Brain Tumor Res Treat.  2016 Oct;4(2):58-62. 10.14791/btrt.2016.4.2.58.

Spontaneous Involution of Rathke’s Cleft Cysts without Visual Symptoms

• Kim CW
• Hwang K
• Joo JD
• Kim YH
• Han JH
• Kim CY

• KMID: 2356971
• DOI: http://doi.org/10.14791/btrt.2016.4.2.58

Abstract

BACKGROUND
There have been various reports in the literature regarding the conservative management of pituitary apoplexy, pituitary incidentalomas and Rathke cleft cysts (RCCs). However, to the best of our knowledge, spontaneous involution of cystic sellar mass has rarely been reported. We report 14 cases of cystic sellar masses with spontaneous involution.
METHODS
A total of 14 patients with spontaneous regression of cystic sellar masses in our hospital were included. The median age was 35 years (range, 5-67), and 8 patients were male. Clinical symptoms, hormone study and MRI were evaluated for all patients. The initial MRI showed all 14 patients with RCCs. Eight patients were presented with sudden onset of headache, and 1 patient with dizziness. Another patient, a 5-year-old child, was presented with delayed growth. Three patients had no symptoms via regular medical work up. All 14 patients had no visual symptoms. The follow-up period ranged from 5.7 to 42.8 months, with the mean of 17.3 months.
RESULTS
The mean initial tumor size was 1.29 cm³ (range, 0.05 to 3.23). After involution, the tumor size decreased to 0.23 cm³ (range, 0 to 0.68) without any treatments. Repeated MRI showed a spontaneous decrease in tumor volume by 78% (range, 34 to 99). The initial MRI showed that the tumor was in contact with the optic chiasm in 7 patients, while compressing on the optic chiasm in 3 patients. Five patients were initially treated with hormone replacement therapy due to hormone abnormality. After the follow-up period, only 2 patients needed a long-term hormone replacement therapy.
CONCLUSION
The spontaneous involution of RCCs is not well quantified before. Their incidence has not been well demonstrated, but this phenomenon might be underreported. Conservative management can be a treatment option in some RCCs without visual symptoms, even in those that are large in size and in contact with the optic nerve via imaging study.

Keyword

Rathke’s cleft cyst; Spontaneous regression

MeSH Terms

Central Nervous System Cysts
Child
Child, Preschool
Dizziness
Follow-Up Studies
Headache
Hormone Replacement Therapy
Humans
Incidence
Magnetic Resonance Imaging
Male
Optic Chiasm
Optic Nerve
Pituitary Apoplexy
Tumor Burden

Figure

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  Fig. 1 An illustrative case. A-D: Initial MRI findings. E-H: Follow-up imaging after 7 months without surgical intervention.

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