Saudi Journal of Gastroenterology
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Year : 2008  |  Volume : 14  |  Issue : 3  |  Page : 142-143
Ciliated hepatic foregut cyst mimicking a hydatid cyst: A case report and review of literature

Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, 71345-1864, Iran

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A ciliated hepatic foregut cyst is a rare cystic lesion of the liver. A 25-year-old man who was referred from an area endemic for hydatid cysts, presented with abdominal pain. Clinical, paraclinical, and imaging studies all suggested the presence of a hydatid cyst. Pathological studies after the resection of the cyst showed the presence of a ciliated hepatic foregut cyst.

Keywords: Hepatic foregut cyst, hydatid cyst, review

How to cite this article:
Geramizadeh B, Salehzadeh A, Nikeghbalian S. Ciliated hepatic foregut cyst mimicking a hydatid cyst: A case report and review of literature. Saudi J Gastroenterol 2008;14:142-3

How to cite this URL:
Geramizadeh B, Salehzadeh A, Nikeghbalian S. Ciliated hepatic foregut cyst mimicking a hydatid cyst: A case report and review of literature. Saudi J Gastroenterol [serial online] 2008 [cited 2021 Jun 19];14:142-3. Available from:

A ciliated hepatic foregut cyst is a rare entity, the first case having been described by Friedrich in 1857, [1] but the term first used by Wheeler and Edmondson in 1984. [2] Since then, numerous cases have been reported mostly in Japanese patients, [3] where they have mimicked other lesions such as neoplasms [4] or parasitic cysts. [3] In this report, we present a case of a hepatic foregut cyst that was operated with the diagnosis of a hydatid cyst of the liver in a patient from an endemic area.

   Case History Top

A 25-year-old man presented to us with abdominal pain but no remarkable medical history; he was referred from an area endemic for Echinococcus granulosus . His chief complaint was a right upper quadrant pain; physical examination findings were unremarkable. Laboratory work-up including liver function tests were completely unremarkable Abdominal sonography revealed a well-defined lesion (27 x 16 mm, 54 HU) in the anterosuperior aspect of the right lobe of the liver, which was highly suggestive of a hydatid cyst [Figure 1]. Serological testing for Echinococcus granulosus was positive for a hydatid cyst. Surgery was undertaken in view of the consideration that a hydatid cyst was the most logical diagnosis in an area of high endemicity for the disease. A small cyst was found during the operation, and a segment of the liver was resected and sent for pathological investigations.

A piece of the liver tissue received in the pathology laboratory was found to have a collapsed cystic structure. The inner and outer surfaces of the cyst were smooth and the wall thickness was <0.1 cm [Figure 2]. Microscopic examination showed a cystic lesion lined by ciliated columnar epithelium, beneath which there were some smooth muscle fibers, collagen, and connective tissue [Figure 3].

The cyst lining was uniform with no evidence of atypia and it was completely in the liver parenchyma. Noncystic liver parenchyma was unremarkable; the lesion was diagnosed as a hepatic foregut cyst. The patient was discharged from the hospital in a good condition and without any complication.

   Discussion Top

Hepatic cysts are present in approximately 5% of the general population. [5] A hepatic foregut cyst is a rare entity with most of the reported cases being from Japan. This cyst may arise from remnants of embryonic foregut, but the exact etiology is unknown. [6]

A hepatic foregut cyst is histologically similar to a bronchogenic cyst. [7] There are hypotheses about its etiology, i.e., it is created because of communications between the thoracic and abdominal cavities through the pericadio-peritoneal canal, eventually separated by pleuroperitoneal membranes. [8]

Most of the cases are reported in adults [9] and the majority of them have been asymptomatic and found incidentally during abdominal imaging studies or surgical exploration. More than 85% of the cases were reported during the last two decades. [5] Since the first report by Friedreich in 1857, about 65 cases have been published, but none from the Middle-East. [5]

The recent rise in case reports is likely explained by increased detection rates, because of the dramatic rise in the use of abdominal imaging. [5] The differential diagnostic possibilities include simple (cholangiogenic) cysts, parasitic cysts, hepatobiliary cystadenomas, and cystic metastatic tumors. [3],[10]

There are rare case reports of the malignant transformation of hepatic foregut cysts, which highlight the importance of careful diagnosis and clinical follow-up of the patients. [11],[12],[13] According to our case report, a hepatic foregut cyst should be included as a differential diagnosis of liver cysts even in areas endemic for parasitic cysts.

   References Top

1.Friedrich N. Cyst emit flimmerepithel in der leber. Arch Pathol Anat 1857;11:466-9.  Back to cited text no. 1    
2.Wheeler DA, Edmondson HA. Ciliated hepatic foregut cyst. Am J Surg Pathol 1984;8:467-70.  Back to cited text no. 2  [PUBMED]  
3.Bogner B, Hegedus G. Ciliated hepatic foregut cyst. Pathol Oncol Res 2002;8:278-9.  Back to cited text no. 3    
4.Wu ML, Abecassis MM, Rao MS. Ciliated hepatic foregut cyst mimicking neoplasm. Am J Gastroenterol 1998;93:2212-4.  Back to cited text no. 4  [PUBMED]  
5.Jakowski JD, Lucas JG, Seth S, Frankel WL. Ciliated hepatic foregut cyst: A rare but increasingly reported liver cyst. Ann Diagn Pathol 2004;8:342-6.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Sato Y, Kitagawa S, Zen Y, Minato H, Nakanuma Y. Ciliated hepatic foregut cyst without smooth muscle layer: A variant of ciliated hepatic foregut cyst? Pathol Int 2006;56:340-4.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Fang SH, Dong DJ, Zhang SZ. Imaging features of ciliated hepatic foregut cyst. World J Gastroenterol 2005;11:4287-9.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Idress MT, Reid-Nicholson M, Unger P, Jaffer S. Subhepatic ciliated foregut cyst. Ann Diagn Pathol 2005;9:54-6.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.Kim S, White FV, McAlister W, Shepherd R, Mychaliska G. Ciliated hepatic foregut cyst in a young child. J Padiatr Surg 2005;40:e51-3.  Back to cited text no. 9    
10.Horri T, Ohta M, Mori T, Sakai M, Hori N, Yamaguchi K, et al. Ciliated hepatic foregut cyst: A repot of one case and review of the literature. Hepatol Res 2003;26:243-8.  Back to cited text no. 10 Lajarte-Thirouard AS, Rioux-Leclercq N, Boudjemma K, Gandon Y, Ramee MP, Turlin B. Squamous cell carcinoma arising in a hepatic foregut cyst. Pathol Res Pract 2002;198:697-700.  Back to cited text no. 11    
12.Furlanetto A, Dei Tos AP. Squamous cell carcinoma arising in a ciliated hepatic foregut cyst. Virchows Arch 2002;441:296-8.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]
13.Vick DJ, Goodman ZD, Ishak KG. Squamous cell carcinoma arising in a ciliated hepatic foregut cyst. Arch Pathol Lab Med 1999;123:1115-7.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]

Correspondence Address:
Bita Geramizadeh
Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, 71345-1864
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-3767.41734

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  [Figure 1], [Figure 2], [Figure 3]

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