LETTER TO EDITOR
Year : 2009 | Volume
: 52 | Issue : 4 | Page : 598--599
Ciliated hepatic foregut cyst
Sanjay D Deshmukh1, Gayatri S Pathak1, Avinash R Joshi1, Ajay M Naik2,
1 Department of Pathology, Shrimati Kashibai Navale Medical College and General Hospital, Narhe, Pune-41, Maharashtra, India
2 Department of Surgery, Shrimati Kashibai Navale Medical College and General Hospital, Narhe, Pune-41, Maharashtra, India
Sanjay D Deshmukh
5-Gurudeep-2 Society, 62, Sahakarnagar, No. 2, Pune-411009
|How to cite this article:|
Deshmukh SD, Pathak GS, Joshi AR, Naik AM. Ciliated hepatic foregut cyst.Indian J Pathol Microbiol 2009;52:598-599
|How to cite this URL:|
Deshmukh SD, Pathak GS, Joshi AR, Naik AM. Ciliated hepatic foregut cyst. Indian J Pathol Microbiol [serial online] 2009 [cited 2020 Jul 8 ];52:598-599
Available from: http://www.ijpmonline.org/text.asp?2009/52/4/598/56150
The ciliated hepatic foregut cyst (CHFC) is a rare, solitary, unilocular, or occasionally multilocular cystic lesion in the liver. On histological evaluation, it is the only cyst which is lined by ciliated pseudo stratified columnar epithelium with subepithelial connective tissue, a smooth muscle layer and fibrous tissue.  We encountered a case of this unusual entity in a two-year-old girl which prompted us to document this case.
A two-year-old girl presented with right hypochondriac mass. Her parents reported the history of a small swelling since two months, which progressively increased in size. On examination, marked firm and nontender hepatomegaly was observed. The ultrasound (USG) examination revealed a large cyst in the right lobe of the liver measuring 11 x 10 x 7 cm 3 . It showed multiple septae and internal echos. There was no evidence of solid tissue within the cyst cavity. The diagnosis of congenital liver cyst was offered. On USG examination, both the kidneys, spleen, and pancreas appeared normal. Nuclear imaging by using H-immuno-diacetic acid (HIDA) revealed a nonobstructed hepatobiliary system with a large cold area which was consistent with a cystic lesion. In the light of the above findings, the surgical removal of the cystic lesion was planned.
Intraoperatively, a large cyst was noted in the right lobe of liver. There was no obvious connection with the biliary system. Partial enucleation with marsupilization of the cyst was done and sent for histopathology.
We received pieces of the cyst wall together measuring 4 x 3 x 2 cm 3 in size. The contents of the cyst had been drained out intraoperatively. The microscopic sections showed a cyst wall, lined by ciliated pseudostratified columnar epithelium, beneath which a loose connective tissue layer was observed, followed by a smooth muscle layer, and outer fibrous wall [Figure 1]. Focal squamous metaplasia was noted. However, multiple sectioning did not show any atypia. Based on the histological evaluation, the diagnosis of CHFC was made.
Postoperatively, the patient made uneventful recovery and was discharged on the tenth day of operation.
Ciliated intrahepatic cysts are rare type of congenital liver cysts, which are most probably derived from remains of the embryonic foregut.  These lesions can be asymptomatic or can present with clinical problems, such as biliary obstruction or malignant transformation.  Our patient had a relatively large cyst. It must be mentioned that in the literature, a slight male preponderance is documented however, this case was of a two-year-old female. 
It may be noted that in this case the cyst was multilocular, whereas unilocular cysts have been more often documented in the literature. 
Microscopically, squamous metaplasia was noted in focal areas without atypia. This finding was important because presence of squamous cell carcinoma has been reported in a few cases.  We feel that when there is a long standing cyst, the presence of squamous metaplasia, and/or malignant transformation should be carefully evaluated in every case of CHFC.
Our experience of this case highlights the importance of observing diligently for the presence of ciliated epithelial lining, when hepatic cystic lesion is encountered.
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