Metastatic prostate adenocarcinoma presenting with ptosis due to sphenoid sinus metastasis: a rare case report

In this case report, we present a rare condition of ptosis due to sphenoid sinus metastasis of prostate adenocarcinoma. Malignancies of paranasal sinuses are rare and account for approximately 5% of all head and neck malignancies. Metastasis to the sphenoid sinus is even rarer. Prostate cancer is the most common cancer in men. While bone and lymph node metastases are common, metastasis to the head and neck region is rare. A 67-year-old male patient reported headache, drooping of the left eyelid (ptosis), and painful eye movements. Contrast-enhanced MRI of the brain and orbits showed a solid mass of approximately 3 × 3 cm predominantly occupying the left half of the left sphenoid sinus. The patient's prostate-specific antigen (PSA) levels were elevated (56). Contrast-enhanced pelvic MRI revealed similar masses in the peripheral and transitional zones of the prostate and lymph node metastasis. A prostate biopsy revealed prostate adenocarcinoma (acinar type) with a Gleason score of 4 + 5. Ga-68 PET-PSMA imaging showed increased uptake in the prostate gland and seminal vesicles. Since there was no increased uptake in the mass in the left sphenoid sinus, a biopsy was performed to determine whether the mass was a metastasis; it confirmed that it was a metastasis of prostate adenocarcinoma. The patient was diagnosed with high-risk and high-volume hormone-sensitive metastatic prostate adenocarcinoma and was started on treatment with bicalutamide, LHRH agonist, and abiraterone. Follow-up visits showed significant decreases in PSA levels, and at the 10th month, Ga-68 PET-PSMA imaging showed significant regression in the prostate and other metastatic lesions. Significant regression was also observed in the solid component of the mass in the left sphenoid sinus. This case demonstrates that prostate cancer can present with ptosis as an initial symptom due to a rare sphenoid sinus metastasis, and although this symptom represents advanced-stage disease, it can indicate diagnosis. Therefore, prostate cancer should be considered in differential diagnosis for masses and related symptoms occurring in the head and neck region.