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Case Reports
. 2022 Sep 1;17(3):527-531.
doi: 10.1055/s-0042-1750798. eCollection 2022 Sep.

Rathke's Cleft Cyst Abscess with a Very Unusual Course

Amy Coulden  1   2   3 , Joshua Pepper  4 , Agata Juszczak  5 , Ruchika Batra  6 , Swarupsinh Chavda  7 , Latha Senthil  7 , John Ayuk  1   3 , Ute Pohl  8 , Santhosh Nagaraju  8 , Niki Karavitaki  1   2   3 , Georgios Tsermoulas  2   4
Affiliations
Case Reports

Rathke's Cleft Cyst Abscess with a Very Unusual Course

Amy Coulden et al. Asian J Neurosurg. .

Abstract

Infected Rathke's cleft cysts (RCC) are extremely rare with only a few published cases. We report the case of a 31-year-old man who presented with headaches, visual disturbance, and hypopituitarism secondary to an infected RCC with extension of abscesses along the optic tract. Magnetic resonance imaging showed ring enhancing cystic lesions within an expanded sella with suprasellar and intraparenchymal extension. The radiological appearance suggested a high-grade optic glioma, but an endoscopic transsphenoidal biopsy revealed frank pus in the pituitary fossa, which subsequently grew Staphylococcus aureus . Pathological examination of the cyst wall showed an inflamed RCC. Following a prolonged course of intravenous antibiotics, the infection resolved and vision improved. RCC abscesses are rare and the intracranial extension of the infection in our case makes it unique.

Keywords: Rathke's cleft cyst; pituitary abscess; transphenoidal surgery.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Preoperative imaging. ( A ) CT plain imaging, axial view showing hypodensity/edema in left basal ganglia region, tracking along visual radiation ( white arrow ). ( B ) Gadolinium-enhanced T1-weighted imaging, sagittal view, showing multi-septate edge enhancing lesion arising from the sella ( white arrow ) and a second smaller contiguous cyst at the superior/posterior aspect. ( C ) Gadolinium-enhanced T1-weighted imaging, axial view showing multi-septate edge enhancing lesion extending along the left optic tract ( white arrow ) in contact with the suprasellar component of the pituitary cyst. ( D ) T2-weighted imaging, axial view showing edema around the abscess ( white arrow ). CT, computed tomography.
Fig. 2
Fig. 2
Intraoperative photographs. ( A ) Pus filled the sphenoid sinus following dural sellotomy. ( B ) Following aspiration of the pus, the cyst wall was dissected of the dura.
Fig. 3
Fig. 3
Histology of the specimen. ( A ) Histology illustrates a benign cyst with acute-on-chronic inflammation ( white asterisk ) in the vicinity of atrophic/fibrotic anterior pituitary gland tissue ( black asterisk ). ( B ) The cyst epithelium is focally ciliated ( black arrow ) and acutely inflamed by infiltrating neutrophils ( white arrow ). Underneath, there is a dense chronic inflammatory infiltrate. ( C ) Focally, the epithelium is eroded by inflammation ( black arrow ), and purulent material is seen in the cyst lumen ( white arrow ). ( D ) The epithelium shows squamous metaplasia and mild reactive atypia in places ( white asterisk ), as secondary changes to the inflammation.
See this image and copyright information in PMC

References

    1. Jain K C, Varma A, Mahapatra A K. Pituitary abscess: a series of six cases. Br J Neurosurg. 1997;11(02):139–143. - PubMed
    1. Li Z, Yang C, Bao X. Clinical features and treatment of secondary pituitary abscess after transsphenoidal surgery: a retrospective study of 23 cases. World Neurosurg. 2018;113:e138–e145. - PubMed
    1. Aranda F, García R, Guarda F J. Rathke's cleft cyst infections and pituitary abscesses: case series and review of the literature. Pituitary. 2021;24(03):374–383. - PubMed
    1. Gomez Perun J, Eiras J, Carcavilla L I. [Intrasellar abscess into a cyst of the Rathke's pouch (authors' translation)] Neurochirurgie. 1981;27(03):201–205. - PubMed
    1. Kimura H, Fukushima T, Matsuda T, Tomonaga M. Abscess formation in a Rathke's cleft cyst [in Japanese] No To Shinkei. 1994;46(04):392–395. - PubMed

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