The Sphenoid Enigma: Unveiling of a Metastatic Rectal Adenocarcinoma in the Greater Wing of Sphenoid—A Rare Case Report with Review of Literature

Metastatic lesions to the skull base are uncommon, with colorectal cancer being a rare primary. Orbital metastases are infrequent, often presenting with nonspecific symptoms that can delay diagnosis. The involvement of the greater wing of sphenoid (GWS) is especially unusual, making early detection challenging. We present a unique case of a young woman in her early 20s who initially presented with ocular symptoms due to a metastatic lesion in the GWS. Radiological investigations revealed a lytic lesion with orbital and middle cranial fossa extension. Histopathological analysis confirmed adenocarcinoma with immunohistochemical markers indicative of colorectal origin. Postoperative positron emission tomography–computed tomography scan identified the primary rectal tumor and widespread metastases. This case emphasizes the importance of maintaining a high degree of suspicion for rare metastatic sites, particularly in young patients, and the critical role of advanced imaging and comprehensive histopathological assessment in diagnosis and management.