Fact-sheet: Rathke cleft cyst


Updated on 06/05/2026 at 7:30 PM

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Definition

Benign cystic lesion of the sellar region.
Epidemiology:
- Common (20%)
- Marked female predominance

The cavity between the anterior and intermediate parts of the pituitary gland may persist (Rathke's cleft) and enlarge due to the epithelial cells of its wall, giving rise to Rathke's cleft cyst.

Clinical features

  • Asymptomatic ++
  • Symptomatic in large forms due to compression of adjacent structures (anterior pituitary, pituitary stalk, and optic chiasm), manifesting as headaches
  • endocrine disturbances
  • visual disturbances.

Laboratory findings

Various endocrine disturbances if large.

CT

Well-defined intrasellar or intra- and suprasellar cystic lesion, in the midline, without contrast enhancement.
No calcifications.
However, the CT appearance is nonspecific, warranting MRI.

MRI

Midline intrasellar lesion, located between the anterior and posterior pituitary, with homogeneous signal, not enhancing after injection.
2 types:

  • Serous (fluid-like): T1 hypointense and T2 hyperintense
  • Mucoid: T1 hyperintense and T2 hypointense
    --> the signal depends on protein content and the degree of hydration of the cyst; cysts of intermediate signal may therefore be found.
    Occasionally, heterogeneous signal with intracystic nodules that are T1 hyperintense and relatively T2 hypointense compared with the rest of the cyst contents, without enhancement after injection, corresponding to proteinaceous concretions.

Diffusion-weighted imaging: hypointense relative to brain parenchyma, with increased ADC.

Management

If asymptomatic: clinical and radiologic follow-up.
If symptomatic: consider transnasal surgery (pneumocephalus or recurrence within 2 years possible).
A Rathke's cleft cyst may remain stable, enlarge, or shrink spontaneously, depending on mucus secretion by the goblet cells located in the single-cell layer of the cyst wall.

Differential diagnosis

  • Pituitary adenoma:
    - hemorrhagic (differential diagnosis with the mucoid form)
    - cystic (with the serous form)
  • Pituitary adenoma apoplexy
  • Craniopharyngioma: presence of calcifications.