Symptomatic Rathke's cleft cyst with amyloid stroma.

Concha, Sergio Tapia; Hamilton, Bruce P.; Millán, Juan Carlos Ruíz San; PE, Jerome McQueen,

doi:10.1136/jnnp.38.8.782

Cited by 26 publications

(5 citation statements)

References 17 publications

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“…1,6 Histologically, Rathke cleft cyst linings often reveal ciliated cuboidal or columnar epithelium with interspersed mucin-producing goblet cells. 5,12,14,19,21,25,26,28 Surgical treatment for Rathke cleft cyst is usually given via the transsphenoidal approach, and consists of cyst drainage and limited excision of its lining. 1,17,18,26 Modifications of this approach include leaving the cyst open to drain into the sphenoid sinus 6 and the instillation of absolute alcohol to cauterize the cystic space when there is no evidence of com-munication with CSF.…”

Section: Discussionmentioning

confidence: 99%

Devastating complications from alcohol cauterization of recurrent Rathke cleft cyst

Hsu¹,

Piva²,

Sadun³

2004

Journal of Neurosurgery

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Rathke cleft cysts are commonly found on autopsy but are seldom symptomatic. Conventional treatment of these lesions consists of transsphenoidal drainage with partial excision of the cyst, and recurrence is rare. Alternatively, the instillation of absolute alcohol into the cyst has been described in several reports, with no complications. The authors report on a woman with Rathke cleft cyst that recurred three times after the initial treatment; the lesion was treated with alcohol cauterization on the final recurrence with devastating complications. This 51-year-old woman presented in 1992 with headaches and visual disturbances. Admission magnetic resonance imaging revealed a sellar/suprasellar lesion that was treated with conventional surgery and was subsequently confirmed to be a Rathke cleft cyst. The patient again presented with recurrence of the cyst at 22, 26, and 31 months after the initial presentation. On the final recurrence the cyst was treated with alcohol cauterization. Postoperatively, the patient awoke blind and suffered a seizure from leakage of the alcohol. The patient remains completely blind in both eyes and is also anosmic and has left lid ptosis and exotropia, which signify damage to the first through third cranial nerves. Rathke cleft cysts have been known to recur after primary surgery; however, this is the first report of a single cyst recurring three times despite conventional surgical treatment. Additionally, this is the first report in which devastating complications from alcohol cauterization of the cyst have been described. The authors therefore advocate caution when attempting alcohol cauterization and advise that meticulous care be taken to ensure the patency of the cyst.

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Section: Discussionmentioning

confidence: 99%

Devastating complications from alcohol cauterization of recurrent Rathke cleft cyst

Hsu¹,

Piva²,

Sadun³

2004

Journal of Neurosurgery

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“…Their origin is almost certainly from remnants of Rathke pouch [22,23]. The suggestion of a derivation from neuroepithelium [24,25] finds no real support. When symptomatic, Rathke's cleft cysts present with mass effect such as headache, visual disturbance, and/ or pituitary dysfunction [20,21].…”

Section: Introductionmentioning

confidence: 96%

Collision lesions of the sella: co-existence of craniopharyngioma with gonadotroph adenoma and of Rathke’s cleft cyst with corticotroph adenoma

et al. 2007

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Collision lesions of the sellar region are relatively uncommon. Most contributions include a pituitary adenoma or a cyst/cystic tumor, particularly a Rathke cleft cyst. The association of craniopharyngioma with an adenoma is particularly rare. Among reported cases, some have included secondary prolactin cell hyperplasia due to pituitary stalk section effect. Herein, we report two collision lesions, including a gonadotroph adenoma with adamantinomatous craniopharyngioma and a corticotroph adenoma with Rathke's cleft cyst. Clinicopathologic correlation and a review of the literature are undertaken.

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“…34 Another theory for the origin of cystic epithelial lesions in this region is that they are derived instead from neuroepithelial sources such as the neural crest, as supported by the finding of amyloid stroma in some examples. 18,21,65,98 A third alternative theory suggests that cystic epithelial lesions are derived from metaplasia of anterior pituitary cells. 3,39,95 Some authors have reported RCCs or CPs occurring in conjunction with pituitary adenomas as transitional or collision lesions.…”

Section: Evidence Supporting Nonectodermal Origins Of Cystic Epithelimentioning

confidence: 99%

Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopathological relationships

Zada¹,

Lin²,

Ojerholm³

et al. 2010

FOC

232

182

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Object Cystic epithelial masses of the sellar and parasellar region may be difficult to differentiate on a clinical, imaging, or even histopathological basis. The authors review the developmental relationships and differentiating features of various epithelial lesions of the sellar region. Methods The authors performed a review of the literature to identify previous studies describing the etiological relationships and differentiating features of various cystic sellar lesions, including craniopharyngioma (CP), Rathke cleft cyst, xanthogranuloma, and dermoid and epidermoid cysts. Results There is significant evidence in the literature to support a common ectodermal origin of selected sellar and suprasellar cystic lesions, which may account for the overlap of features and transitional states observed in some cases. Research obtained from animal studies and reports of transitional cystic epithelial masses or lesions crossing over from typical to more aggressive pathological subtypes have collectively provided a solid foundation for this theory. Histological features that signify transitional entities beyond simple benign Rathke cleft cysts include squamous metaplasia, stratified squamous epithelium, and ciliated or mucinous goblet cells in squamous-papillary CPs. Several studies have identified key clinical, imaging, and histopathological features that can be used in the differentiation of these lesions. Conclusions The pattern of embryological formation of the hypothalamic-pituitary axis plays a major role in its propensity for developing cystic epithelial lesions. Subsequent inflammatory, metaplastic, and neoplastic processes may promote further progression along the pathological continuum, ranging from benign epithelial cysts to aggressive neoplastic cystic CPs. Selected clinical, imaging, and histopathological features can be used collectively to help differentiate these lesions and assign a formal diagnosis, thus accurately guiding further treatment.

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Symptomatic Rathke's cleft cyst with amyloid stroma.

Cited by 26 publications

References 17 publications

Devastating complications from alcohol cauterization of recurrent Rathke cleft cyst

Devastating complications from alcohol cauterization of recurrent Rathke cleft cyst

Collision lesions of the sella: co-existence of craniopharyngioma with gonadotroph adenoma and of Rathke’s cleft cyst with corticotroph adenoma

Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopathological relationships

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