Endocrine Abstracts

Background: Rathke’s cleft cysts (RCC) are benign, cystic lesions arising from remnants of Rathke’s pouch and reported in 13–22% of normal autopsies. Their prognosis after surgical intervention is not clearly defined.

Aim: To analyse the outcome of patients who presented to our Department with RCC between 1/1977-3/2009.

Patients and methods: Thirty-three cases were identified [13 males/20 females, median age at diagnosis 43 years (range 9–87)]. In 4 cases, the diagnosis was established from combination of pathology, imaging and operative evidence, whereas in the remaining ones, the pathology was consistent with this diagnosis.

Results: Suprasellar component was detected in 29/33 (87.9%) of cysts. At presentation, 17/33 (51.5%) of subjects had at least quadrantanopia, 16/33 (48.8%) had gonadotrophin, 11/31 (34.5%) ACTH, 11/31 (34.5%) TSH deficiency and 5/32 (15.6%) had DI. The patients were treated by cyst evacuation combined or not with biopsy/removal of cyst wall (3/33 via craniotomy and 30/33 transsphenoidally). One patient received adjuvant radiotherapy. All, but one, patients had follow-scans during a mean observation period of 45.3 months (2–267). Cyst relapse was detected in 6/32 of the cases at a mean interval following surgery of 29 months (range 3–48 months). Kaplan Meier analysis showed relapse rates 7.9 and 24.5% at 12 and 24 months, respectively. At last assessment, at least quadrantanopia was found in 6/31 (19.4%), ACTH deficiency in 14/33 (42.4%) of cases and 13/33 (39.4%) of patients were on Desmopressin.

Conclusions: In this series of RCCs observed for one of the longest periods following surgical intervention, we have shown considerable recurrence rates, as well as endocrine/visual morbidities. These data advocate careful long-term monitoring of these patients.