Abscess formation within a Rathke's cleft cyst.

We report and discuss the rare case of a pituitary abscess forming within a Rathke's cleft cyst (RCC). A 66-year-old gentleman presented with visual deterioration and symptoms suggestive of hypopituitarism. The patient underwent transsphenoidal debulking of the lesion whereupon purulent material was discovered. Histological examination was suggestive of RCC together with numerous neutrophils characteristic of abscess. Microbiological culture of the material grew Staphylococcus aureus. The patient was treated for a RCC abscess and received antibiotics and endocrine replacement therapy. The patient has been followed up for 2 years without recurrence. Although uncommon, we recommend the consideration of RCC abscess as a differential diagnosis of a pituitary mass lesion as clinical presentation and radiological assessment are not specific in identifying these lesions preoperatively.

An unusual case of ectopic prostate tissue in an intradural lipoma of the conus medullaris.

We report the first case of ectopic prostate tissue in a lipoma of the spine. Ectopic prostate tissue is well documented at a number of sites within the human body. Ectopic prostate tissue has previously been reported in the spine but usually in the context of spinal teratomas. This case is unique in that this is the first description of the presence of benign prostatic tissue in a lipoma of the conus medullaris. This is a highly unusual finding and probably reflects divergent differentiation or a malformative process.

Recurrence of fourth ventricular choroid plexus papilloma with late occurrence of a spinal drop metastasis.

Choroid plexus papillomas are rare tumours, which occasionally spread both intracranially and down the spinal canal. Spinal metastasis has been reported infrequently and only once many years since the initial diagnosis. This is the first reported case of late recurrence, metastasis and transformation of a benign to an atypical lesion.

Radiologic follow-up of non-functioning pituitary adenomas: rationale and cost effectiveness.

Patients with non-functioning pituitary adenomas (NFPAs) are followed-up with serial endocrine, ophthalmologic and radiological assessment. There is a lack of evidence based guidance regarding the frequency and duration of radiological assessment during follow-up. We retrospectively analysed the details of follow-up radiological scanning in a cohort of patients diagnosed with NFPAs in an attempt to devise a rational and cost effective scanning schedule for use in routine clinical practice. 49 patients were identified using the hospital endocrine register. A detailed review of the case notes and follow up scans was undertaken. The data was analysed using descriptive statistics and Kaplan-Meier survival analysis using SPSS ver 13.0 (SPSS Inc. Chicago, IL). The time in which the tumor size in the followed up patients reached a state of 'no change' which persisted for at least two further scans was calculated. 41 patients, followed up for a median duration of 70 months were ultimately analysed. 33 patients had surgery while eight were conservatively managed. The time taken by 50% of tumors to achieve a steady state of 'no change' in tumor size on scans was 30 months. 90% of tumours achieved this state in 88 months. Surgical management did not significantly influence the time required to attain the steady state on a Kaplan-Meier analysis (Log rank test P = 0.06). NFPAs need extended follow-up since late recurrences after treatment are known. Routine radiologic follow up may be uneconomical after the steady state is achieved. Regular Goldmann perimetry beyond this time may be of greater use in selecting patients who actually need repeat surgical debulking. This method of follow up is likely to be more cost effective and reduce the number of scans performed.