Suprasellar Mass – Rathke Cleft Cyst

History: 20 year old female with headache and blurry vision

Sagittal T1-weighted MRI of the brain demonstrates a lobulated sellar and suprasellar mass (blue arrow) which is homogeneously T1 hyperintense. The optic chiasm appears to be draping over this lesion.

This is a case of a Rathke cleft cyst, which is a benign suprasellar mass. Rathke’s pouch is a depression in the roof of the developing mouth in front of the buccopharyngeal membrane. It gives rise to the anterior pituitary (adenohypophysis), a part of the endocrine system. Rathke’s pouch normally closes early in fetal development, but a remnant often persists as a cleft that lies within the pituitary gland. This remnant gives rise to the Rathke cleft cyst seen above.

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

The differential diagnosis of suprasellar masses is best remembered with the mnemonic SATCHMOE:

S: Sarcoid, sellar tumor (adenoma)

A: Anuerysm

T: Teratoma or tuberculosis

C: Craniopharyngioma, cleft cyst, chordoma

H: Hamartoma, hypothalamic glioma

M: Meningioma, metastasis

O: Optic nerve glioma

E: Eosinophilic granuloma, epidermoid