1
|
Focal Benign Liver Lesions and Their Diagnostic Pitfalls. Radiol Clin North Am 2022; 60:755-773. [DOI: 10.1016/j.rcl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
2
|
Hughes DL, Tsakok M, Patel N, Rendek A, Bungay H, Silva MA. Ciliated Hepatic Foregut Cysts: Not as Rare as Previously Believed. Int J Surg Pathol 2022; 31:260-267. [PMID: 35466729 DOI: 10.1177/10668969221095263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Ciliated hepatic foregut cysts (CHFCs) are uncommon cystic lesions within the liver. CHFCs can undergo a malignant transformation to form a primary squamous cell carcinoma of the liver. The true incidence and natural history of CHFCs is unknown and the risk of malignant transformation is unclear. We present a single centre's experience of CFHC management. Methods. A retrospective review of a departmental database identified all patients with CHFCs over a 4 year time period. Patients with CHFCs confirmed on histological assessment or suspected on radiological imaging were included in this study. Clinical information regarding patient demographics, symptomatic presentation, surgical management and histopathological features were noted. The radiological characteristics of CHFCs were recorded and the malignant transformation rate was calculated. Results. 15 patients with CHFC were identified (7 histologically confirmed and 8 radiologically suspected cases). All patients were asymptomatic and the CHFCs were incidental findings. No CHFC developed an interval change in cyst features or underwent a malignant transformation during follow up. MRI serves as the most sensitive modality to diagnose CHFC. Conclusions. CHFCs may be more prevalent than previously reported. Definitive management should encompass a patient centred discussion regarding the merits of long term follow up with serial imaging versus resection on an individual basis once CHFC is diagnosed.
Collapse
Affiliation(s)
- Daniel Ll Hughes
- Department of Hepato-Pancreato-Biliary Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Maria Tsakok
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nikhil Patel
- Department of General Surgery, University College London Hospitals NHS Foundation Trust, UK
- Department of Surgery and Cancer, Imperial College London, UK
| | - Aniko Rendek
- Department of Histopathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Helen Bungay
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael A Silva
- Department of Hepato-Pancreato-Biliary Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
3
|
Gallbladder Ciliated Foregut Cyst Suspected of Malignancy Preoperatively. Case Rep Surg 2021; 2021:6222947. [PMID: 34721920 PMCID: PMC8553437 DOI: 10.1155/2021/6222947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background Gallbladder ciliated foregut cysts (CFCs) of the lower diaphragm are extremely rare. Furthermore, they are rarely suspected of malignancy preoperatively. Case Presentation. A 50-year-old woman was referred to our hospital for further examination and treatment of a gallbladder tumor that was detected using abdominal ultrasonography (US). After a close inspection, she was diagnosed with a gallbladder tumor that was possibly malignant. Accordingly, open whole layer cholecystectomy was performed because intraoperative US revealed a tumor located on the intraperitoneal side of the gallbladder, and a rapid intraoperative pathological diagnosis identified no malignancy. A postoperative pathological examination revealed a cystic lesion with thin walls covered with ciliated epithelium, which laid on a connective tissue with smooth muscle fibers. Based on the above results, the final pathological diagnosis was CFC of the gallbladder without malignancy. Conclusions Cases of gallbladder CFC can be considered as cysts requiring treatment owing to CFCs' potential for malignant transformation and high-frequency symptoms.
Collapse
|
4
|
Lee MJ, Salinas J, Varikatthas W, Alsnih G. A rare gallbladder ciliated foregut cyst in chronic cholecystitis. Int J Surg Case Rep 2016; 20:155-8. [PMID: 26890682 PMCID: PMC4818304 DOI: 10.1016/j.ijscr.2016.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 01/05/2016] [Accepted: 01/16/2016] [Indexed: 11/22/2022] Open
Abstract
Ciliated foregut cysts (CFC) are rare anomalies due to aberrant embryological development arising from a remnant of the embryologic foregut. The solitary cysts are characterised by ciliated pseudostratified columnar epithelium. We present the first ciliated foregut cyst of the gallbladder case reported in Australia, and the ninth known case to be reported worldwide. Ciliated foregut cysts can be difficult to distinguish from neoplasms clinically and radiographically. Reports have shown that these cysts may become dysplastic and is best excised when discovered.
Introduction Ciliated foregut cysts (CFC) are rare anomalies due to aberrant embryological development. It is thought to arise from a remnant of the embryologic foregut. The solitary cysts are characterised by ciliated pseudostratified columnar epithelium. They are usually located above the diaphragm but they can also arise in relation to the liver, gallbladder and pancreas. Presentation of case We present the first ciliated foregut cyst of the gallbladder case reported in Australia, and the ninth known case to be reported worldwide. A 61-year-old male with chronic cholecystitis and cholelithiasis underwent an elective laparoscopic cholecystectomy and intraoperative cholangiogram. Intraoperatively, ‘out-pouching’ was noted on the lateral border of the gallbladder. Microscopically the histopathology showed that the cyst was lined by ciliated columnar epithelium the characteristic feature of a ciliated foregut cyst. Discussion To date only 8 cases of these ciliated foregut cysts in the gallbladder have been reported in literature. Our case is the first reported in Australia. It is unique in that the patient was an older male as opposed to most other previous cases, which were younger females. These cysts can be difficult to distinguish from neoplasms clinically and radiographically. Reports have shown that these cysts may become dysplastic and is best excised when discovered. Conclusion Despite the rarity of CFCs and their potential to mimic malignancy, we propose awareness and understanding of the management for them—being excision and hopefully not cause any confusion or devastatingly allow it to become malignant.
Collapse
Affiliation(s)
- Mee-Jin Lee
- Department of General Surgery, Blacktown Hospital, Sydney, New South Wales, Australia.
| | - James Salinas
- Department of General Surgery, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Winny Varikatthas
- Department of Pathology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ghiyath Alsnih
- Department of General Surgery, Blacktown Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
5
|
Han JE, Noh MH, Kim WJ, Kim DK, Nam HS, Noh MS, Kim GW. A Case of Ciliated Foregut Cyst of the Gallbladder. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 67:49-53. [PMID: 26809633 DOI: 10.4166/kjg.2016.67.1.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Congenital cysts of the gallbladder are extremely rare, hence only a few ciliated foregut cysts of gallbladder have been reported. We report a case of a 20-year-old woman presenting with mild right upper quadrant abdominal discomfort, with normal levels of serum bilirubin and liver function tests. Abdominal ultrasonography revealed a well-defined cystic mass measured about 2 cm attached to the neck of gallbladder, with internal echogenic debris suggesting a complicated cyst, such as a hemorrhagic cyst. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed similar findings. Laparoscopic cholecystectomy showed a slightly distended gallbladder. The size of cyst on the neck was 1.6×1.2 cm, and it contained mucosa lined by ciliated pseudostratified columnar epithelium and underlying smooth muscle layers. Histopathology identified a ciliated foregut cyst of gallbladder.
Collapse
Affiliation(s)
- Ji Eun Han
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Myung Hwan Noh
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Woo Jae Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Dong Kyun Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Hwa Seung Nam
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Mee Sook Noh
- Department of Pathology, Dong-A University College of Medicine, Busan, Korea
| | - Guan Woo Kim
- Department of General Surgery, Dong-A University College of Medicine, Busan, Korea
| |
Collapse
|
6
|
Bishop KC, Perrino CM, Ruzinova MB, Brunt EM. Ciliated hepatic foregut cyst: a report of 6 cases and a review of the English literature. Diagn Pathol 2015; 10:81. [PMID: 26122082 PMCID: PMC4486693 DOI: 10.1186/s13000-015-0321-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/10/2015] [Indexed: 02/08/2023] Open
Abstract
Background Ciliated hepatic foregut cyst (CHFC) is a rare cystic lesion most commonly identified in segment 4 of the liver that arises from the embryonic foregut. The classic histologic pattern is comprised of 4 distinct layers (inner ciliated epithelial lining, smooth muscle, loose connective tissue, fibrous capsule). Although rare, cases of metaplastic and malignant epithelial lining have been described in CHFC. Methods We report 6 additional cases of CHFC, one of which had gastric metaplasia of the cyst lining, and review all reported cases of CHFC in the English literature. We describe the clinicopathologic analysis of 6 cases, with selective immunohistochemical analysis on 1 case with gastric metaplasia. Results Cases occurred in 4 women and 2 men (average age 55 years, range 42 to 67 years). Cysts ranged in size from 0.7 to 17 cm (average 7.2 cm) and were grossly tan-pink to white with blood-filled contents. The majority were located in segment 4 of the liver, however 2 were located in the porta hepatis. Tumor serologies (CA19-9 and/or CEA) were performed in 3 cases; 1 case demonstrated elevated CA19-9, and 2 cases had laboratory values within normal limits. All cases showed the classic histologic findings, however one case additionally had extensive gastric metaplasia. Conclusions In conclusion, CHFC is a rare diagnostic entity that should be considered in the differential diagnosis for cystic hepatic lesions, particularly those located in segment 4 of the liver. Metaplasia and squamous carcinoma can occur, therefore complete surgical excision is the recommended treatment. Electronic supplementary material The online version of this article (doi:10.1186/s13000-015-0321-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Katherine C Bishop
- Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA. .,Department of Obstetrics and Gynecology, Duke University School of Medicine, 40 Duke Medicine Cir #1J, Durham, NC, 27710, USA.
| | - Carmen M Perrino
- Department of Pathology and Immunology, Washington University School of Medicine, Campus Box 8118, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
| | - Marianna B Ruzinova
- Department of Pathology and Immunology, Washington University School of Medicine, Campus Box 8118, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
| | - Elizabeth M Brunt
- Department of Pathology and Immunology, Washington University School of Medicine, Campus Box 8118, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
| |
Collapse
|
7
|
Abstract
Focal liver lesions (FLLs) are commonly encountered on routine imaging studies. Most lesions detected are benign, but many are indeterminate at the time of initial imaging. This article reviews the important role of MR imaging for the detection and characterization of various benign FLLs while illustrating typical imaging appearances and potential pitfalls in interpretation. The utility of diffusion-weighted imaging and hepatocyte-specific contrast agents is also discussed.
Collapse
Affiliation(s)
- Jonathan R Cogley
- Section of Body Imaging, Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA.
| |
Collapse
|
8
|
Tunçyürek Ö, Nart D, Yaman B, Buyukcoban E. A ciliated foregut cyst in a gallbladder: the smallest recorded. Jpn J Radiol 2013; 31:412-8. [PMID: 23532579 DOI: 10.1007/s11604-013-0196-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 02/07/2013] [Indexed: 11/25/2022]
Abstract
Ciliated foregut cysts (CFCs) are rare masses that develop from the tissues which remain from embryological foregut development. In the literature, about a hundred cases have been described in various organs so far. Although rare, there is a risk of development of squamous cell carcinoma from these cysts that typically bear benign features. Prognosis following the development of carcinoma is poor. A female case presented with upper quadrant pain and was sent to radiology for US examination of the abdomen. In 2010, a cyst which was about 5 mm in size was detected on the wall of the gall bladder. In subsequent US, the lesion reached 7 mm in diameter and a shape protruding to the lumen was included in the findings; therefore, it was decided to operate. The mass was diagnosed as a CFC of the gallbladder. We determined that the lesion had the smallest dimension noted in the literature. Congenital gallbladder cysts are detected rather rarely. The US characteristics are enough to make a definitive diagnosis, and the other imaging methods therefore remain unnecessary. Treatment using a laparoscopic surgical method is the first preference.
Collapse
Affiliation(s)
- Özüm Tunçyürek
- Radyoloji Ultrason Bölümü, Aydin Atatürk Devlet Hastanesi, 09010 Aydin, Turkey.
| | | | | | | |
Collapse
|
9
|
Abstract
The high frequency of benign and asymptomatic liver cysts must not underevaluate the potential diagnostic difficulties of liver cystic diseases. Complicated liver cyst or cystic mass of various origin, such as developmental, neoplastic or inflammatory, are important to be recognized by the radiologist. The diagnostic approach is depending on the number of lesions and their dissemination. The presence of a wall, the internal structure of the lesion, particularly the MR signal and the proximity of the biliary tree are the main diagnostic criteria. Some less frequent but characteristic unusual features need to be memorized.
Collapse
Affiliation(s)
- S Precetti
- Service de Radiologie, Hôpital Beaujon, Clichy
| | | | | |
Collapse
|
10
|
Herédia V, Altun E, Ramalho M, Semelka RC. Magnetic resonance imaging of the liver: a review. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2007; 1:213-223. [PMID: 23489308 DOI: 10.1517/17530059.1.2.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this review article, the authors discuss the essential aspects of liver magnetic resonance imaging (MRI), including protocol, intravenous contrast use and disease entities. At present, liver MRI uses fast scanning techniques, allowing the maximization of the principles of image quality, reproducibility of image quality and good conspicuity of disease. MRI is the most accurate imaging modality for the detection and characterization of diffuse and focal liver disease. In the expert opinion section, the authors refer to the advantages and challenges of 3.0T liver imaging.
Collapse
Affiliation(s)
- Vasco Herédia
- University of North Carolina at Chapel Hill, Department of Radiology, CB# 7510, 101 Manning Drive, Chapel Hill, NC 27599-7510, USA +1 919 966 4400 ; +1 919 966 9143 ;
| | | | | | | |
Collapse
|
11
|
Ramalho M, Altun E, Herédia V, Zapparoli M, Semelka R. Liver MR Imaging: 1.5T versus 3T. Magn Reson Imaging Clin N Am 2007; 15:321-47, vi. [PMID: 17893053 DOI: 10.1016/j.mric.2007.06.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article focuses on technical challenges in transferring 1.5T liver protocols to 3T systems and the overall comparison of MR sequences, highlighting the advantages and disadvantages of imaging at the higher field strength. An important benefit is the capacity of acquiring high-quality, thin-section postgadolinium T1-weighted three-dimensional gradientecho sequences, most clinically relevant for the detection and characterization of small hypervascular malignant diseases. Further research and development is necessary to overcome disadvantages, such as with in- and out-of phase T1-weighted gradient-echo sequences, and to minimize artifacts that appear at 3T.
Collapse
Affiliation(s)
- Miguel Ramalho
- Department of Radiology, University of North Carolina at Chapel Hill, CB#7510, 101 Manning Drive, Chapel Hill, NC 27599-7510, USA
| | | | | | | | | |
Collapse
|
12
|
Kaplan KJ, Escobar M, Alonzo M, Berlin JW. Ciliated hepatic foregut cyst: Report of a case on fine-needle aspiration. Diagn Cytopathol 2007; 35:245-9. [PMID: 17351948 DOI: 10.1002/dc.20622] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Ciliated hepatic foregut cyst (CHFC) is a rare, benign, solitary cyst consisting of ciliated columnar epithelium. They are lined by a layer of ciliated columnar cells and contain mucoid material and debris. It is the ciliated epithelium that distinguishes them from other hepatic cysts. The cyst is generally found incidentally on radiologic imaging or during surgical exploration. There has been an increase in the number of reports of CHFC during the past 15 years in the surgical pathology literature, presumably because of increased availability of various radiologic imaging modalities. Although it is rare, CHFC should be included in the differential diagnosis of cystic lesions of the liver and is important to consider in aspirates obtained for the evaluation of possible neoplastic disease. We report a case diagnosed by fine-needle aspiration for a liver cyst discovered incidentally during the evaluation of acute pancreatitis.
Collapse
Affiliation(s)
- Keith J Kaplan
- Department of Pathology, Evanston Hospital, 2650 Ridge Avenue, Evanston, IL 60201, USA.
| | | | | | | |
Collapse
|
13
|
De J, Rossman L, Kott MM, Deavers MT. Cytologic diagnosis of ciliated hepatic foregut cyst. Diagn Cytopathol 2006; 34:846-9. [PMID: 17183760 DOI: 10.1002/dc.20572] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Ciliated hepatic foregut cyst (CHFC) is a rare, benign, solitary cyst occurring most often in the left lobe of the liver. CHFCs are typically found incidentally during radiologic imaging, surgical exploration, or autopsy. Only six cases of CHFC diagnosed by fine needle aspiration have been reported in the literature. We describe a CHFC diagnosed by aspiration in a 70-yr-old woman who presented with a 2-yr history of abdominal discomfort. The radiologically benign-appearing lesion was located in the subcapsular area of segment IV of the liver. The aspirate contained benign ciliated columnar cells and goblet cells suspended in mucoid material. Sections from a cell block demonstrated pseudo-stratified bronchial-type epithelium with mucin secreting cells and an absence of cartilage, characteristic of CHFC. Mucin-containing goblet cells stained with alcian blue. The neuroendocrine cells within the bronchial-type epithelium stained for calcitonin and synaptophysin. On follow-up, a computed tomography (CT) demonstrated the cyst to be unchanged, but as the patient continued to have pain, sclerosis of the cyst was planned. The diagnosis of CHFC by fine needle aspiration and its distinction from other solitary cysts of the liver may prevent unnecessary surgical exploration and excision.
Collapse
Affiliation(s)
- Jitakshi De
- Department of Pathology and Laboratory Medicine, University of Texas Medical School, Houston, TX 77030, USA
| | | | | | | |
Collapse
|
14
|
Abstract
Ciliated hepatic foregut cysts are a rare entity usually found in adults. We present a case of a 3-year-old boy incidentally noted to have a radiographically complex liver cyst on computed tomographic scan. Given the complex appearance, the cyst was excised. Pathology revealed a ciliated hepatic foregut cyst. This is the second child and youngest patient affected with this lesion reported in the literature. The etiology of the lesion and an argument for surgical removal in pediatric patients are presented.
Collapse
Affiliation(s)
- Sunghoon Kim
- Division of Pediatric Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | | | | | | |
Collapse
|
15
|
Abstract
A variety of lesions occur in the normal liver. This review will describe the most common benign, malignant, and infectious lesions. Illustration will be made of the magnetic resonance imaging (MRI) appearance of the most common of these. Due to the high accuracy for liver lesion detection and characterization, and the intrinsic safety of the modality, MR should be considered the primary imaging tool to investigate liver diseases.
Collapse
Affiliation(s)
- Richard C Semelka
- Department of Radiology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina 27599, USA.
| | | | | |
Collapse
|
16
|
Abstract
Ciliated hepatic foregut cyst (CHFC) is a very rare cystic lesion of the liver that is histologically similar to bronchogenic cyst. We report one case of CHFC that was hard to distinguish from solid-cystic neoplasm in imaging features. Magnetic resonance imaging was helpful in differentiating these cysts from other lesions.
Collapse
Affiliation(s)
- Song-Hua Fang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
| | | | | |
Collapse
|
17
|
Cai XJ, Huang DY, Liang X, Yu H, Li W, Wang XF, Peng SY. Ciliated hepatic foregut cyst: report of first case in China and review of literature. JOURNAL OF ZHEJIANG UNIVERSITY. SCIENCE 2004; 5:483-485. [PMID: 14994442 DOI: 10.1631/jzus.2004.0483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To report the first case of ciliated hepatic foregut cyst in China, and review of literature to introduce the characteristics of this disease for doctors to recognize this disease. METHOD Report the clinical procedure of diagnosis and treatment for the first case of ciliated hepatic foregut cyst in China, and to review the embryologic genesis, incidence, clinical manifestation, radiologic features and therapeutic principle of this disease. RESULTS We performed the resection for ciliated hepatic foregut cyst under laparoscopy; the patient recovered well after the procedure. CONCLUSION Ciliated hepatic foregut cyst is quite rare clinically, belongs to non-parasitic, solitary and unilocular cystic lesion, is always less than 4 cm in diameter, mostly seen in the left lobe, and has the tendency of malignant change. It should be removed as soon as diagnosed.
Collapse
Affiliation(s)
- Xiu-jun Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China.
| | | | | | | | | | | | | |
Collapse
|
18
|
Affiliation(s)
- Paolo Del Poggio
- Hepatology Unit, Azienda Ospedaliera di Treviglio (Bg), Piazza Ospedale n, 1, Treviglio 24047, Italy.
| | | | | | | | | |
Collapse
|
19
|
Abstract
Use of a state-of-the-art pattern recognition approach and the combination of various MR sequences and contrast enhancement techniques makes it possible to diagnose most benign hepatic tumors with confidence.
Collapse
Affiliation(s)
- Tomofumi Motohara
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | | | | |
Collapse
|
20
|
Chatelain D, Chailley-Heu B, Terris B, Molas G, Le Caë A, Vilgrain V, Belghiti J, Degott C, Flejou JF. The ciliated hepatic foregut cyst, an unusual bronchiolar foregut malformation: a histological, histochemical, and immunohistochemical study of 7 cases. Hum Pathol 2000; 31:241-6. [PMID: 10685641 DOI: 10.1016/s0046-8177(00)80227-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The ciliated hepatic foregut cyst is an unusual solitary cystic lesion of the liver. In a series of 7 cases of hepatic ciliated cysts, we performed a histological, histochemical, and immunohistochemical study to better define the histogenesis of this rare entity. The patients were 4 women and 3 men, aged 39 to 75 years. Four patients presented with abdominal pain. In 3 cases the cyst was discovered incidentally on ultrasonography. The cysts measured from 1 to 4 cm in diameter. Microscopically, the lining of the columnar epithelium was composed of ciliated cells and mucin secreting goblet cells. The wall was composed of bands of smooth-muscle fibers surrounded by an outer fibrous capsule. The goblet cells stained with PAS, alcian blue, and high-iron diamine. The immunohistochemical study showed that endocrine cells were present within the cyst epithelium, positive for chromogranin, synaptophysin, bombesin, and calcitonin, and negative for serotonin, somatostatin, glucagon, insulin, gastrin, and pancreatic polypeptide. In all the cases, immunoreactivity of some cells for CC10 strongly suggested the presence of Clara cells. Our study shows that the epithelium lining ciliated hepatic foregut cysts has histological, histochemical, and immunohistochemical features similar to those observed in the bronchiolar epithelium. This lesion is a developmental ventral foregut abnormality that could arise from a bronchiolar bud of the tracheobronchial diverticulum.
Collapse
Affiliation(s)
- D Chatelain
- Department of Pathology, Hôpital Beaujon, Clichy, and INSERM U319, Université Paris 7, France
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Vick DJ, Goodman ZD, Deavers MT, Cain J, Ishak KG. Ciliated hepatic foregut cyst: a study of six cases and review of the literature. Am J Surg Pathol 1999; 23:671-7. [PMID: 10366149 DOI: 10.1097/00000478-199906000-00006] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ciliated hepatic foregut cyst (CHFC) is a rare, benign, solitary cyst consisting of ciliated pseudostratified columnar epithelium, subepithelial connective tissue, a smooth muscle layer, and an outer fibrous capsule. We studied six previously unreported cases of CHFC and 50 cases from the literature. The literature search revealed that Friedreich first described the lesion in 1857 and hypothesized its congenital origin. The cyst generally is found incidentally on radiologic imaging or during surgical exploration, although one case presented with portal vein compression. It occurs more frequently in men and is found most commonly in the medial segment of the left hepatic lobe, unlike most other solitary cysts that show a female predominance and greater occurrence in the right hepatic lobe. Two of the 56 cases were multilocular. There has been an increase in the number of reports of CHFC during the past 15 years. This may reflect the increased availability and use of various radiologic imaging modalities. A large number of cases have been reported in the Japanese population, but the significance of this is unclear. CHFC should be considered in the differential diagnosis of other solitary liver cysts, including simple cysts, hepatobiliary cystadenomas, and parasitic cysts.
Collapse
Affiliation(s)
- D J Vick
- Department of Pathology and Area Laboratory Services, Walter Reed Army Medical Center, Washington, DC, USA
| | | | | | | | | |
Collapse
|
22
|
|
23
|
Abstract
We encountered a patient with a ciliated hepatic foregut cyst with accompanying liver cirrhosis, which was hard to distinguish from well-differentiated hepatocellular carcinoma. A lesion 2 cm in diameter was found in the subcapsular region of the medial segment of the liver. It was slightly hypoechoic on ultrasonography, of high attenuation on nonenhanced computed tomography (CT), of high intensity on T1-weighted spin echo images of magnetic resonance imaging (MRI), and of isointensity on T2-weighted spin echo images. It was not enhanced in the arterial phase images of MRI, and was shown as a complete perfusion defect on CT arterial portography. The cyst was enucleated and found to be filled with bloody mucinous fluid.
Collapse
Affiliation(s)
- T Murakami
- Department of Radiology, Osaka University Medical School, Japan
| | | | | | | | | | | |
Collapse
|