Triad of Hypopituitarism, Granulomatous Hypophysitis, and Ruptured Rathkeʼs Cleft Cyst

Albini, Christine H.; MacGillivray, Margaret H.; Fisher, John; Voorhess, Mary L.; Klein, David M.

doi:10.1227/00006123-198801000-00022

Cited by 50 publications

(32 citation statements)

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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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“…In contrast, pituitary adenomas mostly arising from the adenohypophysis are usually grayish white, fleshy or with cystic change, and easy to be curetted. The various reported secondary causes of GRH include tuberculosis, sarcoidosis, syphilis, Wegener's granulomatosis, mycotic granuloma and foreign body granuloma due to ruptured Rathke's cleft cyst, systemic immunologic diseases such as Takayasu's disease, Crohn's disease, and so on (Albini et al, 1988;de Bruin et al, 1991;Toth et al, 1996;Caturegli et al, 2005). Our cases were idiopathic GRH.…”

Section: Casementioning

confidence: 63%

Granulomatous hypophysitis: two case reports and literature review

Shi

Zhang

et al. 2009

J. Zhejiang Univ. Sci. B

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Granulomatous hypophysitis (GRH) is extremely rare and commonly presents with chronic inflammatory of the enlarged pituitary gland. In our study, 66-year-old and 57-year-old women, both Chinese, were diagnosed with GRH presenting preoperatively definite imageology characters as pituitary adenoma. The 66-year-old woman presented with a year of headache, half a year of gradual decrease of visual acuity, and one month of right ptosis. Serum prolactin level was slightly elevated. Screening computed tomography (CT) scanning revealed typical low density mass found on the enlarged sella, which demonstrated invasive extension from the sella to the right cavernous sinus by contrast enhanced magnetic resonance imaging (MRI). Consequently, the patient was diagnosed with probable invasive pituitary adenoma. The other 57-year-old woman complained a light headache and had been previously treated as nonfunctional pituitary adenoma in other hospital. Finally these two patients underwent transsphenoidal microsurgery and were diagnosed with GRH according to postoperative histopathology. They then were treated with steroid. During the follow-up, the clinical symptoms such as headache, visual damage, and ptosis vanished, and the mass of the sellae dramatically shrank on repeated MR images. Clinically and radiologically, GRH is a rare sellar entity easily to be misdiagnosed as a pituitary adenoma. Trans-sphenoidal surgery can decompress the optical nerve or oculomotornerve as a therapeutic strategy, and support biopsy or further pathological diagnosis. However, the hormonal therapy should be emphasized both as diagnostic and therapeutic strategies. Conservative and tentative steroid treatment should be performed in preoperative period without acute nerve damage.

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“…There are some reports of spontaneous rupture of RCC that are usually accompanied with acute hypophysits or hemorrhage (1,8,9,14,15,16,17). The rupture was diagnosed retrospectively in almost all and they did not have the radiological findings before the rupture.…”

Section: Discussionmentioning

confidence: 99%

“…There are a small number of reports on Rathke's cleft cyst (RCC) with the spontaneous rupture (1,8,9,14,15,16,17). Most of those cases were accompanied by acute inflammatory reactions or hemorrhagic change in peripheral organs such as the pituitary gland.…”

Section: Introductionmentioning

confidence: 99%

Rathke’s cleft cyst with non-hemorrhagic rupture resulting in alteration of signal intensity for a short period: case report.

Kambara¹,

Miyazaki²,

Yamasaki³

et al. 2012

Turkish Neurosurgery

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In a case of 23-year-old female with Rathke's cleft cyst (RCC), unusual changes with size and morphology on computed tomography (CT) and magnetic resonance images (MRI) were noted in a short period of 3 weeks after spontaneous rupture. The CT noted that the intracystic isodensity was changed to hyperdensity. And MRI showed not only a decrease in size of the lesion but also changing from hypo-and hyperintensity in T1-and T2-weighted images to hyperintensity in both T1-and T2-weighted images. The intraoperative findings disclosed that the cyst content was milky-like, but not hemorrhagic. We considered that the leakage of cyst content to the cerebrospinal fluid pathway caused not only inflammatory reaction but also waxing and waning of both the cyst size and intralesional protein concentration, which resulted in unusual changing CT and MR appearance. We should take into consideration that the nature of RCC can be altered by not only intracystic hemorrhage but also non-hemorrhagic rupture even for a short period.

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Triad of Hypopituitarism, Granulomatous Hypophysitis, and Ruptured Rathkeʼs Cleft Cyst

Cited by 50 publications

References 0 publications

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

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

Granulomatous hypophysitis: two case reports and literature review

Rathke’s cleft cyst with non-hemorrhagic rupture resulting in alteration of signal intensity for a short period: case report.

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