Intrasellar Epithelial Cysts

Fager, Charles A.; Carter, Harry

doi:10.3171/jns.1966.24.1.0077

Cited by 136 publications

(57 citation statements)

References 9 publications

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“…4 Entirely suprasellar RCCs with a normal sella turcica are relatively rare (incidence 0%-20%). 8,12,13,15,20,24,25,31,36,39 Suprasellar, intrasuprasellar, and intrasellar RCCs are distinct entities with respect to their clinical presentation, resectability, postoperative recurrence, and outcomes. Few authors have classified RCCs based on cyst location and have compared the presentations, different surgical approaches, pathological types, and surgical outcomes.…”

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confidence: 99%

Characteristics of Rathke's cleft cyst based on cyst location with a primary focus on recurrence after resection

Chotai¹,

Liu²,

Qi³

2015

JNS

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Rathke's cleft cysts (RCCs) are nonneoplastic epithelial lesions of the sellar and suprasellar region. They are typically asymptomatic with a slow growth rate. An asymptomatic RCC is most often diagnosed at autopsy with a reported incidence of 5%-33%. 5,[47][48][49] Quite often some RCCs grow over time and can become sufficiently large to cause a compressive effect on surrounding structures, resulting in neurological and endocrine abnormalities. 7,28,37,42 Sixteen patients (18%) had an entirely intrasellar RCC, 21 (24%) had a purely suprasellar cyst, and 50 (58%) had an intrasuprasellar RCC. The mean cyst volume was 2.4 ± 0.9 cm 3 (range 0.36-4.9 cm 3 ). Headache was the most frequent initial symptom (76%) followed by visual disturbance (45%). The transsphenoidal approach was performed for all intrasellar RCCs (16 cysts) and 33 of 50 intrasuprasellar RCCs. The transcranial route was used for all suprasellar cysts (21 cysts) and 17 of 50 intrasuprasellar RCCs. Squamous metaplasia was present in 27 (31%) of 87 RCCs. The occurrence of squamous metaplasia was associated with cyst location (p = 0.027), T1 signal intensity (p = 0.004) and ring enhancement on Gd-enhanced MRI (p = 0.017), and cyst volume (p = 0.045). A suprasellar location (p = 0.048, OR 3.89, 95% CI 1.010-15.020), ring enhancement on Gd-enhanced MRI (p = 0.028, OR 3.922, 95% CI 1.158-13.288), hypointensity on T1-weighted MRI (p = 0.002, OR 6.86, 95% CI 1.972-23.909), and cyst volume (p = 0.01, OR 0.367, 95% CI 0.170-0.789) were independent predictors of squamous metaplasia. The mean time to reaccumulation (11 [12.6%] of 87 cases) and recurrence (7 [8%] of 87 cases) was 14 ± 6 months. Recurrence-free survival was 84.5% at a mean of 98.2 ± 4.6 months after treatment. A suprasellar cyst location (p = 0.007, OR 7.7, 95% CI 1.75-34.54), the occurrence of squamous metaplasia (p = 0.007, OR 19.3,, and isointensity on T2-weighted MRI (p = 0.041, OR 10.29, 95% CI 1.094-96.872) were the independent predictors of RCC recurrence. coNclusioNs A suprasellar cyst location, the occurrence of squamous metaplasia, and isointensity on T2-weighted MRI were independent predictors of RCC recurrence. The extent of resection and type of surgical approach used were not associated with recurrence. A tailored extent of resection based on cyst location and predictive factors is recommended.

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Characteristics of Rathke's cleft cyst based on cyst location with a primary focus on recurrence after resection

Chotai¹,

Liu²,

Qi³

2015

JNS

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“…6 The idea of a spectrum of ectodermally derived cystic lesions in the parasellar region was first proposed by Harrison et al 7 Interestingly, of the 19 cases of sellar and parasellar epithelial cystic lesions they described, 3 showed atypical histological findings and could not be definitely classified as either RCC or craniopharyngioma. 7 Similarly, rare studies have reported cases of RCC with smooth transition from the ciliated columnar epithelium to the stratified squamous epithelium, with calcification more characteristic of craniopharyngioma.…”

Section: Discussionmentioning

confidence: 99%

Craniopharyngioma arising in a Rathke's cleft cyst: case report

Alomari¹,

Kelley²,

Damisah³

et al. 2015

PED

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Craniopharyngioma is one of the most common non-glial intracranial tumors of childhood. Its relation to Rathke's cleft cyst (RCC) is controversial, and both lesions have been hypothesized to lie on a continuum of cystic ectodermal lesions of the sellar region. The authors report on a 7-year-old boy who presented with decreased visual acuity, presumably of at least 2 years' duration, and was found to have a 5.2-cm sellar lesion with rim enhancement. Histological examination of the resected lesion showed a mixture of areas with simple RCC morphology with focal squamous metaplasia and areas with typical craniopharyngioma morphology. Immunohistochemical staining with CK20 and Ki 67 differentially highlighted the 2 morphological components. Testing for beta-catenin and BRAF mutations was negative in the craniopharyngioma component, precluding definitive molecular classification. Follow-up imaging showed minimal residual enhancement and the patient will be closely followed up with serial MRI. Given the clinical and histological findings in the case, a progressive transformation of the RCC to craniopharyngioma seems to be the most plausible explanation for the co-occurrence of the 2 lesion types in this patient. An extensive review of previously proposed theories of the relationship between craniopharyngioma and RCC is also presented.

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“…5,7,11,13 Multiple cases of the isolated CPA craniopharyngioma have been reported. 3,16,20,24 Therefore, it is reasonable to assume that the formation mechanism of ectopic RCC is similar to that of craniopharyngioma.…”

Section: Discussionmentioning

confidence: 99%

An isolated primary Rathke's cleft cyst in the cerebellopontine angle

Fan¹,

Qi²,

Peng³

et al. 2014

JNS

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Rathke's cleft cysts (RCCs) are benign cysts typically located in the sellar or suprasellar region; ectopic isolated lesions are extremely rare. The authors describe the case of a 25-year-old man with a giant symptomatic RCC arising primarily at the cerebellopontine angle (CPA), only the second case reported thus far. The patient presented with a 2-year history of right hearing impairment and tinnitus accompanied by vertigo and headache and a 2-week history of right facial numbness. Subsequently, he underwent total cyst removal via retrosigmoid craniotomy with a good recovery. He experienced no recurrence during a 64-month follow-up period. The possible pathogenesis, differential diagnosis, and surgical treatment of such cysts are discussed in this article. Isolated ectopic RCCs can arise from the ectopic migration of Rathke's pouch cells during the embryonic period. It is still difficult to distinguish ectopic RCCs from other cystic lesions of the CPA given the lack of specific imaging features. Aggressive resection of the cyst wall is not recommended, except when lesions do not closely adhere to adjacent structures.

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Intrasellar Epithelial Cysts

Cited by 136 publications

References 9 publications

Characteristics of Rathke's cleft cyst based on cyst location with a primary focus on recurrence after resection

Characteristics of Rathke's cleft cyst based on cyst location with a primary focus on recurrence after resection

Craniopharyngioma arising in a Rathke's cleft cyst: case report

An isolated primary Rathke's cleft cyst in the cerebellopontine angle

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