[Early childhood angiofibroma in an unusual site]

Neural Crest Stem Cells in Juvenile Angiofibromas

The etiology of juvenile angiofibroma (JA) has been a controversial topic for more than 160 years. Numerous theories have been proposed to explain this rare benign neoplasm arising predominately in adolescent males, focusing mainly on either the vascular or fibrous component. To assess our hypothesis of JA’s being a malformation arising from neural crest cells/remnants of the first branchial arch plexus, we performed immunohistochemical analyses of neural crest stem cells (NCSC) and epithelial-mesenchymal transition (EMT) candidates. Immunoexpression of the NCSC marker CD271^p75 was observed in all investigated JA’s (n = 22), mainly around the pathological vessels. Close to CD271^p75-positive cells, high MMP3-staining was also observed. Additionally, from one JA with sufficient material, RT-qPCR identified differences in the expression pattern of PDGFRβ, MMP2 and MMP3 in MACS^®-separated CD271^p75positive vs. CD271^p75 negative cell fractions. Our results, together with the consideration of the literature, provide evidence that JA’s represent a malformation within the first branchial arch artery/plexus remnants deriving from NCSC. This theory would explain the typical site of tumor origin as well as the characteristic tumor blood supply, whereas the process of EMT provides an explanation for the vascular and fibrous tumor component.

Extranasopharyngeal angiofibroma revisited

BACKGROUND

Angiofibromas in the head and neck region usually arise in the nasopharynx, but may also occur elsewhere. This study aims at evaluating the incidence and clinical features of extranasopharyngeal angiofibroma (ENA).

MATERIAL AND METHODS

Systematic review of the literature (Medline^® and Google^™ ) up to 31 December 2015.

RESULTS

174 cases of ENA were retrieved from a total of 170 publications. In contrast to former publications and previous understanding, the nasal septum was by far the most common site of the disease. Four patients had a congenital lesion, the oldest patient was 87 years old (mean: 28.7 years; median: 23 years). Male gender was predominantly affected, but the sex ratio was more balanced (2.13:1) than in previous reports in the literature until 12/2015. The majority of patients presented with nasal obstruction, either in combination with epistaxis (25.8%) or other symptoms (12.6%). Symptoms had developed within 13.1 months on average (median: 4 months). Brisk bleeding resulted in 11 of 43 biopsy procedures. Surgical resection as first-line therapy was performed in 170 patients. A tumour regrowth within 12 months was registered in four patients.

CONCLUSION

The increasing awareness of ENA and the willingness to publish case reports-not only in Medline-listed journals-resulted in a significant increase of published case reports lately. Although extremely rare, ENAs have to be taken into account in the differential diagnosis of unclear masses, particularly in adult patients presenting with a rapidly developing nasal obstruction resulting from a nasal septum tumour. Female gender or normal vascularity does not exclude the diagnosis. Transnasal resection is sufficient in most cases, and recurrences are rare. Pathologists as well as clinicians should consider ENA in their differential diagnosis of any mass of the upper airway.

Ressecção endoscópica de nasoangiofibroma

O nasoangiofibroma é um tumor benigno com componente vascular que acomete homens jovens, e tem como principal tratamento a cirurgia. Tem sido descrita a utilização de cirurgia endoscópica para a ressecção de tumores em estádios iniciais, sem evidência de permanência de restos tumorais ou recidiva da doença. OBJETIVO: Este estudo tem o objetivo de avaliar a via endoscópica precedida pela embolização como meio de tratamento para nasoangiofibroma em estádios II, e um caso selecionado em estádio III, com avaliação da morbidade pós-operatória a partir das seguintes variáveis: tempo cirúrgico, tempo de internamento pós-operatório, necessidade de transfusão sangüínea, presença de complicações, tempo entre embolização e cirurgia e presença de recidiva tumoral. MATERIAIS E MÉTODOS: Foi realizado em estudo prospectivo, a partir de nove pacientes internados no Hospital Geral de Fortaleza SESA/SUS no período de outubro de 2001 a novembro de 2004. CONCLUSÃO: Pelos dados obtidos, concluiu-se que a via endoscópica, quando precedida pela embolização tumoral, é uma via eficaz no tratamento de nasoangiofibromas em estádios iniciais, com reduzida morbidade pós-operatória.

Endoscopic surgery of nasopharyngeal angiofibroma

Nasopharyngeal angiofibroma is a vascular benign tumor that affects young men, and surgery is the treatment of choice. Endoscopic surgery has been used to excise tumors in their initial stages, when there is no evidence of residual or recurrent disease.

Aim

The aim of this study is to evaluate the endoscopic approach preceded by tumor embolization as treatment option for stages II to III angiofibroma. Treatment morbidity was evaluated through: surgery duration, hospital stay after surgery, the need for blood transfusion, complications, the time span between preoperative embolization and surgery, and tumor recurrence.

Methods

A prospective study was carried out with nine patients treated at the Fortaleza General Hospital SESA/SUS from October 2001 through November 2004.

Conclusion

Based on the results, we may conclud that the endoscopic approach, when preceded by embolization, is effective to treat angiofibromas in their initial stages, with reduced postoperative morbidity.

Extranasopharyngeal angiofibroma: etiology, incidence and management

OBJECTIVE

Angiofibromas in the head and neck area usually arise in the nasopharynx (NA) in adolescent males. They may also occur outside the nasopharynx (ENA) and can therefore be misdiagnosed. An ill-advised biopsy may result in brisk bleeding. This study was undertaken to evaluate the incidence and clinical features of ENA.

MATERIAL AND METHODS

A review of the international literature was performed.

RESULTS

A total of 65 patients with ENAs from 16 different countries were reported in the literature. Two patients had a congenital lesion, the oldest being 78 years old. A total of 48 patients were male (73%). The maxilla was the most commonly affected site (24.6%), with the ethmoid, nasal cavity or septum and other sites being involved less frequently. Symptoms arose in 40 patients within 6 months. Among a wide variety of symptoms, epistaxis with or without nasal obstruction was reported for 18 patients. Brisk bleeding resulting from a total of 23 biopsies occurred in 13 patients, and required blood transfusion in 11. Death was reported for two patients as a result of acute respiratory compromise and endocranial extension.

CONCLUSION

ENAs are extremely rare compared to NAs and have to be acknowledged as a different entity. In comparison to patients with NAs, as female adults are affected, the lesion is diagnosed earlier and is less vascularized and the patients are older. Surgical resection is sufficient treatment due to a tendency for local and less aggressive growth.