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Hemorrhagic and nonhemorrhagic Rathke cleft cysts mimicking pituitary apoplexy
Abstract
Object: Rathke cleft cysts (RCCs) are infrequently symptomatic, and apoplexy is one of the most unusual presentations. Only a few cases of apoplexy associated with RCCs have been reported, and their clinical, imaging, surgical, and pathological features are poorly understood. In the cases that have been reported, intracystic hemorrhage has been a consistent finding. The authors report 6 cases of RCCs in which the presenting clinical and imaging features indicated pituitary apoplexy, both with and without intracystic hemorrhage. Methods: The authors retrospectively reviewed charts and magnetic resonance (MR) imaging studies obtained in patients who underwent transsphenoidal surgery for RCC. Six patients were identified who presented with symptoms and MR imaging characteristics consistent with pituitary apoplexy but were found intraoperatively to have an RCC. All 6 patients presented with a sudden headache, 2 with visual loss, and 1 with diplopia. Review of the preoperative MR images demonstrated mixed signal intensities in the sellar masses suggestive of a hemorrhagic pituitary tumor. In all patients there was a presumed clinical diagnosis of pituitary tumor apoplexy and an imaging-documented diagnosis of hemorrhagic pituitary tumor. Results: All 6 patients underwent transsphenoidal resection to treat the suspected pituitary apoplexy. Intraoperative and histopathological findings were consistent with the diagnosis of an RCC in all cases. Only 2 cases showed evidence of hemorrhage intraoperatively. In all cases, an intracystic nodule was found within the RCC at surgery, and this intracystic nodule was present on the initial MR imaging when retrospectively reviewed. The imaging characteristics of the intracystic nodules were similar to those of acute hemorrhage seen in cases of pituitary apoplexy. Conclusions: The clinical and imaging features of RCCs appear similar to those of hemorrhagic pituitary tumors, making them often indistinguishable from pituitary apoplexy.
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“The incidence of these intracystic nodules varies from 17 to 78 % [28, 29].”
From Magnetic resonance imaging of sellar and juxtasellar abnormalities in the paediatric population: an imaging review (2015) · cites this paper as [29]
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Research works printed but not linked: 16
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- Christophe, 1993, MRI in seven cases of Rathke's cleft cyst in infants and children, 23, 79, 10.1007/BF02012389 · doi:10.1007/bf02012389
- Cohan, 2004, Symptomatic Rathke's cleft cysts: a report of 24 cases, 27, 943, 10.1007/BF03347537 · DOI
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- Nakasu, 1990, Rathke's cleft cyst: computed tomographic scan and magnetic resonance imaging, 103, 99, 10.1007/BF01407513 · doi:10.1007/bf01407513
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- Onesti, 1990, Pituitary hemorrhage into a Rathke's cleft cyst, 27, 644, 10.1227/00006123-199010000-00026 · doi:10.1227/00006123-199010000-00026
- Pawar, 2002, Rathke's cleft cyst presenting as pituitary apoplexy, 9, 76, 10.1054/jocn.2001.0974 · DOI
- Rosales, 2004, Hemorrhagic Rathke's cleft cyst presenting as diplopia, 10, 129, 10.4158/EP.10.2.129 · doi:10.4158/ep.10.2.129
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Cited by
Trifanescu, R., Ansorge, O., Wass, J. A. H., Grossman, A. B., & Karavitaki, N. (2012) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2011.04235.x · Cited by 175
Shields, R., Mangla, R., Almast, J., & Meyers, S. (2015) · Insights into Imaging · doi:10.1007/s13244-015-0401-5 · Cited by 18
Metadata
- Authors
- Binning, M. J., Liu, J. K., Gannon, J., Osborn, A. G., & Couldwell, W. T.
- Venue
- Journal of Neurosurgery
- Published
- 2008-01
- Volume
- 108
- Issue
- 1
- Pages
- 3-8
- ISSN
- 0022-3085
- 1933-0693
- Cited by
- 72
- References
- 0
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