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Abscess formation within a Rathke's cleft cyst.

Coulter IC, Mahmood S, Scoones D, Bradey N, Kane PJ - J Surg Case Rep (2014)

Bottom Line: A 66-year-old gentleman presented with visual deterioration and symptoms suggestive of hypopituitarism.Microbiological culture of the material grew Staphylococcus aureus.The patient has been followed up for 2 years without recurrence.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK ian.coulter@doctors.org.uk.

No MeSH data available.


Related in: MedlinePlus

Histological image illustrating the cyst wall composed of ciliated columnar epithelium characteristic of RCC lying on a thin layer of fibrous tissue (long arrow) with infiltration by numerous neutrophils (small arrow; haemotoxylin and eosin original magnification ×400).
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RJU105F2: Histological image illustrating the cyst wall composed of ciliated columnar epithelium characteristic of RCC lying on a thin layer of fibrous tissue (long arrow) with infiltration by numerous neutrophils (small arrow; haemotoxylin and eosin original magnification ×400).

Mentions: Endocrine biochemistry was indicative of hypopituitarism [cortisol 90 nmol/l, thyroid-stimulating hormone 1.22 mU/l (T4 6.7 pmol/l), testosterone <0.4 nmol/l]. Magnetic resonance imaging (MRI) revealed a cystic sellar lesion compressing the optic chiasm (Fig. 1). Computed tomography scanning demonstrated an uncalcified hypodense cystic lesion within the sellar. Based on the radiological appearances, a macroadenoma or craniopharyngioma was suspected. A transsphenoidal decompression was undertaken whereupon yellow pus was encountered within a predominantly cystic sellar mass. The atypical appearance of the purulent material prompted sampling for microbiological assessment. The lesion was drained and the remaining cavity was thoroughly irrigated with saline. Histological examination of the lesion revealed columnar epithelial cells characteristic of RCC, some of which were ciliated, resting on connective tissue. Admixed inflammatory cells were also observed including quite numerous neutrophils (Fig. 2). The histological differential diagnosis included abscess, pituitary apoplexy and RCC with superimposed inflammation. While histological examination suggested pituitary apoplexy as an alternative pathology, this was not consistent with the clinical presentation. Although initial gram stain was negative for organisms, the pus retrieved grew Staphylococcus aureus sensitive to flucloxacillin and fusidic acid on microbiological culture. The overall picture was suggestive of abscess formation within a RCC.Figure 1:


Abscess formation within a Rathke's cleft cyst.

Coulter IC, Mahmood S, Scoones D, Bradey N, Kane PJ - J Surg Case Rep (2014)

Histological image illustrating the cyst wall composed of ciliated columnar epithelium characteristic of RCC lying on a thin layer of fibrous tissue (long arrow) with infiltration by numerous neutrophils (small arrow; haemotoxylin and eosin original magnification ×400).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4221843&req=5

RJU105F2: Histological image illustrating the cyst wall composed of ciliated columnar epithelium characteristic of RCC lying on a thin layer of fibrous tissue (long arrow) with infiltration by numerous neutrophils (small arrow; haemotoxylin and eosin original magnification ×400).
Mentions: Endocrine biochemistry was indicative of hypopituitarism [cortisol 90 nmol/l, thyroid-stimulating hormone 1.22 mU/l (T4 6.7 pmol/l), testosterone <0.4 nmol/l]. Magnetic resonance imaging (MRI) revealed a cystic sellar lesion compressing the optic chiasm (Fig. 1). Computed tomography scanning demonstrated an uncalcified hypodense cystic lesion within the sellar. Based on the radiological appearances, a macroadenoma or craniopharyngioma was suspected. A transsphenoidal decompression was undertaken whereupon yellow pus was encountered within a predominantly cystic sellar mass. The atypical appearance of the purulent material prompted sampling for microbiological assessment. The lesion was drained and the remaining cavity was thoroughly irrigated with saline. Histological examination of the lesion revealed columnar epithelial cells characteristic of RCC, some of which were ciliated, resting on connective tissue. Admixed inflammatory cells were also observed including quite numerous neutrophils (Fig. 2). The histological differential diagnosis included abscess, pituitary apoplexy and RCC with superimposed inflammation. While histological examination suggested pituitary apoplexy as an alternative pathology, this was not consistent with the clinical presentation. Although initial gram stain was negative for organisms, the pus retrieved grew Staphylococcus aureus sensitive to flucloxacillin and fusidic acid on microbiological culture. The overall picture was suggestive of abscess formation within a RCC.Figure 1:

Bottom Line: A 66-year-old gentleman presented with visual deterioration and symptoms suggestive of hypopituitarism.Microbiological culture of the material grew Staphylococcus aureus.The patient has been followed up for 2 years without recurrence.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK ian.coulter@doctors.org.uk.

No MeSH data available.


Related in: MedlinePlus