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Rathke's cleft cyst

Hiroshi Yokota, Yuki Ida, Daisuke Wajima, Fumihiko Nishimura, Hiroyuki Nakase
BACKGROUND: A Rathke cleft cyst (RCC) with non-hemorrhagic rupture mimicking pituitary apoplexy has been rarely reported. CASE DESCRIPTION: A 52-year-old woman, previously diagnosed with asymptomatic RCC, came to us with a severe headache, along with visual dysfunction and symptoms of pituitary insufficiency. Fluid-attenuated inversion recovery magnetic resonance imaging demonstrated diffuse hyper-intensity in the cerebral cisterns, while watery clear cerebrospinal fluid was obtained by lumbar puncture...
October 21, 2016: World Neurosurgery
Yasuhiro Sasaki, Ayumi Kanamaru, Hisae Uchida, Masataka Yano, Hiroshi Tada
An 51-year-old man had undergone surgery for Rathke's cleft cyst by transsphenoidal approach on October 2015. After the surgery, cerebrospinal fluid (CSF) rhinorrhea arose. Surgical treatment of CSF rhinorrhea was performed by the same approach. Ten days after reoperation, he suffered from severe headache, high fever, and nuchal rigidity. CSF findings indicated bacterial meningitis. CSF culture showed methicillin-resistant Staphylococcus lugdunensis. He received vancomycin intravenously for 19 days and recovered from the bacterial meningitis with no serious complication...
October 21, 2016: Rinshō Shinkeigaku, Clinical Neurology
Yasuhiko Hayashi, Masahiro Oishi, Issei Fukui, Yasuo Sasagawa, Yasuhiro Aida, Mitsutoshi Nakada
BACKGROUND: In Rathke cleft cysts (RCCs), inflammation by the cyst contents infrequently spreads to the surrounding structures. Calcification, which is regarded as a consequence of chronic inflammation of the cyst wall, can rarely be found in RCCs, and moreover, ossification is extremely rare. CLINICAL PRESENTATION: A 60-year-old woman presented with headaches, fatigue and weight loss due to panhypopituitarism. Magnetic Resonance imaging revealed a mass lesion in the sellar region, which was comprised of two different parts, with hypointensity anteriorly and hyperintensity posteriorly on T1-weighted image (WI), and the rim with significant hypointensity entirely on T2-WI...
October 18, 2016: World Neurosurgery
Bette K Kleinschmidt-DeMasters
PURPOSE OF REVIEW: Most pituitary region masses are pituitary adenomas; however, when other sellar region masses are encountered by clinicians or pathologists, the differential diagnosis can be broad. This review will focus on updates for pituitary adenomas, as well as briefly discuss some of these other entities: Rathke cleft cyst, hypophysitis, craniopharyngioma, pituicytoma, and spindle cell oncocytoma. RECENT FINDINGS: The use of new immunohistochemical (IHC) tools for assessing transcription factors, pituitary transcription factor-1, steroidogenic factor-1, and the not-yet-widely available Tpit IHC have provided insights into origin particularly of clinically silent and even hormone-negative pituitary adenomas...
October 18, 2016: Current Opinion in Endocrinology, Diabetes, and Obesity
Lei Cheng, Pin Guo, Peng Jin, Huanting Li, Mingchao Fan, Enyuan Cai
Rathke cleft cysts (RCCs) are nonneoplastic lesions that are thought to be the remnants of Rathke cleft pouch. The authors report a patient presented with a headache and was diagnosed with RCC on imaging. The lesion underwent spontaneous involution. The authors suggest that patients presenting solely with a headache to be treated conservatively, because it is uncertain whether a headache is definitively associated with RCCs and because there is the possibility of spontaneous regression.
October 14, 2016: Journal of Craniofacial Surgery
Nauman S Chaudhry, Michael R Raber, David J Cote, Edward R Laws
Rathke's cleft cysts (RCC) are benign cystic lesions that originate from remnants of the epithelial lining of Rathke's pouch. RCC are known rarely to occur together with a concomitant pituitary adenoma. Here, we report a patient with a pituitary adenoma arising in the same location as a previously-resected RCC, 3 years post-operatively, and review the literature of "collision" sellar lesions. Consecutive transsphenoidal operations from a single-center between 2008 and 2016 were reviewed to identify patients with pituitary adenoma arising after surgical resection of RCC, and a systematic search of the literature was also performed to identify such patient reports, as well as reports of concomitant pituitary adenoma and RCC...
November 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Shannon Coy, Ziming Du, Shu-Hsien Sheu, Terri Woo, Fausto J Rodriguez, Mark W Kieran, Sandro Santagata
Cilia are highly conserved organelles, which serve critical roles in development and physiology. Motile cilia are expressed in a limited range of tissues, where they principally regulate local extracellular fluid dynamics. In contrast, primary cilia are expressed by many vertebrate cell types during interphase, and are intimately involved in the cell cycle and signal transduction. Notably, primary cilia are essential for vertebrate hedgehog pathway activity. Improved detection of motile cilia may assist in the diagnosis of some pathologic entities such as Rathke's cleft cysts, whereas characterizing primary cilia in neoplastic tissues may implicate cilia-dependent signaling pathways as critical for tumorigenesis...
August 26, 2016: Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc
Ioannis Petrakakis, Ariyan Pirayesh, Joachim K Krauss, Peter Raab, Christian Hartmann, Makoto Nakamura
OBJECTIVE: Apart from the "common" lesions (e.g. pituitary adenomas, Rathke's cleft cysts, meningiomas and craniopharyngiomas), there is a plethora of rare tumors or tumor-mimicking lesions in the sellar and suprasellar region (SSR). Due to a lack of characteristic imaging features, there is a dilemma in distinguishing these rare lesions from the more "common" ones preoperatively. Consequently, both diagnosis and definition of surgical goals, as well as further treatment strategies continue to be challenging for all attending physicians...
October 2016: Clinical Neurology and Neurosurgery
Seungjoo Lee, Jun Ho Choi, Chang Jin Kim, Jeong Hoon Kim
OBJECT: Hypophysitis is a rare disease entity mimicking a pituitary adenoma. In spite of crucial disease involving a pituitary gland which is a main component of hormonal axis, there have been minimal researches regarding the hypophysitis. In this study, we described the constellation of the preoperative findings including clinical, radiologic, and endocrinologic features, as well as postoperative outcomes of the hypophysitis. METHODS: The authors reviewed the data retrospectively of a total of 2,814 patients who underwent microsurgery due to pituitary mass lesion (Asan Medical Center)...
July 28, 2016: World Neurosurgery
Roberto Altieri, Valentina Tardivo, Paolo Pacca, Valentina Pennacchietti, Federica Penner, Diego Garbossa, Alessandro Ducati, Massimiliano Garzaro, Francesco Zenga
The introduction of modern endoscopy in neurosurgery brought light to one of the darkest areas: the skull base. In particular, the trans-nasal route allowed skull base surgeons to visualize and dominate the entire midline skull base. We analyzed our surgical series of 199 patients that were affected by several pathologies (pituitary adenomas, clivalchordomas, craniopharyngioma, Rathke's cleft cysts, tuberculum sellaemeningiomas, and craniovertebral junction pathologies with bulbar compression) and treated each by using a 3D-HD endoscope between December 2012 and December 2015 and reviewed the literature...
July 29, 2016: Surgical Technology International
Vivian Thimsen, Annett Hölsken, Michael Buchfelder, Jörg Flitsch, Rudolf Fahlbusch, Harald Stefanits, Marco Losa, David T W Jones, Rolf Buslei
The epithelial cell adhesion molecule (EpCAM) is a type I glycoprotein located on the surface of epithelial cells. It is strongly expressed in many neoplasms and already used in the diagnosis and distinction of various tumour subtypes. Comparative studies about EpCAM expression in cystic sellar lesions are lacking. Therefore, we analysed its distribution pattern in adamantinomatous (aCP) and papillary (pCP) craniopharyngiomas (CP) and Rathke's Cleft Cysts (RCC) using immunohistochemistry and gene expression profiling...
2016: Scientific Reports
Yi Liu, Chao-Hu Wang, Dan-Ling Li, Shi-Chao Zhang, Yu-Ping Peng, Jun-Xiang Peng, Ye Song, Song-Tao Qi, Jun Pan
Whether a mixed type of craniopharyngioma (CP) exists and whether papillary craniopharyngioma (pCP) is on a histopathological continuum with Rathke's cleft cyst (RCC) remain controversial. Herein, we examined the expression and localization of β-catenin, BRAF p.V600E (V600E), and triggering receptor expressed on myeloid cells-1 (TREM-1) in 58 samples including 20 pCPs, 26 adamantinomatous craniopharyngiomas (aCP), and 12 RCCs. Five aCPs were diagnosed with mixed type CPs and the remaining 21 cases were pure aCPs...
July 8, 2016: Oncotarget
Jennifer L Quon, Peter H Hwang, Michael S B Edwards
INTRODUCTION: Transnasal endoscopic transphenoidal approaches are an essential technique for the resection of skull base tumors in adults. Originally devised and most commonly used to treat pituitary adenomas, they have also been used for a variety of other pathologies. However, in the pediatric population, sellar and suprasellar lesions have historically involved a craniotomy. Transnasal endoscopic transphenoidal techniques in children have only been reported as single case reports and only in regard to purely sellar lesions...
August 2016: Neurosurgery
Yasuhiko Hayashi, Daisuke Kita, Issei Fukui, Yasuo Sasagawa, Masahiro Oishi, Michiko Okajima, Osamu Tachibana, Mitsutoshi Nakada
INTRODUCTION: Symptomatic Rathke cleft cysts (RCCs) are rarely detected in neuroradiological screening and are less commonly found in children than in adults. However, when RCCs are observed in children, it is important to carefully distinguish a RCC from a cystic craniopharyngioma (CP) even if surgically treated or conservatively followed up. METHODS: We conducted a retrospective review of clinical data from 11 patients with symptomatic RCCs whose ages were under 18 years and compared the data with data from 15 age- and sex-matched patients with cystic CP who were treated at our institute...
September 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Zachary Rasmussen, Kingsley O Abode-Iyamah, Patricia Kirby, Jeremy D W Greenlee
Rathke's cleft cysts (RCC) are sellar lesions that typically remain asymptomatic throughout life. Symptomatic patients present with headache, visual disturbance and/or pituitary dysfunction and are treated with resection. We present a 61-year-old woman diagnosed with RCC which was resected twice then recurred before undergoing spontaneous resolution. RCC are often managed without surgical intervention. Some of these lesions may spontaneously resolve without surgical intervention while others may become symptomatic...
October 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Yuping Peng, Jun Fan, Yu Li, Mingxin Qiu, Songtao Qi
OBJECTIVE: To evaluate the feasibility of the supraorbital keyhole approach for suprasellar or intrasuprasellar Rathke cleft cysts (RCCs) under pure endoscopic visualization. METHODS: Thirteen surgically treated patients with symptomatic RCCs were analyzed retrospectively. Preoperative manifestations included headache (77%), visual impairment (38%), polyuria (31%), and pituitary dysfunction (15%). The maximal cyst diameter averaged 29.3 mm (23-46 mm). Eight patients (62%) had a purely suprasellar lesion, and 5 (38%) had a sellar lesion with suprasellar extension...
August 2016: World Neurosurgery
W Saeger
Inflammatory findings in the pituitary glands account for approximately 1 % of operations in the sellar region. Primary inflammation (e.g. lymphocytic and idiopathic granulomatous hypophysitis) have to be differentiated from secondary types (e.g. concomittant inflammation with Rathke's cleft cysts, craniopharyngiomas and germinomas) and involvement of the pituitary in generalized inflammation (IgG4-related disease, sarcoidosis and septicopyemia). Langerhans cell histiocytosis also has to be considered for the differential diagnostics...
May 2016: Der Pathologe
Yoshikazu Ogawa, Mika Watanabe, Teiji Tominaga
BACKGROUND: Rathke's cleft cysts generally remain asymptomatic throughout life, but a few patients may suffer severe neurological and/or endocrinological deficits. The symptoms include visual disturbances caused by compression of the optic chiasm, and severe endocrinological deficits caused by repeated intracystic hemorrhage or leakage of cyst content. However, no case of Rathke's cleft cyst has infiltrated into neuroglial tissue with marked cerebral edema. CASE PRESENTATION: Two patients presented with non-infectious re-deterioration of Rathke's cleft cysts with intraparenchymal infiltration and marked cerebral edema, to ipsilateral hypothalamus in one case and to the bilateral frontal lobes in the other...
2016: BMC Research Notes
Vladimir Vasilev, Liliya Rostomyan, Adrian F Daly, Iulia Potorac, Sabina Zacharieva, Jean-François Bonneville, Albert Beckers
Pituitary incidentalomas are a by-product of modern imaging technology. The term 'incidentaloma' is neither a distinct diagnosis nor a pathological entity. Rather, it is a collective designation for different entities that are discovered fortuitously, requiring a working diagnosis based on the input of the radiologist, endocrinologist and often a neurosurgeon. In addition to pathological conditions affecting the pituitary gland, a thorough knowledge of the radiological characteristics of normal variants and technical artifacts is required to arrive at an accurate differential diagnosis...
October 2016: European Journal of Endocrinology
Jean-François Bonneville
Magnetic Resonance Imaging (MRI) is currently considered a major keystone of the diagnosis of diseases of the hypothalamic-hypophyseal region. However, the relatively small size of the pituitary gland, its location deep at the skull base and the numerous physiological variants present in this area impede the precise assessment of the anatomical structures and, particularly, of the pituitary gland itself. The diagnosis of the often tiny lesions of this region--such as pituitary microadenomas--is then difficult if the MRI technology is not optimized and if potential artifacts and traps are not recognized...
2016: Frontiers of Hormone Research
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