Presentation
Headaches.
Patient Data
The pituitary fossa is enlarged with erosion of the dorsum sellae.
Note: These films were obtained preoperatively, and not for the diagnosis as plain x-rays are no longer performed for investigation of the pituitary region.
A well-circumscribed lesion with fluid attenuation expands and remodels the sella with thinning and possible dehiscence of the flood between the fossa and the sphenoid sinus. No calcification.
A large cystic lesion arises from the pituitary fossa, which it expands and remodels, and compresses the optic chiasm. It is fluid-filled but does not suppress on FLAIR. The anterior pituitary tissue is stretched over the cyst.
Features are most consistent with a Rathke's cleft cyst. A cystic macroadenoma and a craniopharyngioma are much less likely.
Case Discussion
The patient went on to have a transsphenoidal resection.
Histology
The section shows a small fragment of anterior pituitary tissue. This is composed of small acini which are somewhat distorted by fibrous tissue. The fragment is covered on one surface by ciliated cuboidal epithelial cells. No atypical nuclear features are seen. The features are of the wall and lining of a Rathke's cleft cyst. No evidence of tumor is seen.
FINAL DIAGNOSIS: Lining and wall of Rathke's cleft cyst; no evidence of tumor seen.
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