Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
Department of Radiology, Tan Tock Seng Hospital, Singapore.
BMJ Case Rep. 2021 Mar 10;14(3):e240411. doi: 10.1136/bcr-2020-240411.
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.
一位 68 岁的中国男性在进行高级别腮腺涎腺癌的分期 MRI 扫描时，被发现蝶窦内有一个小叶状肿块，延伸至斜坡和鼻咽顶。进一步的正电子发射断层扫描显示该病变摄取氟脱氧葡萄糖（FDG）。这被证明是一个诊断难题。患者接受了全腮腺切除术、左侧选择性颈部清扫术和经蝶窦鼻内病变活检。最终组织学显示该病变为异位蝶窦垂体腺瘤（ESSPA）。最初考虑的鉴别诊断包括脊索瘤、转移性癌和鼻咽癌。然而，具有肿瘤外观和 FDG 摄取倾向的重要鉴别诊断是 ESSPA。它需要专门的免疫组织化学染色来诊断，其主要治疗方法是手术切除。
