We report the case of an 81-year-old patient with no pre-existing medical conditions who presented with a one-week history of progressive horizontal diplopia. Contrast-enhanced brain magnetic resonance imaging showed a heterogeneous sellar mass with the infiltration of the cavernous sinus and sella. Hormone levels were within normal limits. Considering an endocrine inactive pituitary adenoma, the patient underwent transsphenoidal resection. After surgery, the preoperative symptoms completely resolved. Histopathologic examination of the tumor specimen revealed melanoma. Since the patient had no history of cancer, an extensive staging workup was performed, which revealed multiple lung metastases. However, no primary tumor was found. We recommended adjuvant brain irradiation and chemo- and immunotherapy, but the patient refused further oncological treatment and died five months after surgery. Reported cases of sellar melanoma are rare, and the combination of sellar melanoma and lung metastasis without a cutaneous primary is unique. Although rare, malignant lesions of the sella must be considered in the differential diagnosis, especially in cases with rapid onset of symptoms.
Keywords: brain and lung metastasis; melanoma; sella; transsphenoidal neurosurgery; whole-brain radiation.
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