PMC7388627_01
Photographs present the patient 3 months (A,B) and 36 months after surgery (C,D).
fendo-11-00460-g0001.jpg
PMC7388627_01_fendo-11-00460-g0001.jpg
F1
Physical examination at that time revealed significant abdominal obesity (BMI 31.6 kg/m2), plethora, and dorsocervical fat pad (Figures 1A,B). Figure 1 presents the patient's photographs at 3 months (Figures 1A,B) and 36 months (Figures 1C,D) after surgery.
Contrast-enhanced MRI showing Rathke's cleft cyst (white solid arrows) anterior to the pituitary stalk and compressing the upper part of the pituitary: (A) T1-weighted contrast-enhanced sagital view, (B) T2-weighted sagital view, (C) T1-weighted contrast-enhanced coronal view, and (D) T2-weighted coronal view. Contrast enhancement of the lower part of the cyst wall in continuity with the pituitary tissue is visible in contrast-enhanced T1-weighted scans [dashed arrows in (A,C)].
fendo-11-00460-g0002.jpg
PMC7388627_01_fendo-11-00460-g0002.jpg
F2
Magnetic resonance imaging of the pituitary gland, performed in May 2016, revealed a cystic lesion which was hypointense on contrast enhanced T1-weighted images and hyperintense on T2-weighted images and had typical features of RCCs (Figure 2).
Coronal and sagital view of the pituitary visualised by positron emission tomography using 11C-methyl-L-methionine magnetic resonance imaging (MET-PET/MR). The study revealed the pituitary gland as being morfologically slightly thicker on the left side of the cyst with a peak of tracer uptake in this area. SUV max was 4.17 for this region compared to SUV max 3.14 in the remaining pituitary tissue. White arrows indicate the location of increased tracer uptake.
fendo-11-00460-g0003.jpg
PMC7388627_01_fendo-11-00460-g0003.jpg
F3
Heterogenous 11C-methionine metabolism was observed around the cyst with a peak of tracer uptake on the left side of the cyst's wall (Figure 3).
Histopathological material (magnification 100x, Olympus DP73). (A) Stained with hematoxylin and eosin. (B) Masson's trichrome staining for connective tissue. Numerous gland cell nests are visible between the fibres of connective tissue of the Rathke's cleft cyst. (C) Staining for ACTH. Numerous groups of ACTH+ cells are visible in the Rathke's cleft cyst's wall. (D) Reticulin staining shows a regular fiber pattern with numerous cell nests suggesting non-adenomatous cell hyperplasia.
fendo-11-00460-g0004.jpg
PMC7388627_01_fendo-11-00460-g0004.jpg
F4
RCC. Reticular fibres retained a regular pattern indicating CH (Figure 4).
Timeline with information from the episode of care.
fendo-11-00460-g0005.jpg
PMC7388627_01_fendo-11-00460-g0005.jpg
F5
The patient was under the care of our Department for 36 months (Figure 5) and was aligned clinically and biochemically with replacement therapy: Hydrocortisone 10-5-0 mg, L-thyroxine 88/100 mug 1 x 1, dydrogesterone 10 mg (14 days a month) and estradiol 2 mg 1 x 1.