Presentation
Visual disturbance in the temporal field bilaterally.
Patient Data
No intracranial hemorrhage or extra-axial collection identified. There is a low attenuating sellar-suprasellar cyst lesion. The ventricles are symmetrical and nondilated. The basal cisterns remain patent. The skull, visualized orbits and paranasal sinuses define normally. Further assessment with MRI pituitary protocol is recommended.
There is a cystic lesion mildly expanding the sella and with a large suprasellar component that displaces the optic chiasm superiorly. The lesion has homogeneous signal, hypo on T1 and hyper on T2, and demonstrates a thin rim of enhancement, which is more bulky anteriorly presumably corresponding to an anterior displaced normal pituitary gland. No cavernous sinus invasion. The remainder imaged brain is unremarkable.
Histopathology:
MICROSCOPIC DESCRIPTION: The section shows a small fragment of mechanically distorted but otherwise unremarkable anterior pituitary tissue. No cyst wall, lining or contents are included. There is no evidence of tumor.
DIAGNOSIS: "Biopsy of tumor": Unremarkable anterior pituitary tissue.
Case Discussion
Unfortunately, the histology was inconclusive, and based on the imaging benign features and lack of tumor cells, the diagnosis is made between either a Rathke's cleft cyst or arachnoid cyst.
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