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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2022; 11(01): 073-075
DOI: 10.1055/s-0041-1726600
Short Communication

Rathke’s Cleft Cyst Abscess—An Unusual Guest in The Sella

Piyush Lodha 
1   Department of Endocrinology, Gandhi Medical College/Gandhi Hospital, Musheerabad, Secunderabad, Hyderabad, India
,
P Rao Srinivas
1   Department of Endocrinology, Gandhi Medical College/Gandhi Hospital, Musheerabad, Secunderabad, Hyderabad, India
,
Vijay Sheker Reddy Danda 
1   Department of Endocrinology, Gandhi Medical College/Gandhi Hospital, Musheerabad, Secunderabad, Hyderabad, India
,
Gollapudi Prakash Rao
2   Department of Neurosurgery, Gandhi Medical College/Gandhi Hospital, Musheerabad, Secunderabad, Hyderabad, India
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Abstract

Abscess formation within a Rathke's cleft cyst (RCC) is extremely rare, particularly at a young age. We report the case of a young girl with abscess formation in RCC. A 21-year-old female presented with headache, vomiting, visual deterioration and features suggestive of hypopituitarism. She had bitemporal hemianopia with impairment of visual acuity. MRI revealed a cystic lesion in the sella with suprasellar extension and peripheral rim enhancement. On the basis of history and imaging, this was indistinguishable from more commonly encountered pituitary pathology. She underwent transsphenoidal decompression, which revealed yellowish purulent material that when cultured grew Staphylococcus epidermidis. Histological examination revealed numerous neutrophils and cyst wall lining with features characteristic of RCC. Postoperatively, she received antibiotics and replacement therapy for hypopituitarism. Three months later, she experienced deterioration in visual fields. Considering persistent disease, she underwent redo surgery which revealed similar findings. Postsurgery, pituitary MRI revealed an empty sella syndrome. Thereafter, follow-up for 1 year was stable with permanent diabetes insipidus and multiple pituitary hormone deficiency on supplementation. Although uncommon, we recommend considering RCC abscess as a differential diagnosis of a pituitary mass lesion, as predicting its presence can be difficult preoperatively. Persistent or recurrent disease is common in these cases, so timely diagnosis and adequate surgical drainage leads to lower morbidity and mortality.

Keywords

Rathke’s cleft cyst abscess - pituitary mass lesion - endoscopic transsphenoidal resection


Publication History

Article published online:
24 November 2021

© 2021. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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