Changes in the epithelium of Rathke cleft cyst associated with inflammation

Hama, Seiji; Arita, Kazunori; Nishisaka, Takashi; Fukuhara, Tatsuro; Tominaga, Atsushi; Sakamoto, Kazuhiko; Yoshioka, Hiroyuki; Eguchi, Kuniki; Sumida, Masayuki; Heike, Yuji; Kurisu, Kaoru

doi:10.3171/jns.2002.96.2.0209

Cited by 87 publications

(75 citation statements)

References 16 publications

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“…The low recovery rates are thought to be associated with an inflammatory process caused by the cyst contents, which may result in irreversible damage to the adjacent hypophysis. 7,8,12,25,33,43,54 Our results show that preoperative headache and visual dysfunction were resolved in 85% and 95% of patients, and both rates compare favorably with the findings of other studies. However, we achieved better resolution in the patients with hypopituitarism and DI than other series of similar sample size (55% and 65%, respectively).…”

Section: Outcome Analysissupporting

confidence: 80%

Individualized surgical strategies for Rathke cleft cyst based on cyst location

Fan¹,

Peng²,

Qi³

et al. 2013

JNS

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R athke cleft cysts (RCCs) are regarded as benign cystic lesions derived from a remnant of the Rathke pouch. They are common findings at autopsy, with a reported incidence of 5% to 33%, and account for 6%-10% of sellar lesions. 3,9,17,32,39,46,49 Although mostly asymptomatic, some RCCs can become sufficiently large to cause compressive effect on surrounding structures, resulting in neurological and endocrine disturbances. As a result, surgical intervention is recommended for symptomatic or at-risk patients.Traditionally, the 2 most common surgical approaches are the endonasal transsphenoidal route and the standard craniotomy. The endonasal approach is typically used for sellar lesions, whereas the craniotomy is indicated for suprasellar lesions. 2,11,38,40 Owing to its reduced invasiveness Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaObject. An assessment regarding both surgical approaches and the extent of resection for Rathke cleft cysts (RCCs) based on their locations has not been reported. The aim of this study was to report the results of a large series of surgically treated patients with RCCs and to evaluate the feasibility of individualized surgical strategies for different RCCs.Methods. We retrospectively reviewed 87 cases involving patients with RCCs (16 intrasellar, 50 intra-and suprasellar, and 21 purely suprasellar lesions). Forty-nine patients were treated via a transsphenoidal (TS) approach, and 38 were treated via a transcranial (TC) approach (traditional craniotomy in 21 cases and supraorbital keyhole craniotomy in 17). The extent of resection was classified as gross-total resection (GTR) or subtotal resection (STR) of the cyst wall. Patients were thus divided into 3 groups according to the approach selected and the extent of resection: TS/STR (n = 49), TC/STR (n = 23), and TC/GTR (n = 15).Results. Preoperative headaches, visual dysfunction, hypopituitarism, and diabetes insipidus (DI) resolved in 85%, 95%, 55%, and 65% of patients, respectively. These rates did not differ significantly among the 3 groups. Overall, complications occurred in 8% of patients in TS/STR group, 9% in TC/STR group, and 47% in TC/GTR group, respectively (p = 0.002). Cerebrospinal fluid (CSF) leakage (3%), new hypopituitarism (9%), and DI (6%) were observed after surgery. All CSF leaks occurred in the endonasal group, while the TC/GTR group showed a higher rate of postoperative hypopituitarism (p = 0.7 and p < 0.001, respectively). It should be particularly noted that preoperative hypopituitarism and DI returned to normal, respectively, in 100% and 83% of patients who underwent supraorbital surgery, and with the exception of 1 patient who had transient postoperative DI, there were no complications in patients treated with supraorbital surgery. Kaplan-Meier 3-year recurrence-free rates were 84%, 87%, and 86% in the TS/STR, TC/STR, and TC/GTR groups, respectively (p = 0.9).Conclusions. It is reasonable to adopt individualized surgical strategies for RCCs based on cyst location....

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Section: Outcome Analysissupporting

confidence: 80%

Individualized surgical strategies for Rathke cleft cyst based on cyst location

Fan¹,

Peng²,

Qi³

et al. 2013

JNS

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“…Furthermore, at the last assessment, FSH/LH, ACTH and TSH deficiency and diabetes insipidus were found in 50, 42 and 47% of the patients respectively. The poor endocrine prognosis is probably related to pituitary damage attributed to chronic pressure by the cyst, to chronic inflammation following cyst rupture or a result of surgery (14,20,23,25,26). Interestingly, it has been suggested that 4-30% of the patients will develop new pituitary hormone deficits post-operatively (8,11,12,23,27) and that the degree of endocrine morbidity is higher after aggressive surgery (5).…”

Section: Survival Function Censoredmentioning

confidence: 99%

Outcome in surgically treated Rathke's cleft cysts: long-term monitoring needed

Trifănescu¹,

Stavrinides²,

Plaha³

et al. 2011

European Journal of Endocrinology

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Objective: To clarify the outcome of all cases of Rathke's cleft cysts (RCC) treated surgically and followed up in Oxford during a long-term period. Subjects and methods: The records of all patients with RCC seen in the Department of Endocrinology between January 1978 and June 2009 were reviewed. Results: A total of 33 patients (20 females, median age 43 years) were identified. At presentation, major visual field defects were detected in 58% of patients and gonadotrophin, ACTH and TSH deficiency in 60, 36 and 36% of patients respectively. Desmopressin treatment was required in 18% of patients. Treatment consisted of cyst evacuation combined with or without biopsy/removal of the wall. Post-operatively, visual fields improved in 83% of patients with impairment, whereas there was no reversal of ACTH or TSH deficiency or of diabetes insipidus. All but one subject had imaging follow-up during a mean period of 48 months (range 2-267). Cyst relapse was detected in 22% of patients at a mean interval of 29 months (range 3-48 months); in 57% of them, the recurrence was symptomatic. Relapse-free rates were 88% at 24-months and 52% at 48-months follow-up. At last assessment, at least quadrantanopia was reported in 19% of patients, gonadotrophin, ACTH and TSH deficiency in 50, 42 and 47% of patients respectively. Desmopressin treatment was required in 39% of patients. Conclusions: In this study of patients with RCC and long-term follow-up, we showed a considerable relapse rate necessitating long-term monitoring. Surgical intervention is of major importance for the restoration of visual field defects, but it does not improve endocrine morbidity, which in the long-term affects a substantial number of patients.

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Section: Casementioning

confidence: 99%

“…Although it is infrequent, RCCs become symptomatic when they are large enough to compress surrounding structures such as the optic chiasm, the pituitary gland, the hypothalamus, or the diaphragma sellae (5,15). In addition, many authors have reported that RCCs cause endocrinologic abnormalities because of the inflammatory spreading of the RCC contents that contain mucin, and this can involve the surrounding pituitary gland (9,17,21).…”

Section: Introductionmentioning

confidence: 99%

“…In cases with hypophysitis, the cyst wall undergoes hyperplastic and metaplastic changes from being single-layered to becoming a stratified epithelium during the progression of inflammation (9). Some authors have insisted that the mucus in the contents of the RCC may be a strong stimulator of tissue injury with not only lymphocytic but also granulomatous reactions in the epithelial cyst wall (9,21). In our cases, the surgical specimens clearly demonstrated massive lymphocyte infiltration only into the posterior lobe with severely damaged pituitary architecture, indicating inflammatory destruction by autoimmune reactions (17).…”

Section: Casementioning

confidence: 99%

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Pure lymphocytic infundibuloneurohypophysitis caused by the rupture of rathke's cleft cyst; report of 2 cases and review of the literature

Hayashi¹,

Oishi²,

Kita³

et al. 2014

Turkish Neurosurgery

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The major symptoms that are caused by Rathke's cleft cysts (RCCs) are visual disturbances, headaches, and endocrine insufficiencies. Among these symptoms, the endocrine insufficiencies are thought to result from the spreading of inflammation that is induced by the cyst contents onto the pituitary gland or the compression of the gland and the pituitary stalk by RCCs. Here, we present 2 rare cases with lymphocytic infundibulohypophysitis with the sudden onset of headaches and subsequent diabetes insipidus (DI). Magnetic resonance imaging revealed remarkable swelling of the pituitary gland with a small mass that was located between the anterior and the posterior lobe of the pituitary gland. Transsphenoidal surgery was performed to remove the mass, and pathological examinations of the cyst wall demonstrated that the epithelial tissue of the RCC and the posterior lobe were affected by massive lymphocytic infiltration. The clinical courses and pathological results of these patients strongly suggested that the rupture of the RCC onto the posterior lobe caused the lymphocytic hypophysitis. Postoperatively, the DI could be controlled with a smaller amount of anti-diuretic hormone replacement compared to that required preoperatively. KEywoRds:Hypophysitis, Rathke's cleft cyst, Lymphocyte, Diabetes insipidus ÖZ Rathke yarığı kistlerinin (RCC'ler) neden olduğu ana belirtiler görme bozuklukları, baş ağrıları ve endokrin yetmezliklerdir. Bu belirtiler arasında endokrin yetmezliklerin, kist içeriğinin oluşturduğu enflamasyonun hipofize yayılması veya hipofizin ve hipofiz sapının RCC'ler ile kompresyonu sonucunda oluştuğu düşünülmektedir. Makalede, aniden baş ağrısı ve sonrasında diabetes insipidus (DI) gelişen 2 nadir lenfositik infundibulohipofizit olgusu sunuldu. Manyetik rezonans görüntüleme hipofizin anterior ve posterior lobu arasında küçük bir kitleyle birlikte hipofizde belirgin şişme göstermiştir. Kitleyi çıkarmak için transsfenoidal cerrahi yapılmış ve kist duvarının patoloji incelemeleri epitelyal RCC dokusu ve posterior lobda masif lenfositik infiltrasyon göstermiştir. Bu hastalarda klinik seyir ve patoloji sonuçları, lenfositik hipofizitin nedeninin RCC'nin posterior loba rüptürü olduğunu kuvvetle düşündürmüştür. Postoperatif olarak DI preoperatif olarak gerekenden daha az miktarda antidiüretik hormon replasmanıyla kontrol altına alınabilmiştir.

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Changes in the epithelium of Rathke cleft cyst associated with inflammation

Cited by 87 publications

References 16 publications

Individualized surgical strategies for Rathke cleft cyst based on cyst location

Individualized surgical strategies for Rathke cleft cyst based on cyst location

Outcome in surgically treated Rathke's cleft cysts: long-term monitoring needed

Pure lymphocytic infundibuloneurohypophysitis caused by the rupture of rathke's cleft cyst; report of 2 cases and review of the literature

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