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