Growing Rathke's cleft cyst

Case contributed by Chris O'Donnell
Diagnosis almost certain

Presentation

Incidental finding in pituitary 7 years ago on CT brain for pulsatile tinnitus. Now visual changes and elevated prolactin levels.

Patient Data

Age: 60 year old
Gender: Female

Follow-up MRI 5 years later

mri

"Snowman" appearing cystic mass (containing CSF-like fluid) in the pituitary extending into the suprasellar cistern causing chiasmal compression. Anterior pituitary (adneohypohysis) displaced anteriorly with the enhancing stalk. No intracystic nodule.

Original MRI 5 yr prior

mri

Predominately intra-sellar cystic mass without intracystic nodule.  Adenohypophysis and stalk displaced anteriorly.

Case Discussion

Rathke cleft cysts are lined by epithelium that can contain goblet cells. These cells can secrete fluid into the cyst lumen thus over time they can enlarge and cause compression to suprasellar structures such as the chiasm and hypothalamus (although this is unusual). The snowman pattern is due to extension of the cyst through the diaphragma sellae hiatus with "waisting" at the hiatus.

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