Rathke cleft cyst

Case contributed by Dr Bruno Di Muzio

Presentation

Visual disturbance in the temporal field bilaterally.

Patient Data

Age: 33-year-old
Gender: Male
CT

No intracranial haemorrhage 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, visualised orbits and para nasal sinuses define normally. Further assessment with MRI pituitary protocol is recommended. 

MRI

MRI Pituitary

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 tumour.

DIAGNOSIS: "Biopsy of tumour": Unremarkable anterior pituitary tissue.

Case Discussion

Unfortunately, the histology was inconclusive, and based on the imaging benign features and lack of tumour cells, the diagnosis is made between either a Rathke's cleft cyst or arachnoid cyst.  

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Case information

rID: 45620
Case created: 1st Jun 2016
Last edited: 2nd Jun 2016
Inclusion in quiz mode: Included

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