Ciliated foregut cyst in the triangle of Calot: the first report

Abstract

Ciliated foregut cysts are rare anomalies arising from remnants of aberrant embryological development. Around 100 reports on the presence of these congenital masses in the tracheobronchial tree, mediastinum, liver, pancreas and, rarely, the gallbladder have been described. In this article, the case of a 33-year-old woman, who was operated for a laparoscopic cholecystectomy, is presented. During the dissection of the triangle of Calot, a cystic mass, attached to the common hepatic duct, was discovered incidentally. This cyst was dissected off the hepatic duct, and no communication between both structures was found. The histopathological diagnosis was consistent with a ciliated foregut cyst. The postoperative course was uneventful. After reviewing the literature on this pathological entity, we found that this is the first report of a ciliated foregut cyst that is located in the triangle of Calot and found separate from the biliary structures, the gallbladder and the liver. We present a review of the literature on this entity, discussing diagnostic measures and therapeutic options.

Keywords: Cholecystectomy; Ciliated; Cyst; Foregut; Gallbladder.

Fig. 1

An intra-operative image showing the ciliated foregut cyst (CFC) within the triangle of Calot attached to the distal part of the common hepatic duct (CHD)

Fig. 2

An intra-operative view of the on-table cholangiogram

Fig. 3

A fluoroscopic view of the on-table cholangiogram. This study shows no filling defects within the biliary tract, normal biliary anatomy and normal flow of the contrast material into the second part of the duodenum. No communication between the bile ducts and the cyst could be found

Fig. 4

Microphotographs showing the histopathological properties of the cyst. a Overall view of the ciliated foregut cyst (haematoxylin and eosin, ×22 magnification). b Pseudostratified ciliated columnar epithelium resting on sub-epithelial connective tissue, a smooth muscle layer and an outer fibrous layer (haematoxylin and eosin, ×349 magnification). c Mucus-laden goblet cells in some areas of the cyst (haematoxylin and eosin, ×540 magnification).d CK7-positive epithelial lining (CK7 immunohistochemical stain, ×400 magnification). The epithelium is negative for CK20 and CDX2 immunohistochemical stains (not shown in the figure)

Fig. 5

An image of the pre-operative ultrasonographic scan of the liver and biliary ducts showing multiple gallstones, normal biliary structures and portal vein and a cystic structure that could be the ciliated foregut cyst (noticed retrospectively)