Ciliated Hepatic Foregut Cyst: A Report of a Case Incidentally Discovered during Transplant Evaluation

Abstract

Ciliated hepatic foregut cyst (CHFC) is a rare benign cyst of the liver derived from an embryonic remnant of foregut epithelium. CHFC is typically asymptomatic and is found incidentally. Recent reports of malignant transformation may warrant surgical removal of CHFC. We present the case of a 54-year-old male who was discovered to have a CHFC while undergoing kidney transplant evaluation.

Ciliated Hepatic Foregut Cyst: Definitive Diagnosis Is Critical to the Optimal Treatment Pathway

“…Out of five cases of SCC in which imaging features were described, atypical characteristics noted were as follows: a malignant cyst with wall irregularity on MRI [ 23 ], SCC with a region of calcification and a mural nodule on CT [ 47 ], and squamous metaplasia with calcification [ 29 ]. While solid wall components have been identified in benign cases, calcifications have only been reported in squamous transformation [ 8 , 9 ]; heterogeneity in a metaplastic [ 39 ] and a malignant cyst [ 40 ] have also been described. Our report notes heterogeneity on CT, which has been reported in both benign and malignant cases [ 11 , 22 ].…”

“…Imaging modalities such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are insufcient for a defnitive diagnosis due to nonspecifc and variable imaging features noted correlating to benign and malignant pathologies [5][6][7]. Terefore, a defnitive diagnosis of CHFC requires histologic confrmation [8] of ciliated pseudostratifed columnar epithelium surrounded by a subepithelial connective tissue layer, a smooth muscle layer, and an outer fbrous capsule [1].…”

Primary Hepatic Mesothelial Cyst: A Rare Entity to Be Considered in the Differential Diagnosis of Neonatal Cystic Lesions

“…When evaluating the histology, ciliated hepatic foregut duplication cysts will be lined with ciliated stratified pseudo-columnar epithelium, mimicking epithelium from the respiratory tract. If the duplication cyst is demonstrating malignant potential, there may be large septations present [ 18 ]. Simple hepatic cysts will be lined with cuboidal biliary epithelium and often filled with serous fluid [ 19 ].…”

“…This means that all will be positive for CK7 and CK19, both characteristic of cells of biliary origin. Both ciliated hepatic foregut duplication cysts and biliary hamartomas are known to be negative for CD-X2, while biliary hamartomas will also be negative for CK20 [ 16 , 18 ]. Ciliated hepatic foregut duplication cysts will also demonstrate positivity for synaptophysin, chromogranin, and calcitonin, due to the neuroendocrine origin cells within the lining of the cyst [ 20 ].…”