Intractable Rathke's cleft cyst hidden behind co-existing giant pituitary adenoma - Case report.

Intractable Rathke's cleft cyst hidden behind co-existing giant pituitary adenoma - Case report.

World Neurosurg. 2019 Jan 02;:

Authors: Nishimura F, Park YS, Motoyama Y, Nakagawa I, Yamada S, Tamura K, Matsuda R, Takeshima Y, Takamura Y, Nakase H

Abstract
BACKGROUND: Although pituitary adenoma (PA) and Rathke's cleft cyst (RCC) share a common embryological origin, concurrent appearances have rarely been reported. We present a case of intractable RCC hidden behind a co-existing giant PA.
CASE DESCRIPTION: A 39-year-old female visited an ophthalmologist with visual disturbance. Brain MRI findings showed a giant mass in the intra- and supra-sellar portion, with a cystic portion contained in the posterior part. Endoscopic endonasal surgery was performed to remove the tumor and histopathology findings revealed a non-functioning pituitary adenoma. Furthermore, another brain MRI procedure showed the appearance of a residual cyst. A second endonasal endoscopic surgery was performed to decompress the growing cyst for the optic chiasma, with cyst drainage and irrigation performed, and portions of the cyst walls obtained. The histopathological diagnosis was RCC with inflammation. Over the course of 1 year, 3 separate recurrences of the growing cyst were noted, with cyst drainage and irrigation performed each time. Finally, ethanol cauterization was used, which stopped the symptomatic RCC recurrence. Eight years after the final procedure, there was no cyst recurrence, and the patient showed a good condition with improved visual acuity and normal pituitary function.
CONCLUSIONS: The presence of a non-enhanced cyst with a PA shown by MRI suggests the possibility of coexisting RCC and PA.

PMID: 30610983 [PubMed - as supplied by publisher]

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