J Korean Neurosurg Soc.  2012 Oct;52(4):404-406. 10.3340/jkns.2012.52.4.404.

A Rathke's Cleft Cyst Presenting with Apoplexy

• Kim E

• KMID: 2190660
• DOI: http://doi.org/10.3340/jkns.2012.52.4.404

Abstract

The occurrence of symptomatic pituitary hemorrhage into a Rathke's cleft cyst (RCC) is extremely rare. The author reports an interesting case of intra- and suprasellar RCC presented with features of pituitary apoplexy. This 62-year-old woman suffered acute headache, mental confusion, and partial hypopituitarism. The characteristics of the magnetic resonance imaging seemed most compatible with a hemorrhagic pituitary adenoma. Transsphenoidal drainage of the cyst contents confirmed the diagnosis of hemorrhagic RCC and resolved the symptoms. All published data on this rare clinical entity are extracted and reviewed.

Keyword

Headache; Hypopituitarism; Pituitary apoplexy; Rathke's cleft cyst; Transsphenoidal approach

MeSH Terms

Drainage
Female
Headache
Hemorrhage
Humans
Hypopituitarism
Magnetic Resonance Imaging
Middle Aged
Pituitary Apoplexy
Pituitary Neoplasms
Stroke

Figure

• 

  Fig. 1 Preoperative magnetic resonance images of a patient presented with pituitary apoplexy. The lesion is mainly isointense with some hyperintense foci on T1-weighted images (A and B). A fluid level (arrow) with isointense signal anteriorly and hypointense signal posteriorly is noted on sagittal T2-weighted image (C). It displays rim enhancement surrounding the cyst following gadolinium infusion (D).

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  Fig. 2 A : Operative and pathology features of a hemorrhagic Rathke's cleft cyst. At surgery, an initial gush of hemorrhagic fluid was followed by a thick yellowish mucinous substance. B : Histopatholgical examination demonstrates a benign cyst consisting of columnar and cuboidal epitheliums and amorphous cyst contents with acute hemorrhages.

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  Fig. 3 Follow-up magnetic resonance images taken 6 years after surgery show no evidence of cyst recurrence.

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