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Isolated pituitary fossa metastasis from a primary tonsillar squamous cell carcinoma: case report

Published online by Cambridge University Press:  01 April 2020

H Merchant ,
D S Rye  and
J A Smith
H Merchant*
Affiliation:
University of Exeter Medical School, Royal Devon and Exeter NHS Foundation Trust, UK
D S Rye
Affiliation:
University of Exeter Medical School, Royal Devon and Exeter NHS Foundation Trust, UK
J A Smith
Affiliation:
Department of Otolaryngology, Royal Devon and Exeter NHS Foundation Trust, UK
*
Author for correspondence: Mr Haider Merchant, 2 Garthside, Church Road, RichmondTW10 5JA, UK E-mail: hm411@exeter.ac.uk
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Abstract

Objective

This paper presents a case of an isolated pituitary fossa metastasis on a background of a previously treated tonsillar squamous cell carcinoma.

Case report

A 64-year-old male, diagnosed with a primary p16-negative squamous cell carcinoma in the right tonsil, was treated with a course of chemoradiotherapy with curative intent. Positron emission tomography/computed tomography, performed at six months post-treatment, revealed a good local response and no distant metastases. The patient was placed on routine follow up at two-monthly intervals. Two months into follow up, he presented with a right-sided oculomotor nerve palsy and partial Horner's syndrome. Imaging and biopsy revealed a pituitary fossa metastasis (p16-negative squamous cell carcinoma), and a further positron emission tomography/computed tomography visualised this lesion. He was deemed unsuitable for further intervention and underwent palliative radiotherapy for symptom control.

Conclusion

This case represents the first reported isolated pituitary fossa metastasis from a tonsillar squamous cell carcinoma. A high degree of clinical suspicion is recommended, along with a low threshold for biopsy and a cautioned use of positron emission tomography/computed tomography, when investigating such patients.

Keywords

Pituitary NeoplasmsPositron Emission Tomography Computed TomographySquamous Cell CarcinomaSella TurcicaOculomotor Nerve DiseasesTonsillar Neoplasms
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 4 , April 2020 , pp. 369 - 371
Copyright
Copyright © JLO (1984) Limited, 2020

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Footnotes

Mr H Merchant takes responsibility for the integrity of the content of the paper

Presented as a poster at the Association of Surgeons in Training annual conference, 22–24 March 2019, Belfast, Northern Ireland, UK.

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