Fig. 16.1
An illustrative case of haemorrhagic RCC (Komatsu et al. 2010). A 46-year-old man had a 4-day history of severe headache. Neurological and endocrinological findings were normal. Coronal MR imaging show an intrasellar cystic mass with suprasellar extension, which is isointense on T1-weighted imaging (a) and mixed intensity on T2-weighted imaging (b). Rim enhancement is demonstrated along the cyst wall after gadolinium injection (c)
Fig. 16.2
Haematoxylin and eosin (H&E)-stained section of the case shown in Fig. 16.1 (Komatsu et al. 2010). Operative findings showed that the cyst was filled with haematoma. Pathologic examination shows that the RCC consists of ciliated columnar epithelium. The final diagnosis is RCC with haemorrhage (original magnification: a ×200, b ×400)
Fig. 16.3
Coronal and sagittal MRI of RCC with hypophysitis (Komatsu et al. 2010). A 77-year-old man developed a 2-day history of panhypopituitarism. MRI showed an intrasellar cyst with isointensity on T1-weighted imaging (a) and mixed intensity on T2-weighted imaging (b). Rim enhancement along the cyst wall is seen following gadolinium injection (c coronal view, d sagittal view)
Fig. 16.4
Histology of the surgical specimen (H&E) of the case illustrated in Fig. 16.3 showing ciliated columnar epithelium and diffuse lymphocytic infiltration (a, original magnification ×200) (Komatsu et al. 2010). Immunohistological staining is positive for cytokeratin AE1/AE3, which is a marker for epithelium, on the cyst wall (b, original magnification ×200)
16.5 Treatment
Hormonal replacement is important for cases with severe endocrinological deficits with acute onset. Drainage of cyst contents by a transsphenoidal approach is carried out as surgical treatment. There is a high rate of improvement of visual symptoms following surgery (Onesti et al. 1990; Kurisaka et al. 1998; Nishioka et al. 1999; Pawar et al. 2002; Binning et al. 2008; Komatsu et al. 2010; Chaiban et al. 2011). On the other hand, surgery can contribute to recovery from the endocrinological dysfunction, but the degree of endocrinological recovery varies (Binning et al. 2008; Komatsu et al. 2010; Chaiban et al. 2011). Further investigations regarding the effects of surgery on endocrine function are needed.
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