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Pituitary Adenoma Associated With Rathke’s Cleft Cyst: Report of 15 Cases

  • Wenhao Wu (a1) (a2), Guijun Jia (a1) (a2), Wang Jia (a1) (a2), Guilin Li (a3) (a4), Junting Zhang (a1) (a2) and Liwei Zhang (a1) (a2)...
Abstract

Objective: The concomitant presence of pituitary adenoma (PA) with Rathke’s cleft cyst (RCC) is rare, and most of the literature published is case reports. RCC’s clinicopathological features have not been well described. Methods: We retrospectively reviewed the data of 15 patients with PA associated with RCC. We also provide a systematic review of the literature. Results: The patients included males and seven females. The transsphenoidal approach was adopted for all patients except one, who underwent right frontal craniotomy. Complete resection was achieved in nine cases, with grossly complete resection in five and partial removal in one. Of the PA subtypes available, five patients had nonfunctional pituitary adenomas, three had multiple-hormone secreting PAs, three had prolactin-producing adenomas, and one had a growth hormone-secreting adenoma. All of the patients’ symptoms and abnormal endocrine test results resolved or were relieved after surgery. The mean follow-up time was 27.6±16.6 months. All of the patients recovered well and had no signs of recurrence during their follow-up, except for one patient. Conclusions: A cyst-like signal indicated on images or cystic materials encountered during operation in a patient with PA suggest the possibility of PA associated with RCC. Transsphenoidal surgery is the preferred approach and can resolve or relieve patients’ symptoms to a great extent. Histologically, nonfunctional PA and prolactinoma are the most common types of PA coexisting with RCC; the mechanisms of PA associated with RCC need to be investigated further.

Des adénomes hypophysaires associés á des kystes de la poche de Rathke : 15 cas rapportés. Objectif: La présence concomitante d’adénomes hypophysaires (AP) et de kystes de la poche de Rathke (KPR) demeure inhabituelle. La plupart des travaux de recherche publiés sur le sujet l’ont été sous forme d’études de cas. On peut aussi ajouter que les caractéristiques cliniques et pathologiques des KPR n’ont pas été très bien décrites jusqu’à maintenant. Méthodes: Nous avons révisé de façon rétrospective les données de 15 patients chez qui l’on avait diagnostiqué des AP associés à des KPR. Nous avons également procédé à une recension systématique des écrits sur le sujet. Résultats: Huit patients étaient de sexe masculin; sept d’entre eux, de sexe féminin. Hormis un patient, chez qui l’on a pratiqué une craniotomie frontale sur le côté droit, une intervention par voie transsphénoïdale a été privilégiée pour tous les autres patients. Une résection complète a été effectuée chez neuf patients alors qu’on a plutôt procédé à une résection largement complète chez cinq d’entre eux et à une élimination partielle chez un seul. Parmi tous les sous-types d’AP détectés, cinq patients étaient atteints d’AP non fonctionnels; trois, d’AP sécrétant de multiples hormones; trois, d’adénomes produisant de la prolactine; un, d’un adénome produisant des hormones de croissance. Tous les symptômes des patients ont disparu ou ont été soulagés à la suite de la chirurgie mentionnée ci-dessus. De plus, aucun test du système endocrinien ne s’est révélé anormal par la suite. La période de suivi des patients a été en moyenne de 27,6±16,6 mois. À l’exception d’un seul d’entre eux, tous se sont bien rétablis et n’ont montré aucun signe de récidive durant leur période de suivi. Conclusions: Des signaux indiquant la présence d’un kyste à la suite d’examens d’imagerie, de même que des tissus kystiques trouvés lors d’une intervention chirurgicale chez un patient atteint d’AP, suggèrent la possibilité que les AP soient associés aux KPR. Une intervention chirurgicale par voie transsphénoïdale demeure l’approche à privilégier car elle peut faire disparaître ou soulager dans une grande mesure les symptômes des patients atteints. D’un point de vue histologique, les AP non fonctionnels et les prolactinomes sont les types d’AP qui coexistent le plus souvent avec les KPR. Enfin, les mécanismes liant les AP aux KPR devront être examinés de façon plus approfondie.

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Corresponding author
Correspondence to: Liwei Zhang, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, No.6 Tiantan Xili, Dong Cheng District, Beijing 100050, China. Email: zhlwttyy@163.com
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Canadian Journal of Neurological Sciences
  • ISSN: 0317-1671
  • EISSN: 2057-0155
  • URL: /core/journals/canadian-journal-of-neurological-sciences
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