Cytologic diagnosis of ciliated hepatic foregut cyst

Ciliated hepatic foregut cyst (CHFC) is a rare, benign, solitary cyst occurring most often in the left lobe of the liver. CHFCs are typically found incidentally during radiologic imaging, surgical exploration, or autopsy. Only six cases of CHFC diagnosed by fine needle aspiration have been reported in the literature. We describe a CHFC diagnosed by aspiration in a 70-yr-old woman who presented with a 2-yr history of abdominal discomfort. The radiologically benign-appearing lesion was located in the subcapsular area of segment IV of the liver. The aspirate contained benign ciliated columnar cells and goblet cells suspended in mucoid material. Sections from a cell block demonstrated pseudo-stratified bronchial-type epithelium with mucin secreting cells and an absence of cartilage, characteristic of CHFC. Mucin-containing goblet cells stained with alcian blue. The neuroendocrine cells within the bronchial-type epithelium stained for calcitonin and synaptophysin. On follow-up, a computed tomography (CT) demonstrated the cyst to be unchanged, but as the patient continued to have pain, sclerosis of the cyst was planned. The diagnosis of CHFC by fine needle aspiration and its distinction from other solitary cysts of the liver may prevent unnecessary surgical exploration and excision.