Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 5512  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
  »  Article in PDF (1,810 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

 
  In this Article
 »  References
 »  Article Figures

 Article Access Statistics
    Viewed2154    
    Printed65    
    Emailed0    
    PDF Downloaded34    
    Comments [Add]    
    Cited by others 5    

Recommend this journal

 


 
Table of Contents    
TOPIC OF THE ISSUE: LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 3  |  Page : 309-310

Pituitary adenoma and concomitant Rathke's cleft cyst: A case report and review of the literature


Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province,610041, China

Date of Submission08-Aug-2011
Date of Decision05-Sep-2011
Date of Acceptance06-Sep-2011
Date of Web Publication14-Jul-2012

Correspondence Address:
Kun Wang
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province,610041
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.98520

Rights and Permissions



How to cite this article:
Wang K, Ma L, You C. Pituitary adenoma and concomitant Rathke's cleft cyst: A case report and review of the literature. Neurol India 2012;60:309-10

How to cite this URL:
Wang K, Ma L, You C. Pituitary adenoma and concomitant Rathke's cleft cyst: A case report and review of the literature. Neurol India [serial online] 2012 [cited 2019 Nov 14];60:309-10. Available from: http://www.neurologyindia.com/text.asp?2012/60/3/309/98520


Sir,

This report presents a patient with a non-functioning pituitary adenoma (NFPA) with coexisting Rathke's cleft cysts (RCC), an extremely rare co-occurrence.

A 42-year-old woman was referred for evaluation of severe headache of two weeks' duration. Neurological examination was essentially normal. A visual field evaluation by neuro-ophthalmology revealed no visual field defect. The serum prolactin level was 39.36 ng/ mL and other hormone levels were in a normal range. Magnetic resonance imaging (MRI) revealed an intrasellar cystic solid mass with suprasellar extension, which measured approximately 2.4 cm in the greatest dimension [Figure 1]a. The mass lesion showed two different intensities, iso-intense on T1-weighted and hyper-intense on T2-weighted sequences with a hypo-intensity on T1 and T2-weighted image in the mass [Figure 1]a and b. Post-contrast image showed marked enhancement of the solid part [Figure 1]c. Surgery was performed using the endonasal transsphenoidal approach. During surgery, a gray bulging mass with a capsule was exposed. Incision of the capsule revealed a grayish soft mass which was totally curetted. Clear yellowish mucoid fluid was aspirated during curettage. Histopathology examination revealed a non-functioning pituitary adenoma and a concomitant RCC [Figure 2] and [Figure 3]. The patient's hospital course was uneventful. The postoperative MRI (obtained six months after surgery) showed total resection of the tumor, and there was no evidence of cystic recollection.
Figure 1: Preoperative MRI scan. Sagittal T1-weighted image (a) and axial T2-weighted image (b) show an intrasellar mass with two different signal intensities. Post-contrast image showed marked enhancement of the solid part (c)

Click here to view
Figure 2: Histological appearance of the tumor. (a) Multiple mucin-filled cysts are interspersed within the adenoma tissue (H and E, ×10); (b) The solid part contained many clusters of uniform pituitary adenoma cells arranged in solid nests and sheets without lobular architecture (H and E, ×40); (c) The cysts had a connective tissue wall and were lined by a single layer of ciliated columnar epithelium (H and E, ×20)

Click here to view
Figure 3: Immunohistochemical appearance of the tumor. (a) Stain for syna shows strong reactivity in adenoma cells; (b) stain for ki-67 is less than 1%

Click here to view


RCCs are commonly believed to be cysts derived from remnants of the Rathke's pouch [1] and are usually asymptomatic, less than 3 mm in diameter and have been found in 13-33% of normal pituitary glands. [2] However, the coexistence of RCC with a pituitary adenoma is rare. Only 39 patients involving a pituitary adenoma with a concomitant RCC were identified in 21 articles, on review of the literature. A preoperative diagnosis of these collision sellar lesions based on MRI findings is very difficult. [2] RCC shows variable position, size, and signal intensity on MRI, and there is no specific pattern of pituitary displacement. The MRI intensity of RCC depends on protein concentration. Only in 15 of the 39 reported cases of collision RCC and pituitary adenoma, the lesion contained two different signal intensities on MRI. [2] In our patient, the pituitary adenoma was enclosed by the RCC, and it shows two different signal intensities on MRI.

The relationship between pituitary adenomas and RCCs is uncertain. [3] It is widely believed that Rathke's pouch gives rise to anterior pituitary with the proliferation of its anterior wall, and pituitary adenomas are known to originate from the anterior pituitary through clonal alteration. [4] Thus, RCC deriving from remnants of Rathke's pouch and pituitary adenomas could be suggested to have a common embryonic origin. [5] Although pituitary adenomas and RCCs have a shared ancestry, they rarely occur simultaneously. [6] The pathogenesis of the two collision lesions remains to be clarified.

 
 » References Top

1.Shanklin WM. The histogenesis and histology of an integumentary type of epithelium in the human hypophysis. Anat Rec 1951;109:217-31.  Back to cited text no. 1
[PUBMED]    
2.Noh SJ, Ahn JY, Lee KS, Kim SH. Pituitary adenoma and concomitant Rathke's cleft cyst. Acta Neurochir (Wien) 2007;149:1223-8.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Melmed S. Mechanisms for pituitary tumorigenesis: The plastic pituitary. J Clin Invest 2003;112:1603-18.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Koutourousiou M, Kontogeorgos G, Wesseling P, Grotenhuis AJ, Seretis A. Collision sellar lesions: Experience with eight cases and review of the literature. Pituitary 2010;13:8-17.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Kamoshima Y, Sawamura Y, Iwasaki YK, Fujieda K, Takahashi H. Case of Carney complex complicated with pituitary adenoma and Rathke cleft cyst. No Shinkei Geka 2008;36:535-9.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Sumida M, Migita K, Tominaga A, Iida K, Kurisu K. Concomitant pituitary adenoma and Rathke's cleft cyst. Neuroradiology 2001;43:755- 9.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Pituitary Adenoma Associated With Rathke’s Cleft Cyst: Report of 15 Cases
Wenhao Wu,Guijun Jia,Wang Jia,Guilin Li,Junting Zhang,Liwei Zhang
Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques. 2018; 45(01): 68
[Pubmed] | [DOI]
2 First Report of Coexistence of Two Ectopic Pituitary Tumors: Rathke Cleft Cyst and Silent Adrenocorticotropic Hormone Adenoma
Mirza Pojskic,Blazej Zbytek,Neal S. Beckford,Frederick A. Boop,Kenan I. Arnautovic
World Neurosurgery. 2017; 104: 1048.e1
[Pubmed] | [DOI]
3 Spontaneous pituitary adenoma occurring after resection of a Rathke’s cleft cyst
Nauman S. Chaudhry,Michael R. Raber,David J. Cote,Edward R. Laws
Journal of Clinical Neuroscience. 2016; 33: 247
[Pubmed] | [DOI]
4 Rathke Cleft Cyst with a Coexisting Gonadotropin Producing Pituitary Adenoma
Chi-Man Yip,Hui-Hwa Tseng,Shu-Shong Hsu,Huang-I Hsu
Open Journal of Modern Neurosurgery. 2015; 05(03): 71
[Pubmed] | [DOI]
5 Combined pituitary adenoma and Rathkeæs cleft cysts: Two multicystic cases and literature review
Zhou, P. and Cai, B. and Ma, W. and Jiang, S.
Neurology India. 2012; 60(6): 665-667
[Pubmed]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow