Nasopharyngeal angiofibroma

Nasopharyngeal angiofibroma
Classification and external resources
Micrograph of a nasopharyngeal angiofibroma. H&E stain.
DiseasesDB	32229
MedlinePlus	001572
eMedicine	ent/470

Nasopharyngeal angiofibroma (also called juvenile nasopharyngeal angiofibroma)^[1][2] is a histologically benign but locally aggressive vascular tumor that grows in the back of the nasal cavity. It most commonly affects adolescent males.^[3] Patients with nasopharyngeal angiofibroma usually present with one-sided nasal obstruction and recurrent bleeding.

Signs and symptoms

• Frequent chronic epistaxis or blood-tinged nasal discharge
• Nasal obstruction and rhinorrhea
• Conductive hearing loss from eustachian-tube obstruction
• Diplopia, which occurs secondary to erosion into the cranial cavity and pressure on the optic chiasma
• Rarely anosmia, recurrent otitis media, and eye pain

Diagnosis

If nasopharyngeal angiofibroma is suspected based on physical exam (a smooth submucosal mass in the posterior nasal cavity), imaging studies such as CT or MRI should be performed. Biopsy can lead to extensive bleeding since the tumor is composed of blood vessels without a muscular coat.

Differential diagnosis

• Antro-choanal polyp (benign neoplasm)
• Rhinosporidiosis (as bleeding point is here too)
• Malignancy - nasopharyngeal carcinoma, lymphoma, plasmacytoma, rhabdomyosarcoma
• Chordoma
• Nasopharyngeal cyst
• Pyogenic granuloma

Treatment

Medical treatment is usually given before surgery to reduce the blood loss - includes the usage of Diethylstilbestrol 2-3 wks before surgery to make the surgery less vascular.

Nasopharyngeal angiofibroma is sometimes treated by surgery.^[4] Pre-surgery angiography may allow for embolization, reducing intraoperative blood loss. Hypotensive Anaesthesia is the usual modality followed to reduce blood loss. Patients with tumors that have extended into the cranial cavity or whose tumors can't be safely reached by surgery may receive radiation therapy. Also Radiation therapy helps in case where recurrence is the main problem. Endoscopy has recently been used in patients with tumors of limited extension that have been pre-operatively embolized.

Prognosis

Prognosis for nasopharyngeal angiofibroma is favorable. Because these tumors are benign, metastasis to distal sites does not occur. However, these tumors are highly vascularized and grow rapidly. Removal is important in preventing nasal obstruction and recurrent epistaxis. Mortality is not associated with nasopharyngeal angiofibroma ^[5]

References