PMC6259038_01
CT Abdomen/Pelvis showing axial section of CT a large mass in the right upper quadrant measuring approximately 15 x 12 x 11 cm. A conspicuous fat fluid level is present, as well as partial rim calcification.
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A conspicuous fat fluid level is present, as well as partial rim calcification (Fig. 1).
MRI Abdomen/Pelvis T1/T2 signal axial section of right upper quadrant mass with presence of fat fluid level and no internal enhancement.
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Multisequence contrast-enhanced MRI imaging again demonstrated the presence of a fat fluid level (Fig. 2), and the absence of internal enhancement.
MRI Abdomen/Pelvis Coronal section of right upper quadrant mass demonstrating mass effect and marked upward displacement of right diaphragm.
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There was marked upward displacement of the right hemidiaphragm as the result of mass effect (Fig. 3).
The internal aspect of the cyst (A) contained adherent hair (arrow) while the external aspect (B) demonstrated areas of necrosis, hemorrhage and fibrinopurulent exudates. Several detached fragments of cyst contents consisted of conglomerates of hair admixed with soft, caseous, necrotic material (C).
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Gross pathological examination revealed a firm rubbery textured cyst wall (13 x 9 x 0.8 cm) and cyst contents (Fig. 4).
Histological examination revealed hyalinized cyst wall containing distended bile ducts (asterisk) and areas of dystrophic calcification (arrow, A, 40X). Numerous hair shafts within the cyst wall were identified (arrow, B, 100X) as well as foreign body giant cells (arrows, C) surrounding fragments of keratin (asterisks, C, 100X). Sections from the cyst content showed hair shafts cut transversely (circle) and longitudinally (arrow) with surrounding necrotic material (D, 200X). All sections stained with hematoxylin and eosin.
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Microscopic exam of the cyst wall demonstrated extensive areas of hyalinization with areas of dystrophic calcification (Fig. 5).