Document Detail

Changes in the epithelium of Rathke cleft cyst associated with inflammation.
MedLine Citation:
PMID:  11838792     Owner:  NLM     Status:  MEDLINE    
OBJECT: Rathke cleft cysts (RCCs) are composed of tall, well-differentiated, ciliated columnar epithelia. Their structures are altered by hyperplasia or squamous metaplasia, but their cause remains unknown. METHODS: The authors studied pathological findings and anterior pituitary function in 20 patients harboring RCCs. They classified RCC epithelium as either single (a single ciliated columnar cell lining or a flattened cuboidal cell lining) or stratified (a stratified ciliated columnar cell lining, basal cell hyperplasia, columnar cell hyperplasia, or squamous metaplasia). Inflammation was classified as acute, subacute, chronic, or end stage. The epithelial cell lining was observed in 13 specimens obtained during surgery (six specimens contained single and seven contained stratified epithelia). Inflammation had penetrated the cyst epithelium or subjacent stroma in 10 patients, and the stage of inflammation correlated well with the type of epithelia group: early stages of inflammation in the single epithelium group and chronic or end-stage inflammation in the stratified epithelia (p = 0.0027). The adenohypophysis was identified in 21 surgical specimens. Postoperatively, growth hormone (p = 0.019), cortisol (p = 0.027), and thyroid-stimulating hormone (p = 0.039) responses significantly worsened as the inflammation progressed. The presence of diabetes insipidus correlated well with advanced stages of neurohypophysitis (p = 0.025). CONCLUSIONS: Epithelial stratification in the RCC is caused by inflammation that may extend into the adjacent adenohypophysis or neurohypophysis and overwhelm the hypophysis, resulting in panhypopituitarism. Transsphenoidal excision may represent the best choice for treatment, at least for cases of RCC in which there is partial impairment of hypophysial function.
Seiji Hama; Kazunori Arita; Takashi Nishisaka; Toshiyuki Fukuhara; Atsushi Tominaga; Kazuhiko Sugiyama; Hiroyuki Yoshioka; Kuniki Eguchi; Masayuki Sumida; Yuji Heike; Kaoru Kurisu
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  96     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2002 Feb 
Date Detail:
Created Date:  2002-02-12     Completed Date:  2002-03-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  209-16     Citation Subset:  AIM; IM    
Department of Neurosurgery, Hiroshima University School of Medicine, Japan.
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MeSH Terms
Central Nervous System Cysts / pathology*,  physiopathology*,  surgery
Epithelium / pathology*,  physiopathology*,  surgery
Inflammation / pathology*,  physiopathology*,  surgery
Magnetic Resonance Imaging
Middle Aged
Pituitary Gland, Anterior / pathology*,  physiopathology*,  surgery
Pituitary Gland, Posterior / pathology,  physiopathology,  surgery
Pituitary Neoplasms / pathology*,  physiopathology*,  surgery
Retrospective Studies
Severity of Illness Index

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