Because of advances in imaging, incidental diagnosis of midline intracranial neuroendocrine cystic masses is increasingly common. Two of these lesion types are usually asymptomatic but can grow large enough to press on surrounding neurovascular structures:
- Rathke cleft cysts (RCCs)—Non-neoplastic pituitary lesions that can cause headache, vision loss, and endocrine dysfunction
- Pineal gland cysts (PCs)—Can cause headache, hydrocephalus, and/or visual dysfunction
Addressing a gap in the literature, Edward R. Laws, MD, director of the Pituitary and Neuroendocrine Program at Brigham and Women’s Hospital, and colleagues examined whether there’s a link between RCCs and PCs. In the Journal of Neurological Surgery, Part B— Skull Base, they report no significant relationship.
The researchers reviewed data on 1,115 consecutive operative patients with pituitary lesions and 52 patients with pineal gland lesions who were treated at the Brigham between April 2008 and February 2020. To increase specificity, only patients with PCs measuring ≥5 mm in at least one imaging plane were included.
The team identified 116 patients with RCCs, all managed operatively, and 34 patients with PCs, all managed conservatively.
- 74% female
- Median age 38 (range, 12–78)
- RCC description—Most commonly an ovoid cyst located in the area of the intermediate lobe of the pituitary gland, inferior and posterior to the insertion of the pituitary infundibulum; suprasellar extension in 43%
- PCs were also present in 14 of these patients (12%)
- 74% female
- Median age 37 (range, 21–64)
- PC description—Unilocular or multilocular; spherical or ovoid; commonly located along the longitudinal axis of the pineal gland
- RCCs were also present in three of these patients (9%)
Group With Both RCCs and PCs (n=17)
- 70% female
- Mean age 37 (range, 17–61)
- Mean maximal diameter of RCCs—13 mm (range, 5–40 mm)
- Mean maximal diameter of PCs—7.5 mm (range, 5–17 mm)
Univariate analysis revealed no positive association between RCC and PC.