Nasopharyngeal carcinoma presenting as a sellar mass mimicking a pituitary macroadenoma: a case report
Soheil Mirzaei, Maryam Haghighi-Morad, Shahram Sabeti, Guive Sharifi, Zahra Motaghed, Reza NaseriBackground:
Nasopharyngeal carcinoma (NPC) is an epithelial malignancy of the head and neck. It may invade the skull base and cause cranial nerve deficits. Rarely, extension to the sellar or parasellar region can mimic a pituitary lesion.
Case presentation:
A 51-year-old man presented with progressive deviation of the left eye, left eyelid ptosis, and severe bilateral visual loss. Examination showed left third and fourth cranial nerve palsies. Laboratory tests revealed mild anemia, thrombocytopenia, lymphopenia, and a low TSH level. Imaging demonstrated an invasive sellar/parasellar mass with skull base destruction. The patient underwent endoscopic transsphenoidal surgery. A pituitary macroadenoma was initially suspected, but pathology confirmed non-keratinizing NPC invading the pituitary region.
Conclusion:
NPC may rarely extend to the sphenoid sinus and sellar region. It can clinically and radiologically mimic pituitary macroadenoma. In atypical sellar or parasellar masses, especially with cranial nerve palsy, ophthalmoplegia, sphenoid sinus involvement, or bone destruction, NPC should be considered in the differential diagnosis.