Spontaneous Resolution of Pituitary Cystic Lesion
DOI:
https://doi.org/10.17140/NOJ-7-133Keywords:
Pituitary gland; Pituitary cystic lesion; Cystic pituitary adenoma (cPA); Magnetic resonance imaging (MRI)Abstract
Differentiating between cystic lesions of pituitary gland may be challenging. Usual differentials are cystic pituitary adenoma (cPA)
and Rathke’s cleft cyst (RCC). Diagnostic certainty of magnetic resonance imaging (MRI) is limited in the absence of usual suggestive features. Furthermore, RCC can co-exist with approximately 2% of pituitary adenomas. Over time, these cystic lesions
may remain static, resolve spontaneously, or result in symptomatology relating to mass effect and/or hormonal disruption. In
cases of an asymptomatic lesion being found incidentally, little is known about how it may progress, raising question whether to
proceed with surgical management or follow-up. We a present case of a spontaneously resolving pituitary cystic lesion with imaging features more suggestive of cPA than RCC, for which watchful waiting proved a successful treatment strategy. The current
case serves as a reminder that small cystic lesions can be followed-up with spontaneous resolution and should be offered active
treatment only when clinically required.
References
Babu R, Back AG, Komisarow JM, Owens TR, Cummings TJ, Britz GW. Symptomatic Rathke’s cleft cyst with a co-existing pituitary tumor; Brief review of the literature. Asian J Neurosurg. 2013; 8(4): 183-187. doi: 10.4103/1793-5482.125662
Ezzat S, Asa SL, Couldwell WT, et al. The prevalence of pituitary adenomas. Cancer. 2004; 101(3): 613-619. doi: 10.1002/cncr.20412
Zhang J, Gu J, Ma Y, et al. Uneven distribution of regional blood supply prompts the cystic change of pituitary adenoma. World Neurosurg. 2017; 103: 37-44. doi: 10.1016/j.wneu.2017.03.109
Naylor MF, Scheithauer BW, Forbes GS, Tomlinson FH, Young WF. Rathke cleft cyst: Ct, mr, and pathology of 23 cases. J Comput Assist Tomogr. 1995; 19(6): 853-859.
Nishio S, Mizuno J, Barrow DL, Takei Y, Tindall GT. Pituitary tumors composed of adenohypophysial adenoma and Rathke’s cleft cyst elements: A clinicopathological study. Neurosurgery. 1987; 21(3): 371-377. doi: 10.1227/00006123-198709000-00016
Yoshino A, Katayama Y, Watanabe T, Hirota H. Vanishing pituitary mass revealed by timely magnetic resonance imaging: two cases of spontaneous resolution of nonfunctioning pituitary adenoma. Acta Neurochir (Wien). 2005; 147(3): 253-257. doi: 10.1007/s00701-004-0443-9
Sieg EP, Stepanyan H, Payne R, Ouyang T, Zacharia BE. Vanishing pituitary macroadenoma: A case report. Cureus. 2016; v.8(10): e838. doi: 10.7759/cureus.838
Bahar A, Kashi Z, Nowzari A. Spontaneous regression of one nonfunctioning pituitary macroadenoma associated with abnormal liver enzyme tests. Casp J Intern Med. 2011; 2(1): 201-204.
Kameno K, Yano S, Shinojima N, Kuratsu J-I. Spontaneous regression of nonfunctioning pituitary macroadenoma: A case report. Interdiscip Neurosurg. 2016; 5: 45-47. doi: 10.1016/j. inat.2016.06.003
Landy SH. Spontaneous involution of Rathke cleft cysts: Is it rare or just underreported? Report of 9 cases: Comments. 2010; 50: 1618.
Nishio S, Morioka T, Suzuki S, Fukui M. Spontaneous regression of a pituitary cyst: Report of two cases. Clin Imaging. 2001; 25(1): 15-17. doi: 10.1016/s0899-7071(00)00233-3
Naik VD, Thakore NR. A case of symptomatic Rathke’s cyst. BMJ Case Rep. 2013; 2013: pii: bcr2012006943. doi: 10.1136/bcr-2012-006943
Fernández-Balsells MM, Murad MH, Barwise A, et al. Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. J Clin Endocrinol Metab. 2011; 96(4): 905-912. doi: 10.1210/jc.2010-1054
Park M, Lee SK, Choi J, et al. Differentiation between cystic pituitary adenomas and rathke cleft cCysts: A diagnostic model using MRI. AJNR Am J Neuroradiol. 2015; 36(10): 1866-1873. doi: 10.3174/ajnr.A4387
Bonneville JF. Hemorrhagic pituitary adenoma versus Rathke cleft cyst: A frequent dilemma. AJNR Am J Neuroradiol. 2016; 37(3): E27-E28. doi: 10.3174/ajnr.A4653
Choi SH, Kwon BJ, Na DG, Kim JH, Han MH, Chang KH. Pituitary adenoma, craniopharyngioma, and Rathke cleft cyst involving both intrasellar and suprasellar regions: Differentiation Submit your article to this journal | https://openventio.org/submit-manuscript/ 4 Kanodia AK et al using MRI. Clin Radiol. 2007; 62(5): 453-462. doi: 10.1016/j. crad.2006.12.001
Kucharczyk W, Peck WW, Kelly WM, Norman D, Newton TH. Rathke cleft cysts: CT, MR imaging, and pathologic features. Radiology. 1987; 165: 491-495. doi: 10.1148/radiology.165.2.3659372
Binning MJ, Gottfried ON, Osborn AG, Couldwell WT. Rathke cleft cyst intracystic nodule: A characteristic magnetic resonance imaging finding. J Neurosurg. 2005; 103(5): 837-840. doi: 10.3171/ jns.2005.103.5.0837
Byun WM, Kim OL, Kim DS. MR imaging findings of Rathke’s cleft cysts: Significance of intracystic nodules. Am J Neuroradiol. 2000; 21(3): 485-488.
Shin JL, Asa SL, Woodhouse LJ, Smyth HS, Ezzat S. Cystic lesions of the pituitary: Clinicopathological features distinguishing craniopharyngioma, Rathke’s cleft cyst, and arachnoid cyst. J Clin Endocrinol Metab. 1999; 84(11): 3972-3982. doi: 10.1210/ jcem.84.11.6114
Raper DMS, Besser M. Clinical features, management and recurrence of symptomatic Rathke’s cleft cyst. J Clin Neurosci. 2009; 16(3): 385-389. doi: 10.1016/j.jocn.2008.04.023
Kinoshita Y, Tominaga A, Usui S, et al. The long-term recurrence of Rathke’s cleft cysts as predicted by histology but not by surgical procedure. J Neurosurg. 2016; 125(4): 1002-1007. doi: 10.3171/2015.8.JNS151282
Chotai S, Liu Y, Pan J, Qi S. Characteristics of Rathke’s cleft cyst based on cyst location with a primary focus on recurrence after resection. J Neurosurg. 2015; 122(6): 1380-1389. doi: 10.3171/2014.12.JNS14596
Saeki N, Kubota M, Yamaura A, Ishige N. Fluctuating visual field defects in Rathke’s cleft cysts: MRI analysis. J Clin Neurosci. 1999; 6(6): 524-527. doi: 10.1016/s0967-5868(99)90018-8
Binning MJ, Liu JK, Gannon J, Osborn AG, Couldwell WT. Hemorrhagic and nonhemorrhagic Rathke cleft cysts mimicking pituitary apoplexy. J Neurosurg. 2008; 108(1): 3-8. doi: 10.3171/ JNS/2008/108/01/0003
Duan K, Asa SL, Winer D, Gelareh Z, Gentili F, Mete O. Xanthomatous hypophysitis is associated with ruptured Rathke’s cleft Cyst. Endocr Pathol. 2017; 28(1): 83-90. doi: 10.1007/s12022- 017-9471-x
Schatz NJ, Job OM, Glaser JS. Spontaneous resolution of pituitary adenoma after apoplexy. J Neuroophthalmol. 2000; 20(1): 42-44. doi: 10.1097/00041327-200020010-00014
Kachhara R, Nair S, Gupta AK. Spontaneous resolution of a non-functioning pituitary adenoma following an apoplexy. Neurol India. 2000; 48(3): 294-296. Case Report | Volume 7 | Issue 1|
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Neuro (NEURO) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.