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Clinicopathological characteristics in patients presenting with acute onset of symptoms caused by Rathke’s cleft cysts

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Abstract

Background

Symptomatic Rathke’s cleft cyst is usually accompanied by a long history of headache, visual disturbance, and hypopituitarism; however, rare cases present with acute onset and the clinical features in such cases remain uncertain. We report herein the clinical features of Rathke’s cleft cyst with acute onset and discuss the clinical significance.

Method

In this study, we defined acute onset as the clinical course with clinical symptoms within a 7-day history. From among 35 cases of symptomatic Rathke’s cleft cyst that were pathologically diagnosed at Fukuoka University Hospital between 1990 and 2009, five cases presented with acute onset. The symptoms, endocrinological findings, MR image findings, and pathological findings of these cases were analyzed retrospectively.

Findings

Mean age was 56.8 years. Initial symptoms included headache (n = 3), general malaise (n = 2), polyuria (n = 2), and fever (n = 1). MR imaging revealed an intrasellar cystic lesion with suprasellar extension in all cases and showed rim enhancement in three cases. All cases were treated by transsphenoidal surgery. Pathological findings included hemorrhage (n = 2), hypophysitis (n = 2), and abscess formation in the cyst (n = 1). Postoperatively, all symptoms, except for hypopituitarism, improved in all cases.

Conclusions

Rathke’s cleft cysts sometimes present with acute onset, and the presentation is consistent with the features of pituitary apoplexy caused by pituitary adenoma. Although pituitary apoplexy due to hemorrhage, inflammation, or infection due to an underlying Rathke’s cleft cyst is difficult to diagnose pre-operatively, Rathke’s cleft cyst should be included in the differential diagnosis, and early surgical treatment is needed, as for pituitary apoplexy caused by pituitary adenoma.

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Correspondence to Fuminari Komatsu.

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Comment

In this report, in the 10-year series of 35 Rathke's cleft cysts treated at Fukuoka University, five cases that presented with pituitary apoplexy are presented. The finding is that a lot of individuals carry Rathke's cleft cysts; some of these cysts became symptomatic due to their mass effect. Only a few of these cysts present with pituitary apoplexy. In these cases, hemorrhage, hypophysitis, or abscess is the cause of the sudden onset. For clinical symptoms and treatment, the Rathke's cleft cyst becomes the secondary pathology.

For these rare pathologies with even more uncommon presentation, the retrospective analysis still remains our only source of information. So, it is important to publish series of this kind.

Jens Lehmberg

Munich, Germany

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Komatsu, F., Tsugu, H., Komatsu, M. et al. Clinicopathological characteristics in patients presenting with acute onset of symptoms caused by Rathke’s cleft cysts. Acta Neurochir 152, 1673–1678 (2010). https://doi.org/10.1007/s00701-010-0687-5

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  • DOI: https://doi.org/10.1007/s00701-010-0687-5

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