Ciliated Hepatic Foregut Cyst Research Articles

Ciliated Hepatic Foregut Cysts: Not as Rare as Previously Believed.

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.

Ciliated Hepatic Foregut Cysts: About A Case and Review of the Literature

Ciliated hepatic foregut cysts (CHFCs) are a benign cyst of the liver with a ciliated coating. It is an extremely rare solitary cystic lesion. In this paper, we present a case of CHFCs in a 41-year-old woman. Our goal was to insist by the report of this clinical observation and the review of the literature on the main issue of this pathology which is to ensure a regular and rigorous monitoring of patients with CHFCs or a radical surgical treatment to anticipate or avoid malignant complications.

Ciliated hepatic foregut cysts: A case series and literature review

Background: Ciliated hepatic foregut cysts (CHFCs) are rare, uniloculate, cystic lesions of embryological origin and are of significance due to their malignant potential. They are the only ciliated cystic lesions known to occur in the liver, tend to be asymptomatic and are found more frequently in male patients. They are often incidental findings on imaging or during surgery, typically in segment IV of the liver. This study highlights two cases of CHFCs managed at a regional tertiary centre in 2018, and reviews the current literature on CHFCs. Material and Methods: A PubMed search for CHFCs was completed.Of the aforementioned two patients with CHFCs, relevant clinical information was obtained from electronic patient records. Results: The literature review yielded 81 papers. Although the exact aetiology is unknown, several reports hypothesize that CHFCs originate from detachment and migration of buds from the oesophageal and bronchial regions of the foregut that are entrapped by the liver during embryonic development. CHFCs are mostly found in segments IVA and IVB, and have unique histology; ciliated pseudostratified columnar epithelium. The mechanism of malignant transformation is unclear but rate of transformation is estimated at 6%. Case 1: A 47 year old fit and healthy male whose CHFC was identified incidentally on imaging, underwent laparoscopic segment IV hepatic resection with CHFC confirmed histologically. Case 2: A 64 year old male with haemangiopericytoma of the brain, who developed a liver metastasis; also haemangiopericytoma. His CHFC was an incidental finding wholly excised during an ALPPS procedure for resection of this metastasis. Conclusion: CHFCs are rare lesions. The malignant transformation risk is based on anecdotal case series data. The evidence for optimum management is lacking; and a patient-centred choice between long term follow-up or definitive laparoscopic resection must be made. Recommendation for surgery is based on level 3 evidence.

Minimally invasive management of hepatic cysts: indications and complications.

Liver cysts are divided into congenital and acquired. Congenital cystic lesions include polycystic liver disease, simple cysts, duct related and ciliated hepatic foregut cysts. Acquired cystic lesions are divided into infectious and non-infectious. The infectious cysts are the hydatid cyst, the amoebic abscess, and the pyogenic abscess, whereas the non-infectious cysts are neoplastic cysts and false cysts. While modern medicine provides a lot of minimally invasive therapeutic modalities, there has emerged a pressing need for understanding the various types of liver cysts, the possible minimal therapeutic options along with their indications and complications. We aim is to clarify the role of minimally invasive techniques in the management of hepatic cysts. A literature review was performed using the MEDLINE database. The search terms were: liver cyst, minimally invasive, laparoscopic, percutaneous, drainage and fenestration. We reviewed 82 English language publications articles, published until October 2017. Minimally invasive management of liver LC is an emerging field including many therapeutic modalities ranging from the percutaneous aspiration of pyogenic abscesses to laparoscopic hepatectomy for hepatic cystadenomas. The most used techniques are percutaneous drainage, laparoscopic fenestration, and laparoscopic hepatectomy. The application of the various minimally invasive approaches, as well as their indication and complications, depend on the type of the cystic lesion, its size and its position in the liver. Percutaneous drainage is mostly used in simple cysts, hydatid cysts, pyogenic abscesses and bilomas. Laparoscopic fenestration is mostly used in simple cysts and polycystic liver disease. Finally, laparoscopic hepatectomy is mostly used in polycystic liver disease, hydatid cysts, and cystadenomas.

Cisto ciliado hepático: Revisão de Literatura

Ciliated hepatic foregut cyst (CHFC) is a rare cystic liver disease that predominantly affects adult men and is usually asymptomatic. From embryonic of the foregut origin, CHFC presents the average size of 3.6 cm and they are well defined, are unilocular and are located in the medial segment of the left hepatic lobe. Diagnosis is based on incidental finding in radiological examinations which are with hypoechoic images on ultrasound, hypo or isoattenuating on computer tomography and hyperintense on T2 ponderation on MRI. Definitive diagnosis is given with the histological study evidencing the four layers typical of the cyst wall. The monitoring is important because of the possibility of malignant transformation in about 5% of cases. This theme has relevance due to the increase in incidence, difficulty of diagnosis, complications and the lack of knowledge of the scientific community. The purpose of this literature review is to demonstrate the importance of the diagnosis, the clinical-diagnostic features and suspicion of the frame. A review was made on the period from March 2014 to July 2015. The descriptors used were: "ciliated hepatic foregut cyst"; "diagnosis of ciliated hepatic foregut cyst" and "image of ciliated hepatic foregut cyst". We emphasize the importance of CHCH as a differential diagnosis for cystic lesions of the liver, given its importance for symptomatic patients with lesions and to patients that are asymptomatic, due of the risk of malignancy described in the literature. The complementary propaedeutic is indispensable to elucidate the diagnosis, being essential the histopathological study.

The cancer-testis Sp17 and ASP are expressed in the ciliated hepatic foregut cysts

Meeting abstracts Although ciliated hepatic foregut cysts (CHFCs) are retained benign lesions, a case of squamous cell metaplasia and three cases of squamous cell carcinoma arising from CHFCs has been reported. The potential of malignant transformation make it necessary the identification of new

Ciliated Hepatic Foregut Cyst: Two Case Reports in Children and Review of the Literature

Ciliated hepatic foregut cyst (CHFC) is a rare lesion which originates from detached hepatic diverticulum or from detachment and migration of buds from the esophageal and bronchial regions of the foregut which subsequently get entrapped by the liver during the early embryonic development of the foregut. CHFCs are mostly seen in adults and are rarely reported in children, with only about 10 cases reported in this age group. Hereby, we present two cases of CHFC in two 3.5-year-old boys; one of them had cystic lesion at medial segment of left lobe of liver (common site), and in the other one it was located at right lobe of liver (less common site). Histologically, both cysts had four layers composed of inner ciliated, pseudostratified, columnar epithelium; subepithelial connective tissue; smooth muscle layer; and an outer fibrous layer.

Ciliated Hepatic Foregut Cyst: 103 Cases in the World Literature

Ciliated hepatic foregut cysts (CHFC) are rare, typically benign, lesions whose incidence has been increasing recently. Despite this increase in incidence, they remain rare and several key characteristics remain poorly understood, including the range of presentation and the risk of malignant conversion. To better understand CHFC, an extensive review of the international literature was performed. Characteristics including size, location, contents, presenting symptoms, and risk of malignancy were analyzed. In addition, an illustrative case is presented to highlight a potential pitfall in diagnosis: Although the presentation is thought to be typically painless or vaguely painful, these lesions may also present with hemorrhage and sudden severe abdominal pain. Importantly, although malignant degeneration is uncommon, analysis revealed that malignancy is significantly associated with size, which was significantly larger (median 10 cm) in malignant CHFC compared with the typical benign CHFC (3 cm) (P < 0.01). Large or symptomatic cysts, or small asymptomatic cysts that are atypical, should be resected.

Ciliated hepatic foregut cyst

Ciliated hepatic foregut cyst (CHFC) is a rare developmental disorder of the liver. Diagnoses of CHFC has become frequent during the past two decades due to technological progress and increased use of various imaging modalities.1 Clinically and radiologically, this lesion can be difficult to distinguish from the other cystic neoplasms of the liver. In this issue, we present a case of CHFC and discuss the typical histopathologic findings.

A Case of Ciliated Hepatic Foregut Cyst Discovered by Chance in Elderly Patient with Cholecystitis and Cholangitis

Ciliated hepatic foregut cyst (CHFC) is a rare disease that originates from the tracheobronchial tree of the foregut. Most patients with CHFC, which is believed to be a non-malignant neoplasm, are clinically asymptomatic. However, there havebeen some case reports that identify it as changing to malignant in the last decade of the condition. Surgical excision is,therefore, preferred to observation as the treatment of CHFC. However, surgical excision of CHFC in asymptomatic elderlypatients is controversial. We experienced a rare case of a 73-year-old female patient who was accidentally diagnosed with CHFC while being diagnosed for cholecystitis and cholangitis. The patient simultaneously underwent laparoscopic cholecystectomy and resection of CHFC, which was finally diagnosed as benign. We report asymptomatic CHFC in elderlypatient, focusing our discussion on whether surgical excision of CHFC is necessary for asymptomatic elderly patients. Accor-ding to a review of case reports, surgical excision of CHFC is not necessary for asymptomatic elderly patients.

Ciliated Hepatic Foregut Cyst: Four Case Reports with a Review of the Literature

Ciliated hepatic foregut cysts (CHFCs) are rare congenital legions that arise from the embryonic foregut. The cysts are formed during fetal development by evagination from their respective portions of the foregut, and are characterized by a ciliated epithelial lining. Approximately 100 cases of CHFC have been reported, of which only 13 were in children. Although CHFC is typically benign, malignant transformation to squamous cell carcinoma (SCC) has been reported in 3 cases. Survival rate after progression to malignancy is poor, as SCC in this setting is biologically aggressive. We present 4 new cases of CHFC in children between 5 months and 17 years old. Our cases are unusual, as some of the cysts exhibit multilocularity and biliary communication, and 2 of our patients were diagnosed under the age of 1. Additionally, 1 of the cysts was 19.3 cm in diameter, making it the largest reported CHFC to our knowledge. Ciliated hepatic foregut cysts should be included in the differential diagnosis of hepatic lesions.

Prenatal and postnatal ciliated hepatic foregut cysts in infants

Purpose Ciliated Hepatic Foregut Cyst (CHFC) is a rare congenital lesion arising from the embryonic foregut. Since squamous cell carcinomas arising from CHFC have been reported in adults, complete resection should be considered. We report our experience with CHFC. Methods We reviewed the charts of 2 patients who had surgery after prenatal detection of a CHFC and 2 patients with postnatal diagnosis. Results Two patients had antenatally detected liver cyst. Postnatal ultrasonography showed a cyst in segment IV, with wall calcifications and sediments. Bile ducts were encased in the wall of the cyst. They underwent central hepatectomy with double biliary diversion and uneventful post operative course. The two other patients underwent non anatomical resection of a cyst on the left lobe and in segment IV, found prior or during liver surgery. Pathology examination showed cysts filled with mucinous fluid, surrounded by an epithelium composed of ciliated cells. One case had a squamous metaplasia. Conclusion In infants, CHFC are found antenatally or incidentally. A solitary uni or mutilocular cyst with wall calcifications, sediments, located in the central liver segments should raise the diagnosis. Resection of large cysts in the central segments of the liver is challenging and biliary diversion should be considered.

Squamous cell carcinoma arising in a ciliated hepatic foregut cyst: Case report and literature review

We report a case of squamous cell carcinoma arising in a ciliated hepatic foregut cyst (CHFC) in the left lobe of the liver in a 60-year-old woman. Gross examination revealed an irregular, partially encapsulated, smooth tumor mass with multiple cystic areas, 3–5 mm in size. Microscopically, the lining of the microcysts was composed of ciliated columnar epithelium with scattered goblet cells. Multiple foci of squamous metaplasia of the columnar epithelium were observed, which showed areas with dysplastic changes and other areas with carcinomatous transformation. Our case also showed an inconspicuous or absent smooth muscle layer. This case suggests that CHFC deserves careful clinical follow-up and differential diagnosis to exclude malignant transformation. Total surgical excision of the cyst is recommended.

Laparoscopic Excision for an Enlarged Ciliated Hepatic Foregut Cyst as a Minimally Invasive Procedure

Ciliated hepatic foregut cyst (CHFC) is a very rare cystic lesion of the liver. Although CHFC has traditionally been considered to lack malignant potential, recent reports have shown the malignant transformation of this lesion into squamous-cell carcinoma. It is difficult to differentiate CHFC from malignant tumor, and it is important to consider in aspiration cytology for the evaluation of possible neoplastic disease. In this paper, we describe the case of a 57-year-old female who underwent a laparoscopic excision of an enlarged CHFC that was diagnosed by fine-needle aspiration cytology. Laparoscopic excision may be adopted as a minimally invasive surgical procedure for CHFC.

Ciliated hepatic foregut cyst discovered after kidney transplantation in a hepatitis C virus-infected patient: a report of one case and review of the literature

Ciliated hepatic foregut cyst (CHFC) is a rare liver lesion derived from the embryonic foregut. In most cases, CHFC remains asymptomatic but some malignant transformations have been reported. Typical imaging features usually lead to diagnosis using ultrasonography, computed tomography scan examination or MRI. When the diagnosis remains uncertain, a fine needle aspiration with cytology is appropriate. The presence of ciliated epithelial cells with hepatocytes and mucous cells on aspiration cytology is enough to assess the diagnosis. Surgery is recommended when there is uncertain diagnosis or malignant lesion suspicion. We report herein, the case of a CHFC discovered in a hepatitis C virus-infected patient following a renal transplantation. To eliminate a lymphoma or a liver tumor arising because of patient's immunosuppression status, a surgical resection of the lesion was performed. The surgical outcome was uneventful. Regarding this case, embryogenesis, morphological characteristics and treatment of the lesions are discussed.

線毛性前腸性肝嚢胞(ciliated hepatic foregut cyst）の1例-本邦報告例24例の検討-

We report a 52-year-old patient with a small hepatic mass which was ultrasonographically anechoic with scattered high echoic spots, and appearing slightly hyperattenuating relative to the surrounding parenchyma on unenhanced CT scans. Laparotomy revealed that the lesion was a unilocular cyst containing a mucinous fluid. The histologic diagnosis was ciliated hepatic foregut cyst (CHFC). The CHFC is a rare congenital cystic tumor which derives from the embryologic foregut. Up to 2006, only 24 cases, including our case, had been reported in Japan. The patients were 13 men and 11 women, aged between 41 years and 79 years. All of the lesions were solitary and unilocular. In 22 cases, the CHFC was located in the medial segment of the left lobe, mostly just beneath the hepatic surface. In all 24 Japanese cases, the cystic wall was benign histologically. However, reports of 3 malignant cases overseas indicates we should treat this disease cautiously.

A Case Report of a Ciliated Hepatic Foregut Cyst in the Liver

ciliated hepatic foregut cyst (CHFC) is a rare cystic lesion consisting of a ciliated pseudostratified columnar epithelium, subepithelial connective tissue, a smooth muscle layer, and an outer fibrous capsule. A CHFC is usually unilocular and occurs at a higher frequency in males. A predilection exists at the medial segment located at the left lobe of the liver. We report the first case of a ciliated hepatic foregut cyst mimicking hepatic metastasis on a CT scan of a patient concurrently afflicted with gastric cancer.

Ciliated hepatic foregut cyst: Report of a case on fine‐needle aspiration

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.

Catheter-Based Drainage and Agitation for Definitive Cytological Diagnosis of a Ciliated Hepatic Foregut Cyst in a Child

Ciliated hepatic foregut cyst (CHFC) is an uncommon lesion, which rarely presents in the pediatric population. It is congenital in origin and manifests because of the migration of a bronchiolar bud of the foregut through the pleuroperitoneal canal. CHFC is accompanied by a broad list of differential diagnoses and is difficult to diagnose by means of radiologic evaluation. Therefore, fine-needle aspiration with cytology has been used in an attempt to diagnose this lesion. In previously reported cases, this approach has been moderately successful in the diagnosis of CHFC, while in others, no definitive diagnosis was achieved because of the retrieval of scattered, irregular cells insufficient for cytologic evaluation. We report a case of a 16-year-old girl who presented with a CHFC and discuss a promising alternative for obtaining large, intact cellular specimens to facilitate cytologic evaluation and definitive diagnosis.

Ciliated hepatic foregut cyst with extensive squamous metaplasia: report of a case

Ciliated hepatic foregut cysts (CHFC) are rare cystic lesions of the liver composed of a ciliated pseudostratified columnar epithelium with mucous cells, connective tissue, and smooth muscles bundles. We report the first case of CHFC with extensive squamous metaplasia without dysplasia or carcinoma. A unilocular, avascular, hypoechoic 60-mm liver lesion located in segment IV was detected by ultrasonography in a 31-year-old woman. The cyst was surgically removed and was lined mainly by a regular squamous epithelium without keratin formation. After extensive sampling, a ciliated pseudostratified columnar epithelium with some alcian blue-positive goblet cells was identified. The lesion was totally examined and there was no epithelial dysplasia or carcinoma. Squamous epithelium is very rare in hepatic foregut cysts and may degenerate into squamous carcinoma. Squamous epithelium is also described in biliary cysts. When squamous epithelium is identified in a liver cyst, an extensive sampling is recommended to identify possible foci of squamous carcinoma and to classify more precisely the histological type of the lesion. Because some cases of squamous carcinoma have been described in CHFC, surgical removal of the lesion may be more appropriate than close follow-up or sclerosing therapy.