Ciliated hepatic cyst leading to squamous cell carcinoma of the liver - A case report and review of the literature.
BACKGROUND
Ciliated hepatic foregut cysts (CHFC) are rare, typically benign liver lesions. Primary squamous cell carcinoma (SCC) of the liver is also a rare entity with only approximately 25 reported cases in the literature. Recently, there have been four reports of malignant transformation of CHFC into primary squamous cell carcinoma of the liver. Here we report a fifth with unique presentation and review the literature.


METHODS
A 34 year-old man, with a history of ulcerative colitis, was incidentally found to have a 10cm lesion in the right anterior sector plus left medial section of the liver on computerized tomography (CT) scan. The patient was asymptomatic at presentation and neoplastic markers were not elevated. Sequential transarterial chemoembolization (TACE) and portal vein embolization (PVE) allowed for left lateral section plus segment 1 hypertrophy and subsequent resection. Histology later revealed the cyst to be a CHFC and showed its malignant transformation. At 6 month follow-up, the patient has lung and abdominal recurrence.


CONCLUSIONS
With now the fifth case of malignant transformation of CHFC being reported, approximately 5% of all reported CHFC have undergone malignant transformation. This frequency, taken together with the aggressive disease course and poor prognosis, suggests that CHFC must not be presumed benign and should be regarded with clinical suspicion.


CONCLUSIONS
Accurate diagnosis of CHFC is mandatory given its potential malignant transformation. Even in asymptomatic CHFC, surgical excision is recommended. In addition, in cases of otherwise unresectable lesions, sequential TACE and PVE may provide optimal hypertrophy of future liver remnant.
Medical College of Wisconsin, Department of Surgery, Division of Surgical Oncology, Milwaukee, WI 53226, United States.
J M
JM
Wilson
R
R
Groeschl
B
B
George
K K
KK
Turaga
P J
PJ
Patel
K
K
Saeian
T C
TC
Gamblin
Ciliated hepatic foregut cyst; Liver; Portal vein embolization (PVE); Squamous cell carcinoma; Transcatheter arterial chemoembolization (TACE)