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First Report of Coexistence of Two Ectopic Pituitary Tumors: Rathke Cleft Cyst and Silent Adrenocorticotropic Hormone Adenoma.
World Neurosurg. 2017 Aug; 104:1048.e1-1048.e7.WN

Abstract

BACKGROUND

Rathke cleft cysts (RCCs) and pituitary adenomas (PAs) are thought to have a common embryonic ancestry; however, PAs with a concomitant RCC inside the sella turcica are rarely observed. Ectopic pituitary tumors are also rare.

CASE DESCRIPTION

We present the case of a 65-year-old woman with an ectopic RCC in the sphenoid sinus and outside the sella turcica concomitant with an adrenocorticotropic hormone (ACTH)-staining, clinically silent PA. The patient had headache but no endocrine or visual disturbances. Preoperative magnetic resonance imaging revealed infrasellar cystic lesion in the sphenoid sinus with erosion of the clivus and intact sellar floor. The patient underwent gross total microsurgical resection through the transnasal route with an uneventful postoperative course.

CONCLUSIONS

To our knowledge, this is the first reported ectopic RCC located outside the sella turcica with a concomitant ACTH-staining PA. This also appears to be the first ACTH-staining adenoma concomitant with RCC reported in the literature, regardless of location, not presenting with Cushing disease. This case shows that we can now include pituitary adenoma with or without a concomitant RCC in the differential diagnosis of processes in the sphenoid sinus. As both PAs and RCCs are benign sellar lesions, surgical management of a concomitant occurrence of these tumors mainly depends on the size of the lesions and their clinical manifestations. For patients with PA and concomitant RCC, surgical resection should be considered, as there is an approximatrely 20% recurrence rate of the cyst after resection and the possibility of future clival erosion, if left untreated.

Authors+Show Affiliations

Department of Neurosurgery, University of Marburg, Marburg, Germany.Department of Pathology and Laboratory Medicine; Center for Adult Cancer Research; University of Tennessee Health Science Center, Memphis, Tennessee.Department of Otolaryngology-Head-Neck Surgery, University of Tennessee-Memphis, Memphis, Tennessee.Semmes Murphey Neurologic and Spine Institute and Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.Semmes Murphey Neurologic and Spine Institute and Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA. Electronic address: kenanarnaut@yahoo.com.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28532906

Citation

Pojskić, Mirza, et al. "First Report of Coexistence of Two Ectopic Pituitary Tumors: Rathke Cleft Cyst and Silent Adrenocorticotropic Hormone Adenoma." World Neurosurgery, vol. 104, 2017, pp. 1048.e1-1048.e7.
Pojskić M, Zbytek B, Beckford NS, et al. First Report of Coexistence of Two Ectopic Pituitary Tumors: Rathke Cleft Cyst and Silent Adrenocorticotropic Hormone Adenoma. World Neurosurg. 2017;104:1048.e1-1048.e7.
Pojskić, M., Zbytek, B., Beckford, N. S., Boop, F. A., & Arnautović, K. I. (2017). First Report of Coexistence of Two Ectopic Pituitary Tumors: Rathke Cleft Cyst and Silent Adrenocorticotropic Hormone Adenoma. World Neurosurgery, 104, e1-e7. https://doi.org/10.1016/j.wneu.2017.05.070
Pojskić M, et al. First Report of Coexistence of Two Ectopic Pituitary Tumors: Rathke Cleft Cyst and Silent Adrenocorticotropic Hormone Adenoma. World Neurosurg. 2017;104:1048.e1-1048.e7. PubMed PMID: 28532906.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - First Report of Coexistence of Two Ectopic Pituitary Tumors: Rathke Cleft Cyst and Silent Adrenocorticotropic Hormone Adenoma. AU - Pojskić,Mirza, AU - Zbytek,Blazej, AU - Beckford,Neal S, AU - Boop,Frederick A, AU - Arnautović,Kenan I, Y1 - 2017/05/19/ PY - 2017/03/23/received PY - 2017/05/09/revised PY - 2017/05/11/accepted PY - 2017/5/24/pubmed PY - 2017/9/26/medline PY - 2017/5/24/entrez KW - ACTH pituitary adenoma KW - Clival invasion KW - Ectopic pituitary adenoma KW - Rathke cleft cyst KW - Sphenoid sinus tumor SP - 1048.e1 EP - 1048.e7 JF - World neurosurgery JO - World Neurosurg VL - 104 N2 - BACKGROUND: Rathke cleft cysts (RCCs) and pituitary adenomas (PAs) are thought to have a common embryonic ancestry; however, PAs with a concomitant RCC inside the sella turcica are rarely observed. Ectopic pituitary tumors are also rare. CASE DESCRIPTION: We present the case of a 65-year-old woman with an ectopic RCC in the sphenoid sinus and outside the sella turcica concomitant with an adrenocorticotropic hormone (ACTH)-staining, clinically silent PA. The patient had headache but no endocrine or visual disturbances. Preoperative magnetic resonance imaging revealed infrasellar cystic lesion in the sphenoid sinus with erosion of the clivus and intact sellar floor. The patient underwent gross total microsurgical resection through the transnasal route with an uneventful postoperative course. CONCLUSIONS: To our knowledge, this is the first reported ectopic RCC located outside the sella turcica with a concomitant ACTH-staining PA. This also appears to be the first ACTH-staining adenoma concomitant with RCC reported in the literature, regardless of location, not presenting with Cushing disease. This case shows that we can now include pituitary adenoma with or without a concomitant RCC in the differential diagnosis of processes in the sphenoid sinus. As both PAs and RCCs are benign sellar lesions, surgical management of a concomitant occurrence of these tumors mainly depends on the size of the lesions and their clinical manifestations. For patients with PA and concomitant RCC, surgical resection should be considered, as there is an approximatrely 20% recurrence rate of the cyst after resection and the possibility of future clival erosion, if left untreated. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/28532906/First_Report_of_Coexistence_of_Two_Ectopic_Pituitary_Tumors:_Rathke_Cleft_Cyst_and_Silent_Adrenocorticotropic_Hormone_Adenoma_ DB - PRIME DP - Unbound Medicine ER -