A Case of Ciliated Hepatic Foregut Cyst that was Difficult to Distinguish from Abscess of the Round Ligament of the Liver

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 83; no. 6; pp. 1125 - 1129
• Main Authors: HONDA, Haruyasu, AKAZAWA, Tomoyuki, TSUZAWA, Toyokazu, HAYASHI, Seiichi, KODAIRA, Himiko
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2022
• Subjects: abscess of the round ligament of the liver; ciliated hepatic foregut cyst
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.83.1125

A 47-year-old woman with a 5-day history of epigastric pain visited our hospital. She had tenderness in the region but no fever. Blood test results were unremarkable except for a slightly increased CRP level. Imaging examination revealed a 45-mm-sized cyst with a thick capsule in the round ligament of the liver. Because an infectious cyst was suspected, antibiotics were administered, and her abdominal pain disappeared within a few days. Surgery performed based on the preoperative diagnosis of an abscess of the round ligament of the liver revealed a 5-cm-sized mass in the round ligament of the liver, which was in contact with the surface of the liver for approximately 1.5 cm. The resected specimen measured 55 × 33 mm in size, the lumen was filled with a milky white fluid, and no histopathological continuity with the round ligament of the liver was noted. The inner surface of the cyst wall was lined with multiciliated columnar epithelium, and the subepithelium comprised fibrous connective tissue with loose connective tissue and a smooth muscle layer. The patient was thus diagnosed with ciliated hepatic foregut cyst. Distinguishing ciliated hepatic foregut cyst from an abscess was challenging in the present case because of its atypical growth. Normally, ciliated hepatic foregut cysts grow directly beneath the hepatic capsule, i.e., inwardly ; however, in our case, there was an outward growth to the round ligament of the liver.