Symptomatic Rathke's cleft cyst with a co-existing pituitary tumor; Brief review of the literature

Abstract

Pituitary adenomas and Rathke's cleft cysts (RCCs) share a common embryological origin. Occasionally, these two lesions can present within the same patient. We present a case of a 39-year-old male who was found to have a large sellar lesion after complaints of persistent headaches and horizontal nystagmus. Surgical resection revealed components of a RCC co-existing with a pituitary adenoma. A brief review of the literature was performed revealing 38 cases of co-existing Rathke's cleft cysts and pituitary adenomas. Among the cases, the most common symptoms included headache and visual changes. Rathke's cleft cysts and pituitary adenomas are rarely found to co-exist, despite having common embryological origins. We review the existing literature, discuss the common embryology to these two lesions and describe a unique case from our institution of a co-existing Rathke's cleft cyst and pituitary adenoma.

Keywords: Adenoma; Rathke's cleft cyst; development; neoplasm; pituitary; sella; tumor.

Figure 1

Magnetic resonance imaging (MRI) images of a cystic sellar lesion found to be a combined Rathke's cleft cyst with pituitary adenoma. (a) Axial T1-weighted MRI, (b) axial T2-weighted MRI, (c) sagittal T1-weighted MRI and (d) sagittal T1-weighted post-contrast MRI showing peripheral enhancement

Figure 2

(a) Pituitary adenoma is present among hemorrhage, (b) Cuboidal epithelial lining was immunopositive for cytokeratin and is consistent with a Rathke cleft cyst component (a and b hematoxylin and eosin, ×20)