Ciliated Foregut Cyst of the Gallbladder: Report of a Case and Review of Literature

Cystic lesions of the gallbladder are very rare and they are generally lined by single columnar or mucinous epithelium. A ciliated cyst of foregut origin is extremely rare in gallbladder. To our knowledge, only five cases have been reported so far. Here, we present the sixth case found incidentally in ultrasonographic examination in a 41-year-old woman suffering from chronic right upper quadrant pain. Laparoscopic cholecystectomy was performed for the gallstones and a benign appearing cyst in ultrasonography. Macroscopically, a submucosal unilocular cyst was located in the neck of the gallbladder. There was no communication with the lumen. Histologically, the cyst was lined by pseudostratified ciliated epithelium containing goblet cells and had a muscular wall. The postoperative course was uneventful. Patient was discharged on the second day of the operation and was well after 2 months. 1. Introduction Ciliated foregut cyst is an uncommon developmental anomaly that usually develops above the diaphragm in the form of bronchial and esophageal cysts. Foregut cysts below the diaphragm are very rare and generally found in the liver [1]. Extrahepatic cases are much rarer. To our knowledge, only five cases of ciliated foregut cyst of the gallbladder were reported so far [2–6]. Here we report the sixth case in literature. 2. Materials and Methods Cholecystectomy material was fixed in 10% formaldehyde. Representative slices were obtained and embedded in paraffin. The paraffin blocks were cut into 5？m thick sections and stained with hematoxylin and eosin. Periodic acid-Schiff stain was used for histochemistry. Smooth muscle actin (SMA), estrogen receptor (ER), and progesterone receptor (PR) antibodies were used for immunohistochemistry. 3. Results 3.1. Case Report A 41-year-old woman was admitted to our hospital with right upper quadrant pain. Laboratory data of the liver function tests, biliary enzymes, and serum tumor markers were normal. Abdominal ultrasonography revealed gallstones and a benign appearing cystic lesion located in the neck of the gallbladder. Laparoscopic cholecystectomy was performed. Macroscopic examination of the specimen revealed a submucosal unilocular cyst, located in the neck of the gallbladder, measuring 3.5 2 1.5？cm, without communication to the lumen (Figure 1). The cyst contained blurry mucoid fluid. Its wall was thin and the inner surface was smooth. Gallbladder mucosa showed diffuse linear yellow streaks compatible with cholesterosis. Figure 1: Gross appearance of a unilocular intramural cyst located under the mucosa showing