Hayes Annabelle G, Low Julia P, Shoung Nicholas, Fung Sebastian, McCormack Ann I
Department of Diabetes and Endocrinology, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.
School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.
Pituitary. 2024 Dec 27;28(1):9. doi: 10.1007/s11102-024-01486-w.
Rathke's cleft cysts (RCC) are present in up to 20% of autopsy studies but only a minority necessitate surgical treatment. Inflammation of RCC is thought to be significant in three processes: the development of classical symptoms, a predisposition to rupture or apoplexy, and increasing the rate of RCC recurrence. We aim to characterize clinical presentation, histological and radiological findings in patients with surgically managed RCC.
We conducted a retrospective case series of 31 RCC, which had undergone surgical management between April 2016 and April 2024. Histopathology and radiology were independently reviewed by neuropathologist and neuroradiologist, and case notes were reviewed for clinical and biochemical data.
Median age was 43 years (IQR 32-63); 77% were female. 23/31 demonstrated inflammation of RCC cyst epithelium (n = 13), cyst wall (n = 20) or anterior pituitary (adenohypophysitis) (n = 12). 8 cases were not inflamed. Preoperative features included pituitary dysfunction (70%), headache (65%), visual disturbance (26%) and polyuria/polydipsia (7%). Six patients presented with features of apoplexy. Headache was more prevalent (92%) in patients with adenohypophysitis vs. those without (47%), p = 0.020, and present in all 11 cases where inflammation in the adenohypophysis was chronic. Pituitary dysfunction was not associated with inflammation overall (76% vs. 70% p = ns), nor specifically within the adenohypophysis (75 vs. 63% p = 0.69). Histological inflammation was associated with radiological loss of posterior bright spot (70% vs. 14% p = 0.024).
Headache but not pituitary dysfunction was associated with adenohypophyseal inflammation. A trend of increasing headache prevalence was seen with increasing degree of inflammatory infiltrate within RCC.
在高达20%的尸检研究中发现存在拉克氏裂囊肿（RCC），但只有少数需要手术治疗。RCC的炎症被认为在三个过程中具有重要意义：典型症状的出现、破裂或卒中的易感性以及RCC复发率的增加。我们旨在描述接受手术治疗的RCC患者的临床表现、组织学和影像学表现。
我们对2016年4月至2024年4月期间接受手术治疗的31例RCC进行了回顾性病例系列研究。神经病理学家和神经放射学家分别对组织病理学和影像学进行了评估，并查阅病例记录以获取临床和生化数据。
中位年龄为43岁（四分位间距32 - 63岁）；77%为女性。23/31例显示RCC囊肿上皮（n = 13）、囊肿壁（n = 20）或垂体前叶（腺垂体炎）（n = 12）存在炎症。8例无炎症。术前特征包括垂体功能障碍（70%）、头痛（65%）、视力障碍（26%）和多尿/烦渴（7%）。6例患者出现卒中表现。腺垂体炎患者中头痛更为普遍（92%），而无腺垂体炎患者中头痛发生率为47%，p = 0. 020，并且在腺垂体炎症为慢性的所有11例病例中均有头痛。总体而言，垂体功能障碍与炎症无关（76%对70%，p = 无统计学意义），在腺垂体内部也无特异性关联（75%对63%，p = 0.69）。组织学炎症与影像学上后亮点的消失相关（70%对14%，p = 0.024）。
头痛而非垂体功能障碍与腺垂体炎相关。随着RCC内炎症浸润程度的增加，头痛患病率呈上升趋势。
