Rare and remarkable: Exploring the enigma of ciliated cysts of the gallbladder

Ciliated cysts of the gallbladder are rare congenital anomalies derived from embryonic foregut remnants. These benign lesions, lined by distinctive ciliated columnar epithelium, present diagnostic challenges due to non-specific imaging findings and their extreme rarity. A 51-year-old woman presented with intermittent right upper quadrant abdominal pain lasting two years. Imaging revealed a cystic lesion measuring initially 11 × 10 mm on the gallbladder's lateral wall. Due to lesion growth observed over follow-up, laparoscopic cholecystectomy was performed. Histopathology confirmed a subserosal, unilocular cyst lined with ciliated columnar epithelium, without communication to the gallbladder lumen. This report represents the sixteenth documented global case and the first Romanian instance of a gallbladder ciliated cyst. The lesion’s rarity and nonspecific clinical and radiological presentations hinder accurate preoperative diagnosis. Histopathological analysis remains essential to distinguish these cysts from bronchogenic cysts and biliary neoplasms. Surgical excision is advisable, especially when symptoms are present or malignancy cannot be confidently excluded. Despite their rarity, ciliated gallbladder cysts should be included in the differential diagnosis of atypical cystic gallbladder lesions. Laparoscopic cholecystectomy offers a safe, definitive treatment method, providing both diagnostic confirmation and symptom resolution.