Large Ossified Rathke's Cleft Cyst: A Case Report and Review of the Literature

Lee, Choong Hyun; Seo, Eui Kyo; Cho, Yong Jae; Kim, Sang Jin

doi:10.3340/jkns.2008.44.4.256

Cited by 11 publications

(13 citation statements)

References 7 publications

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“…7) Only 13 cases of RCC with granulomatous change have been diagnosed by pathological examination (Table 1). 1,[4][5][6][8][9][10][11][12][13]16,18,20) Four cases showed xanthogranulomatous change (Cases 3, 4, 6, and 8) and 2 cases had ossification of the cyst wall (Cases 6 and 8). Another case of ossifying xanthogranuloma in the dermis was described as being secondary to a metaplastic process.…”

Section: Discussionmentioning

confidence: 99%

Rathke's Cleft Cyst With Xanthogranulomatous Change -Case Report-

Miyajima

Oka

Utsuki

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Fig. 1 Computed tomography scans showing a solid intrasellar lesion appearing isodense with rod-like calcification (arrow). AbstractA 58-year-old man presented with a rare case of Rathke's cleft cyst (RCC) manifesting as headache and visual disturbance. Goldman's perimeter showed he had bitemporal hemianopia. Magnetic resonance imaging revealed a solid intrasellar lesion. He underwent surgery via a right pterional approach. The lesion was red, solid, and fibrous. Histological examination revealed a few columnar epithelial cells with poor cilia in a xanthogranulomatous lesion. Only 13 cases of RCC with granulomatous change have been diagnosed by pathological examination, including 4 xanthogranulomatous cases. Xanthogranuloma of the sellar region is relatively rare. The etiology is still unknown. We speculate that xanthogranulomas of the sellar region may be caused by reaction to the presence of RCC.

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Section: Discussionmentioning

confidence: 99%

Rathke's Cleft Cyst With Xanthogranulomatous Change -Case Report-

Miyajima

Oka

Utsuki

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…1,3,10,11) Symptomatic RCC with calcification also tends to develop with vision and visual field disturbance. 6,9) Conventional cyst drainage is ineffective at treating a symptomatic RCC with calcification because the extremely hard granulation tissue and calcification compress the optic nerve. Therefore, tissue and calcification removal are essential to relieve pressure on the optic nerve.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports mention various approaches, but all involved removal. 6,8,9) In such an event, the most important aspects of the surgical strategy to deal with symptomatic RCC with calcification are location of the solid components and direction of extension, thickness of the calcified components, and extent of compression of the optic nerve. The surgical approach must be chosen based on these findings.…”

Section: Discussionmentioning

confidence: 99%

“…2) Magnetic resonance (MR) imaging shows RCC as a cystic mass extending into the sella turcica or suprasellar region, with various levels of intensity and imaging findings depending on the cyst content and the nature of the cyst wall. 4,7,[11][12][13] In contrast, RCC with calcification or ossification is rare, 6,8,9,11) with 13% of all cases of RCC. 11) Differentiation of RCC with calcification from a craniopharyngioma is crucial among the sellar lesions with calcification, but the preoperative diagnosis has been craniopharyngioma in previous cases, so differentiation is difficult.…”

Section: Introductionmentioning

confidence: 99%

“…11) Differentiation of RCC with calcification from a craniopharyngioma is crucial among the sellar lesions with calcification, but the preoperative diagnosis has been craniopharyngioma in previous cases, so differentiation is difficult. 6,8,9) Calcification in an RCC is presumed to have formed by cholesterin granulation tissue organizing as a result of repeated inflammation and bleeding. Neuroimaging findings have revealed a central portion consisting of solid and cystic components and a thick calcification enclosing structure similar to armor, here called``armor-like calcification,'' characteristic of RCC with calcification and ossification.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Treatment of a Calcified Rathke's Cleft Cyst With Endoscopic Extended Transsphenoidal Surgery-Case Report-

Arai

Horiguchi

Saeki

et al. 2011

Neurol. Med. Chir.(Tokyo)

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A 34-year-old male presented with a rare case of Rathke's cleft cyst (RCC) with calcification manifesting as persistent high fever and impaired consciousness. Physical findings revealed panhypopituitarism and bitemporal hemianopsia. Computed tomography showed mass lesions with marked calcification within the sella turcica and the suprasellar region. Magnetic resonance imaging showed solid and cystic components compressing the optic nerve. The preoperative diagnosis was craniopharyngioma. Initial endonasal transsphenoidal surgery (TSS) was performed with a surgical microscope, but the mass was extremely hard, so only partial removal was possible. Second endonasal extended TSS was performed with a neuroendoscope. The solid components were totally removed, but calcifications adhering to the optic nerve could not be removed completely. The histological diagnosis was RCC with marked granulation reaction. RCC with calcification is rare and difficult to differentiate from craniopharyngioma on neuroimages. Extremely thick calcification of the sella turcica enclosing granulation tissue and the cyst similar to armor, here called``armor-like calcification,'' is a characteristic imaging finding of RCC with calcification. The most important aspect is choosing a surgical approach to carefully and effectively relieve pressure upon the optic nerve. Endonasal extended TSS with an endoscope was effective in the present case.

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Clinicopathological features of sellar region xanthogranuloma: correlation with Rathke’s cleft cyst

et al. 2013

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Xanthogranuloma of the sellar region is a rare clinical observation. Although it was included in the World Health Organization (WHO) brain tumor classification in 2000, its clinical features and pathogenesis remain uncertain. We report herein seven cases of xanthogranuloma of the sellar region who underwent transsphenoidal surgery at Tokyo Women's Medical University between 2005 and 2011, and discuss the clinical characteristics of this tumor. Six out of these 7 patients (86 %) presented with endocrinological dysfunction, six (86 %) had headaches, five (71 %) had visual field disturbances, and three (43 %) had diplopia including two with unilateral ptosis. Pathological findings revealed cholesterol clefts, hemosiderin deposits, chronic inflammatory infiltrates, multinucleated giant cells, macrophages, and fibrous proliferation. Of these seven cases, components of Rathke's cleft cyst were observed for six. Xanthogranuloma in the sellar region is suspected of being a terminal stage resulting from a secondary reaction caused by repeated inflammatory change, hemorrhage, and degeneration of a Rathke's cleft cyst.

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Large Ossified Rathke's Cleft Cyst: A Case Report and Review of the Literature

Cited by 11 publications

References 7 publications

Rathke's Cleft Cyst With Xanthogranulomatous Change -Case Report-

Rathke's Cleft Cyst With Xanthogranulomatous Change -Case Report-

Surgical Treatment of a Calcified Rathke's Cleft Cyst With Endoscopic Extended Transsphenoidal Surgery-Case Report-

Clinicopathological features of sellar region xanthogranuloma: correlation with Rathke’s cleft cyst

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