Triple sellar collision lesion: a unique case of pituitary adenoma, Rathke cleft cyst, and xanthogranuloma—case report and systematic review of the literature

TL;DR

A rare case of three coexisting sellar lesions—pituitary adenoma, Rathke cleft cyst, and xanthogranulomatous hypophysitis—is reported and analyzed.

Contribution

This is the third reported case of three histopathologically distinct lesions coexisting in the sellar region.

Findings

A 54-year-old female presented with three concurrent sellar lesions: pituitary adenoma, Rathke cleft cyst, and xanthogranulomatous hypophysitis.

The patient exhibited symptoms of mass compression and elevated free thyroxine levels.

Transsphenoidal endoscopic resection revealed a non-functional macroadenoma with XGH due to RCC rupture.

Abstract

The coexistence of three lesions in the sellar region is exceedingly rare. Only two cases with three histopathologically distinct lesions have been reported. However, here, we present a unique case of a 54-year-old female with pituitary adenoma (PA), xanthogranulomatous hypophysitis (XGH), and a Rathke cleft cyst (RCC). Clinically, the patient manifested symptoms of mass compression, such as moderate-intensity headaches and progressive visual acuity decrease. Relevant endocrinological evaluation revealed elevated free thyroxine levels without clinical manifestations. MRI revealed a suprasellar mass compatible with a macroadenoma. The patient underwent transsphenoidal endoscopic resection, resulting in a non-functional macroadenoma with associated XGH due to the rupture of RCC. Furthermore, in this article, we analyze the possible mechanisms involved in the pathogenesis of these lesions, emphasizing the type of spectrum to which they belong and the manifestations present.

The online version contains supplementary material available at 10.1007/s10014-025-00504-4.

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