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Rathke Cleft Cyst


Rathke's pouch is a normal component of development which eventually forms the anterior lobe, pars intermedia and pars tuberalis of the pituitary gland. This pouch normally closes early in fetal development, but a remnant often persists as a cleft that lies within the pituitary gland. Occasionally, this remnant gives rise to a large cyst, the Rathke's cleft cyst (RCC), that causes symptoms.

Symptomatic RCCs are relatively uncommon lesions, accounting for less than 1% of all primary masses within the brain. RCCs can be seen at any age, although most are identified in adults.

MRI of patient with Rathke's cleft cyst

Intrasellar RCCs are usually asymptomatic and are found incidentally at autopsy or MR imaging. RCCs may also present with visual disturbances, symptoms of pituitary dysfunction, and headaches. RCCs are diagnosed with MRI or CT scans of the brain or pituitary.

Other possible diagnoses that are considered when a cystic mass is seen in the area of the pituitary includes an arachnoid cyst, a cystic pituitary adenoma, or a craniopharyngioma. Symptomatic RCC warrant transsphenoidal surgical drainage and/or excision. The recurrence rate following surgical treatment is extremely low.


The pituitary gland is derived from two sources. The anterior lobe is an upgrowth of ectoderm from the roof of the stodeum, while the posterior lobe is a down groth of neurectoderm from the diencephalon. In the middle of the fourth week, a diverticulum, Rathke's pouch, grows upwards from the roof of what will become the mouth towards the developing brain. As the upgrowth contacts a downgrowth from the brain, the infundibulum, it begins to pinch off from its connection with the stomodeum. By the sixth week the connection between Rathke's pouch and the oral cavity degenerates. The cells of Rathke's pouch proliferate to form the pars distalis, and extend up the anterior aspect of the infundibulum as the pars tuberallis. The posterior surface of Rathke's pouch does not proliferate but forms the poorly developed pars intermedia. The infundibulum having grown down from the floor of the diencephalon, expands as the axons of cells in the diencephalon grow down into it.

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