Pekic Djurdjevic Sandra, Arsic Arsenijevic Valentina
Neuroendocrine Unit, Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Center, 11000 Belgrade, Serbia.
School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
J Fungi (Basel). 2025 Mar 19;11(3):233. doi: 10.3390/jof11030233.
Chronic fungal sinusitis (FS) can cause bone erosion and extend to the sellar region, often misdiagnosed as pituitary tumors or malignancies. We report a 56-year-old immunocompetent female with sphenoid FS presenting as a giant sellar mass compressing the optic chiasm, with normal pituitary function. The surgery successfully resolved her symptoms, and a histological examination confirmed the presence of a fungal hyphal mass. We conducted a literature review of 52 publications on FS cases with bone erosion and inflammatory extension to the sellar region, which included analyses of 67 patients (35 females, mean age 49.6 years, half immunocompetent). The most common symptom was headache (73.1%), followed by visual complaints (71.7%), visual deterioration (40.3%), ophthalmoplegia (38.8%), and visual field defects (13.4%). Symptom duration averaged 4.5 months in 65.7% of cases. was the most frequent (71.6%). Hormonal abnormalities included hypopituitarism (25.4%) and hyperprolactinemia (13.4%). Surgery was performed in 92.5% of patients. Common diagnoses included pituitary abscess (41.8%), fungal granuloma (16.4%), aspergillosis (16.4%) and allergic FS (14.9%). Antifungal therapy was administered in 53.7% of cases. Cure was achieved in 67.2%, while the mortality rate was 10.4%. Early recognition of fungal involvement, supported by a multidisciplinary approach, is essential for the accurate diagnosis and effective treatment. This highlights the need for vigilance to improve the outcomes in similar cases.
慢性真菌性鼻窦炎（FS）可导致骨质侵蚀并蔓延至鞍区，常被误诊为垂体肿瘤或恶性肿瘤。我们报告一例56岁免疫功能正常的女性，患有蝶窦FS，表现为巨大鞍区肿块压迫视交叉，垂体功能正常。手术成功缓解了她的症状，组织学检查证实存在真菌菌丝团块。我们对52篇关于FS伴骨质侵蚀和炎症蔓延至鞍区的病例文献进行了综述，其中包括对67例患者（35例女性，平均年龄49.6岁，半数免疫功能正常）的分析。最常见的症状是头痛（73.1%），其次是视觉症状（71.7%）、视力下降（40.3%）、眼肌麻痹（38.8%）和视野缺损（13.4%）。65.7%的病例症状持续时间平均为4.5个月。 最为常见（71.6%）。激素异常包括垂体功能减退（25.4%）和高催乳素血症（13.4%）。92.5%的患者接受了手术。常见诊断包括垂体脓肿（41.8%）、真菌性肉芽肿（16.4%）、曲霉菌病（16.4%）和变应性FS（14.9%）。53.7%的病例接受了抗真菌治疗。治愈率为67.2%，死亡率为10.4%。在多学科方法的支持下，早期识别真菌累及对于准确诊断和有效治疗至关重要。这凸显了提高警惕以改善类似病例治疗效果的必要性。
