IL6 and cyst: Emerging evidence suggests that the intracystic environment in PLD is not immunologically neutral but rather characterized by chronic, cytokine-rich inflammation and dysregulated cholangiocyte signaling, including interleukin-6/interleukin-8 and vascular endothelial growth factor pathways.14,15) Conceptually, such a milieu—together with cyst stasis, intermittent hemorrhage, and relative hypoxia—could provide “fertile soil” that facilitates survival and proliferation of E. histolytica once trophozoites reach the liver via the portal circulation.