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| TOPIC OF THE ISSUE: LETTER TO EDITOR |
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| 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
Kun Wang, Lu Ma, Chao You
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province,610041, China
| Date of Submission | 08-Aug-2011 |
| Date of Decision | 05-Sep-2011 |
| Date of Acceptance | 06-Sep-2011 |
| Date of Web Publication | 14-Jul-2012 |
Correspondence Address:
Kun Wang
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province,610041
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.98520
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 |
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)
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 | 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)
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 | 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%
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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.
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| 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.
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[Figure 1], [Figure 2], [Figure 3]
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