Nam Kukjin, Seo Min Young
Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
J Rhinol. 2024 Mar;31(1):37-41. doi: 10.18787/jr.2023.00070. Epub 2024 Mar 31.
Isolated sphenoid fungal sinusitis (ISFS) is a rare condition characterized by fungal infection of the sphenoid sinus. It often presents with non-specific symptoms, which can lead to misdiagnosis. This study presents two unique cases of ISFS with mucocele that were initially misdiagnosed as chordoma based on preoperative radiographic findings. Two cases of ISFS were thoroughly investigated, including clinical examinations, radiological assessments, and surgical explorations. The patients' symptoms, radiographic findings, surgical procedures, and postoperative outcomes were documented. In both cases, radiographic assessments raised suspicion of chordoma due to bony destruction and soft tissue lesions involving the sphenoid sinus and clivus. However, endoscopic sinus surgery revealed fungal balls and mucoceles, confirming the diagnosis of ISFS. Postoperative pathology confirmed the presence of aspergilloma. The patients recovered well with appropriate treatment. ISFS is challenging to diagnose due to its deep anatomical location and non-specific symptoms. Visual disturbances, particularly affecting the abducens nerve, are common. Sphenoid sinus mucocele, though rare, can be present. Surgical exploration plays a crucial role in establishing an accurate diagnosis and initiating appropriate treatment. ISFS can mimic other skull base lesions, such as chordoma, on preoperative radiography. These cases underscore the value of surgical exploration in reaching an accurate diagnosis and highlight the need for the cautious interpretation of radiological findings in sphenoid sinus lesions to ensure optimal patient care.
孤立性蝶窦真菌性鼻窦炎（ISFS）是一种罕见疾病，其特征为蝶窦真菌感染。它常表现为非特异性症状，可能导致误诊。本研究报告了两例伴有黏液囊肿的ISFS独特病例，这两例病例最初根据术前影像学检查结果被误诊为脊索瘤。对两例ISFS病例进行了全面调查，包括临床检查、影像学评估和手术探查。记录了患者的症状、影像学检查结果、手术过程及术后结果。在这两例病例中，由于蝶窦和斜坡出现骨质破坏及软组织病变，影像学评估怀疑为脊索瘤。然而，鼻内镜鼻窦手术发现真菌球和黏液囊肿，从而确诊为ISFS。术后病理证实存在曲霉菌瘤。经适当治疗，患者恢复良好。由于ISFS解剖位置深且症状不具特异性，其诊断具有挑战性。视觉障碍较为常见，尤其影响展神经。蝶窦黏液囊肿虽罕见，但可能存在。手术探查在准确诊断及启动适当治疗方面起着关键作用。在术前影像学检查中，ISFS可能会被误诊为其他颅底病变，如脊索瘤。这些病例强调了手术探查在准确诊断中的价值，并突出了在蝶窦病变中谨慎解读影像学检查结果以确保为患者提供最佳治疗的必要性。
