Primary aspergillosis of the sphenoid sinus with pituitary invasion – a rare differential diagnosis of sellar lesions

Abstract

Aspergillosis belongs to the group of mycotic diseases of paranasal sinuses. The invasive forms, and particularly the fulminant forms, are potentially fatal. Isolated aspergillosis of the sphenoid sinus or the clivus is a difficult diagnosis, since the often misleading clinical manifestations of this rare disease develop late. These patients become apparent by neurological signs such as cavernous sinus syndrome, pseudotumor of the pituitary or the orbit. Diagnosis is often made intra-operatively or on histological examination. We report a case of invasive aspergillosis uniquely involving the sellar area revealed by clinical features suggesting a pseudotumor of the pituitary. Although such lesions are almost always seen in immune suppressed subjects, in our case, the patient was immune competent and had no past history of sinusitis.The question of whether, and when to perform limited or extensive surgery remains an issue for discussion, owing to the rarity of this disease honed by lack of experience. It depends on several factors: the kind of disease, the immunity, the subtype of invasive fungal sinusitis and the degree of tissue invasion.

Acute Chiasmal Abscess Resulting from Perineural Extension of Invasive Sino-Orbital Aspergillosis in an Immunocompetent Patient

“…Intracranial extension often results in mortality despite therapy. Nonetheless, invasive sino-orbital aspergillosis may occur in immunocompetent patients (3, 17, 18, 29, 30, 32, 35, 43). The standard treatment for invasive sino-orbital disease has been radical surgical intervention, including orbital exenteration, sinus excision, and aggressive intracranial debridement (9, 13, 22, 31).…”

Isolated Sphenoid Sinus Lesions: Experience with a Few Rare Pathologies

“…[35] It is considered that surgical treatment should aim more at radically removing the mycotic infected lesion, rather than draining it though there is no significant difference in outcome even if drainage is done, especially in invasive fungal sinusitis. [36] Postoperative progression of disease even after antimycotic therapy may lead to fatal outcomes. [37] Our reported case was of primary focal fungal ball with combined zygomycosis and Aspergillus infection without invasion, successfully treated with decompression followed by antifungal therapy.…”

Fatal Case of Cerebral Aspergillosis : A Case Report and Literature Review

“…However, the number of reported cases increased significantly in the last decade (Table 1)7,10-14,16,19). Aspergillus can reach the CNS by three different routes.…”