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Paper 1
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 40 year old male had an incidental finding of a low density sella mass on a CT head which was performed for trauma. The report states that a Rathke cleft cyst is the most likely differential and an MRI brain is recommended.
Test Paper 2
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
The differential diagnosis would include Rathke cleft cyst, but that is usually intrasellar and thin-walled in appearance. Craniopharyngioma contains calcification and is heterogeneous on MR. Medulloblastoma is usually infratentorial and within the posterior fossa arising in the roof of the fourth ventricle, appears hyperdense on CT, and shows contrast enhancement. Macroadenoma is typically seen in an older age group, whereas microadenoma is hypointense on T1 and non-enhancing post-gadolinium.
Key terms
Published in Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad, Neurosurgery, 2014
Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad
Rathke’s cleft cyst – a benign, epithelium-lined intrasellar cyst found on the pituitary gland, which occurs when Rathke’s pouch does not develop properly.
Ophthalmic Manifestations of Rathke’s Cleft Cyst and Its Association to Radiological Characteristics
Published in Current Eye Research, 2021
Hyeshin Jeon, Hie Bum Suh, Woohyun Chung, Hee-young Choi
Rathke’s cleft cyst (RCC) is a benign epithelial-lined cyst formed by the failure in the obliteration of the embryonic cleft of the Rathke’s pouch located in the sellar and suprasellar region1; however, its pathogenesis remains controversial.2 Most RCCs are usually small, asymptomatic, and remain stable during life, and therefore, are usually incidental findings.1,3 Though symptoms with RCC are rare, where they do occur then headache, endocrine dysfunction, and visual disturbance are the commonest presenting symptoms. Symptoms occur if the cyst enlarges and compresses the surrounding structures.4–6 Ophthalmic manifestations include decreased visual acuity, visual field defect, and diplopia, and the incidence varies between 14% and 90%, possibly due to differences in the inclusion criteria among the reported studies and inconsistencies in objective ophthalmic evaluations.6–8
Deflation of a Rathke cleft cyst triggered rupture of a superior hypophyseal artery aneurysm: a case report
Published in British Journal of Neurosurgery, 2019
Ryuheki Kitai, Takahiro Yamauchi, Yoshikazu Arai, Tetsuya Hosoda, Norichika Hashimoto, Kenzo Tsunetoshi, Yoshifumi Higashino, Ken-Ichiro Kikuta
A Rathke cleft cyst (RCC) is a benign cystic lesion, exhibiting visual impairment, endocrine deficiencies, and headache require surgery.1 These symptoms result from a mass effect or repeated inflammation due to leakage of the mucus contents of the cyst. Transsphenoidal surgery (TSS) is safe and widely performed.1 However, the most serious complications are cerebrovascular complications such as iatrogenic carotid—cavernous fistula and pseudoaneurysm formation in the internal carotid artery.2,3 These complications are caused by direct injury to the intracavernous portion of the internal carotid artery. We herein report the first case of a ruptured superior hypophyseal artery aneurysm triggered by the rapid deflation of an RCC after TSS.
Paraneoplastic Cushing syndrome, case-series and review of the literature
Published in Acta Clinica Belgica, 2018
Annelies Deldycke, Christel Haenebalcke, Youri Taes
A 68-year-old female patient was referred to the endocrinology department due to quickly evolving hyperglycemia. Anorexia, diarrhea, and weight loss since a few months were present. Evening salivary cortisol, 24-h urinary-free cortisol, ACTH measurement, and dexamethasone suppression test demonstrated an ACTH-dependent hypercortisolemia (see results in Table 2). MRI of the brain showed a small lesion on the left side of the pituitary gland which according to the neurosurgeon could either be a micro-adenoma or a Rathke’s cleft cyst. To differentiate between a pituitary origin or an ectopic origin, the patient was referred to Ghent University Hospital to perform a sinus petrosus sampling. The sampling demonstrated an ACTH-gradient (central/peripheral) smaller than 2, a gradient smaller than 3 after stimulation with corticotropin releasing hormone (CRH), and there was no clear left–right gradient, indicative for an ectopic ACTH secretion. No overt tumor was detected. Computed tomography (CT-scan) of the chest showed a small lung nodule, but the lesion had no malignant aspect and was stable upon re-evaluation scans months later. On CT-scan of the abdomen, no abnormalities were found apart from multiple liver hemangioma’s and a myoma of the uterus. FDG-PET/CT scan and 68 Ga-Dotatoc PET/CT scan, were unable to demonstrate malignancy. Initially, she was started on a monthly somatostatin analog with good response. But after three months, her condition started to decline with anorexia and muscle weakness. Kétoconazole was associated to the therapy but no clinical improvement was present. A bilateral adrenalectomy was performed, with normalization of cortisolemia and slow improvement in muscle function. During further follow-up (6 months), no primary tumor could be identified.