Summary
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.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
GA Antoine RH Gates AO Park (1988) ArticleTitleInvasive aspergillosis in a patient with aplastic anemia receiving amphotericin B Head Neck Surg 10 199–203 Occurrence Handle3235347 Occurrence Handle1:STN:280:DyaL1M7ntl2ntg%3D%3D
SA Berger SC Edberg G David (1986) ArticleTitleInfectious disease in the sella turcica Rev Infect Dis 8 747–755 Occurrence Handle3538314 Occurrence Handle1:STN:280:DyaL2s%2FmvFelug%3D%3D
S Chandra M Goyal NK Mishra et al. (2000) ArticleTitleInvasive aspergillosis presenting as a cavernous sinus mass in immuno competent individuals; report of 3 cases Neuroradiology 42 108–111 Occurrence Handle10663485 Occurrence Handle1:STN:280:DC%2BD3c7jtVGitw%3D%3D Occurrence Handle10.1007/s002340050025
T Chang MM Teng SF Wang et al. (1992) ArticleTitleAspergillosis of the paranasal sinuses Neuroradiology 34 520–523 Occurrence Handle1436464 Occurrence Handle1:STN:280:DyaK3s%2Fmtlyjuw%3D%3D Occurrence Handle10.1007/BF00598965
JM Coleman GG Hogg JV Rosenfeld et al. (1995) ArticleTitleInvasive central nervous system aspergillosis: cure with liposomal amphotericin B, itraconazole, and radical surgery – case report and review of the literature Neurosurgery 36 858–863 Occurrence Handle7596522 Occurrence Handle1:STN:280:DyaK2MzhvFKhtQ%3D%3D
C De Foer E Fossion JM Vaillant (1990) ArticleTitleSinus aspergillosis J Craniomaxillofac Surg 18 33–40 Occurrence Handle2406288 Occurrence Handle1:STN:280:DyaK3c7lsVehsg%3D%3D
PE Drakos A Nagler R Or et al. (1993) ArticleTitleInvasive fungal sinusitis in patients undergoing bone marrow transplantation Bone Marrow Transplant 12 203–208 Occurrence Handle8241977 Occurrence Handle1:STN:280:DyaK2c%2FmtV2nsg%3D%3D
C Framme J Rosenfeld HG Sachs (2000) ArticleTitleInvasive aspergillose mit orbitabefall unter immunkompetenz Ophthalmologe 97 280–284 Occurrence Handle10827465 Occurrence Handle1:STN:280:DC%2BD3c3os1Orsw%3D%3D Occurrence Handle10.1007/s003470050527
S Garcia-Asensio JM Artigas R Barrena (2000) ArticleTitleOptic nerve aspergillosis: report of a case diagnosed by fine-needle aspiration biopsy Eur Radiol 10 573–575 Occurrence Handle10795534 Occurrence Handle1:STN:280:DC%2BD3c3lsVGmsw%3D%3D Occurrence Handle10.1007/s003300050963
TR Hedges LS Leung (1976) ArticleTitleParasellar and orbital apex syndrome caused by aspergillosis Neurology 26 117–120 Occurrence Handle943065 Occurrence Handle1:STN:280:DyaE287is1Knsw%3D%3D
TE Johnson RR Casiano JW Kronish et al. (1999) ArticleTitleSino-orbital aspergillosis in acquired immunodeficiency syndrome Arch Ophthalmol 117 57–64 Occurrence Handle9930161 Occurrence Handle1:STN:280:DyaK1M7ivFShsA%3D%3D
CA Kennedy GL Adams JP Neglia et al. (1997) ArticleTitleImpact of surgical treatment on paranasal fungal infections in bone marrow transplant patients Otolaryngol Head Neck Surg 116 610–616 Occurrence Handle9215371 Occurrence Handle1:STN:280:DyaK2szlvVamsw%3D%3D Occurrence Handle10.1016/S0194-5998(97)70236-5
H Kurita Y Shiokawa K Furuya et al. (1995) ArticleTitleParasellar aspergillus granuloma extending from the sphenoid sinus: report of two cases Surg Neurol 44 489–494 Occurrence Handle8629236 Occurrence Handle1:STN:280:DyaK283ivV2kuw%3D%3D Occurrence Handle10.1016/0090-3019(95)00208-1
Z Landoy C Rotstein D Shedd (1985) ArticleTitleAspergillosis of the nose and paranasal sinuses in neutropenic patients at an oncology center Head Neck Surg 8 83–90 Occurrence Handle3935605 Occurrence Handle1:STN:280:DyaL28%2FosFSqtA%3D%3D
J Larranaga J Fandino J Gomez-Bueno et al. (1989) ArticleTitleAspergillosis of the sphenoid sinus simulating a pituitary tumor Neuroradiology 31 362–363 Occurrence Handle2797432 Occurrence Handle1:STN:280:DyaK3c%2FhsFKnug%3D%3D Occurrence Handle10.1007/BF00344187
KM Parker JK Nicholson RC Cezayirli et al. (1996) ArticleTitleAspergillosis of the sphenoid sinus: presentation as a pituitary mass and postoperative gallium-67 imaging Surg Neurol 45 354–358 Occurrence Handle8607085 Occurrence Handle1:STN:280:DyaK287otFOktw%3D%3D Occurrence Handle10.1016/0090-3019(95)00484-X
A Ramos-Gabatin RM Jordan (1981) ArticleTitlePrimary pituitary aspergillosis responding to transsphenoidal surgery and combined therapy with amphotericin-B and 5-fluorocytosine: case report J Neurosurg 54 839–841 Occurrence Handle7241195 Occurrence Handle1:STN:280:DyaL3M3hslGlsw%3D%3D Occurrence Handle10.3171/jns.1981.54.6.0839
K Rieske W Handrick H Muller et al. (1998) ArticleTitleTherapy of sinuorbital aspergillosis with amphotericin B colloidal dispersion Mycoses 41 287–292 Occurrence Handle9861833 Occurrence Handle1:STN:280:DyaK1M%2FnvVyhtA%3D%3D
Rizk SS, Kraus DH, Gerresheim G, et al (2000) Aggressive combination treatment for invasive fungal sinusitis in immunocompromised patients. Ear Nose Throat J 79: 278–280, 282, 284–275
M Scanarini A Rotilio L Rigobello et al. (1991) ArticleTitlePrimary intrasellar coccidioidomycosis simulating a pituitary adenoma Neurosurgery 28 748–751 Occurrence Handle1876258 Occurrence Handle1:STN:280:DyaK3MzktlWitA%3D%3D Occurrence Handle10.1097/00006123-199105000-00022
MM Schubert DE Peterson JD Meyers et al. (1986) ArticleTitleHead and neck aspergillosis in patients undergoing bone marrow transplantation. Report of four cases and review of the literature Cancer 57 1092–1096 Occurrence Handle3510710 Occurrence Handle1:STN:280:DyaL287gsFOnsg%3D%3D Occurrence Handle10.1002/1097-0142(19860315)57:6<1092::AID-CNCR2820570604>3.0.CO;2-7
Stammberger H (1992) Spezifische Entzündungen der äußeren und inneren Nase sowie der Nebenhöhlen. In: Naumann HH, Helms J, Herberhold C et al (eds) Oto-Rhino-Laryngologie in Klinik und Praxis, Band 2 Nase, Nasennebenhöhlen, Gesicht, Mundhöhle und Pharynx, Kopfspeicheldrüsen. Thieme, Stuttgart, pp 151–175
M Streppel G Bachmann G Arnold et al. (1999) ArticleTitleSuccessful treatment of an invasive aspergillosis of the skull base and paranasal sinuses with liposomal amphotericin B and itraconazole Ann Otol Rhinol Laryngol 108 205–207 Occurrence Handle10030242 Occurrence Handle1:STN:280:DyaK1M7ltleisQ%3D%3D
AC Swift DW Denning (1998) ArticleTitleSkull base osteitis following fungal sinusitis J Laryngol Otol 112 92–97 Occurrence Handle9538458 Occurrence Handle1:STN:280:DyaK1c7pvFamuw%3D%3D
KY Tzen TC Yen KJ Lin (1999) ArticleTitleValue of Ga-67 SPECT in monitoring the effects of therapy in invasive aspergillosis of the sphenoid sinus Clin Nucl Med 24 938–941 Occurrence Handle10595472 Occurrence Handle1:STN:280:DC%2BD3c%2FmtV2hsw%3D%3D Occurrence Handle10.1097/00003072-199912000-00006
E Yumoto S Kitani H Okamura et al. (1985) ArticleTitleSino-orbital aspergillosis associated with total ophthalmoplegia Laryngoscope 95 190–192 Occurrence Handle3968952 Occurrence Handle1:STN:280:DyaL2M7htVajsA%3D%3D
E Zapater M Armengot A Campos et al. (1996) ArticleTitleInvasive fungal sinusitis in immunosuppressed patients. Report of three cases Acta Otorhinolaryngol Belg 50 137–142 Occurrence Handle8767259 Occurrence Handle1:STN:280:DyaK28zjslCitg%3D%3D
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Pinzer, T., Reiß, M., Bourquain, H. et al. Primary aspergillosis of the sphenoid sinus with pituitary invasion – a rare differential diagnosis of sellar lesions. Acta Neurochir (Wien) 148, 1085–1090 (2006). https://doi.org/10.1007/s00701-006-0811-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-006-0811-8