Pituitary metastasis as the first sign of distant spread in mandibular squamous cell carcinoma

To describe a rare case of pituitary metastasis arising from mandibular squamous cell carcinoma (SCC), in which pituitary-related symptoms represented the first clinical evidence of distant metastatic disease. Case report and targeted literature review. A patient with previously treated mandibular SCC presented with new-onset visual disturbance and endocrine dysfunction. Imaging, endocrine evaluation, and histopathologic confirmation were performed. Published reports of pituitary metastases from head and neck SCC were reviewed. Magnetic resonance imaging demonstrated an enhancing sellar mass with suprasellar extension and infundibular thickening concerning for metastatic disease. Endoscopic endonasal biopsy confirmed metastatic keratinizing SCC consistent with the primary mandibular tumor. No other distant metastases were identified on staging imaging. Visual field deficits and partial hypopituitarism were the sole presenting manifestations of metastatic spread. Pituitary metastasis from mandibular SCC is exceptionally rare and may present as the earliest sign of distant disease.