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

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


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 carcino-embryonic antigen (CEA) were extremely high (978118 U/mL and 973 ìg/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.

Original languageEnglish
Pages (from-to)16355-16358
Number of pages4
JournalWorld Journal of Gastroenterology
Issue number43
StatePublished - 21 Nov 2014


  • Carbohydrate antigen 19-9
  • Carcinoembryonic antigen
  • Ciliated hepatic foregut cyst
  • Computed tomography-guided fine-needle aspiration
  • Magnetic resonance imaging
  • Squamous cell carcinoma


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