Rathke’s cleft cyst with non-hemorrhagic rupture resulting in alteration of signal intensity for a short period: case report.

Abstract

In a case of 23-year-old female with Rathke's cleft cyst (RCC), unusual changes with size and morphology on computed tomography (CT) and magnetic resonance images (MRI) were noted in a short period of 3 weeks after spontaneous rupture. The CT noted that the intracystic isodensity was changed to hyperdensity. And MRI showed not only a decrease in size of the lesion but also changing from hypo-and hyperintensity in T1-and T2-weighted images to hyperintensity in both T1-and T2-weighted images. The intraoperative findings disclosed that the cyst content was milky-like, but not hemorrhagic. We considered that the leakage of cyst content to the cerebrospinal fluid pathway caused not only inflammatory reaction but also waxing and waning of both the cyst size and intralesional protein concentration, which resulted in unusual changing CT and MR appearance. We should take into consideration that the nature of RCC can be altered by not only intracystic hemorrhage but also non-hemorrhagic rupture even for a short period.

Review of xanthomatous lesions of the sella

“…Since that time, numerous additional case reports of XG have suggested that, when an etiology can be identified at all, it is a hemorrhagic RCC that is implicated. In addition, since the report of Paulus et al , numerous examples of hemorrhagic and non‐hemorrhagic RCCs mimicking pituitary apoplexy have been published, underscoring the fact that bleeding into RCC may be both subclinical and clinically relevant . The etiological mechanism behind hemorrhage into RCCs is obscure, but usually there is no identified antecedent traumatic or other inciting event.…”