Ciliated hepatic foregut cyst with high intra-cystic carbohydrate antigen 19-9 level

A ciliated hepatic foregut cyst(CHFC)is a rare foregut developmental malformation usually diagnosed in adulthood.Five percent of reported cases of CHFC transform into squamous cell carcinoma.We report the presentation,evaluation,and surgical management of a symptomatic 45-year-old male found to have a 6.2 cm CHFC.Contrast tomography-guided fine-needle aspirationdemonstrated columnar,ciliated epithelium consistent with the histologic diagnosis of CHFC.The intracystic levels of carbohydrate antigen(CA)19-9 and carcinoembryonic antigen(CEA)were extremely high(978118U/m L and 973μg/L,respectively).Histologically,the wall of the cyst showed characteristic pseudopapillae lined with a ciliated stratified columnar epithelium,underlying smooth muscle,an outer fibrous layer and no atypia.Immunohistochemistry for CA19-9 and CEA was positive.This is the first case report of a CHFC in which levels of CA 19-9 and CEA were measured.Our findings suggest that a large sized multilocular cyst and elevated cyst CA19-9 and CEA levels do not exclude a CHFC from consideration in the diagnosis.CHFCs should be included in the differential diagnosis of hepatic lesions.Accurate diagnosis of a CHFC is necessary given its potential for malignant transformation,and surgical excision is recommended.