Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

Intrasellar xanthogranuloma with abscess formation in a patient with Rathke's cleft cyst

Yo Tsuda, M.D.1), Takuya Oguri, M.D., Ph.D.1), Keita Sakurai, M.D., Ph.D.2), Tadashi Watanabe, M.D., Ph.D.3), Nagako Maeda, M.D., Ph.D.4) and Hiroyuki Yuasa, M.D., Ph.D.1)

1)Department of Neurology, Tosei General Hospital
2)Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital
3)Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital
4)Department of Pathology, Japanese Red Cross Nagoya Daini Hospital

An 80-year-old woman diagnosed with granulomatosis with polyangiitis (GPA) complained of a sustained, nonpulsatile headache. Her brain MRI diffusion-weighted images revealed a high-signal-intensity, space-occupying lesion in the sellar region that was rim-enhanced on gadolinium-enhanced T1-weighted images. Pituitary involvement of GPA was initially suspected based on her condition; however, an abscess formation within an existing Rathke's cleft cyst was also considered according to a previous MRI finding that had been conducted for an unrelated purpose. A trans-sphenoidal resection of the lesion revealed an abscess with foam cells. These findings were consistent with a diagnosis of a xanthogranuloma with abscess formation in the Rathke's cleft cyst, and her headache was completely resolved without any immune therapy that is required for GPA. Thus, differential diagnosis of space-occupying lesions in the seller region should include xanthogranuloma with abscess formation, especially if a Rathke's cleft cyst is detected as an antecedent finding.
Full Text of this Article in Japanese PDF (489K)

(CLINICA NEUROL, 58: 411|413, 2018)
key words: xanthogranuloma, Rathke's cleft cyst, abscess formation, magnetic resonance imaging (MRI)

(Received: 28-Feb-18)