Diagnosis of concomitant pituitary adenoma and Rathke's cleft cyst with magnetic resonance imaging

• The diagnosis of concomitant PA and RCC is very difficult.
• Surgery via the trans-sphenoidal route was performed on 17 cases and trans-frontal approach was chosen for one patient.
• A cyst-like structure within the pars intermedia of PA is a prominent MRI feature of coexisted PA and RCC.
• Total resection of coexisted RCC must be achieved and fat graft should be avoided during surgery.

IntroductionThe diagnosis of concomitant pituitary adenoma (PA) and Rathke's cleft cyst (RCC) is difficult because PA and RCC cause similar symptoms. This study aimed to investigate magnetic resonance imaging (MRI) characteristics and surgical management of sellar lesions for concomitant PA and RCC.MethodsA retrospective study was performed in 18 patients with concomitant PA and RCC who visited our hospital between June 2008 and May 2014. MRI features, surgical management, histopathological diagnosis and prognosis of concomitant PA and RCC were summarized.ResultsOf the 18 patients, 3 cases were diagnosed with concomitant PA and RCC and 2 with concomitant PA and intermedia cyst by preoperative MRI. The remaining 8 cases were misdiagnosed as cystic formation of PA, 3 cases were bleeding of PA, and 2 cases were RCC. Surgery via the trans-sphenoidal route was performed in 17 cases and trans-frontal approach was chosen for one patient. All PAs resected were diagnosed by histological examination and the diagnosis of concomitant PA and RCC was histologically confirmed.ConclusionA non-enhancing cyst-like structure within the pars intermedia of PA usually located in the midline is a prominent MRI feature of coexisted PA and RCC. Total resection of coexisted RCC must be achieved and fat graft should be avoided during surgery because of high recurrence rate of RCC and complicated hypophysitis.