Giant Suprasellar Rathke's Cleft Cyst Mimicking Craniopharyngioma: Implications for a Spectrum of Cystic Epithelial Lesions of Ectodermal Origin

Osamah J. Choudhry; Asad Choudhry; Smruti K. Patel; Ada Baisre; Jean Anderson Eloy; James K. Liu

doi:10.1055/s-0032-1304814

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2012; 73(05): 324-329
DOI: 10.1055/s-0032-1304814

Case Report

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Giant Suprasellar Rathke's Cleft Cyst Mimicking Craniopharyngioma: Implications for a Spectrum of Cystic Epithelial Lesions of Ectodermal Origin

Osamah J. Choudhry

¹Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, United States

,

Asad Choudhry

¹Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, United States

,

Smruti K. Patel

¹Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, United States

,

Ada Baisre

²Department of Pathology and Laboratory Medicine, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, United States

,

Jean Anderson Eloy

¹Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, United States

³Department of Otolaryngology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, United States

⁴Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, United States

,

James K. Liu

¹Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, United States

⁴Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, United States

› Author Affiliations

Abstract

Cystic epithelial lesions such as Rathke's cleft cysts (RCCs) and craniopharyngiomas may be difficult to distinguish on a clinical, radiographic, and sometimes histopathological basis. We describe a case of a giant 6.5 cm suprasellar cystic lesion that was presumed to be a craniopharyngioma based on the neuroimaging findings. The lesion extended from the anterior skull base and sella turcica to the lateral ventricle and sylvian fissure resulting in obstructive hydrocephalus. Complete surgical removal of the suprasellar lesion was achieved using an extended frontotemporal transbasal skull base approach. Intraoperatively, the cyst wall was thickened and partially calcified, resembling a craniopharyngioma. However, the histopathological examination revealed findings most consistent with a RCC with additional features of extensive squamous metaplasia, metaplastic bone formation, and chronic inflammation. The case raises the issue of whether there is a pathologic continuum of parasellar ectodermal lesions which may account for the overlap of features and transitional states. In this report, we discuss the possible spectrum between RCCs and craniopharyngiomas, and also emphasize the importance of complete resection of the cyst wall in RCCs that exhibit squamous metaplasia, inflammation, or ossification to minimize the probability of recurrence.

Keywords

Rathke's cleft cyst - craniopharyngioma - suprasellar lesions - epithelial cyst

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References

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