gms | German Medical Science

Objective: Originating from remnants of Rathke's pouch, Rathke’s cleft cysts (RCC) develop as cystic lesions between the anterior and posterior lobe of the pituitary gland. If symptomatic, their treatment is most often surgical in the sense of microsurgical or endoscopic resection via the transsphenoidal corridor. However, most of these lesions are asymptomatic and can be followed. The natural course of RCCs is almost always one of slow growth and spontaneous regression of a RCC is very rare.

Method: We report on a case of spontaneous regression of a symptomatic RCC with subsequent recovery of pre-existing endocrine dysfunction and resolution of headaches.

Results: A 60-year-old man complained about headaches. The visual fields as well the formal ophthalmologic examination were within normal limits. Laboratory investigation revealed a partial hypopituitarism with a slight central hypothyroidism without need for substitution. An MRI study showed a cystic, T2-hyperintense, sellar lesion measuring 17x15x12 mm with a thin contrast enhancing rim on the left side compatible with a RCC. At one year follow-up the patient had no complains. Headaches had completely resolved and the hormone work-up revealed a regression of the previous slight hypopituitarismus. The MRI study showed a complete regression of the cystic lesion and a normal sized and shaped pituitary gland. A further follow-up MRI after 12 months showed no relapse of the RCC.

Conclusions: Because of the possibility of spontaneous involution of RCCs, follow-up examinations seem to be justified in cases without debilitating symptoms.