Rathke’s Cyst
Rathke's cyst, also known as Rathke cleft cyst (RCC), is a noncancerous cyst lined with epithelium that typically develops in the sella turcica and is believed to arise from the remnants of Rathke's pouch. Rathke's pouch is the embryonic structure that gives rise to the anterior and intermediate lobes of the pituitary gland.
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Although the pathogenesis of Rathke's cyst remains unclear, it is believed to be congenital, originating from remnants of Rathke's pouch. This pouch also gives rise to the adenohypophysis, the anterior glandular portion of the pituitary gland, so RCCs share a similar lineage with pituitary adenomas. It is rare, but both lesions may coexist.
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Rathke's cyst is congenital in origin, although its pathogenesis is by no means clear; it is generally believed that the cells of origin are the remnants of Rathke's pouch. The adenohypophysis (the anterior glandular part of the pituitary gland) is also driven embryologically from the anterior wall of Rathke's pouch and so RCCs have a similar lineage to that of a pituitary adenoma, and rarely both lesions may occur in concurrency.
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Rathke's cyst is typically diagnosed based on visual problems resulting from cyst compression on the optic nerve(s) or endocrine symptoms. The diagnostic process for Rathke's cyst involves pre- and post-contrast MRI/MRA and CT scans, as well as neuro-ophthalmologic and endocrinologic evaluations.
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Asymptomatic Rathke's cysts do not usually require treatment except for patients with neurological or endocrinological symptoms. The primary treatment for RCCs is typically trans-sphenoidal surgery, which involves partial excision and drainage of the cyst. In rare cases, a formal craniotomy may be performed, typically through a right frontal bone flap. Simple cyst aspiration is not recommended as it may cause the cyst to recur. Radiation therapy is not an effective treatment for these benign lesions.