Rathke cleft cyst with entirely ossified cyst wall and partially solid content in the cyst: a case report and literature review.

Rathke cleft cyst with entirely ossified cyst wall and partially solid content in the cyst: a case report and literature review.

World Neurosurg. 2016 Oct 18;:

Authors: Hayashi Y, Oishi M, Fukui I, Sasagawa Y, Aida Y, Nakada M

Abstract
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. During the transsphenoidal surgery, the cyst wall was so rigid that it was difficult to cut and remove it. The cyst contained mucinous fluid with both old and new hemorrhages, and yellowish, elastic hard, solid nodule. Postoperative histological diagnosis was RCC with unusual lymphocyte infiltration, massive granulation, and mature bone formation. Six months later, the fluid in the cyst re-accumulated and the patient presented with headaches. Removal of the entire cyst wall and the aspiration of the cyst content were performed to collapse the cyst cavity and, consequently, to prevent further recurrence. Postoperatively, panhypopituitarism was unchanged and the symptoms were treated with hormonal replacement. The cyst has not recurred for 2 years after the second surgery.
CONCLUSIONS: Persistent, long-term inflammation induced by the RCC content, mucin-containing fluid, and several phases of hemorrhage, presumably promoted the formation of mature bone on the cyst wall and of the elastically solid nodule within the cyst.

PMID: 27769949 [PubMed - as supplied by publisher]

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