Spontaneous involution of a Rathke's cleft cyst

Rathke cleft cysts (RCCs) are non-tumorous cystic formations in the sellar and suprasellar regions. They arise from the failure of Rathke's pouch to regress during embryonic development. Most RCCs are discovered incidentally during autopsies and can remain stable or enlarge over time; spontaneous involution is rare. The most common symptoms of large RCCs include headaches, vision disturbances or hormonal imbalances. We present a case of a quadragenarian man with an incidentally detected RCC that showed spontaneous regression on follow-up MRI over 3 years. This article also discusses the radiological features, natural history and potential mechanisms behind the spontaneous resolution of RCCs.