Extranasopharyngeal angiofibroma in a 15-month-old child

Extranasopharyngeal angiofibroma in children: A case report

BACKGROUND

Sporadic cases of extranasopharyngeal angiofibroma in children, especially preschool children, have been reported in the literature.

CASE SUMMARY

We present a case of extranasopharyngeal angiofibroma in a 4-year-old boy. The presenting symptoms, imaging findings, treatment, histological appearance, and follow-up data are described in detail. For this patient, we performed embolization on two occasions, and then, resected the tumor completely. During the treatment, the patient developed a soft-palate perforation due to aseptic necrosis. However, the healing ability was good, and the perforation healed spontaneously. We additionally reviewed all pediatric cases of extranasopharyngeal angiofibroma published up to 30 June 2020 in the PubMed, Baidu Scholar, Scopus, and Web of Science databases. We identified 45 pediatric patients [average (10.98 ± 4.86), boys 39 (86.7%)]. The highest proportion of cases occurred in adolescence [22 (48.9%)]. The top three sites of occurrence of extranasopharyngeal angiofibroma in children were the maxillary sinus, nasal septum, and inferior turbinate.

CONCLUSION

Extranasopharyngeal angiofibromas can occur throughout childhood, and predominantly present with nasal obstruction and spontaneous rhinorrhagia.

Frontoethmoidal Extranasopharyngeal Angiofibroma With Orbital Pyocele

Significance StatementExtranasopharyngeal angiofibromas (ENA) are rare vascular tumors that do not conform to the clinical characteristics of typical nasopharyngeal angiofibromas. We present the management of an angiofibroma in a rare site, within the frontal sinus with a concomitant orbital pyocele, which was completely excised via an endoscopic approach. ENAs should be considered as a differential diagnosis in patients with sinonasal mass and epistaxis. Awareness of this rare entity will avoid radical surgery thus decreasing postoperative morbidity.

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.

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.

Extranasopharyngeal angiofibroma: clinical and radiological presentation

Nasopharyngeal angiofibroma (NA) is a rare, vascular tumor affecting adolescent males. Due to aggressive local growth, skull base location and risk of profound hemorrhage, NA is a challenge for surgeons. Angiofibromas have been sporadically described in extanasopharyngeal locations. We review ten cases of extranasopharyngeal angiofibroma (ENA) and discuss the incidence, clinical presentation and management of this pathology. The group consisted of 4 males and 5 females aged 8–49. There were 7 patients with nasal angiofibroma, 1 patient with laryngeal angiofibroma, 1 patient with oral angiofibroma and another patient with infratemporal fossa tumor. In patients with nasal angiofibroma most common presenting symptoms were nasal obstruction and epistaxis. Patients with laryngeal angiofibroma suffered from mild dysphagia and patients with the infratemporal fossa tumor had painless cheek swelling. In four patients with nasal tumor computed tomography (CT) demonstrated mass with strong to intermediate contrast enhancement. In one patient with nasal tumor carotid angiography demonstrated pathological vessels without intensive tumor blush. Infratemporal fossa tumor showed intensive contrast enhancement on CT and magnetic resonance imaging (MRI) scans, and abundant vascularity on angiography. Laryngeal and oral angiofibroma required no radiological imaging. Three nasal tumors were evaluated before introduction of CT to clinical practice. All patients underwent surgery. No recurrences developed. ENAs differ significantly from NAs regarding clinical and radiological presentations. They lack typical clinical and radiological features as they develop in all age groups and in females, may be less vascularised, arise from various sites and produce a variety of symptoms.

Atypical angiofibromas: a report of four cases

In this study, our four patients with angiofibroma with various atypical features are presented. Related literature is reviewed and criteria for atypicality are proposed. 14 patients, diagnosed and treated for angiofibroma in the Otorhinolaryngology Department of Faculty of Medicine in Uludag University between January 1992 and December 2003, have been evaluated. The files of the patients were examined and four patients with atypical characteristics have been included in the study. Angiofibromas presenting with at least one of the following criteria such as origin or location other than nasopharynx, presenting complaints other than nasal obstruction or epistaxis, aged younger than seven or older than 25, female sex, atypical histopathology and multifocalitiy were considered as "atypical". Four of 14 angiofibromas (28.5%), which were diagnosed and treated in our clinic, had atypical features. The reasons for atypicality were unusual localization in three patients and uncommon initial symptom in one case. In the atypical localization group, neoplasm was located in tonsil in one case, and in inferior turbinate in two patients. The only patient with atypical initial symptom presented with a bulging in the cheek. The patients, who have different characteristics other than classical angiofibromas, may be called "Atypical Angiofibroma (AAF)", under the scope of the related literature and our experience. These patients should be included in atypical group according to the characteristics such as, localization, symptom, age, sex, histopathology and multifocality.

[Extra-naso-pharyngeal angiofibroma: report of a new case and review of literature]

Juvenile nasopharyngeal angiofibromas are vascular neoplasms, which originate characteristically in the posterior lateral wall of the nasopharynx. Although angiofibromas extend beyond the nasopharynx commonly, sometimes they can have their origin outside nasopharynx. We present an unusual case of extranasopharyngeal angiofibroma. A high level of suspicion is essential for an adequate diagnosis and treatment of these neoplasms.

Extranasopharyngeal angiofibroma

Juvenile nasopharyngeal angiofibromas are vascular neoplasms, which originate characteristically in the posterior lateral wall of the nasopharynx. Although angiofibromas extend beyond the nasopharynx commonly, they rarely originate outside the nasopharynx. Reports of primary extranasopharyngeal angiofibromas have appeared sporadically in the literature. We present an unusual case of an angiofibroma arising from the middle turbinate. The clinical characteristics of extranasopharyngeal angiofibromas do not conform to that of nasopharyngeal angiofibromas. Therefore, they can present diagnostic challenges. A methodic evaluation and a high index of suspicion are essential in establishing the proper diagnosis and treatment.