Endoscopic Endonasal Resection of Concomitant Pituitary Adenoma and Rathke’s Cleft Cyst: A Case Report and Review of Literature

Background Pituitary adenomas (PA) and Rathke’s cleft cysts (RCC) are deemed to have a common ancestry, since RCC are thought to be derived from remnants of the Rathke’s pouch, and the adenohypophysial cells, from which PA develop, originates from proliferation of the anterior wall of the Rathke’s pouch. Nonetheless, concomitant PA and RCC are an extremely rare entity that has been addressed by few reports in the literature.

Case Description We describe two cases of concomitant adrenocorticotropic hormone (ACTH)-secreting PA and RCC, and a recurrent ACTH-secreting PA and RCC. The diagnosis was made based on preoperative MRI in one case, while in the other case, the RCC was detected intraoperatively. Both cases were treated with endoscopic endonasal transsphenoidal surgery. A review of the English literature of previously reported cases with concomitant PA and RCC is also included. To date, 33 reports with a total of 176 cases with concomitant PA and RCC are found in the literature. Out of those, only six reports, with a total of nine cases, have described ACTH-secreting PA associated with RCC.

Conclusion The advance in diagnostic imaging modalities have led to increased detection of RCC. In the scenario of a coexisting PA and RCC, the symptoms are usually due to the adenoma rather than the cyst. The presence of a cystic lesion within and/or adjacent to a PA, whether on preoperative MRI or intraoperative, should raise suspicion of a coexisting RCC. Endoscopic endonasal approach can be considered a great option for management of concomitant sellar lesions.