Infection of a Rathke Cleft Cyst: A Rare Cause of Pituitary Abscess

Naama, Okacha; Gazzaz, Miloudi; Boulahroud, Omar; Elmoustarchid, Brahim

doi:10.1089/sur.2013.069

Cited by 14 publications

(12 citation statements)

References 5 publications

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“…Furthermore, the PPBS positive rate has been demonstrated to be significantly lower in RCC patients compared with that in normal individuals (16), suggesting that the cyst has an effect on the posterior pituitary and pituitary stalk. Additionally, it has been reported that inflammatory responses are present within certain cases of RCC (6,20). The current study revealed that the PPBS+ rate was significantly lower in RCC patients with inflammatory responses than those without.…”

Section: Discussionmentioning

confidence: 99%

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MRI and pathological features of Rathke cleft cysts in the sellar region

Wang

Nie

et al. 2019

Exp Ther Med

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The aim of the present study was to investigate the MRI and pathological features of Rathke cleft cysts (RCC) in the sellar region. A total of 45 RCC cases were retrospectively analyzed. RCC size, location, intracyst nodules and general signals, as well as the posterior pituitary bright spot (PPBS) were analyzed using MRI-T1 weighted images (T1WI) and T2WI. The relationship between the presence of PPBS and histopathological features was additionally evaluated. On T1WI, there were 18 cases of isointense signal, 16 cases of hyperintense signal, 9 cases of hypointense signal, 1 case of heterogeneous signal and 1 case with a stratification effect, with isointense signal in the upper part and hyperintense signal in the lower part. On T2WI, there were 5 cases of isointense signal, 27 cases of hyperintense signal, 11 cases of hypointense signal and 1 case of the stratification effect. There were 10 cases of PPBS+ and 35 cases of PPBS-. There were no significant differences in the age, sex, cyst location and size between PPBS+ and PPBS- cases. However, PPBS+ cases had significantly lower inflammation than PPBS- cases. A total of 20 cases of intracystic nodules were identified on MRI scans, most of which exhibited T2 -hypointense signals. The shape of RCC nodules varied and there were 17 cases where the nodules were non-adherent to the cyst wall. The MRI signals of RCCs varied and most nodules were floating within cysts. Intracystic nodules are characteristic features of RCCs when observed by MRI and thus are of high diagnostic value. Most patients with RCC were also PPBS-, which may be associated with an increased inflammatory response.

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Section: Discussionmentioning

confidence: 99%

“…Common symptoms of symptomatic RCCs include headache, vision loss, visual field defects and pituitary endocrine dysfunction (4). Uncommon symptoms include meningitis (5), pituitary abscess (6) and intracranial aneurysms (7). RCCs can be slow or acute in onset (7).…”

Section: Introductionmentioning

confidence: 99%

MRI and pathological features of Rathke cleft cysts in the sellar region

Wang

Nie

et al. 2019

Exp Ther Med

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“…[12–14] Pituitary abscess formation within RCC does not usually result in significant diabetes insipidus. [15,16] Panhypopituitarism is rare in RCC though patients with symptomatic RCC usually have pituitary dysfunction of varying degrees. [17–19] In our case, the endocrine work-up results revealed panhypopituitarism resulting in adrenal insufficiency, hypothyroidism, and gonadal failure.…”

Section: Discussionmentioning

confidence: 99%

“…[15,28] The limitation of our case was that routine cytology test and bacterial culture were not conducted, though the pathological test showing no inflammation cell infiltration partially proved the lesion not to be infectious. The clinical progression of our patient mainly included symptomatic deteriorations, severe hyponatremia, and consciousness disturbance.…”

Section: Discussionmentioning

confidence: 99%

Rathke cleft cyst masquerading as pituitary abscess

Yang

Bao²,

Liu³

et al. 2017

Medicine

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Background: Rathke cleft cyst (RCC) is a rare cystic sellar entity, which is usually small in size and asymptomatic in most patients. RCC presenting panhypopituitarism and a cystic lesion with rim enhancement on magnetic resonance imaging is extremely rare. Therefore, it is easy to be misdiagnosed as pituitary abscess because of the similar clinical manifestations and neuroimaging changes.Case summary: We report a rare case of RCC masquerading as pituitary abscess clinically and radiologically with no evidence of central nervous system infection. The patient was initially suspected to be diagnosed with pituitary abscess, which was denied by the histopathological findings of RCC with no intraoperative drainage of abscess.We present an uncommon case of RCC masquerading as pituitary abscess in a 62-year-old Chinese male patient. The patient was admitted to Peking Union Medical College Hospital complaining of severe frontal pulsatile headache, visual acuity deficit, polyuria, polydipsia, and slight disturbance of consciousness. The biochemical and endocrinological examinations revealed severe hyponatremia and panhypopituitarism. Magnetic resonance imaging showed a sellar lesion with the apparent cystic change and rim enhancement. Accordingly, pituitary abscess was misdiagnosed at the beginning.The patient received hormone replacement therapy and underwent a trans-sphenoidal surgery. The surgical findings were uneventful. The histopathological examinations showed no infiltration of inflammatory cells or pus, and proved the lesion to be RCC.Conclusion: Through this rare case, we aim to emphasize that the differential diagnosis of sellar lesions requires constant vigilance and that RCC may lead to clinical and radiological changes similar with pituitary abscess.Abbreviations: DWI = diffusion-weighted image, Gd-DTPA = gadolinium-diethylene triamine pentaacetic acid, MRI = magnetic resonance imaging, PUMCH = Peking Union Medical College Hospital, RCC = Rathke cleft cyst, T1WI = T1-weighted image, T2WI = T2-weighted image, VA = visual acuity.

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“…Rim enhancement with contrast on T1WI is generally considered diagnostic of pituitary abscess but also can be detected in RCC, especially in infected RCC. [23] It is difficult to distinguish pituitary abscess and infected RCC according to MRI features alone. Pituitary abscess is rare and usually causes severe DI, hypopituitarism, and headache,[4] whereas the hormone levels were normal in our patient.…”

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confidence: 99%