Computed tomography in intra- and suprasellar epithelial cysts (symptomatic Rathke cleft cysts)

The computed tomographic (CT) and pathologic findings in three cases of intra- and suprasellar epithelial cysts (symptomatic Rathke cleft cysts) are described. Literature review revealed that the characteristic CT finding is an intrasellar and/or suprasellar low-density mass that may or may not be enhanced. The enhancement is ringlike or capsular in nature. Whether the cyst wall is enhanced or not seems to be dependent on the histologic features. It is suggested that the enhancement may be caused by an inflammatory process, either septic or aseptic, or squamous metaplasia in the wall, which is possibly induced by degeneration or infection of the cyst contents. Without these additional pathologic processes, the Rathke cleft cyst, a simple retention cyst, may exhibit no contrast enhancement.