Symptomatic Rathke's Cleft Cysts Research Articles

Acute Adrenal Insufficiency Due to Symptomatic Rathke's Cleft Cyst.

A 65-year-old Japanese man who suffered from secondary hypopituitarism due to Rathke's cleft cyst is reported. Although computed tomography failed to detect any pituitary abnormality, magnetic resonance imaging demonstrated the presence of a cystic intrasellar mass, initially suggesting craniopharyngioma or abscess. Operative findings revealed Rathke's cleft cysts within the pituitary fossa which resulted in secondary hypopituitarism. Among cases of secondary hypopituitarism with abnormal findings in the pituitary, symptomatic Rathke's cleft cysts should be included in the differential diagnosis of adrenal insufficiency.

Clinical, radiographic, and pathological features of symptomatic Rathke's cleft cysts

The clinical, radiographic, and pathological findings in 155 patients with symptomatic Rathke's cleft cysts are discussed. Eight patients were treated by the authors and 147 were collected in a review of the literature. This lesion occurred more often in female than male patients by a 2:1 margin, and the mean age at presentation was 38 years. The average patient had been symptomatic for nearly 3 years at the time of treatment, with the most common symptoms and signs being pituitary dysfunction, visual disturbances, and headaches. Affected children generally were pituitary dwarfs. The sella was enlarged in 80% of cases, and the cyst was situated in both an intrasellar and a suprasellar location in 71%. Computerized tomography revealed a low-density cystic mass with capsular enhancement in one-half of the cases. A variable appearance was seen with magnetic resonance imaging. Partial excision and drainage of the cyst by the transsphenoidal approach is the recommended treatment, as the recurrence rate is low. Most symptoms and signs improved or resolved following surgery with the exception of hypopituitarism and diabetes insipidus. The cyst lining was usually composed of ciliated cuboidal or columnar epithelium. Theories as to the origin of Rathke's cleft cysts are also discussed.

Asymptomatic and Symptomatic Rathke's Cleft Cysts

Pituitary cysts are fairly often found incidentally in anatomical studies, but symptomatic cysts are relatively uncommon. In this study, the histological characteristics of 42 asymptomatic and three symptomatic Rathke's cleft cysts were examined and compared. The 42 cysts found incidentally at autopsy were classified as small (less than 1 mm in diameter), medium (1 to 5 mm), or large (over 5 mm). There were 23 small (55%), 13 medium (31%), and six large (14%) cysts. The mean ages of the three patient groups were 66, 60, and 53 years, respectively. Flattened epithelial cells were the most common cells in small cysts, while cuboidal to columnar epithelial cells were more prevalent in medium and large cysts. The larger cysts tended to contain cilia. The three symptomatic cysts were histologically confirmed to be Rathke's cleft cysts by their characteristic ciliated columnar epithelial lining. No essential histological differences were observed between asymptomatic and symptomatic cysts, and the mechanism of change from asymptomatic to symptomatic Rathke's cleft cyst was not clarified. Small nests of epithelium at the junction of the pars tuberalis and pituitary stalk are considered to be remnants of Rathke's pouch and are thought to give rise to craniopharyngioma. In their most typical forms, Rathke's cleft cysts and craniopharyngiomas are histologically distinguishable, craniopharyngiomas being composed of stratified squamous epithelium and simple Rathke's cleft cysts of a layer of cuboidal or columnar epithelium on a basement membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

Epithelial cells in symptomatic rathke's cleft cysts: A light- and electron-microscopic study

Epithelial cells composing symptomatic Rathke's cleft cysts were examined electron microscopically in two cases, and the fine structures were compared with those of the mucosa in the normal sphenoid sinus, of the normal choroid plexuses, and of a craniopharyngioma with goblet and ciliated cells. The Rathke's cleft cysts were composed of a single or pseudostratified epithelial layer abutting on the connective tissue. The epithelial cells were of four different kinds of cells, such as goblet, ciliated, flat, and basal cells. The flat cells containing bundles of tonofilaments and desmosomes were the squamous cells. They were present in a single-epithelial layer in both cases. The basal cells were present as small, wedge-shaped cells, even if the number was very small. The epithelial cells in Rathke's cleft cysts were more similar to those of the mucosa in the sphenoid sinus and those of a craniopharyngioma with goblet and ciliated cells than those of the choroid plexus. This study indicates the close relationship between Rathke's cleft cysts and mucosa in the sphenoid sinus or craniopharyngioma with ciliated and goblet cells.

Symptomatic Rathke's cleft cysts

Two unusual cases of symptomatic Rathke's cleft cysts are reported. In one, the cyst was entirely suprasellar with a normal sella turcica. The gross visual failure, hypothalamic disturbances, and hypopituitarism of the patient resolved after a transfrontal aspiration and partial excision of the wall of the cyst. The second patient was a pituitary dwarf with hypothalamic dysfunction, but with normal vision. The patient had a large intrasellar cyst that exhibited marked suprasellar extension with calcification of the capsular rim. After transsphenoidal aspiration and partial excision of the wall of the cyst, the patient achieved a satisfactory recovery. The differential features between Rathke's cleft cyst and craniopharyngioma are highlighted.

Trans-sphenoidal removal of a Rathke??s cleft cyst

Symptomatic Rathke's cleft cysts are uncommon. We present a case with suprasellar extension manifested by hypopituitarism and visual disturbances. The treatment was trans-sphenoidal evacuation and partial removal of the capsule. We suggest that the trans-sphenoidal approach to these lesions is usually adequate and that radical removal of the capsule is not necessary.