A Rathke's Cleft Cyst Presenting with Apoplexy

the patient underwent magnetic resonance (MR) imaging of the sella with and without contrast injection.Initial MR images demonstrated a 26 mm-sized sellar mass with suprasellar component of heterogeneous signal intensity with peripheral rim enhancement.The lesion had mixed signal intensities on both T1-and T2-weighted scans, with an intracystic fluid level (Fig. 1).These findings suggested the presence of hemorrhage in a pituitary adenoma, RCC, or craniopharyngioma.There were no abnormal vascular lesions on the neuroimages.Pituitary endocrionological findings indicated partial hypopituitarism : the levels of follicle-stimulating hormone, luteinizing hormone, and growth hormone were normal, but thyroid-stimulating hormone, adrenocorticotropic hormone, and cortisol levels were low.The patient' s serum prolactin level was mildly elevated to 50 ng/mL suggesting compression of pituitary stalk.Transsphenoidal microsurgery encountered a bulging of the sella floor which was quite thinned out.Upon opening of the dura mater, there was immediate expression of a bloody serous, mucinous, and yellowish substance (Fig. 2A).Cyst contents were completely evacuated and the cyst wall was partially excised.Histology revealed the lesion to be a sellar cyst with epithelial linings which was suggestive of RCC, as well as evidence of acute hemorrhage mixed in with the contents of the cyst (Fig. 2B).Postoperatively, the patient's headaches disappeared, and the prolactin and sodium levels were normalized.