Intractable Rathke Cleft Cyst Hidden Behind Coexisting Giant Pituitary Adenoma

Although pituitary adenoma (PA) and Rathke cleft cyst (RCC) share a common embryologic origin, concurrent appearances have rarely been reported. We present a case of intractable RCC hidden behind a coexisting giant PA.

A 39-year-old woman presented to an ophthalmologist with visual disturbance. Brain magnetic resonance imaging findings showed a giant mass in the intrasellar and suprasellar portion, with a cystic portion contained in the posterior part. Endoscopic endonasal surgery was performed to remove the tumor, and histopathologic findings revealed a nonfunctioning PA. Further brain magnetic resonance imaging showed the appearance of a residual cyst. A second endonasal endoscopic surgery was performed to relieve compression of the optic chiasm by the growing cyst, followed by cyst drainage and irrigation, and portions of the cyst walls were obtained. The histopathologic diagnosis was RCC with inflammation. Over the course of 1 year, 3 separate recurrences of the growing cyst were noted, with cyst drainage and irrigation performed each time. Finally, ethanol cauterization was performed, which stopped the symptomatic RCC recurrence. Eight years after the final procedure, there was no cyst recurrence, and the patient's condition was good with improved visual acuity and normal pituitary function.

The presence of a nonenhanced cyst with a PA on magnetic resonance imaging suggests the possibility of coexisting RCC and PA.