A Patient with a “Good Nose”

Abstract

We report on a 33-year-old man who underwent an odyssey of doctors for investigation of dysphagia. Eventually, a nasopharyngeal mass was found by several otorhinolaryngologists who repeatedly recommended biopsy or excision, because a polyp or fibroma was assumed on nasal endoscopy and MR imaging. However, we finally diagnosed the nasopharyngeal mass to be an ectopic pituitary gland after thorough clinical (cleft lip and palate) and radiological re-examination. Literally, the patient had a “good nose”, since he refused manipulations on the nasopharyngeal tumour and assumably prevented inadvertent hypopituitarism. We conclude that biopsy or excision of nasopharyngeal masses should always be considered carefully, especially in patients with facial anomalies.

Key words

ectopic pituitary - incidentaloma - nasal polyp - hypopituitarism

References

• 1 Currarino G, Maravilla KR, Salyer KE. Transsphenoidal canal (large craniopharyngeal canal) and its pathologic implications.  Am J Neuroradiol. 1985;  6 39-43
• 2 Das CJ, Seith A, Gamangagatti S, Goswami R. Ectopic pituitary adenoma with an empty sella.  Am J Roentgenol. 2006;  186 1468-1472
• 3 Ekinci G, Kilic T, Baltacioglu F, Elmaci I, Altun E, Pamir MN, Erzen C. Transsphenoidal (large craniopharyngeal) canal associated with a normally functioning pituitary gland and nasopharyngeal extension, hyperprolactinemia, and hypothalamic hamartoma.  Am J Roentgenol. 2003;  180 76-77
• 4 Hori A, Schmidt D, Kuebber S. Immunohistochemical survey of migration of human anterior pituitary cells in developmental, pathological, and clinical aspects: a review.  Microsc Res Tech. 1999;  46 59-68
• 5 Hori E, Akai T, Kurimoto M, Hirashima Y, Endo S. Growth hormone-secreting pituitary adenoma confined to the sphenoid sinus associated with a normal-sized empty sella.  J Clin Neurosci. 2002;  9 196-199
• 6 Hughes ML, Carty AT, White FE. Persistent hypophyseal (craniopharyngeal) canal.  Br J Radiol. 1999;  72 204-206
• 7 Marsot-Dupuch K, Smoker WR, Grauer W. A rare expression of neural crest disorders: an intrasphenoidal development of the anterior pituitary gland.  Am J Neuroradiol. 2004;  25 285-288
• 8 Osman M, Allan JC, Kramer B. A pharyngeal and ectopic hypophysis in a neonate with craniofacial abnormalities: a case report and review of development and structure.  Cleft Palate Craniofac J. 2006;  43 117-122
• 9 Tweedie AR, Keith A. Ectopia of the pituitary, with other congenital anomalies of the nose, palate and upper lip.  J R Soc Med. 1910-1911;  5 47-54
• 10 Weber FT, Donnelly  WH Jr, Bejar RL. Hypopituitarism following extirpation of a pharyngeal pituitary.  Am J Dis Child. 1977;  131 525-528

Correspondence