Ciliated hepatic foregut cyst mimicking neoplasm

Abstract

We describe a ciliated hepatic foregut cyst that was clinically considered neoplastic because it was large, bilocular, and associated with a high serological level of carbohydrate antigen 19-9 (CA 19-9). Histologically, the wall of the cyst showed characteristic pseudopapillae lined by ciliated stratified columnar epithelium with interspersed goblet cells and underlying smooth muscle. The epithelium was strongly immunoreactive for CA 19-9. We therefore conclude that large size, multilocularity, and elevated CA 19-9 do not exclude ciliated hepatic foregut cysts from diagnostic consideration.

Ciliated hepatic foregut cyst

“…On ultrasound scan, most appear as hypoechoic cysts [5]. On CT scan, they are nonenhancing rounded lesions and have a variable density related to their thick viscid contents (which may include calcium crystals and cholesterol [6,9]); this may lead to a misdiagnosis of malignancy [7][8][9]. On MRI, ciliated hepatic foregut cysts are typically hyperintense on T2-weighted sequences but have a variable appearance on T1-weighted images [5,10].…”

“…However, in none of these cases was a communication between the cyst and the biliary tree confirmed. Interestingly, bile ductules have been identified within the fibrous capsule of the cyst in several cases [6,8,12,13].…”

“…They are typically found in an anterior subcapsular position in the medial segments of the liver (segments 4, 5, or 8). Only exceptionally rare are they multilocular [3] or septated [8]. Ciliated hepatic foregut cysts may cause abdominal pain, but in most reports, they have been an incidental finding either during investigation of unrelated pathology or during autopsy [2,3].…”

Current management of noninfectious hepatic cystic lesions: A review of the literature

“…Imaging characteristics include: predominance in segment Ⅳ, small size, subcapsular location. Two thirds are hypoechoic on US, hypodense on CT, and highly hyperintense on T2-weighted images on MRI [97,100] . Biliary hamartomas (also known as von Meyenburg complexes) are asymptomatic lesions, usually discovered incidentally during liver surgery [101] .…”

Quiste hepático ciliado embrionario multilocular: Aportación de un nuevo caso y revisión de la literatura

“…Menos frecuentemente aparecen en el hígado, y se denominan quistes hepáticos ciliados embrionarios (ciliated hepatic foregut cyst-CHFC) (6).…”