SFEBES2021 Poster Presentations Neuroendocrinology and Pituitary (47 abstracts)
Rathke’s cleft cyst with a very unusual course
Amy Coulden 1 , Joshua Pepper 2 , Agata Juszczak 3 , Ruchika Batra 4 , Swarupsinh Chavda 5 , Latha Senthil 5 , John Ayuk 1 , Ute Pohl 6 , Santhos Nagaraju 6 , Niki Karavitaki 1 & Georgios Tsermoulas 2
1Endocrine Department, Queen Elizabeth Hospital, Birmingham, United Kingdom; 2Neurosurgery Department, Queen Elizabeth Hospital, Birmingham, United Kingdom; 3Endocrine Department, Birmingham Heartlands Hospital, Birmingham, United Kingdom; 4Ophthalmology Department, Queen Elizabeth Hospital, Birmingham, United Kingdom; 5Radiology Department, Queen Elizabeth Hospital, Birmingham, United Kingdom; 6Neuropathology Department, Queen Elizabeth Hospital, Birmingham, United Kingdom
A 31-year-old man without previous medical history presented to his local hospital with one week history of generalised severe headache. Brain CT was reported as negative for acute intracranial pathology. Five weeks later, he re-presented with worsening headache and blurring of vision. Brain CT revealed a large area of hypodensity centred on the left thalamus/basal ganglia and subsequent MRI with contrast showed a medium size pituitary cyst with suprasellar extension and two contiguous tandem cysts with thick enhancing walls along the left optic tract. The sellar cyst was compressing the optic chiasma and the lateral cysts were causing perilesional oedema of the left basal ganglia. He had bitemporal field defects. Pituitary function tests showed hypogonadotropic hypogonadism and mild hyperprolactinaemia (538mU/l, 73-407). There was no polyuria/polydipsia. CRP was 31 mmol/l and ESR 29 mm/hr. At that stage, he was referred to neurosurgery and discussion in the pituitary and brain MDTs suggested a high grade optic glioma, as the main differential. Endoscopic transsphenoidal biopsy was performed and frank pus in the pituitary fossa was found intraoperatively. The pus was evacuated and the cyst wall was sampled for biopsy. Initial culture grew a staphylococcus aureus. Pathology showed a benign cyst with acute on chronic inflammation consistent with inflammed Rathke’s cleft cyst. Septic screen revealed no source of infection. A prolonged course of IV antibiotics were given with good radiological and visual improvement. The sellar cyst has not recurred and the two presumed abscesses along the left optic tract have significantly reduced in size. Abscess in a Rathke’s cleft cyst with extension along the optic pathways has been very rarely reported. The course of the development of the abscess and the atypical findings on imaging make our case unique and highlight the value of intraoperative findings and careful pathological review.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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