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

World Journal of Gastroenterology 2014年第43期20卷 16355-16358页

作者： Ziv Ben Ari Oranit Cohen-Ezra Jonathan Weidenfeld Tania Bradichevsky Ella Weitzman Uri Rimon Yael Inbar Michal Amitai Barak Bar-Zachai Roni Eshkenazy Arie Ariche Daniel Azoulay Liver Disease Center Sheba Medical Center and Sackler School of MedicineTel Aviv University52621 Tel AvivIsrael Department of Pathology Sheba Medical Center and Sackler School of MedicineTel Aviv University52621 Tel AvivIsrael Department of Radiology Sheba Medical Center and Sackler School of MedicineTel Aviv University52621 Tel AvivIsrael Depatrment of Hepatobiliary Surgery Sheba Medical Center and Sackler School of MedicineTel Aviv University52621 Tel AvivIsrael

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 aspiration demonstrated 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 (978118 U/mL and 973 μg/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.

关键词： Ciliated hepatic foregut cyst Carbohydrate antigen 19-9 Carcinoembryonic antigen computed tomography-guided fine-needle aspiration Magnetic resonance imaging Squamous cell carcinoma

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