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Aliyev A, Ibrahimli A, Azizova N, Alishev N, Ahmadov E. A Rare Case of Symptomatic Ciliated Hepatic Foregut Cyst in a 17-Year-Old Female. Cureus 2023; 15:e43498. [PMID: 37719579 PMCID: PMC10500217 DOI: 10.7759/cureus.43498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
A ciliated hepatic foregut cyst (CHFC) is a very uncommon cystic hepatic lesion that arises from an embryonic remnant of the foregut epithelium. CHFC is predominantly asymptomatic and is found incidentally. However, it can show various clinical presentations such as pain and weight loss. We present the case of a 17-year-old female who came to our hospital with complaints of right subcostal pain and abdominal discomfort and was diagnosed with CHFC by biopsy. Successful laparoscopic resection was performed due to the possibility of malignant transformation. Even though the majority of the patients are asymptomatic and cysts are commonly found incidentally, when the lesion has concerning features, they may need follow-up or resection due to rare reported cases of malignant transformation.
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Affiliation(s)
| | | | | | - Nijat Alishev
- Invasive Radiology, Liv Bona Dea Hospital, Baku, AZE
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2
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Kato T, Schammel CMG, Fenton H, Trocha SD, Devane AM. Ciliated Hepatic Foregut Cyst: Definitive Diagnosis Is Critical to the Optimal Treatment Pathway. Case Reports Hepatol 2023; 2023:6637890. [PMID: 37503330 PMCID: PMC10371551 DOI: 10.1155/2023/6637890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Background. Ciliated hepatic foregut cyst (CHFC) is a rare, benign cyst of the liver, derived from the embryonic foregut epithelium. Although CHFCs are typically asymptomatic, some present with nonspecific abdominal symptoms. Imaging modalities alone are insufficient for diagnosis, with intrahepatic cholangiocarcinoma included in the differential due to nonspecific imaging features; definitive diagnosis relies on histologic confirmation. These lesions are often benign; however, larger lesions can have malignant transformation into squamous cell carcinoma (SCC), which carries a poor prognosis, thus making a definitive diagnosis, no matter what size, essential. Here, we present a case of CHFC as well as a comprehensive literature review. Given these data, we propose an algorithm for definitive diagnosis.
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Affiliation(s)
- Tatsuhiro Kato
- University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA
| | - Christine M. G. Schammel
- University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA
- Pathology Associates, Greenville, SC 29605, USA
| | | | - Steven D. Trocha
- Department of Surgery, Prisma Health Upstate, Greenville, SC 29605, USA
| | - A. Michael Devane
- University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA
- Department of Radiology, Prisma Health Upstate, Greenville, SC 29605, USA
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Seyed-Alagheband SA, Zargarani M, Soheilinejad F, Sohooli M, Shekouhi R. A ciliated hepatic foregut cyst mimicking hydatid cyst treated with laparoscopic surgery; a case-report and review of literature. Int J Surg Case Rep 2023; 106:108226. [PMID: 37120896 PMCID: PMC10173192 DOI: 10.1016/j.ijscr.2023.108226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Congenital hepatic foregut cyst (CHFC) is a rare condition that is derived from an abnormal detachment of esophageal buds during foregut embryonic development. Early treatment is generally recommended due to the potential of malignant transformation. In this study, we are reporting our experience with laparoscopic resection of CHFC in a female patient. CASE PRESENTATION A 41-year-old female farmer presented with a 5-month history of right upper quadrant (RUQ) pain with a palpable mass. Abdominal examination revealed a visible subhepatic large mass with an estimated size of 10 cm, which was horizontally mobile. Abdominopelvic ultrasonography showed a 76 ∗ 87 ∗ 15 cm single subhepatic cyst with internal septations. The patient was scheduled to undergo laparoscopic surgical resection of the cyst with an initial diagnosis of a hepatic hydatid cyst. Histopathologic evaluations showed that the cyst wall was composed of four layers consistent with the diagnosis of CHFC. CLINICAL DISCUSSION Due to the disease's rarity there have been various recommendations regarding treatment of CHFC in literature including observation with serial imaging, aspiration, and surgical excision. However, surgical excision is considered the most reasonable option given the chance of malignant transfusion, particularly in patients with enlarging cysts with size of more than 4 cm, cyst wall abnormality, abnormal liver function tests, and symptomatic cases. CONCLUSION Surgical resection is a feasible option for resection of CHFC given that the cyst wall is thick enough to be excised from the hepatic parenchyma and the lesion is situated on the surface of the liver.
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Affiliation(s)
| | - Mehdi Zargarani
- Department of Surgery, Lorestan University of Medical Sciences, Lorestan, Khorramabad, Iran
| | - Fatemeh Soheilinejad
- Department of Surgery, Lorestan University of Medical Sciences, Lorestan, Khorramabad, Iran
| | - Maryam Sohooli
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Shekouhi
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
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Silva C, Ferreira L, Branco C, Simões V, Canha A, Silva DS, Daniel J, Davide J. Ciliated hepatic foregut cyst: A case report and review of literature. Int J Surg Case Rep 2022; 96:107356. [PMID: 35810683 PMCID: PMC9284052 DOI: 10.1016/j.ijscr.2022.107356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023] Open
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.
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Affiliation(s)
- Cláudio Silva
- HEBIPA – Hepatobiliary and Pancreatic Unit, Department of General Surgery (Head: José Davide), Hospital de Santo António, Centro Hospitalar e Universitário do Porto EPE – Porto, Largo do Prof. Abel Salazar, 4099-001, Portugal,Corresponding author at: General Surgery Service – Centro Hospitalar e Universitário do Porto, Largo do Prof. Abel Salazar 4099-001, Porto, Portugal.
| | - Luísa Ferreira
- Department of Pathology, Hospital de Santo António, Centro Hospitalar e Universitário do Porto EPE – Porto, Largo do Prof. Abel Salazar, 4099-001, Portugal
| | - Cláudio Branco
- HEBIPA – Hepatobiliary and Pancreatic Unit, Department of General Surgery (Head: José Davide), Hospital de Santo António, Centro Hospitalar e Universitário do Porto EPE – Porto, Largo do Prof. Abel Salazar, 4099-001, Portugal
| | - Vítor Simões
- HEBIPA – Hepatobiliary and Pancreatic Unit, Department of General Surgery (Head: José Davide), Hospital de Santo António, Centro Hospitalar e Universitário do Porto EPE – Porto, Largo do Prof. Abel Salazar, 4099-001, Portugal
| | - António Canha
- HEBIPA – Hepatobiliary and Pancreatic Unit, Department of General Surgery (Head: José Davide), Hospital de Santo António, Centro Hospitalar e Universitário do Porto EPE – Porto, Largo do Prof. Abel Salazar, 4099-001, Portugal
| | - Donzília Sousa Silva
- HEBIPA – Hepatobiliary and Pancreatic Unit, Department of General Surgery (Head: José Davide), Hospital de Santo António, Centro Hospitalar e Universitário do Porto EPE – Porto, Largo do Prof. Abel Salazar, 4099-001, Portugal
| | - Jorge Daniel
- HEBIPA – Hepatobiliary and Pancreatic Unit, Department of General Surgery (Head: José Davide), Hospital de Santo António, Centro Hospitalar e Universitário do Porto EPE – Porto, Largo do Prof. Abel Salazar, 4099-001, Portugal
| | - José Davide
- HEBIPA – Hepatobiliary and Pancreatic Unit, Department of General Surgery (Head: José Davide), Hospital de Santo António, Centro Hospitalar e Universitário do Porto EPE – Porto, Largo do Prof. Abel Salazar, 4099-001, Portugal
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Enke T, Manatsathit W, Merani S, Fisher K. Ciliated Hepatic Foregut Cyst: A Report of a Case Incidentally Discovered during Transplant Evaluation. Case Rep Gastrointest Med 2019; 2019:7828427. [PMID: 31687226 PMCID: PMC6803733 DOI: 10.1155/2019/7828427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/28/2019] [Indexed: 11/18/2022] Open
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.
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Affiliation(s)
- Thomas Enke
- The University of Nebraska Medical Center, NE, USA
| | - Wuttiporn Manatsathit
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shaheed Merani
- Department of Transplant Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kurt Fisher
- Department of Pathology, University of Nebraska Medical Center, Omaha, NE, USA
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Bruns NE, Asfaw SH, Stackhouse KA, Falk GA, Magnuson DK, Seifarth FG. Laparoscopic excision of a ciliated hepatic foregut cyst in a child: A case report and review of the literature. Ann Med Surg (Lond) 2016; 4:467-9. [PMID: 26779336 PMCID: PMC4685211 DOI: 10.1016/j.amsu.2015.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
Introduction Ciliated hepatic foregut cysts (CHFC) are rare congenital hepatic lesions derived from the embryonic foregut. Because of potential transformation to squamous cell carcinoma in adulthood, the mainstay of therapy is surgical resection. To our knowledge, we report the first case of CHFC in a child that was successfully excised laparoscopically. Presentation of case We report a case of a 4-year-old boy that was diagnosed with an asymptomatic 5-cm liver cyst. After surveillance for 3 years, the cyst grew to 7 cm at which time it was successfully resected laparoscopically. The pathology was consistent with CHFC. Discussion There have been few previous reports of CHFCs in children, all of which described excision via a laparotomy. This is the first case report of laparoscopic resection of CHFC in a child. Conclusion This case report suggests that laparoscopy may be safe and effective for resection of CHFCs with favorable anatomy such as peripheral location and noninvolvement of key vascular and biliary structures. Ciliated hepatic foregut cyst (CHFC) is a rare congenital hepatic lesion. Indications for excision include large size, symptoms and LFT abnormalities. Laparoscopic excision is safe for CHFC and should be considered.
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Affiliation(s)
- Nicholas E Bruns
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, 9500 Euclid Ave, A120, Cleveland, OH, 44195, USA
| | - Sofya H Asfaw
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, 9500 Euclid Ave, A120, Cleveland, OH, 44195, USA
| | - Kathryn A Stackhouse
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, 9500 Euclid Ave, A120, Cleveland, OH, 44195, USA
| | - Gavin A Falk
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, 9500 Euclid Ave, A120, Cleveland, OH, 44195, USA
| | - David K Magnuson
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, 9500 Euclid Ave, A120, Cleveland, OH, 44195, USA
| | - Federico G Seifarth
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, 9500 Euclid Ave, A120, Cleveland, OH, 44195, USA
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Ansari-Gilani K, Modaresi Esfeh J. Ciliated hepatic foregut cyst: report of three cases and review of imaging features. Gastroenterol Rep (Oxf) 2015; 5:75-78. [PMID: 26126985 PMCID: PMC5444260 DOI: 10.1093/gastro/gov028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Ciliated hepatic foregut cysts (CHFCs) are rare cystic lesions which are most commonly asymptomatic. They can be clinically important as they may, on rare occasions, undergo malignant transformation or cause mass effect if significantly enlarged. Three cases of CHFCs are presented in this article and their imaging features are reviewed.
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Affiliation(s)
- Kianoush Ansari-Gilani
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Jamak Modaresi Esfeh
- Department of Gastroenterology & Hepatology, Cleveland Clinic, Cleveland, OH, USA
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