Accepted Manuscript Suprasellar colloid cyst: an unusual location Martin Catala PII:
S1878-8750(14)00477-X
DOI:
10.1016/j.wneu.2014.05.018
Reference:
WNEU 2373
To appear in:
World Neurosurgery
Received Date: 12 December 2013 Accepted Date: 9 May 2014
Please cite this article as: Catala M, Suprasellar colloid cyst: an unusual location, World Neurosurgery (2014), doi: 10.1016/j.wneu.2014.05.018. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Suprasellar colloid cyst : an unusual location
Martin CATALA (1,2)
RI PT
(1) Laboratoire de Biologie du Développement (Directrice : Dr Sylvie SchneiderMaunoury), UMR 7622 CNRS, Université Pierre et Marie Curie, Paris, France.
(2) Fédération de Neurologie (Pr Catherine Lubetzki), Groupe Hospitalier Pitié-
Address for correspondance
M AN U
Laboratoire de Biologie du Développement
UMR 7622 CNRS, Université Pierre et Marie Curie 9 quai Saint Bernard Boîte courier 24 75252 Paris Cedex 05
TE D
France
Téléphone : (33-1) 44 27 36 90
EP
Email : [email protected]
AC C
SC
Salpêtrière, Paris, France
ACCEPTED MANUSCRIPT Paniraj et al. (1) recently reported the case of a 27 year-old woman with headaches and visual disturbances that leads to the discovery of a cyst located exclusively in the suprasellar region. Pathological analysis of the cyst whose content is eosinophilic showed that the wall is composed of cuboidal and columnar ciliated cells. These cells are decorated by antibodies directed against cytokeratin and EMA. The authors conclude
RI PT
that the lesion is a colloid cyst. This case reports needs to develop two general comments. The first one corresponds to the histological nature of this cyst.
Colloid cysts predominate largely in the third ventricle as indicated by the authors. Few
SC
cases have been reported in another location. The histological definition of colloid cyst is not simple. Thus, Nomikos et al. (2) reported 18 cases of colloid cysts in a series of 69 supra and intrasellar cysts but they do not define the histological criteria that allow
M AN U
them to conclude to this diagnosis. The principal neuropathology textbooks (3, 4, 5) state that the histological appearance of the wall of colloid cysts is variable even within the same lesion. The cells are cuboidal or columnar, may contain cilia and mucin. The main differential histological diagnosis is the so-called Rathke’s cleft cyst (3, 4, 5). This type of cyst is located in the sellar, suprasellar or both regions (6). The lining cells are
TE D
cuboidal or prismatic, ciliated and produce mucin (3, 4, 5). The only observed difference is the presence of an inconstant squamous metaplasia in Rathke’s cleft cyst (3, 4, 5) while this type of lesion is never encountered in the context of colloid cysts (3, 4, 5). However, it should be noted that squamous metaplasia is uncommon in the case of
EP
Rathke's cleft cyst and its absence does not allow excluding such a diagnosis. Thus, the classic microscopic appearance reported by the authors is compatible with both colloid
AC C
and Rathke’s cleft cyst. The authors attribute to immunohistochemistry a major role in the classification of these cysts (1). Thus, according to them, Rathke’s cleft cysts are positive for GFAP and skin type cytokeratin, whereas colloid cysts are not. We note, however, that these staining experiments were not achieved in this case report thus weakening their argument. In addition, their immunological data are inaccurate. Colloid cyst wall is never actually labelled by anti-GFAP antibody (7, 8). But, epithelial cells of Rathke’s cleft cyst do not always express GFAP (7, 8). Thus, the absence of labelling with an antibody directed against GFAP cannot exclude the final diagnosis of Rathke’s cleft cyst contrary to the assertions of the authors (1). The term skin type cytokeratin is very imprecise. Indeed, epidermis expresses at least 7 different types of cytokeratins (9).
ACCEPTED MANUSCRIPT Cytokeratin 1 studied by Uematsu et al. (7) sometimes marks the walls of Rathke's cleft cyst but not that of colloid cysts. However, the expression of cytokeratin 1 is observed in cells of superficial squamous stratified epithelia (9). Thus, the inconstant expression of cytokeratin 1 in Rathke’s cleft cysts could reflect the presence of a squamous metaplasia. Nevertheless, the absence of labelling with antibodies against cytokeratin 1 does not
RI PT
exclude the diagnosis of this type of cyst (7). In conclusion, all the histological data reported by Paniraj et al. (1) does not allow to confirm the colloid nature of the cyst and to exclude a Rathke’s cleft cyst.
SC
The second comment concerns the theories quoted by the authors to account for the development of such lesions. Paniraj et al. (1) quote Graziani et al. (10) who attribute the embryonic origin of neurenteric cysts, Rathke’s cleft cysts and colloid cysts to
M AN U
endoderm. They precisely consider that these lesions in suprasellar location arise from Seessel’s pouch (10) incorrectly quoted sessile pouch by the authors (1). This pouch is a diverticulum of the foregut endoderm described first by Albert Seessel in the chick embryo. It is well known that Seessel’s pouch does not participate in the formation of the adenohypophysis contrarily to what have been stated in old theories (11). In other
TE D
words, all the adenophypophysis including Rathke’s cleft derives from an ectodermal pocket, namely Rathke’s pouch (11). It seems thus very unlikely for me that the so-called Rathke’s cleft cysts develop from endoderm of Seessel’s pouch and not from ectoderm.
EP
In conclusion, the case reported by Paniraj et al. (1) represents in my opinion a purely
AC C
suprasellar Rathke’s cleft cyst whose origin is the ectoderm and not the endoderm.
1. Paniraj GL, Panigrahi M, Reddy AK, Satish: Suprasellar colloid cyst: an unusual location. World Neurosurgery 2013. 2. Nomikos P, Buchfelder M, Fahlbusch R: Intra-and suprasellar colloid cysts. Pituitary 2:123-126, 1992. 3. Bigner DD, McLendon RE, Bruner JM: Russell & Rubinstein Pathology of tumours of the nervous system. 6th edition. London: Arnold; 1998. 4. Ironside JW, Moss TH, Louis DN, Lowe JS, Weller RO: Diagnostic pathology of nervous system tumours. London: Churchill Livingstone; 2002.
ACCEPTED MANUSCRIPT 5. Graham DI, Lantos PL: Greenfield’s neuropathology. 7th edition. London: Arnold; 2002. 6. Potts MB, Jahangiri A, Lamborn KR, Blevins LS, Kunwar S, Aghi MK: Suprasellar Rathke cleft cysts: clinical presentation and treatment outcomes. Neurosurgery 69:1058-1069, 2011.
nervous
system,
characteristic
expression
of
RI PT
7. Uematsu Y, Rojas-Corona RR, Llena JF, Hirano A: Epithelial cysts in the central cytokeratins
in
an
immunohistochemical study. Acta Neurochir (Wien) 107:93-101, 1990.
8. Lach B, Scheithauer BW, Gregor A, Wick MR: Colloid cyst of the third ventricle. A
epithelium. J Neurosurg 78:101-111, 1993.
SC
comparative immunohistochemical study of neuraxis cysts and choroid plexus
9. Moll R, Divo M, Langbein L: The human keratins: biology and pathology.
M AN U
Histochem Cell Biol 129:705-733, 2008.
10. Graziani N, Dufour H, Figarella-Branger D, Donnet A, Bouillot P, Grisoli F: Do the suprasellar neurenteric cyst, the Rathke cleft cyst and the colloid cyst constitute a same entity? Acta Neurochir (Wien) 133:174-180, 1995. 11. Catala M, Trouillas J: Embryology of the human hypophysis. EMC (Elsevier SAS,
AC C
EP
TE D
Paris), Endocrinologie-Nutrition, 10-017-A-10, 2006 [in French].
S1878-8750(14)00477-X
DOI:
10.1016/j.wneu.2014.05.018
Reference:
WNEU 2373
To appear in:
World Neurosurgery
Received Date: 12 December 2013 Accepted Date: 9 May 2014
Please cite this article as: Catala M, Suprasellar colloid cyst: an unusual location, World Neurosurgery (2014), doi: 10.1016/j.wneu.2014.05.018. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Suprasellar colloid cyst : an unusual location
Martin CATALA (1,2)
RI PT
(1) Laboratoire de Biologie du Développement (Directrice : Dr Sylvie SchneiderMaunoury), UMR 7622 CNRS, Université Pierre et Marie Curie, Paris, France.
(2) Fédération de Neurologie (Pr Catherine Lubetzki), Groupe Hospitalier Pitié-
Address for correspondance
M AN U
Laboratoire de Biologie du Développement
UMR 7622 CNRS, Université Pierre et Marie Curie 9 quai Saint Bernard Boîte courier 24 75252 Paris Cedex 05
TE D
France
Téléphone : (33-1) 44 27 36 90
EP
Email : [email protected]
AC C
SC
Salpêtrière, Paris, France
ACCEPTED MANUSCRIPT Paniraj et al. (1) recently reported the case of a 27 year-old woman with headaches and visual disturbances that leads to the discovery of a cyst located exclusively in the suprasellar region. Pathological analysis of the cyst whose content is eosinophilic showed that the wall is composed of cuboidal and columnar ciliated cells. These cells are decorated by antibodies directed against cytokeratin and EMA. The authors conclude
RI PT
that the lesion is a colloid cyst. This case reports needs to develop two general comments. The first one corresponds to the histological nature of this cyst.
Colloid cysts predominate largely in the third ventricle as indicated by the authors. Few
SC
cases have been reported in another location. The histological definition of colloid cyst is not simple. Thus, Nomikos et al. (2) reported 18 cases of colloid cysts in a series of 69 supra and intrasellar cysts but they do not define the histological criteria that allow
M AN U
them to conclude to this diagnosis. The principal neuropathology textbooks (3, 4, 5) state that the histological appearance of the wall of colloid cysts is variable even within the same lesion. The cells are cuboidal or columnar, may contain cilia and mucin. The main differential histological diagnosis is the so-called Rathke’s cleft cyst (3, 4, 5). This type of cyst is located in the sellar, suprasellar or both regions (6). The lining cells are
TE D
cuboidal or prismatic, ciliated and produce mucin (3, 4, 5). The only observed difference is the presence of an inconstant squamous metaplasia in Rathke’s cleft cyst (3, 4, 5) while this type of lesion is never encountered in the context of colloid cysts (3, 4, 5). However, it should be noted that squamous metaplasia is uncommon in the case of
EP
Rathke's cleft cyst and its absence does not allow excluding such a diagnosis. Thus, the classic microscopic appearance reported by the authors is compatible with both colloid
AC C
and Rathke’s cleft cyst. The authors attribute to immunohistochemistry a major role in the classification of these cysts (1). Thus, according to them, Rathke’s cleft cysts are positive for GFAP and skin type cytokeratin, whereas colloid cysts are not. We note, however, that these staining experiments were not achieved in this case report thus weakening their argument. In addition, their immunological data are inaccurate. Colloid cyst wall is never actually labelled by anti-GFAP antibody (7, 8). But, epithelial cells of Rathke’s cleft cyst do not always express GFAP (7, 8). Thus, the absence of labelling with an antibody directed against GFAP cannot exclude the final diagnosis of Rathke’s cleft cyst contrary to the assertions of the authors (1). The term skin type cytokeratin is very imprecise. Indeed, epidermis expresses at least 7 different types of cytokeratins (9).
ACCEPTED MANUSCRIPT Cytokeratin 1 studied by Uematsu et al. (7) sometimes marks the walls of Rathke's cleft cyst but not that of colloid cysts. However, the expression of cytokeratin 1 is observed in cells of superficial squamous stratified epithelia (9). Thus, the inconstant expression of cytokeratin 1 in Rathke’s cleft cysts could reflect the presence of a squamous metaplasia. Nevertheless, the absence of labelling with antibodies against cytokeratin 1 does not
RI PT
exclude the diagnosis of this type of cyst (7). In conclusion, all the histological data reported by Paniraj et al. (1) does not allow to confirm the colloid nature of the cyst and to exclude a Rathke’s cleft cyst.
SC
The second comment concerns the theories quoted by the authors to account for the development of such lesions. Paniraj et al. (1) quote Graziani et al. (10) who attribute the embryonic origin of neurenteric cysts, Rathke’s cleft cysts and colloid cysts to
M AN U
endoderm. They precisely consider that these lesions in suprasellar location arise from Seessel’s pouch (10) incorrectly quoted sessile pouch by the authors (1). This pouch is a diverticulum of the foregut endoderm described first by Albert Seessel in the chick embryo. It is well known that Seessel’s pouch does not participate in the formation of the adenohypophysis contrarily to what have been stated in old theories (11). In other
TE D
words, all the adenophypophysis including Rathke’s cleft derives from an ectodermal pocket, namely Rathke’s pouch (11). It seems thus very unlikely for me that the so-called Rathke’s cleft cysts develop from endoderm of Seessel’s pouch and not from ectoderm.
EP
In conclusion, the case reported by Paniraj et al. (1) represents in my opinion a purely
AC C
suprasellar Rathke’s cleft cyst whose origin is the ectoderm and not the endoderm.
1. Paniraj GL, Panigrahi M, Reddy AK, Satish: Suprasellar colloid cyst: an unusual location. World Neurosurgery 2013. 2. Nomikos P, Buchfelder M, Fahlbusch R: Intra-and suprasellar colloid cysts. Pituitary 2:123-126, 1992. 3. Bigner DD, McLendon RE, Bruner JM: Russell & Rubinstein Pathology of tumours of the nervous system. 6th edition. London: Arnold; 1998. 4. Ironside JW, Moss TH, Louis DN, Lowe JS, Weller RO: Diagnostic pathology of nervous system tumours. London: Churchill Livingstone; 2002.
ACCEPTED MANUSCRIPT 5. Graham DI, Lantos PL: Greenfield’s neuropathology. 7th edition. London: Arnold; 2002. 6. Potts MB, Jahangiri A, Lamborn KR, Blevins LS, Kunwar S, Aghi MK: Suprasellar Rathke cleft cysts: clinical presentation and treatment outcomes. Neurosurgery 69:1058-1069, 2011.
nervous
system,
characteristic
expression
of
RI PT
7. Uematsu Y, Rojas-Corona RR, Llena JF, Hirano A: Epithelial cysts in the central cytokeratins
in
an
immunohistochemical study. Acta Neurochir (Wien) 107:93-101, 1990.
8. Lach B, Scheithauer BW, Gregor A, Wick MR: Colloid cyst of the third ventricle. A
epithelium. J Neurosurg 78:101-111, 1993.
SC
comparative immunohistochemical study of neuraxis cysts and choroid plexus
9. Moll R, Divo M, Langbein L: The human keratins: biology and pathology.
M AN U
Histochem Cell Biol 129:705-733, 2008.
10. Graziani N, Dufour H, Figarella-Branger D, Donnet A, Bouillot P, Grisoli F: Do the suprasellar neurenteric cyst, the Rathke cleft cyst and the colloid cyst constitute a same entity? Acta Neurochir (Wien) 133:174-180, 1995. 11. Catala M, Trouillas J: Embryology of the human hypophysis. EMC (Elsevier SAS,
AC C
EP
TE D
Paris), Endocrinologie-Nutrition, 10-017-A-10, 2006 [in French].
