Spontaneous and asymptomatic rupture of an RCC with resolution of symptoms

• Published in: BMJ case reports Vol. 17; no. 3; p. e258534
• Main Authors: Chaudhry, Maaria, Botterbush, Kathleen, Zhang, Justin K, Coppens, Jeroen
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 12.03.2024; BMJ Publishing Group
• Subjects: Asymptomatic; Carcinoma, Renal Cell; Case reports; Central Nervous System Cysts - surgery; Cysts; Humans; Hydrocephalus; Kidney Neoplasms; Magnetic Resonance Imaging - methods; Male; Older people; Pituitary gland; Retrospective Studies; Rupture; Steroids; Surgery; Thyroid gland; Neuroimaging; Neurology; Neurological injury; Neurosurgery
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2023-258534

There is no standard of care for management of Rathke cleft cysts (RCCs), and protocol for spontaneous rupture or residual capsule fragments is not well documented.Our case involves a Caucasian man in his 80s who presented with muscle weakness, fatigue, bitemporal hemianopia and pain. Further examination demonstrated decreased thyroid and cortisol levels. MRI revealed a 1.6×1.5×1.3 cm sellar homogenous mass with extension into the suprasellar cistern. While the size of the cyst was rather large, a decision was made to follow conservatively with serial MRI. At 3 years, the mass had spontaneously regressed. The patient was asymptomatic without imaging evidence of RCC recurrence at 4-year follow-up.Classic indications for surgical intervention in suprasellar cysts were subtle in our patient and his advanced age made us take a conservative approach. Current data are lacking regarding management of RCCs presenting with endocrine dysfunction. Our case suggests that RCCs presenting with endocrine dysfunction may be managed conservatively with serial imaging-based monitoring.