Atypical angiofibromas: a report of four cases

Intraosseous angio-lipo-fibroma of the mandible: Report of a rare case with review of literature

INTRODUCTION AND IMPORTANCE

Angiolipofibroma is rare lesion with extraordinarily vascular structure, occurs within the head and neck region, typically springing up in the nasopharyngeal location, with a locally competitive efficiency.

CASE PRESENTATION

Male patient, aged 25 years old was referred to oral surgeon with the aim of surgical removal of a painless lesion of the left posterior mandibular area. he has well heath without any medical history The mass was removed by the oral surgeon and subjected to histological analysis the final diagnosis was found to be an intraosseous angiolipofibroma.

CLINICAL DISCUSSION

The significance of this report lies in the rarity of the presence of angiolipofibroma in the mandible and the clinical and radiographic manifestations were only a silent unilocular radiolucent lesion. Only a few cases have been published describing angiolipofibroma in the mandible. it is difficult to diagnose on clinical and radiographic features only.

CONCLUSION

The definitive diagnosis is based on histological examination. The surgical treatment was enough.

Presurgical embolization of nasopharyngeal fibroma: A case report

Nasopharyngeal fibroma (NF) is a rare nasopharyngeal tumor of a benign histological nature but with local aggressiveness. It is a hypervascular tumor and the main feeding artery comes from the internal maxillary artery. Surgery is the treatment of choice for this tumor but carries a significant risk of bleeding from surgical treatment. Thus, embolization carried out preoperatively effectively reduces intraoperative bleeding and thereby allows complete resection for large tumors.

Extra Nasopharyngeal Angiofibroma Arising From Oropharynx: A Clinical Report

Angiofibroma arising from sites other than nasopharynx is rare and termed as Extra nasopharyngeal angiofibroma (ENA). ENAs commonly arise from nasal septum, maxillary sinus, and inferior turbinate. But angiofibroma arising from oropharynx have not been frequently reported. We present here a case of middle-aged male who presented with a large pedunculated oropharyngeal mass attached to palatopharyngeal fold. Endoscopic radiofrequency assisted transoral excision of mass was done. Histopathological features were consistent with angiofibroma arising from oropharynx. Patient recovered well with no evidence of recurrence till 18 months of follow up. In this report, we have tried to emphasize the diagnostic workup for oropharyngeal mass. This report also provides an insight into the clinical and pathological behavior of extra nasopharyngeal angiofibroma.

Contemporary Surgical Management of Juvenile Nasopharyngeal Angiofibroma

Objectives Juvenile nasopharyngeal angiofibromas (JNAs) are uncommon tumors with an evolving treatment paradigm. The objective of this study was to compare our prior experience reported in 2005 with our most contemporary series to compare practice improvements and the impact of expanded endonasal procedures.

Design Retrospective review comparing a contemporary 22 patients with JNA who underwent surgical management between 2005 and 2019, compared with a historical cohort of 65 patients from the same center.

Results The most common presenting symptom was epistaxis (68%). The median maximum tumor diameter was 4.4 cm. All patients underwent preoperative embolization. An endoscopic endonasal approach (EEA) was used in 18 patients (82%), compared with 9% in the series prior to 2005. Gross total resection was achieved in all patients. The median estimated blood loss was 175 and 350 mL for EEA and open (transfacial) cases, respectively. Only two patients (9%) required a blood transfusion compared with 52% on the previous series. The median follow-up was 19 months. The overall recurrence rate was 9% in this series and 24% in the previous series. No patient required radiation therapy in follow-up compared with 3% in our historical cohort.

Conclusion There have been significant changes regarding the management of patients with JNA compared with the previous Mayo Clinic experience. The EEA has become the preferred route over the transfacial approaches to treat JNA in selected patients who do not have intracranial extension. Preoperative embolization has aided in reducing the postoperative transfusion rates.

A unique intraluminal growth of juvenile nasopharyngeal angiofibroma: A case report

Juvenile nasopharyngeal angiofibroma (JNA) is a rare, hypervascular, benign tumor which is mainly seen among male adolescents. The tumor typically originates from the sphenopalatine fossa, but could spread through natural foramens and fissures.

There are some reports of atypical growth of this tumor in literature but the intraluminal growth, which could be seen in paraganglioma and glomus tumors, has not reported yet in angiofibroma. In this article we present a case of extensive angiofoibroma with intraluminal involvement of the ophthalmic vein.

Our patient was a 19-year-old boy with a complaint of nasal obstruction and occasional epistaxis since a year ago, without any visual or neurologic complaints. The patient underwent an endoscopic resection of the tumor after embolization via the nasal cavity.

The intraoperative findings revealed the tumor extension to the orbit, intracranial space and cavernous sinus via inferior orbital fissure. The intracranial extension of the tumor was extradural and was successfully excised without CSF leakage. An interesting finding in this patient, was an intraluminal extension of the tumor in to the ophthalmic vein, which was completely excised endoscopically. (pre and post operation pictures are available in the full text). The definitive treatment of angiofibroma is surgical excision. Different surgical approaches are used but nowadays endoscopic resection with or without pre-operative embolization is the first choice of treatment. The intraluminal growth of the tumor was also excised as a pedunculated mass separately.

Diode Laser Management of Primary Extranasopharyngeal Angiofibroma Presenting as Maxillary Epulis: Report of a Case and Literature Review

Juvenile nasopharyngeal angiofibroma is a rare vascular neoplasm, mostly occurring in adolescent males, and representing 0.05% of all head and neck tumors. Nevertheless, it is usually recognized as the most common benign mesenchymal neoplasm of the nasopharynx. Usually, it originates from the posterolateral wall of the nasopharynx and, although histologically benign, classically shows a locally aggressive behavior with bone destruction as well as spreading through natural foramina and/or fissures to the nasopharynx, nasal and paranasal cavities, spheno-palatine foramen, infratemporal fossa and, very rarely, to the cranial cavity. Extranasopharyngeal angiofibroma is considered a distinct entity due to older age at presentation, different localizations (outside the nasopharyngeal pterygopalatine fossa) and attenuated clinical course. Extranasopharyngeal angiofibroma has been sporadically described in the oral cavity. We report a case of extranasopharyngeal angiofibroma with primary and exclusive involvement of the adherent gingiva of the anterior maxilla, managed by preoperative diode laser trans-mucosal photocoagulation and subsequent surgical removal. The current literature on primary extranasopharyngeal angiofibroma is also reviewed.

Extranasopharyngeal angiofibroma mimicking choanal polyp in patients with chronic paranasal sinusitis

Extranasopharyngeal angiofibroma (ENA) is an angiofibroma that occurs in the extranasopharynx. It shows pathologic findings, such as juvenile angiofibroma (JNA), which accounts for 0.5% of head and neck mass. However, compared with JNA, the prevalence, affected site, and clinical characteristics are completely different, which leads some physicians to classify ENA as a disease different from JNA. ENA of the nasal turbinate origin are rarely reported in the literature. In addition, choanal polyp originating from the posterior part of the nasal turbinate is uncommonly reported. Recently, we encountered two cases of ENA, which were not diagnosed by intraoperative frozen section examination, but were histopathologically diagnosed post-operatively. Although we were unable to diagnose and perform embolization pre-operatively, ENA has been successfully treated by endoscopic surgery, without profuse bleeding.

Juvenile primary extranasopharyngeal angiofibroma, presenting as cheek swelling

Angiofibroma is a locally advancing immensely vascular tumor that essentially arises from the nasopharynx. The clinical characteristics of extranasopharyngeal angiofibroma (ENA) do not accord to that of nasopharyngeal angiofibroma and can present a diagnostic confront. We describe a case of primary juvenile ENA in a 19-year-old patient who presented with a rapidly enlarging mass of the cheek region. The case is unusual because of its anatomic location. The diagnostic and management particulars are sketched.

Nasopharyngeal angiofibroma in a 32-year-old man

Nasopharyngeal angiofibroma (NA) is a benign, highly vascularised tumour of the nasopharynx, which typically occurs in young males aged 14-25 years. We report an interesting case of an NA arising de novo in a 32-year-old male. He was referred to our facility for severe nasal haemorrhage after biopsy of a left nasopharyngeal mass. In the operating room, extensive bleeding was noted, and an endoscopic medial maxillectomy was performed, and the left internal maxillary artery was ligated allowing for near total resection of the lesion. The pathological specimen confirmed the diagnosis of NA. To our knowledge, this is one of the oldest patients presenting with a de novo NA, in his fourth decade of life, confirming that this diagnosis must be considered in all those with large nasopharyngeal masses.

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.

A rare location of angiofibroma in the inferior turbinate in young woman

Introduction Juvenile nasopharyngeal angiofibroma is a rare benign neoplasm in the nasopharynx. The tumor tends to be locally aggressive and is typically seen in adolescent boys. Extranasopharyngeal angiofibromas have been reported sporadically in the literature. They most commonly originate from the maxillary sinus. Objectives A 26-year-old woman was referred to our clinic with intermittent epistaxis from the right nasal passage for the previous 2 months. Maxillofacial magnetic resonance imaging showed a lobular, contoured mass originating from the right inferior turbinate and hanging in the right nasal cavity, with dense contrast enhancement denoting hypervascularity. Resumed Report Vascular feeding of the mass was seen from the right internal maxillary artery with angiography, and this branch was embolized. On the following day, the patient underwent transnasal endoscopic excision of the mass. An approximately 3-cm-diameter mass was excised by partial turbinectomy, and the posterior edge of the remaining turbinate was cauterized. Conclusion Extranasopharyngeal angiofibromas are rarely seen, and the inferior turbinate is an extremely rare location for them. This young woman is the first case reported in the English literature of angiofibroma originating from the inferior turbinate. We should consider these neoplasms can be found in female, nonadolescent patients with extranasopharyngeal localization, and we should not perform biopsy because of its massive bleeding.

Extranasopharyngeal angiofibroma originating in the inferior turbinate: a distinct clinical entity at an unusual site

Introduction The extranasopharyngeal angiofibroma is histologically similar to juvenile nasopharyngeal angiofibroma, differing from the latter in clinical and epidemiologic characteristics. Objectives We present a case of extranasopharyngeal angiofibroma originating in the inferior turbinate. Resumed Report The patient was a girl, 8 years and 6 months of age, who had constant bilateral nasal obstruction and recurrent epistaxis for 6 months, worse on the right side, with hyposmia and snoring. Nasal endoscopy showed a reddish lesion, smooth, friable, and nonulcerated. Computed tomography showed a lesion with soft tissue density in the right nasal cavity. We used an endoscopic approach and found the lesion inserted in the right inferior turbinate. We did a subperiosteal dissection and excision with a partial turbinectomy with a resection margin of 0.5 cm. Histopathology reported it to be an extranasopharyngeal angiofibroma. Conclusion Although rare, extranasopharyngeal angiofibroma should be considered in the diagnosis of vascular tumors of the head and neck.

Extranasopharyngeal angiofibroma of the nasal septum: a rare clinical entity

Angiofibromas (AFs) are benign, potentially local aggressive, and rich vascular neoplasms that originate from posterior lateral wall of the nasopharynx in adolescent males. However, they could be encountered in sites other than nasopharynx. The maxillary sinus is the most common location of extranasopahryngeal AFs. The nasal septum is an extremely rare location, and only 15 cases had been reported in literature. In this present case, an unusual extranasal AF originating from the anterior part of the nasal septum is reported with its clinical, laboratory, and treatment options and theories proposed to explain the origin of extranasopharyngeal AFs are discussed.

Immunohistochemistry in diagnosis of extranasopharyngeal angiofibroma originating from nasal cavity: case presentation and review of the literature

Angiofibromas are rare vascular tumors which originate predominantly in the nasopharynx and occur typically in male adolescents. Extranasopharyngeal sites such as nasal cavity and paranasal sinuses are less frequent. This review article was undertaken to evaluate the incidence, clinical features and management of extranasopharyngeal angiofibromas originating exclusivelly from nasal cavity structures. Our focus of interest was to evaluate the significance of immunohistochemical analysis in diagnosis of such extremely rare neoplasms. In the PubMed and Google Search, we found only 39 cases of nasal angifibroma, 27 males and 12 females from 1980 to 2012. The most prevalent site of origin was nasal septum, followed by inferior and middle turbinate. The commonest symptoms were nasal obstruction and epistaxis. Nasal angiofibromas are clinically distinct from nasopharyneal angiofibromas and can therefore be misdiagnosed. The differential diagnosis includes other vascular lesions, such as lobular capillary hemangioma and sinonasal-type hemangiopericytoma. Although immunohistochemistry is not necessary for differentiation between angiofibroma and capillary hemangioma, that diagnostic procedure may be helpful in distinction from sinonasal hemangiopericytoma. As an ilustration for immunohistochemical analysis, we presented a case of an elderly woman with tumor arising from the middle turbinate, diagnosed as angiofibroma. The staining was positive for CD34, CD31, factor VIII, vimentin and smooth muscle alpha-actin, and negative for desmin.

Exclusive Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma

Objective

To systematically review the exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma in the literature to define the clinical features in terms of staging and the treatment outcomes in terms of bleeding, recurrence, residual tumor, and complications.

Data Sources

Online databases, including PubMed and EMBASE, were used. Reference sections of identified studies were examined for additional articles.

Review Methods

The literature was searched by 2 reviewers with the following inclusion criteria: English or French language and exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma. We were only able to perform a meta-analysis on the categorical outcomes using DerSimonian and Laird random effects models.

Results

Ninety-two studies were included with a majority of retrospective studies (54/92; 58.6%). No randomized controlled trials were found. A total of 821 patients were identified. The Radowski classification was the most commonly used (29/92; 31.15%). The mean operative blood loss was 564.21 mL (minimum, 20 mL; maximum, 1482 mL). It was 414.6 mL (minimum, 20 mL; maximum, 1000 mL) and 774.2 mL (minimum, 228 mL; maximum, 1482 mL), respectively, in the group with and without embolization. No conclusion could be made because it was not stratified by tumor stage and because of the absence of randomized controlled trials. The random effect estimate of recurrence was 10% (95% confidence interval [CI], 8.3-11.7). It was 9.3% (95% CI, 7.2-11.5) for complications and 7.7% (95% CI, 5.4-10.1) for residual tumor.

Conclusion

The endoscopic treatment is an evolving modality. It is considered today the treatment of choice. A new classification system based on the endoscopic approach should be proposed in future studies.

An unusual location of juvenile angiofibroma: a case report and review of the literature

A 10-year-old boy presented with left-sided nasal obstruction and epistaxis. Endoscopic evaluation revealed a polypoid mass in the vestibule arising from the lateral wall of the nasal cavity anteroinferior to the left inferior turbinate. Computed tomography (CT) scan showed a soft tissue opacity in the vestibule of the left nasal cavity. After the endoscopic excision of the mass, postoperative and histopathological analyses confirmed the diagnosis of an angiofibroma.

Extranasopharyngeal Angiofibroma from Nasal Vestibule: A Rare Presentation

The term extranasopharyngeal angiofibroma has been applied to vascular, fibrous nodules occurring outside the nasopharynx. These rare benign neoplasms characterized by a different biological history and clinical features with respect to nasopharyngeal tumors and, for these reasons, they should be regarded as atypical clinical entity.

A 60-year-old male presented to us with a mass in the left nasal cavity since last 1 year. Examination revealed an irregular, pinkish mass arising from the lateral aspect of left nasal vestibule. The mass was excised and sent for histopathological reporting which confirmed angiofibroma. This case is reported for its atypicality being the rarest site of origin with no case reported so far in medical literature.

How to cite this article

Malipatil SR. Extranasopharyngeal Angiofibroma from Nasal Vestibule: A Rare Presentation. Int J Otorhinolaryngol Clin 2013;5(3):169-172.

Bilateral non-superselective embolization with particles under transient occlusion of the internal carotid artery in the management of juvenile nasopharyngeal angiofibroma: technical note

Juvenile nasopharyngeal angiofibroma (JNA) is a rare histologically benign tumor, highly vascularized, with usually aggressive behavior, and can extend from the nasal cavity to neighboring structures. We present the case of a 14-year-old male harboring a JNA, presenting with an active severe and persistent epistaxis. Two previous surgical attempts of removal were unsuccessful, because of profuse intraoperative bleeding. Angiography showed a highly vascularized neoplasm with multiple branches arising from both internal carotid arteries, with absence of branches from the external carotid due to previous surgical ligation. Direct puncture tumor embolization was not possible because removal of nasal packing triggered major hemorrhage. The only option for embolization was a technique of non-superselective embolization with particles under transient occlusion of the internal carotid artery. The procedure was performed uneventfully from either side, the tumor was subsequently removed, and the patient had no recurrence 2 years after the initial treatment.

A case of extranasopharyngeal angiofibroma of the ethmoid sinus: a distinct clinical entity at an unusual site

Angiofibromas of the head and neck usually arise from the nasopharynx in adolescent boys. The term extranasopharyngeal angiofibroma (ENA) has been applied to vascular fibrous nodules that arise outside the nasopharynx. Because the clinical characteristics of ENA are not consistent with those of juvenile nasopharyngeal angiofibroma (JNA), diagnosis of the former can be challenging. Biopsy is ill advised in a patient with an ENA because it might result in brisk bleeding. A high index of suspicion and a methodical evaluation are essential in establishing the proper diagnosis and treatment. We report the rare case of a 16-year-old girl who presented with a pinkish lobulated mass in her left nostril that had arisen from the anterior ethmoid sinus. The mass was removed via a lateral rhinotomy approach. Postoperative histopathologic analysis identified it as an angiofibroma. To best of our knowledge, only 9 cases of ENA arising from the ethmoid sinus have been previously reported in the English-language literature.

Endoscopic approach for excision of juvenile nasopharyngeal angiofibroma: complications and outcomes

The purposes of this study are to report the efficacy of the endoscopic approach for juvenile nasopharyngeal angiofibroma (JNA) and to compare its related intra- and postoperative complications with findings from traditional approaches in the literatures. This study is a retrospective report of 47 cases of JNA that were treated with nasal endoscopic surgery between 1998 and 2005. According to the staging system by Radkowski et al (Arch Otolaryngol Head Neck Surg. 1996;122:122-129), the staging of the included patients were the following: 21 in stages IA to IIB, 22 in IIC, 3 in IIIA, and 1 in IIIB. Five patients were embolized before surgery. The mean blood hemorrhage in embolized patients was 770 mL, whereas in nonembolized patients, it was 1403.6 mL. In the follow-up period (mean, 2.5 years), the recurrence was found in 9 patients (19.1%), and mean time of recurrence was 17 months after surgery. The rupture of cavernous sinus occurred in 2 cases with no mortality. The mean hospital stay was 3.1 days in all cases and 1.8 days in embolized patients. The findings of this study demonstrate that endoscopic resection of JNA is a safe and effective technique because of decrease in blood loss, hospitalization, and recurrence rate, especially in tumors that are not extended through intracranial space. It is therefore strongly recommended that this modality is implemented as the first surgical step for tumors with stages I to IIIA of the Radkowski's staging system.

Radiofrequency-induced thermotherapy of nasopharyngeal angiofibroma and immunohistochemical analysis of vessel proliferation: a case report

Introduction

Nasopharyngeal angiofibroma presents with symptoms of nasal obstruction and epistaxis. The treatment of choice is embolization followed by surgery.

Case presentation

A 52-year-old man underwent surgery for nasopharyngeal angiofibroma after adjuvant radiofrequency-induced thermotherapy. To the best of the authors' knowledge, this is the first case of angiofibroma with clinical follow-up after thermocoagulation therapy supported by quantitative, double immunohistochemistry. We found this case of angiofibroma to be of interest owing to the presentation of symptoms leading to biopsy, the pathohistological observations obtained with synchronous Ki67/cluster of differentiation 34 and Ki67/smooth muscle actin immunohistochemistry and high pericyte proliferation.

Conclusion

Coagulation of angiofibroma vessels followed by acquisition of a thick mantle of pericytes in a patient with a nasopharyngeal growth suggests that radiofrequency-induced thermotherapy could be a useful, palliative therapy for bleeding nasopharyngeal angiofibroma, supporting vessel maturation prior to surgical tumor removal.

Atypical angiofibroma of larynx - a case report

Primary extra nasopharyngeal angiofibroma of larynx is a very rare tumour. We here by present a case of angiofibroma of larynx affecting the anterior commissure & subglottic region in larynx-a rare site of involvement.