Incidental paraganglioma of sella : A case report and literature review

Most primary paragangliomas of the head and neck occur in the carotid, jugular body, tympanic ventricle, and vagus nerves. Primary sellar paragangliomas are rare, and their long-term outcomes remain unknown. It is also unclear whether they can be classified as asymptomatic incidentalomas in the sellar region. A 75-year-old man who had been followed up for 15 years for an asymptomatic non-functional pituitary adenoma strongly requested surgery and underwent endoscopic transsphenoidal surgery to remove the tumor. Intraoperatively, the tumor was found to be elastic, harder than the pituitary adenoma, fibrous, and not extremely vascularized. The tumor was excised extracapsularly, although residual tumor tissue remained in the medial part of the bilateral cavernous sinuses. A histopathological assessment revealed negative epithelial markers, positive neuroendocrine markers, and partial positivity for S-100, leading to a diagnosis of paraganglioma. Cervicothoracic and abdominal computed tomography, along with spinal magnetic resonance imaging, revealed no apparent neoplastic lesions. The patient experienced no recurrence for 5 years following the resection. The majority of sellar tumors are pituitary adenomas, craniopharyngiomas, Rathke's cleft cysts, or metastatic brain tumors. Herein, we present a case of an asymptomatic primary sellar paraganglioma that was successfully resected. The case highlights that paraganglioma can be included among incidentalomas in the sellar region. Routine follow-up should generally be recommended for patients with asymptomatic sellar incidentalomas.