{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T10:56:36Z","timestamp":1770116196466,"version":"3.49.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","license":[{"start":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T00:00:00Z","timestamp":1737331200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,1,20]]},"abstract":"\n BACKGROUND<\/jats:title>\n Rathke cleft cysts (RCCs) are benign sellar\/suprasellar lesions that result from mucin-secreting vestigial remnants within the pars intermedia of the pituitary gland. When symptomatic, they can present with retro-orbital headaches, visual field defects, and\/or pituitary dysfunction.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n \n A 35-year-old female presented with subacute retro-orbital headache, right ptosis, and blurred vision. Workup revealed panhypopituitarism with central hypothyroidism and adrenal insufficiency. Imaging demonstrated a sellar\/suprasellar mass with subacute intralesional hemorrhage, which was thought to represent chronic pituitary apoplexy. The patient underwent an endoscopic endonasal approach in which the initial intraoperative frozen section suggested papillary craniopharyngioma. Subsequent specimens suggested RCC, thus presenting a surgical management conundrum. Hemihypophysectomy with lesionectomy was performed. Final histopathology demonstrated RCC with squamous metaplasia (RCC-SM), rupture, and hemorrhage.\n BRAF V600E<\/jats:italic>\n was not detected. However, activating mutations in\n KRAS<\/jats:italic>\n and\n MAP2K1<\/jats:italic>\n were identified.\n <\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n RCC can undergo SM and rupture, leading to a hemorrhagic-appearing cystic sellar\/suprasellar mass associated with cranial nerve palsies and hypopituitarism that mimics pituitary apoplexy. Intraoperative frozen sections can be ambiguous due to overlapping histopathological features with craniopharyngioma, complicating surgical decision-making. The authors hypothesize that RCC-SM may represent a transitional state between RCC and craniopharyngioma. Neurosurgeons should be mindful of this transitional entity and be prepared to modify their surgical strategy accordingly.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24657<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24657","type":"journal-article","created":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T15:54:05Z","timestamp":1737388445000},"source":"Crossref","is-referenced-by-count":0,"title":["Rathke cleft cyst with squamous metaplasia and activating mutations of mitogen-activated protein kinase signaling: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"given":"Adham","family":"Halaoui","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Diego, La Jolla, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanie","family":"Estrella","sequence":"additional","affiliation":[{"name":"Department of Neuropathology, University of California, San Diego, La Jolla, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carol H.","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University of California, San Diego, La Jolla, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa S.","family":"Goodwill","sequence":"additional","affiliation":[{"name":"Department of Neuropathology, University of California, San Diego, La Jolla, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas L.","family":"Beaumont","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Diego, La Jolla, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"7","key":"bib1","series-title":"J Clin Endocrinol Metab","first-page":"2357","article-title":"Clinical, radiological and pathological features of patients with Rathke's cleft cysts: tumors that may recur","volume":"82","author":"Mukherjee","year":"1997","unstructured":"Mukherjee JJIslam NKaltsas G, et al. Clinical, radiological and pathological features of patients with Rathke's cleft cysts: tumors that may recur. J Clin Endocrinol Metab. 1997;82(7):2357-2362."},{"issue":"4","key":"bib2","series-title":"J Neurosurg","first-page":"577","article-title":"Surgery for Rathke cleft cysts: technical considerations and outcomes","volume":"101","author":"Benveniste","year":"2004","unstructured":"Benveniste RJKing WAWalsh JLee JSNaidich TPPost KD. Surgery for Rathke cleft cysts: technical considerations and outcomes. J Neurosurg. 2004;101(4):577-584."},{"issue":"4","key":"bib3","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopathological relationships","volume":"28","author":"Zada","year":"2010","unstructured":"Zada GLin NOjerholm ERamkissoon SLaws ER. Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopathological relationships. Neurosurg Focus. 2010;28(4):E4."},{"issue":"2","key":"bib4","series-title":"J Neurosurg","first-page":"189","article-title":"Surgical outcomes in 118 patients with Rathke cleft cysts","volume":"102","author":"Aho","year":"2005","unstructured":"Aho CJLiu CZelman VCouldwell WTWeiss MH. Surgical outcomes in 118 patients with Rathke cleft cysts. J Neurosurg. 2005;102(2):189-193."},{"issue":"5","key":"bib5","series-title":"World Neurosurg","first-page":"527","article-title":"Symptomatic Rathke cleft cyst: clinical features and surgical outcomes","volume":"78","author":"Kim","year":"2012","unstructured":"Kim E. Symptomatic Rathke cleft cyst: clinical features and surgical outcomes. World Neurosurg. 2012;78(5):527-534."},{"key":"bib6","series-title":"World Neurosurg","first-page":"e35","article-title":"Soft gasket seal reconstruction after endoscopic endonasal transtuberculum resection of craniopharyngiomas","volume":"162","author":"Albonette-Felicio","year":"2022","unstructured":"Albonette-Felicio TMartinez-Perez RVankoevering K, et al. Soft gasket seal reconstruction after endoscopic endonasal transtuberculum resection of craniopharyngiomas. World Neurosurg. 2022;162:e35-e40."},{"key":"bib7","series-title":"Schmidek & Sweet Operative Neurosurgical Techniques: Indications, Methods, and Results","first-page":"194","article-title":"The endoscopic endonasal approach for craniopharyngiomas","author":"Beaumont","year":"2022","unstructured":"Beaumont TLHardesty DACarrau RLPrevedello DM. The endoscopic endonasal approach for craniopharyngiomas. In: Qui\u00f1ones-Hinojosa ASchmidek HH, eds. Schmidek & Sweet Operative Neurosurgical Techniques: Indications, Methods, and Results. 7th ed. Elsevier; 2022:194-202."},{"issue":"3","key":"bib8","series-title":"Brain Sci","first-page":"515","article-title":"Current advances in papillary craniopharyngioma: state-of-the-art therapies and overview of the literature","volume":"13","author":"Jannelli","year":"2023","unstructured":"Jannelli GCalvanese FPaun LRaverot GJouanneau E. Current advances in papillary craniopharyngioma: state-of-the-art therapies and overview of the literature. Brain Sci. 2023;13(3):515."},{"issue":"17","key":"bib9","series-title":"Cancer","first-page":"2910","article-title":"Targeted treatment of papillary craniopharyngiomas harboring BRAF V600E mutations","volume":"125","author":"Juratli","year":"2019","unstructured":"Juratli TAJones PSWang N, et al. Targeted treatment of papillary craniopharyngiomas harboring BRAF V600E mutations. Cancer. 2019;125(17):2910-2914."},{"issue":"1","key":"bib10","series-title":"Endocr Pathol","first-page":"23","article-title":"Comparative immunohistochemical assessment of craniopharyngioma and related lesions","volume":"18","author":"Le","year":"2007","unstructured":"Le BHTowfighi JKapadia SBLopes MB. Comparative immunohistochemical assessment of craniopharyngioma and related lesions. Endocr Pathol. 2007;18(1):23-30."},{"issue":"31","key":"bib11","series-title":"Oncotarget","first-page":"50564","article-title":"TREM-1 expression in craniopharyngioma and Rathke's cleft cyst: its possible implication for controversial pathology","volume":"7","author":"Liu","year":"2016","unstructured":"Liu YWang CHLi DL, et al. TREM-1 expression in craniopharyngioma and Rathke's cleft cyst: its possible implication for controversial pathology. Oncotarget. 2016;7(31):50564-50574."},{"issue":"4","key":"bib12","series-title":"J Neurosurg","first-page":"535","article-title":"Clinical, radiographic, and pathological features of symptomatic Rathke\u2019s cleft cysts","volume":"74","author":"Voelker","year":"1991","unstructured":"Voelker JLCampbell RLMuller J. Clinical, radiographic, and pathological features of symptomatic Rathke\u2019s cleft cysts. J Neurosurg. 1991;74(4):535-544."},{"issue":"6","key":"bib13","series-title":"Acta Neurochir (Wien)","first-page":"1069","article-title":"Rathke\u2019s cleft cysts with significant squamous metaplasia\u2014high risk of postoperative deterioration and close origins to craniopharyngioma","volume":"155","author":"Ogawa","year":"2013","unstructured":"Ogawa YWatanabe MTominaga T. Rathke\u2019s cleft cysts with significant squamous metaplasia\u2014high risk of postoperative deterioration and close origins to craniopharyngioma. Acta Neurochir (Wien). 2013;155(6):1069-1075."},{"issue":"6","key":"bib14","series-title":"Neuropathol Appl Neurobiol","first-page":"733","article-title":"BRAF V600E analysis for the differentiation of papillary craniopharyngiomas and Rathke\u2019s cleft cysts","volume":"41","author":"Schweizer","year":"2015","unstructured":"Schweizer LCapper DH\u00f6lsken A, et al. BRAF V600E analysis for the differentiation of papillary craniopharyngiomas and Rathke\u2019s cleft cysts. Neuropathol Appl Neurobiol. 2015;41(6):733-742."},{"key":"bib15","series-title":"Front Genet","first-page":"49","article-title":"Rathke\u2019s cleft cyst as origin of a pediatric papillary craniopharyngioma","volume":"9","author":"Schlaffer","year":"2018","unstructured":"Schlaffer SMBuchfelder MStoehr RBuslei RH\u00f6lsken A. Rathke\u2019s cleft cyst as origin of a pediatric papillary craniopharyngioma. Front Genet. 2018;9:49."},{"issue":"1","key":"bib16","series-title":"Signal Transduct Target Ther","first-page":"386","article-title":"KRAS mutation: from undruggable to druggable in cancer","volume":"6","author":"Huang","year":"2021","unstructured":"Huang LGuo ZWang FFu L. KRAS mutation: from undruggable to druggable in cancer. Signal Transduct Target Ther. 2021;6(1):386."},{"issue":"11","key":"bib17","series-title":"Trends Cancer","first-page":"955","article-title":"Next batter up! Targeting cancers with KRAS-G12D mutations","volume":"9","author":"Zeissig","year":"2023","unstructured":"Zeissig MNAshwood LMKondrashova OSutherland KD. Next batter up! Targeting cancers with KRAS-G12D mutations. Trends Cancer. 2023;9(11):955-967."},{"issue":"7","key":"bib18","series-title":"Cancer Gene Ther","first-page":"961","article-title":"Targeting KRASG12D mutation in non-small cell lung cancer: molecular mechanisms and therapeutic potential","volume":"31","author":"Tang","year":"2024","unstructured":"Tang YPu XYuan XPang ZLi FWang X. Targeting KRASG12D mutation in non-small cell lung cancer: molecular mechanisms and therapeutic potential. Cancer Gene Ther. 2024;31(7):961-969."},{"issue":"4","key":"bib19","series-title":"Clin Cancer Res","first-page":"655","article-title":"A small molecule with big impact: MRTX1133 targets the KRASG12D mutation in pancreatic cancer","volume":"30","author":"Wei","year":"2024","unstructured":"Wei DWang LZuo XMaitra ABresalier RS. A small molecule with big impact: MRTX1133 targets the KRASG12D mutation in pancreatic cancer. Clin Cancer Res. 2024;30(4):655-662."},{"issue":"7","key":"bib1","series-title":"J Clin Endocrinol Metab","first-page":"2357","article-title":"Clinical, radiological and pathological features of patients with Rathke's cleft cysts: tumors that may recur","volume":"82","author":"Mukherjee","year":"1997","unstructured":"Mukherjee JJIslam NKaltsas G, et al. Clinical, radiological and pathological features of patients with Rathke's cleft cysts: tumors that may recur. J Clin Endocrinol Metab. 1997;82(7):2357-2362."},{"issue":"4","key":"bib2","series-title":"J Neurosurg","first-page":"577","article-title":"Surgery for Rathke cleft cysts: technical considerations and outcomes","volume":"101","author":"Benveniste","year":"2004","unstructured":"Benveniste RJKing WAWalsh JLee JSNaidich TPPost KD. Surgery for Rathke cleft cysts: technical considerations and outcomes. J Neurosurg. 2004;101(4):577-584."},{"issue":"4","key":"bib3","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopathological relationships","volume":"28","author":"Zada","year":"2010","unstructured":"Zada GLin NOjerholm ERamkissoon SLaws ER. Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopathological relationships. Neurosurg Focus. 2010;28(4):E4."},{"issue":"2","key":"bib4","series-title":"J Neurosurg","first-page":"189","article-title":"Surgical outcomes in 118 patients with Rathke cleft cysts","volume":"102","author":"Aho","year":"2005","unstructured":"Aho CJLiu CZelman VCouldwell WTWeiss MH. Surgical outcomes in 118 patients with Rathke cleft cysts. J Neurosurg. 2005;102(2):189-193."},{"issue":"5","key":"bib5","series-title":"World Neurosurg","first-page":"527","article-title":"Symptomatic Rathke cleft cyst: clinical features and surgical outcomes","volume":"78","author":"Kim","year":"2012","unstructured":"Kim E. Symptomatic Rathke cleft cyst: clinical features and surgical outcomes. World Neurosurg. 2012;78(5):527-534."},{"key":"bib6","series-title":"World Neurosurg","first-page":"e35","article-title":"Soft gasket seal reconstruction after endoscopic endonasal transtuberculum resection of craniopharyngiomas","volume":"162","author":"Albonette-Felicio","year":"2022","unstructured":"Albonette-Felicio TMartinez-Perez RVankoevering K, et al. Soft gasket seal reconstruction after endoscopic endonasal transtuberculum resection of craniopharyngiomas. World Neurosurg. 2022;162:e35-e40."},{"key":"bib7","series-title":"Schmidek & Sweet Operative Neurosurgical Techniques: Indications, Methods, and Results","first-page":"194","article-title":"The endoscopic endonasal approach for craniopharyngiomas","author":"Beaumont","year":"2022","unstructured":"Beaumont TLHardesty DACarrau RLPrevedello DM. The endoscopic endonasal approach for craniopharyngiomas. In: Qui\u00f1ones-Hinojosa ASchmidek HH, eds. Schmidek & Sweet Operative Neurosurgical Techniques: Indications, Methods, and Results. 7th ed. Elsevier; 2022:194-202."},{"issue":"3","key":"bib8","series-title":"Brain Sci","first-page":"515","article-title":"Current advances in papillary craniopharyngioma: state-of-the-art therapies and overview of the literature","volume":"13","author":"Jannelli","year":"2023","unstructured":"Jannelli GCalvanese FPaun LRaverot GJouanneau E. Current advances in papillary craniopharyngioma: state-of-the-art therapies and overview of the literature. Brain Sci. 2023;13(3):515."},{"issue":"17","key":"bib9","series-title":"Cancer","first-page":"2910","article-title":"Targeted treatment of papillary craniopharyngiomas harboring BRAF V600E mutations","volume":"125","author":"Juratli","year":"2019","unstructured":"Juratli TAJones PSWang N, et al. Targeted treatment of papillary craniopharyngiomas harboring BRAF V600E mutations. Cancer. 2019;125(17):2910-2914."},{"issue":"1","key":"bib10","series-title":"Endocr Pathol","first-page":"23","article-title":"Comparative immunohistochemical assessment of craniopharyngioma and related lesions","volume":"18","author":"Le","year":"2007","unstructured":"Le BHTowfighi JKapadia SBLopes MB. Comparative immunohistochemical assessment of craniopharyngioma and related lesions. Endocr Pathol. 2007;18(1):23-30."},{"issue":"31","key":"bib11","series-title":"Oncotarget","first-page":"50564","article-title":"TREM-1 expression in craniopharyngioma and Rathke's cleft cyst: its possible implication for controversial pathology","volume":"7","author":"Liu","year":"2016","unstructured":"Liu YWang CHLi DL, et al. TREM-1 expression in craniopharyngioma and Rathke's cleft cyst: its possible implication for controversial pathology. Oncotarget. 2016;7(31):50564-50574."},{"issue":"4","key":"bib12","series-title":"J Neurosurg","first-page":"535","article-title":"Clinical, radiographic, and pathological features of symptomatic Rathke\u2019s cleft cysts","volume":"74","author":"Voelker","year":"1991","unstructured":"Voelker JLCampbell RLMuller J. Clinical, radiographic, and pathological features of symptomatic Rathke\u2019s cleft cysts. J Neurosurg. 1991;74(4):535-544."},{"issue":"6","key":"bib13","series-title":"Acta Neurochir (Wien)","first-page":"1069","article-title":"Rathke\u2019s cleft cysts with significant squamous metaplasia\u2014high risk of postoperative deterioration and close origins to craniopharyngioma","volume":"155","author":"Ogawa","year":"2013","unstructured":"Ogawa YWatanabe MTominaga T. Rathke\u2019s cleft cysts with significant squamous metaplasia\u2014high risk of postoperative deterioration and close origins to craniopharyngioma. Acta Neurochir (Wien). 2013;155(6):1069-1075."},{"issue":"6","key":"bib14","series-title":"Neuropathol Appl Neurobiol","first-page":"733","article-title":"BRAF V600E analysis for the differentiation of papillary craniopharyngiomas and Rathke\u2019s cleft cysts","volume":"41","author":"Schweizer","year":"2015","unstructured":"Schweizer LCapper DH\u00f6lsken A, et al. BRAF V600E analysis for the differentiation of papillary craniopharyngiomas and Rathke\u2019s cleft cysts. Neuropathol Appl Neurobiol. 2015;41(6):733-742."},{"key":"bib15","series-title":"Front Genet","first-page":"49","article-title":"Rathke\u2019s cleft cyst as origin of a pediatric papillary craniopharyngioma","volume":"9","author":"Schlaffer","year":"2018","unstructured":"Schlaffer SMBuchfelder MStoehr RBuslei RH\u00f6lsken A. Rathke\u2019s cleft cyst as origin of a pediatric papillary craniopharyngioma. Front Genet. 2018;9:49."},{"issue":"1","key":"bib16","series-title":"Signal Transduct Target Ther","first-page":"386","article-title":"KRAS mutation: from undruggable to druggable in cancer","volume":"6","author":"Huang","year":"2021","unstructured":"Huang LGuo ZWang FFu L. KRAS mutation: from undruggable to druggable in cancer. Signal Transduct Target Ther. 2021;6(1):386."},{"issue":"11","key":"bib17","series-title":"Trends Cancer","first-page":"955","article-title":"Next batter up! Targeting cancers with KRAS-G12D mutations","volume":"9","author":"Zeissig","year":"2023","unstructured":"Zeissig MNAshwood LMKondrashova OSutherland KD. Next batter up! Targeting cancers with KRAS-G12D mutations. Trends Cancer. 2023;9(11):955-967."},{"issue":"7","key":"bib18","series-title":"Cancer Gene Ther","first-page":"961","article-title":"Targeting KRASG12D mutation in non-small cell lung cancer: molecular mechanisms and therapeutic potential","volume":"31","author":"Tang","year":"2024","unstructured":"Tang YPu XYuan XPang ZLi FWang X. Targeting KRASG12D mutation in non-small cell lung cancer: molecular mechanisms and therapeutic potential. Cancer Gene Ther. 2024;31(7):961-969."},{"issue":"4","key":"bib19","series-title":"Clin Cancer Res","first-page":"655","article-title":"A small molecule with big impact: MRTX1133 targets the KRASG12D mutation in pancreatic cancer","volume":"30","author":"Wei","year":"2024","unstructured":"Wei DWang LZuo XMaitra ABresalier RS. A small molecule with big impact: MRTX1133 targets the KRASG12D mutation in pancreatic cancer. 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