A 68-year-old Chinese man was found to have a lobular mass in the sphenoid sinus which extended to the clivus and the roof of the nasopharynx on a staging MRI scan performed for his high-grade parotid salivary duct carcinoma. Further positron emission tomography scan showed that this lesion was fluorodeoxyglucose (FDG) avid. This proved to be a diagnostic dilemma. The patient underwent a total parotidectomy, left selective neck dissection and a transphenoidal biopsy of his nasal lesion. Final histology revealed that this lesion was a synchronous ectopic sphenoid sinus pituitary adenoma (ESSPA). Initial differential diagnoses that were considered included a chordoma, metastatic carcinoma and nasopharyngeal carcinoma. However, an important differential with a neoplastic appearance and a tendency for positive FDG uptake is an ESSPA. It requires dedicated immunohistochemical staining to diagnose, and its mainstay of treatment is surgical excision.
- nose and throat/otolaryngology
- head and neck cancer
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Contributors AC contributed substantially to the conception and design of the case report as well as the literature review and discussion. AYQS provided the scan images which includes the MRI sagittal reconstruction image and important intellectual content regarding scan interpretation. BM was critical in interpreting the histological findings of the lesion and providing important intellectual content with regards to the immunohistochemical stains required to diagnose such a lesion. JLT was the clinician in direct care of the patient. He made substantial contributions to the conception and design of the case report and revised it critically. All authors approve of the current version. All authors agree to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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