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| PHOTO ESSAY |
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| Year : 2023 | Volume
: 3
| Issue : 2 | Page : 591-593 |
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Intrasellar Rathke's cleft cyst with bilateral temporal optic disk pallor in a myopic girl
Rutusha Dodwad1, Dipankar Das2, Ganesh Chandra Kuri3, Madhusmita Mahapatra1, Obaidur Rehman4
1 Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
2 Departments of Uvea, Ocular Pathology and Neuro-Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
3 Neuro-Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
4 Department of Oculoplasty, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| Date of Submission | 01-Aug-2022 |
| Date of Acceptance | 07-Dec-2022 |
| Date of Web Publication | 28-Apr-2023 |
Correspondence Address:
Rutusha Dodwad
Sri Sankaradeva Nethralaya, 96 Basistha Road, Beltola, Guwahati, Assam
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_1897_22
Keywords: Bilateral temporal disk pallor, Rathke's pouch cyst, retinal nerve fiber layer
How to cite this article:
Dodwad R, Das D, Kuri GC, Mahapatra M, Rehman O. Intrasellar Rathke's cleft cyst with bilateral temporal optic disk pallor in a myopic girl. Indian J Ophthalmol Case Rep 2023;3:591-3 |
How to cite this URL:
Dodwad R, Das D, Kuri GC, Mahapatra M, Rehman O. Intrasellar Rathke's cleft cyst with bilateral temporal optic disk pallor in a myopic girl. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Jun 5];3:591-3. Available from: https://www.ijoreports.in/text.asp?2023/3/2/591/374909 |
Rathke's cleft cyst (RCC) originates from the remnants of Rathke's pouch, which disappears during the third or fourth week of embryonic period.[1] Magnetic resonance imaging (MRI) is the investigation modality of choice for its diagnosis.[2]
A 13-year-old Indian girl presented to a tertiary eye care center in Northeast India. Best corrected visual acuity was 20/20, N6 in both eyes (OU). Slit-lamp biomicroscopy examination was unremarkable. Dilated fundus findings correlated with disk photograph, which revealed temporal disk pallor in OU [Figure 1]. Optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) revealed significant nasal and temporal thinning of RNFL in left eye (OS) [Figure 2]. Humphrey visual field (HVF) analyzer 30-2 showed a central defect in OS [Figure 3]. Magnetic resonance imaging (MRI) of the brain and orbit revealed an oval, nonenhancing intrasellar lesion of approximately 7 × 4 mm size between the lobes of the pituitary gland. The lesion was hyperintense on T1-weighted imaging and hypointense on T2-weighted imaging. The optic nerve calibers were relatively reduced with mild prominence of perioptic cerebrospinal fluid sheath. The lesion was suggestive of intrasellar Rathke's pouch cyst [Figure 4]. Patient was referred to a neurologist for further management. | Figure 1: Optic disk photo showing temporal disk pallor in the right eye (a) and in the left eye (b)
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 | Figure 2: OCT RNFL showing normal appearance in OD. Nasal and temporal thinning of retinal nerve fiber layer seen in OS. OCT = optical coherence, RNFL = retinal nerve fiber
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 | Figure 3: Visual field on HVF 30-2 was reliable. Findings were unremarkable in OD (a) and showed a central defect in OS (b). HVF = Humphrey visual field
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 | Figure 4: MRI of the brain and orbit T1-weighted images in (a) coronal section and (b) sagittal section, showing an oval-shaped intrasellar lesion between the lobes of the pituitary gland. The lesion is hyperintense on T1-weighted image and hypointense on T2-weighted image. No contural deformity of the pituitary gland or suprasellar extension is seen, suggestive of intrasellar Rathke's pouch cyst. MRI = magnetic resonance imaging
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| Discussion | |  |
RCC is a sellar and/or suprasellar benign lesion derived from the remnants of Rathke's pouch.[1] It is a rare lesion of the pituitary gland with an asymptomatic presentation.[3] The most common symptoms are of pituitary dysfunction, headaches, and ophthalmic manifestations including visual field defects such as bitemporal and homonymous defects, diplopia, gradually developing atrophy of the optic nerve, and papilledema.[4],[5] We report a case of RCC showing significant RNFL defects, visual field defects on HVF 30-2, and significant MRI findings.
MRI is superior to computed tomography (CT) in the evaluation of the RCC.[2]
Acknowledgement
Sri Kanchi Sankara Health and Educational Foundation is acknowledged.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Raghunath A, Sampath S, Devi BI. Is there a need to diagnose Rathke's cleft cyst pre operatively. Neurol India 2010;58:69-73.  [ PUBMED] [Full text] |
| 2. | Naik VD, Thakore NR. A case of symptomatic Rathke's cyst. BMJ Case Rep 2013;2013:bcr2012006943. doi: 10.1136/bcr-2012-006943. |
| 3. | Raper DMS, Besser M. Clinical features, management and recurrence of symptomatic Rathke's cleft cyst. J Clin Neurosci 2009;16:385-9. |
| 4. | Voelker JL, Campbell RL, Muller J. Clinical, radiographic, and pathological features of symptomatic Rathke's cleft cysts. J Neurosurg 1991;74:535-44. |
| 5. | Wagener HP, Love JG. Fields of vision in cases of tumor of Rathke's pouch. Arch Ophthalmol 1943;29:873-87. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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