Ciliated hepatic foregut cyst: A case report and review of literature. (July 2022) - Silva, Cláudio
Abstract: Introduction: Ciliated hepatic foregut cyst (CHFC) is a rare cystic lesion that arises from the embryonic foregut with approximately 100 cases reported. Most commonly identified in segment IV of the liver, CHFC is typically asymptomatic and incidentally found on abdominal imaging. It is important to consider this entity in the differential diagnosis of atypical liver lesions since CHFC carries a risk of transformation into squamous cell carcinoma. A suspicion of CHFC is therefore an indication for surgical resection. Case presentation: A 62-year-old male presented to surgery consultation for further evaluation of a hepatic cyst incidentally found on abdominal ultrasound. The patient was completely asymptomatic. Both abdominal computerized tomography and magnetic resonance imaging scan confirmed a 4 cm subcapsular cyst in segment IVa. Additional workup was unremarkable. Considering the diagnostic doubt the patient underwent laparoscopic cyst enucleation. Histology revealed a ciliated pseudostratified epithelium consistent with a CHFC. Clinical discussion: CHFC is a rare diagnostic entity that should be considered in the differential diagnosis of cystic hepatic lesions, particularly those located in segment IV of the liver. Since it is frequently asymptomatic, CHFC is usually found incidentally during surgery or imaging studies. Diagnosis of CHFC preoperatively is difficult due to the lack of specific radiographic findings. Moreover, metaplasia and squamous carcinoma can occur. Therefore complete surgical excision is the recommended treatment. Conclusion: Despite its rarity, CHFC carries a risk of malignant transformation. Accurate diagnosis is mandatory and surgical excision is recommended even in asymptomatic CHFC. Highlights: The ciliated hepatic foregut cyst is extremely rare, though increasingly being reported. CHFC is a benign cyst with potential for malignant transformation. Due to lack of evidence, management is not standardized. Complete surgical excision through a laparoscopic approach must be the treatment of choice.