Ann Pediatr Endocrinol Metab.  2017 Sep;22(3):164-169. 10.6065/apem.2017.22.3.164.

Clinical manifestations of Rathke’s cleft cysts and their natural progression during 2 years in children and adolescents

Affiliations
  • 1Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea. kimho@yuhs.ac
  • 2Department of Pediatrics, Sowha Children’s Hospital, Seoul, Korea.

Abstract

PURPOSE
Rathke's cleft cyst (RCC) is an asymptomatic benign lesion. With increased interest in pediatric endocrinology, the prevalence of RCCs in children is also increasing. However, the clinical relevance and proper management of RCC is not well defined in children. Therefore, we investigated the clinical manifestations and radiologic features of RCC in children and adolescents, as well as the natural progression of RCC.
METHODS
We retrospectively reviewed the medical records of 91 children and adolescents with RCC diagnosed with magnetic resonance imaging (MRI) in Severance Children's Hospital from January 2006 to December 2015. The clinical, hormonal, and imaging findings were analyzed in patient groups classified according to age. The size of each cyst was assessed in sixty patients who underwent follow-up MRI during the 2 years.
RESULTS
Female patients were predominant (64 vs. 27). The common clinical features at presentation were endocrine dysfunction (59.3%), headache (23.0%), and dizziness (4.4%). Symptoms related to endocrine disorders were more frequent in younger patients. In 7 patients managed surgically, the cysts were significantly larger and more frequently located in the suprasellar region. Of 60 nonsurgical patients with a follow-up MRI performed within 2 years after the diagnosis, the RCC size increased in about 26.7% (n=16).
CONCLUSION
Although 94.4% of the patients with RCC had clinical symptoms, surgery was performed in only about 7.5% of patients. RCC is associated with pituitary insufficiency, thus, baseline and follow-up endocrine function tests are required. Additionally, regular MRI follow-up is required in long-term period to monitor change in size.

Keyword

Central nervous system cysts; Child; Adolescent; Endocrine system diseases; Hormones; Natural history

MeSH Terms

Adolescent*
Central Nervous System Cysts
Child*
Diagnosis
Dizziness
Endocrine System Diseases
Endocrinology
Female
Follow-Up Studies
Headache
Humans
Hypopituitarism
Magnetic Resonance Imaging
Medical Records
Natural History
Prevalence
Retrospective Studies

Cited by  1 articles

Prevalence of Pathological Brain Lesions in Girls with Central Precocious Puberty: Possible Overestimation?
Jong Seo Yoon, Cheol Hwan So, Hae Sang Lee, Jung Sub Lim, Jin Soon Hwang
J Korean Med Sci. 2018;33(51):.    doi: 10.3346/jkms.2018.33.e329.


Reference

References

1. Raper DM, Besser M. Clinical features, management and recurrence of symptomatic Rathke's cleft cyst. J Clin Neurosci. 2009; 16:385–9.
Article
2. Voelker JL, Campbell RL, Muller J. Clinical, radiographic, and pathological features of symptomatic Rathke's cleft cysts. J Neurosurg. 1991; 74:535–44.
Article
3. Esiri M. Russell and Rubinstein's pathology of tumors of the nervous system. Sixth edition. J Neurol Neurosurg Psychiatry. 2000; 68:538D.
Article
4. Raghunath A, Sampath S, Devi BI, Chandramouli BA, Lal GJ, Chickabasaviah YT, et al. Is there a need to diagnose Rathke's cleft cyst preoperatively? Neurol India. 2010; 58:69–73.
5. Teramoto A, Hirakawa K, Sanno N, Osamura Y. Incidental pituitary lesions in 1,000 unselected autopsy specimens. Radiology. 1994; 193:161–4.
Article
6. Mukherjee JJ, Islam N, Kaltsas G, Lowe DG, Charlesworth M, Afshar F, et al. Clinical, radiological and pathological features of patients with Rathke's cleft cysts: tumors that may recur. J Clin Endocrinol Metab. 1997; 82:2357–62.
Article
7. Takanashi J, Tada H, Barkovich AJ, Saeki N, Kohno Y. Pituitary cysts in childhood evaluated by MR imaging. AJNR Am J Neuroradiol. 2005; 26:2144–7.
8. Oh YJ, Park HK, Yang S, Song JH, Hwang IT. Clinical and radiological findings of incidental Rathke's cleft cysts in children and adolescents. Ann Pediatr Endocrinol Metab. 2014; 19:20–6.
Article
9. Trifanescu R, Ansorge O, Wass JA, Grossman AB, Karavitaki N. Rathke's cleft cysts. Clin Endocrinol (Oxf). 2012; 76:151–60.
Article
10. Han SJ, Rolston JD, Jahangiri A, Aghi MK. Rathke's cleft cysts: review of natural history and surgical outcomes. J Neurooncol. 2014; 117:197–203.
Article
11. Lim HH, Yang SW. Risk factor for pituitary dysfunction in children and adolescents with Rathke's cleft cysts. Korean J Pediatr. 2010; 53:759–65.
Article
12. Potts MB, Jahangiri A, Lamborn KR, Blevins LS, Kunwar S, Aghi MK. Suprasellar Rathke cleft cysts: clinical presentation and treatment outcomes. Neurosurgery. 2011; 69:1058–68.
13. Culver SA, Grober Y, Ornan DA, Patrie JT, Oldfield EH, Jane JA Jr, et al. A case for conservative management: characterizing the natural history of radiographically diagnosed Rathke cleft cysts. J Clin Endocrinol Metab. 2015; 100:3943–8.
Article
14. Kanter AS, Sansur CA, Jane JA Jr, Laws ER Jr. Rathke's cleft cysts. Front Horm Res. 2006; 34:127–57.
Article
15. Aho CJ, Liu C, Zelman V, Couldwell WT, Weiss MH. Surgical outcomes in 118 patients with Rathke cleft cysts. J Neurosurg. 2005; 102:189–93.
Article
16. Brassier G, Morandi X, Tayiar E, Riffaud L, Chabert E, Heresbach N, et al. Rathke's cleft cysts: surgical-MRI correlation in 16 symptomatic cases. J Neuroradiol. 1999; 26:162–71.
17. Binning MJ, Liu JK, Gannon J, Osborn AG, Couldwell WT. Hemorrhagic and nonhemorrhagic Rathke cleft cysts mimicking pituitary apoplexy. J Neurosurg. 2008; 108:3–8.
Article
18. Saeki N, Sunami K, Sugaya Y, Yamaura A. MRI findings and clinical manifestations in Rathke's cleft cyst. Acta Neurochir (Wien). 1999; 141:1055–61.
Article
19. Kucharczyk W, Peck WW, Kelly WM, Norman D, Newton TH. Rathke cleft cysts: CT, MR imaging, and pathologic features. Radiology. 1987; 165:491–5.
Article
20. Nemoto Y, Inoue Y, Fukuda T, Shakudo M, Katsuyama J, Hakuba A, et al. MR appearance of Rathke's cleft cysts. Neuroradiology. 1988; 30:155–9.
Article
21. Nishioka H, Haraoka J, Izawa H, Ikeda Y. Magnetic resonance imaging, clinical manifestations, and management of Rathke's cleft cyst. Clin Endocrinol (Oxf). 2006; 64:184–8.
Article
22. Bonneville F, Cattin F, Marsot-Dupuch K, Dormont D, Bonneville JF, Chiras J. T1 signal hyperintensity in the sellar region: spectrum of findings. Radiographics. 2006; 26:93–113.
Article
23. Bonneville F, Chiras J, Cattin F, Bonneville JF. T2 hypointense signal of rathke cleft cyst. AJNR Am J Neuroradiol. 2007; 28:397.
Full Text Links
  • APEM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr