title: Rathke cleft cyst masquerading as pituitary abscess: A case report.
abstract: BACKGROUND
  Rathke cleft cyst (RCC) is a rare cystic sellar entity, which is usually small in size and asymptomatic in most patients. RCC presenting panhypopituitarism and a cystic lesion with rim enhancement on magnetic resonance imaging is extremely rare. Therefore, it is easy to be misdiagnosed as pituitary abscess because of the similar clinical manifestations and neuroimaging changes.
  
  
  METHODS
  We report a rare case of RCC masquerading as pituitary abscess clinically and radiologically with no evidence of central nervous system infection. The patient was initially suspected to be diagnosed with pituitary abscess, which was denied by the histopathological findings of RCC with no intraoperative drainage of abscess.We present an uncommon case of RCC masquerading as pituitary abscess in a 62-year-old Chinese male patient. The patient was admitted to Peking Union Medical College Hospital complaining of severe frontal pulsatile headache, visual acuity deficit, polyuria, polydipsia, and slight disturbance of consciousness. The biochemical and endocrinological examinations revealed severe hyponatremia and panhypopituitarism. Magnetic resonance imaging showed a sellar lesion with the apparent cystic change and rim enhancement. Accordingly, pituitary abscess was misdiagnosed at the beginning.The patient received hormone replacement therapy and underwent a trans-sphenoidal surgery. The surgical findings were uneventful. The histopathological examinations showed no infiltration of inflammatory cells or pus, and proved the lesion to be RCC.
  
  
  CONCLUSIONS
  Through this rare case, we aim to emphasize that the differential diagnosis of sellar lesions requires constant vigilance and that RCC may lead to clinical and radiological changes similar with pituitary abscess.
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Chengxian
authors.initials: C
authors.lastname: Yang
authors.forename: Xinjie
authors.initials: X
authors.lastname: Bao
authors.forename: Xiaohai
authors.initials: X
authors.lastname: Liu
authors.forename: Kan
authors.initials: K
authors.lastname: Deng
authors.forename: Ming
authors.initials: M
authors.lastname: Feng
authors.forename: Yong
authors.initials: Y
authors.lastname: Yao
authors.forename: Renzhi
authors.initials: R
authors.lastname: Wang
mesh_terms: D001922:Brain Abscess / Q000175:diagnosis*; D020863:Central Nervous System Cysts / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D010900:Pituitary Diseases / Q000175:diagnosis*