Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Dec 20;87(2):929-933.
doi: 10.1097/MS9.0000000000002964. eCollection 2025 Feb.

Fungal skull base lesion masquerading as malignancy: a diagnostic dilemma. Illustrative case report

Kodeeswaran M  1 , S Muthuchitra  2 , Noorul Hidhaya S  3 , Vishaal P  3 , P B Janakiraman  2 , Tamilarasan P  2 , K P Priyadharshan  1 , Jamila Alagarsamy  2 , Gaurav R Dhoka  1 , Bipin Chaurasia  4
Affiliations
Case Reports

Fungal skull base lesion masquerading as malignancy: a diagnostic dilemma. Illustrative case report

Kodeeswaran M et al. Ann Med Surg (Lond). .

Abstract

Introduction: The clivus is an uncommon site for fungal infections and is typically associated with tumors or metastases. Invasive fungal sinusitis extending to the skull base is exceptionally rare and often mimics clival malignancies such as chordomas or metastases. This overlap in clinical and radiological features can lead to diagnostic delays.

Case presentation: The authors present a case of a 36-year-old immunocompetent male who presented with symptoms and imaging findings suggestive of a malignant skull base tumor, particularly clival chordoma. However, histopathological analysis revealed invasive fungal sinusitis with clival involvement.

Discussion: In skull base lesions, particularly those involving the clivus, fungal infections should remain a differential diagnosis, even in patients without immunocompromising conditions. Early diagnosis using biopsy and microbiological analysis is essential for appropriate surgical management and antifungal therapy.

Conclusion: This case highlights the importance of considering the fungal etiology in clival lesions, especially in high-risk patients. Prompt diagnosis and a multidisciplinary approach can significantly improve the outcomes in rare and complex presentations.

Keywords: clival chordoma mimic; clival lesions; fungal sinusitis; immunocompetent patients; invasive fungal infections; skull base invasion; surgical management.

PubMed Disclaimer

Conflict of interest statement

All the authors declare to have no conflicts of interest relevant to this study.

Figures

Figure 1.
Figure 1.
Magnetic resonance imaging in the multiple sagittal section (A) and coronal section (B) reveal a hyperintense lesion occupying the left clivus and is seen extending into the pituitary fossa.
Figure 2.
Figure 2.
T1 weighted magnetic resonance imaging in the axial cut reveals a hyperintense mass that is solid-cystic in nature causing erosion of the sphenoid bone in the middle cranial fossa.
Figure 3.
Figure 3.
Grocott-Gomori methenamine silver (GMS) stained preparation of biopsy specimen in high power view (40x) showing branching septate fungal hyphae.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Palsetia DR, Vijan AV, Gala FB, et al. . Clival and paraclival lesions: a pictorial review. Indian J Radiol Imaging 2023;33:201–17. - PMC - PubMed
    1. Khawaja AM, Venkatraman A, Mirza M. Clival chordoma: case report and review of recent developments in surgical and adjuvant treatments. Pol J Radiol 2017;82:670–75. - PMC - PubMed
    1. Carretta A, Sollini G, Guaraldi F, et al. . Clival metastases: single-center retrospective case series and literature review. J Clin Med 2024. a;13:2580. - PMC - PubMed
    1. Ilaslan H, Schils J, Nageotte W, et al. . Clinical presentation and imaging of bone and soft-tissue sarcomas. Cleve Clin J Med 2010;77 Suppl 1:S2–7. - PubMed
    1. Sohrabi C, Mathew G, Maria N, et al. . The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg 2023;109:1136–40. - PMC - PubMed

Publication types

LinkOut - more resources