A rare gallbladder ciliated foregut cyst in chronic cholecystitis

• Ciliated foregut cysts (CFC) are rare anomalies due to aberrant embryological development arising from a remnant of the embryologic foregut.
• The solitary cysts are characterised by ciliated pseudostratified columnar epithelium.
• We present the first ciliated foregut cyst of the gallbladder case reported in Australia, and the ninth known case to be reported worldwide.
• Ciliated foregut cysts can be difficult to distinguish from neoplasms clinically and radiographically.
• Reports have shown that these cysts may become dysplastic and is best excised when discovered.

IntroductionCiliated foregut cysts (CFC) are rare anomalies due to aberrant embryological development. It is thought to arise from a remnant of the embryologic foregut. The solitary cysts are characterised by ciliated pseudostratified columnar epithelium. They are usually located above the diaphragm but they can also arise in relation to the liver, gallbladder and pancreas.Presentation of caseWe present the first ciliated foregut cyst of the gallbladder case reported in Australia, and the ninth known case to be reported worldwide. A 61-year-old male with chronic cholecystitis and cholelithiasis underwent an elective laparoscopic cholecystectomy and intraoperative cholangiogram. Intraoperatively, ‘out-pouching’ was noted on the lateral border of the gallbladder. Microscopically the histopathology showed that the cyst was lined by ciliated columnar epithelium the characteristic feature of a ciliated foregut cyst.DiscussionTo date only 8 cases of these ciliated foregut cysts in the gallbladder have been reported in literature. Our case is the first reported in Australia. It is unique in that the patient was an older male as opposed to most other previous cases, which were younger females. These cysts can be difficult to distinguish from neoplasms clinically and radiographically. Reports have shown that these cysts may become dysplastic and is best excised when discovered.ConclusionDespite the rarity of CFCs and their potential to mimic malignancy, we propose awareness and understanding of the management for them—being excision and hopefully not cause any confusion or devastatingly allow it to become malignant.