ueki T, Gao YT et al (2002) K-ras mutation, p53 overexpression, and microsatellite instability in biliary tract cancers: a population-based study in China. Clin Cancer Res 8:3156–3163

    PubMed  CAS  Google Scholar 

  20. Rizzi PM, Ryder SD, Portmann B et al (1996) p53 Protein overexpression in cholangiocarcinoma arising in primary sclerosing cholangitis. Gut 38:265–268

    Article  PubMed  CAS  Google Scholar 

  21. Roa JC, Roa I, Correa P et al (2005) Microsatellite instability in preneoplastic and neoplastic lesions of the gallbladder. J Gastroenterol 40:79–86

    Article  PubMed  CAS  Google Scholar 

  22. Rocha FG, Matsuo K, Blumgart LH et al (2010) Hilar cholangiocarcinoma: the Memorial Sloan-Kettering Cancer Center experience. J Hepatobiliary Pancreat Sci 17:490–496

    Article  PubMed  Google Scholar 

  23. Sasaki R, Takeda Y, Funato O et al (2007) Significance of ductal margin status in patients undergoing surgical resection for extrahepatic cholangiocarcinoma. World J Surg 31:1788–1796

    Article  PubMed  Google Scholar 

  24. Schottenfeld D, Beebe-Dimmer J (2006) Chronic inflammation: a common and important factor in the pathogenesis of neoplasia. CA Cancer J Clin 56:69–83

    Article  PubMed  Google Scholar 

  25. Shimada K, Sano T, Sakamoto Y et al (2007) Surgical outcomes of the mass-forming plus periductal infiltrating types of intrahepatic cholangiocarcinoma: a comparative study with the typical mass-forming type of intrahepatic cholangiocarcinoma. World J Surg 31:2016–2022

    Article  PubMed  Google Scholar 

  26. Tannapfel A, Benicke M, Katalinic A et al (2000) Frequency of p16(INK4A) alterations and K-ras mutations in intrahepatic cholangiocarcinoma of the liver. Gut 47:721–727

    Article  PubMed  CAS  Google Scholar 

  27. Tannapfel A, Sommerer F, Benicke M et al (2003) Mutations of the BRAF gene in cholangiocarcinoma but not in hepatocellular carcinoma. Gut 52:706–712

    Article  PubMed  CAS  Google Scholar 

  28. Uenishi T, Hirohashi K, Kubo S et al (2001) Histologic factors affecting prognosis following hepatectomy for intrahepatic cholangiocarcinoma. World J Surg 25:865–869

    Article  PubMed  CAS  Google Scholar 

  29. Wise C, Pilanthananond M, Perry BF et al (2008) Mechanisms of biliary carcinogenesis and growth. World J Gastroenterol 14:2986–2989

    Article  PubMed  CAS  Google Scholar 

  30. Wittekind C, Meyer HJ (2010) TNM Klassifikation maligner Tumore. Wiley, Weinheim

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  1. Institut für Pathologie, BG-Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    J. Munding & A. Tannapfel

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  1. J. Munding
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  2. A. Tannapfel
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Correspondence to J. Munding.

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Munding, J., Tannapfel, A. Anatomisch-pathologische Besonderheiten der Klatskin-Tumoren. Chirurg 83, 208–214 (2012). https://doi.org/10.1007/s00104-011-2175-8

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