What is Rathke’s Cleft Cyst: Signs, Symptoms, Treatment, Diagnosis

During the process of embryogenesis, Rathke’s pouch is formed at the roof of the mouth of the embryo. Eventually, it forms the anterior part of the pituitary gland called adenohypophysis. If for any reason, some part of Rathke’s pouch remains unaltered and increases in size, it may form Rathke’s Cleft Cyst (RCC). This kind of cyst normally seems like a cleft in-between the anterior and posterior lobes of the pituitary gland. It is benign in nature and has a round, dumbbell, or slightly ovoid shape. In most of the cases, RCC does not cause any problem. However, for some patients with Rathke’s Cleft Cyst different physical problems may occur wherein they need immediate attention.

In most of the situations, Rathke’s Cleft Cyst remain undetected unless some symptoms become visible or detected accidentally while diagnosing some other disease. In the majority of the cases these cysts remain very small in size (maximum 2 mm in diameter) and do not possess any visible symptoms. However, it can be as big as 40mm. Some other characteristics of Rathke’s Cleft Cyst are as follows:

• RCCs are normally transparent possess different colors like blue, light yellow, green, pink, or tan.
• The fluid inside the cyst is normally watery, gelatinous or thick but in some cases, it can be like mobile oils.
• These cysts are made up of vascularized stroma along with three types of epithelial cells, viz. mucous secreting epithelial, ciliated epithelial, and non-ciliated epithelial.

When an Rathke’s Cleft Cyst increases in volume, it starts compressing the hypothalamus, pituitary gland, pituitary stalk, and optic chasm. This is when several types of symptoms start showing in the patients.

Following are the most known signs and symptoms of Rathke’s Cleft Cyst:

• Hypopituitarism or Selective Hypopituitarism: This is a condition when the rate of secretion of one or more hormones secreted by the pituitary gland decreases significantly creating many other bodily disorders including growth retardation and cognitive dysfunction.
• Endocrinopathy: It is a disease of the endocrine gland and closely linked to hypopituitarism.
• Visual Defect as a Sign of Rathke’s Cleft Cyst: Due to an unusual pressure on the optic chiasm, a patient with Rathke’s Cleft Cyst may experience blurred vision.
• Headache as a Symptom of Rathke’s Cleft Cyst: Patients with these kinds of cystic growths may experience frequent headache especially in the anterior part of the head.

Apart from this, doctors and researchers dealing with Rathke’s Cleft Cyst have also detected some other indications of Rathke’s Cleft Cyst though in very rare cases such as unusual frontal extension, pituitary adenomas, pituitary apoplexy, empty Sella syndrome, intra-cystic abscesses, etc.

There is no specific age limitation in this disease but adults above the age of 20 are mostly affected by Rathke’s Cleft Cyst. The tests for diagnosis include:

• MRI and CT scan are frequently used to spot these kinds of cystic growths.
• CT scan can help in spotting the cyst and assessing the extension of calcification of the cyst. CT scan also helps in measuring the amount of calcium present in the cyst which is not possible through MRI. Moreover, CT scan can also assess the bony remodeling of Rathke’s Cleft Cyst more precisely than MRI.
• However, doctors prefer sagittal and coronial MRI scans over CT scan due to the following reasons:
• MRI provides a more accurate and authentic report on the present condition of Rathke’s Cleft Cyst and how much pressure it is putting on the optic chasm, hypothalamus, and optic nerves.
• MRI provides a better view of the lateral expansion of Rathke’s Cleft Cyst.

Besides, doctors may also undertake differential diagnosis to sort out the possibility of other mass formations such as Pituitary Adenoma, Arachnoid Cyst, Craniopharyngioma, etc. At the same time, some blood tests are also performed for a complete hormonal blood evaluation for pituitary hormones.

Small asymptomatic Rathke’s Cleft Cysts which are mostly detected while treating any other issues rarely require any treatment. In millions of cases where the cyst is too small, doctors advise to observe the condition periodically by MRI or CT scan. Many such cysts remain same for years or disappear over time. However, larger Rathke’s Cleft Cysts whose diameter is more than 10mm need treatment. These Rathke’s Cleft Cysts normally puts pressure on the surrounding areas including the pituitary gland and hypothalamus. It is also found that these cystic masses grow in size steadily generating many other problems as discussed before.

Surgery is the most common treatment for large-sized Rathke’s Cleft Cyst that causes headache, pituitary dysfunction, and visual problems. These days, very advanced Endonasal Endoscopic Approach (EEA) is performed followed by some medications. In this form of surgery, nasal cavities are used to reach at the spot and remove the cyst. In this surgery, no incisions are required; hence, a patient recovers quickly.

Rathke’s Cleft Cyst is a rare disease. Surgery is needed if the cyst gets really bigger. Smaller ones do not pose any problem. Diagnosis is a major challenge for the doctors since the symptoms resemble many other diseases. Through the surgical process, Rathke’s Cleft Cyst can be removed completely. In very few cases, it may relapse over 5-10 years’ time span. With the advancement of medical science, Rathke’s Cleft Cyst treatment is getting easier.

Also Read:

• Branchial Cleft Cyst: Causes, Symptoms, Treatment, Prognosis, Diagnosis