Rathke's cleft cyst
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A lobulated lesion fills the sella and extends into the anterior aspect of the suprasellar cistern. It is T1 and T2 hyperintense, the T2 signal brighter than adjacent CSF. A small low T2 signal internal nodule is seen inferiorly on the left.
A rim of slowly enhancing tissue at the left inferolateral margin likely reflects normal enhancing residual pituitary tissue.
The lesion displaces the infundibulum anterosuperiorly and distorts the posterior optic nerves, also displacing the chiasm superiorly.
T1/T2 hyperintense lesion is favored to be a Rathke's cleft cyst.
The patient went on to have a transsphenoidal resection.
The sections show a small fragment of tissue which is covered on one surface by a layer of ciliated cuboidal epithelial cells. These show strong immunostaining for cytokeratins CAM5.2 and AE1/AE3. The underlying tissue contains a moderate chronic inflammatory cell infiltrate. No anterior pituitary acini are identified. The features are consistent with the wall and lining of a Rathke's cleft cyst. No evidence of tumor is seen.
FINAL DIAGNOSIS: Features consistent with wall and lining of Rathke's cleft cyst.
The patient has been followed up for 7 years and is doing well without recurrence.