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GH-Producing Pituitary Adenoma and Concomitant Rathke's Cleft Cyst: A Case Report and Short Review.

Tamura R, Takahashi S, Emoto K, Nagashima H, Toda M, Yoshida K - Case Rep Neurol Med (2015)

Bottom Line: A diagnosis of growth hormone- (GH-) producing PA was confirmed from hormonal examinations and additional MRI.In a few cases, concomitant RCCs were fenestrated, but GH levels normalized postoperatively as in the cases without RCC fenestration.If radiographic imaging shows typical RCC, and PA is not obvious at first glance, the possibility of concomitant PA still needs to be considered.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.

ABSTRACT
Concomitant pituitary adenoma (PA) and Rathke's cleft cyst (RCC) are rare. In some cases, such PA is known to produce pituitary hormones. A 53-year-old man was admitted to our hospital with a diagnosis of lacunar infarction in the left basal ganglia. Magnetic resonance imaging (MRI) incidentally showed a suprasellar mass with radiographic features of RCC. When he consulted with a neurosurgical outpatient clinic, acromegaly was suspected based on his appearance. A diagnosis of growth hormone- (GH-) producing PA was confirmed from hormonal examinations and additional MRI. Retrospectively, initial MR images also showed intrasellar mass that is compatible with the diagnosis of PA other than suprasellar RCC. The patient underwent endonasal-endoscopic removal of the PA. Since we judged that the RCC of the patient was asymptomatic, only the PA was completely removed. The postoperative course of the patient was uneventful and GH levels gradually normalized. Only 40 cases of PA with concomitant RCC have been reported to date, including 13 cases of GH-producing PA. In those 13 cases, RCC tended to be located in the sella turcica, and suprasellar RCC like this case appears rare. In a few cases, concomitant RCCs were fenestrated, but GH levels normalized postoperatively as in the cases without RCC fenestration. If radiographic imaging shows typical RCC, and PA is not obvious at first glance, the possibility of concomitant PA still needs to be considered. In terms of treatment, removal of the RCC is not needed to achieve hormone normalization.

No MeSH data available.


Related in: MedlinePlus

(a) Neuroendoscope shows the clear margin between normal gland and PA. PA looks soft and yellowish. (b) Neuroendoscopic view after removal of the PA, which was easy to remove. (c) Neuroendoscope shows the wall of the RCC. Resecting the suprasellar RCC while retracting normal gland was difficult. (d) The floor of the sella turcica was reconstructed using fat tissue. We did not aspirate or resect the cyst wall.
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fig3: (a) Neuroendoscope shows the clear margin between normal gland and PA. PA looks soft and yellowish. (b) Neuroendoscopic view after removal of the PA, which was easy to remove. (c) Neuroendoscope shows the wall of the RCC. Resecting the suprasellar RCC while retracting normal gland was difficult. (d) The floor of the sella turcica was reconstructed using fat tissue. We did not aspirate or resect the cyst wall.

Mentions: Removal of the PA using an endonasal-endoscopic approach was performed. Intraoperatively, the margin between the normal pituitary gland and adenoma was clear (Figure 3(a)). We identified the yellowish adenoma and completed gross total removal using suction (Figure 3(b)). We then retracted the pituitary gland and identified the wall of the RCC (Figure 3(c)). We did not aspirate or resect the cyst wall for fear of cerebrospinal fluid (CSF) leakage. The floor of the sella turcica was reconstructed using fat tissue (Figure 3(d)). Histologically, the tumor was composed of monotonous eosinophilic cells (Figure 4(a)). Positive staining was observed with GH immunohistochemistry (Figure 4(b)); thus the tumor was diagnosed as GH-producing PA. Postoperative computed tomography revealed gross total removal of the adenoma.


GH-Producing Pituitary Adenoma and Concomitant Rathke's Cleft Cyst: A Case Report and Short Review.

Tamura R, Takahashi S, Emoto K, Nagashima H, Toda M, Yoshida K - Case Rep Neurol Med (2015)

(a) Neuroendoscope shows the clear margin between normal gland and PA. PA looks soft and yellowish. (b) Neuroendoscopic view after removal of the PA, which was easy to remove. (c) Neuroendoscope shows the wall of the RCC. Resecting the suprasellar RCC while retracting normal gland was difficult. (d) The floor of the sella turcica was reconstructed using fat tissue. We did not aspirate or resect the cyst wall.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4389828&req=5

fig3: (a) Neuroendoscope shows the clear margin between normal gland and PA. PA looks soft and yellowish. (b) Neuroendoscopic view after removal of the PA, which was easy to remove. (c) Neuroendoscope shows the wall of the RCC. Resecting the suprasellar RCC while retracting normal gland was difficult. (d) The floor of the sella turcica was reconstructed using fat tissue. We did not aspirate or resect the cyst wall.
Mentions: Removal of the PA using an endonasal-endoscopic approach was performed. Intraoperatively, the margin between the normal pituitary gland and adenoma was clear (Figure 3(a)). We identified the yellowish adenoma and completed gross total removal using suction (Figure 3(b)). We then retracted the pituitary gland and identified the wall of the RCC (Figure 3(c)). We did not aspirate or resect the cyst wall for fear of cerebrospinal fluid (CSF) leakage. The floor of the sella turcica was reconstructed using fat tissue (Figure 3(d)). Histologically, the tumor was composed of monotonous eosinophilic cells (Figure 4(a)). Positive staining was observed with GH immunohistochemistry (Figure 4(b)); thus the tumor was diagnosed as GH-producing PA. Postoperative computed tomography revealed gross total removal of the adenoma.

Bottom Line: A diagnosis of growth hormone- (GH-) producing PA was confirmed from hormonal examinations and additional MRI.In a few cases, concomitant RCCs were fenestrated, but GH levels normalized postoperatively as in the cases without RCC fenestration.If radiographic imaging shows typical RCC, and PA is not obvious at first glance, the possibility of concomitant PA still needs to be considered.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.

ABSTRACT
Concomitant pituitary adenoma (PA) and Rathke's cleft cyst (RCC) are rare. In some cases, such PA is known to produce pituitary hormones. A 53-year-old man was admitted to our hospital with a diagnosis of lacunar infarction in the left basal ganglia. Magnetic resonance imaging (MRI) incidentally showed a suprasellar mass with radiographic features of RCC. When he consulted with a neurosurgical outpatient clinic, acromegaly was suspected based on his appearance. A diagnosis of growth hormone- (GH-) producing PA was confirmed from hormonal examinations and additional MRI. Retrospectively, initial MR images also showed intrasellar mass that is compatible with the diagnosis of PA other than suprasellar RCC. The patient underwent endonasal-endoscopic removal of the PA. Since we judged that the RCC of the patient was asymptomatic, only the PA was completely removed. The postoperative course of the patient was uneventful and GH levels gradually normalized. Only 40 cases of PA with concomitant RCC have been reported to date, including 13 cases of GH-producing PA. In those 13 cases, RCC tended to be located in the sella turcica, and suprasellar RCC like this case appears rare. In a few cases, concomitant RCCs were fenestrated, but GH levels normalized postoperatively as in the cases without RCC fenestration. If radiographic imaging shows typical RCC, and PA is not obvious at first glance, the possibility of concomitant PA still needs to be considered. In terms of treatment, removal of the RCC is not needed to achieve hormone normalization.

No MeSH data available.


Related in: MedlinePlus