Ciliated hepatic foregut cyst: a case report and review of literature on a rare hepatic cystic lesion.

Introduction: Ciliated hepatic foregut cyst (CHFC) is one of the rarely reported cystic lesions of the liver, with approximately 200 cases reported in the literature. Although most patients with CHFC are asymptomatic and diagnosed incidentally, they should be investigated thoroughly to rule out other possible differential diagnoses, as CHFCs carry a risk of malignant transformation into squamous carcinoma. Case presentation: A 19-year-old female was found to have a liver lesion during laparoscopic appendectomy for acute appendicitis. Post-appendectomy liver imaging revealed a solitary 6.4 cm well-defined, multilocular cystic lesion centered in the left liver without features of malignancy. There was no communication with the biliary system; however, there was mild dilatation of the intrahepatic biliary radicles. The differential diagnoses included biliary cystadenoma, simple cyst, and cystic biliary hamartoma. Based on these findings and the absence of malignant features in the cyst, an open cholecystectomy and nonanatomical resection of segments 4/5 was performed. The patient had an uneventful postoperative recovery and was discharged in good condition. Histopathological examination revealed a CHFC, and the patient was followed up for 2 years without complications. Discussion: CHFC is a rare benign liver cyst with the potential for malignant transformation. Among 223 reported cases, 2.7% were malignant. Most lesions are found incidentally, typically in segment IV. Owing to the variable imaging features, a definitive diagnosis requires histological confirmation. Larger cysts or those with irregular walls pose a higher risk. Surgical excision, preferably laparoscopic, is the treatment of choice, with no reported recurrences. The role of surveillance for small, asymptomatic cysts remains controversial. Conclusion: Accurate preoperative diagnosis of CHFC is often challenging. Nevertheless, given its potential for malignant transformation, a high index of suspicion is warranted in such cases. When clinical and radiological features raise concerns, complete surgical excision remains the treatment of choice.