A rare case of a ciliated hepatic foregut cyst with progressive enlargement causing obstructive jaundice.
Satoshi Watanabe, Takahiro Kubo, Shinsaku Nagamatsu et al.
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Case in brief
A 73-year-old woman presented with anorexia and obstructive jaundice. Imaging showed a 40-mm unilocular cyst in hepatic segment 4, first identified 10 years earlier but enlarged over the preceding 5 months. Cholangiography demonstrated compression near the hepatic hilum, complete obstruction of the right intrahepatic bile duct, and stenosis of the left; a left-sided biliary stent was placed. Because of the enlargement and suspected involvement of the right duct, she underwent extended right hepatectomy. Pathology identified a ciliated hepatic foregut cyst (CHFC).
What made this case unusual
The CHFC had remained stable for years before enlarging over a short period and causing obstructive jaundice, without malignant transformation.
Diagnostic / clinical pearl
A CHFC can cause clinically significant biliary obstruction through enlargement and compression, even when pathology does not show malignant transformation.
Why it matters
The case highlights that the natural history of CHFCs is poorly understood and that prolonged stability does not exclude later rapid enlargement.