Recurrent Cushing's disease due to postoperative seeding of tumor cells in the sphenoid sinus: a case report with review of the literature.
Tatsuma Matsuda, Noriaki Fukuhara, Masahiko Tosaka et al.
✦ AI-curated · Sources linked
Case in brief
A 30-year-old woman with recurrent Cushing's disease developed biochemical and clinical symptoms after initial endocrine remission following gross total resection of an ACTH-secreting PitNET. Despite long-term medical therapy, her hypercortisolism progressed. Nearly 10 years post-surgery, reoperation revealed a small tumor in the sphenoid sinus, confirmed as recurrent corticotrophic PitNET. Complete resection led to immediate endocrine remission.
What made this case unusual
The case highlights the rare occurrence of recurrent Cushing's disease due to postoperative seeding of tumor cells into the sphenoid sinus, a site often overlooked in imaging studies.
Diagnostic / clinical pearl
Clinicians should consider the possibility of tumor cell seeding in the sphenoid sinus when evaluating MRI-negative recurrences of Cushing's disease.
Why it matters
This case underscores the importance of thorough surgical techniques and careful inspection of the sphenoid sinus to prevent iatrogenic tumor seeding and improve patient outcomes.