Rathke's cleft cyst
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A well defined intrasellar intra-pituitary cystic lesion is noted epicentered on the left aspect of the pituitary gland measuring 9x7x11 mm. It exhibits homogeneous hypointense signal on T1 and T2, with no postcontrast enhancement. It shows restricted diffusion on DWI.
It exerts a mild mass effect in the form of stretching the surrounding pituitary gland, mildly encroaching upon the related suprasellar cistern, mild displacement of the pituitary stalk to the right side. No mass effect upon the optic chiasm.
MRI features are suggestive of a benign intra-pituitary cystic lesion, mostly Rathke's cleft cyst. Classical features are thin-walled intra-pituitary cyst with homogeneous fluid content and no enhancement. Majority of these cysts show high signal on T1 and T2 1. However, in our case, it shows intermediate signal intensity on T1 and T2 with diffusion restriction. Hypointensity on T1 could be correlated with an increased incidence of associated endocrinopathy 2.
Differential diagnosis is a pituitary cystic adenoma which differs in the presence of fluid-fluid level, septations, a hypointense rim on T2WI and eccentric location.
- 1. M. Park, S.-K. Lee, J. Choi, S.-H. Kim, S.H. Kim, N.-Y. Shin, J. Kim, S.S. Ahn. Differentiation between Cystic Pituitary Adenomas and Rathke Cleft Cysts: A Diagnostic Model Using MRI. (2015) American Journal of Neuroradiology. doi:10.3174/ajnr.A4387 - Pubmed
- 2. Oh YJ, Park HK, Yang S, Song JH, Hwang IT. Clinical and radiological findings of incidental Rathke's cleft cysts in children and adolescents. (2014) Annals of pediatric endocrinology & metabolism. 19 (1): 20-6. doi:10.6065/apem.2014.19.1.20 - Pubmed