Ruptured Rathke Cleft Cyst Mimicking Pituitary Apoplexy

Abstract

Rathke cleft cysts (RCCs) are benign cystic lesions of the sellar and suprasellar region that are asymptomatic in most cases. Occasionally, compression of the optic pathway and hypothalamo-pituitary structures may cause clinical symptoms, such as headaches, visual deficits and endocrinopathies. Acute presentation caused by hemorrhage into an RCC have been described in the literature, and the term “Rathke cleft cyst apoplexy” has been coined. We present the case of a 32-year-old man with acute onset of meningitis-type symptoms and imaging findings resembling hemorrhagic pituitary tumor apoplexy. In retrospect, clinical symptoms, intraoperative appearance, and histologic examination were compatible with the diagnosis of nonhemorrhagic rupture of an RCC. Thus, the clinical presentation of “Rathke cleft cyst apoplexy” is not necessarily caused by hemorrhage.

Keywords

Rathke cleft cyst - pituitary apoplexy - sellar mass - RCC rupture - nonhemorrhagic RCC apoplexy

• References

• 1 Zada G. Rathke cleft cysts: a review of clinical and surgical management. Neurosurg Focus 2011; 31 (1) E1
• 2 Choudhry OJ, Choudhry A, Patel SK, Baisre A, Eloy JA, Liu JK. Giant suprasellar Rathke's cleft cyst mimicking craniopharyngioma: implications for a spectrum of cystic epithelial lesions of ectodermal origin. J Neurol Surg A Cent Eur Neurosurg 2012; 73 (5) 324-329
• 3 Matsushima T, Fukui M, Ohta M, Yamakawa Y, Takaki T, Okano H. Ciliated and goblet cells in craniopharyngioma. Light and electron microscopic studies at surgery and autopsy. Acta Neuropathol 1980; 50 (3) 199-205
• 4 Teramoto A, Hirakawa K, Sanno N, Osamura Y. Incidental pituitary lesions in 1,000 unselected autopsy specimens. Radiology 1994; 193 (1) 161-164
• 5 Aho CJ, Liu C, Zelman V, Couldwell WT, Weiss MH. Surgical outcomes in 118 patients with Rathke cleft cysts. J Neurosurg 2005; 102 (2) 189-193
• 6 Chaiban JT, Abdelmannan D, Cohen M, Selman WR, Arafah BM. Rathke cleft cyst apoplexy: a newly characterized distinct clinical entity. J Neurosurg 2011; 114 (2) 318-324
• 7 Binning MJ, Liu JK, Gannon J, Osborn AG, Couldwell WT. Hemorrhagic and nonhemorrhagic Rathke cleft cysts mimicking pituitary apoplexy. J Neurosurg 2008; 108 (1) 3-8
• 8 Melmed S, Casanueva FF, Hoffman AR , et al; Endocrine Society. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96 (2) 273-288
• 9 Liu JK, Couldwell WT. Pituitary apoplexy in the magnetic resonance imaging era: clinical significance of sphenoid sinus mucosal thickening. J Neurosurg 2006; 104 (6) 892-898
• 10 Perry A, Brat DJ. Practical Surgical Neuropathology: A Diagnostic Approach. Philadelphia, PA: Churchill Livingstone/Elsevier; 2010