Ciliated Hepatic Foregut Cyst with Obstructive Jaundice

Abstract

Ciliated hepatic foregut cysts (CHFCs) are rare congenital cystic lesion that are most often solitary, unilocular, and located in the subcapsular region of the medial segment of the left hepatic lobe. The mucoid fluid contents affect imaging studies and often make definitive diagnosis difficult. CHFCs are usually asymptomatic and found incidentally. We report a 69-year-old female patient with a CHFC causing obstructive jaundice, which was difficult to differentiate from a biliary cystic neoplasm. A well-defined cystic lesion measuring 25 mm in diameter was located in the porta hepatis region. The lesion was densely adherent to the left and right hepatic ducts, riding on the bifurcation, and the common hepatic duct was extrinsically compressed. An extended left hepatectomy was performed. A diagnosis of CHFC was made on the basis of typical histological findings. CHFC should be included in the differential diagnosis for cystic lesions of the liver.

Cisto ciliado hepático: Revisão de Literatura

“…Além desses, existem relatos isolados de hipertensão portal, esplenomegalia e icterícia obstrutiva, causados por compressão da veia porta. 26,27 O aspecto característico assintomático da lesão pode ser explicado pela histogênese e embriogênese, designando a sua origem de um divertículo ou broto traqueobronquial anormal que pode ter migrado caudalmente para ser incluído ao fígado durante o desenvolvimento embrionário precoce do intestino anterior . .…”

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

“…CHFCs are mostly asymptomatic; however, symptomatic cases were not uncommon (43% of cases), primarily abdominal pain (36/37). In several cases, CHFC compressed hepatic ductal structures resulting in jaundice [ 2 , 17 , 18 , 37 , 46 , 50 ]. The size of symptomatic cysts (median 6 cm, IQR 5.45; one outlier at 130 cm [ 49 ]) was significantly larger than the size of asymptomatic cysts (median 3 cm, IQR 1.9, p = 0.01).…”

“…In hyperattenuating lesions, attenuation was 80 HU [ 16 , 51 ]. Outer rim enhancement was reported in two cases [ 31 , 37 ]. MRI was rarely employed [ 31 , 39 , 41 ].…”

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

“…When symptomatic, the majority present with right upper quadrant abdominal pain [2, 3]. However, a few cases of CHFCs causing jaundice from biliary obstruction have been reported [5, 6]. Classically, CHFCs are located in the left lobe of the liver, specifically segment IV, but can present within the right lobe as well [2, 3].…”