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

Early-onset juvenile nasopharyngeal angiofibroma (JNA): a systematic review

BACKGROUND

Juvenile Nasopharyngeal Angiofibroma (JNA) is a fibrovascular tumor of the nasopharynx that classically presents in adolescent males. The reported mean age of onset is between 13 and 22 years old [1-6]. Significant androgen stimulation is hypothesized to explain the strong predisposition for JNA to present in young adolescent males. However, considerable variability in age at diagnosis exists with rare involvement of very young patients incongruent with typical male pubertal growth patterns.

OBJECTIVE

The purpose of this systematic review is to identify cases of early-onset JNA (EOJNA), (defined as age < 10 years) in the literature and to examine the disease characteristics and treatments used in this patient group. A case of a 7 year old boy with EOJNA at our institution is also described and presented.

METHODS

We searched Embase, Cochrane database and MEDLINE from 1996 to February 2021 for studies that reported cases of EOJNA. Relevant clinico-demographic data, disease severity and treatment outcomes were recorded and analyzed using descriptive statistics. We compared our findings with reported means for JNA in all ages.

RESULTS

We identified 29 studies containing a total of 34 cases of EOJNA. The vast majority (31/34) of patients were males and the mean age of diagnosis was 8.15 years old. The most common presenting symptoms were nasal obstruction (65.2%) and epistaxis (60.9%). Patients were most commonly Radkowski stage II (39.4%) and III (39.4%). Primary treatment modalities included open surgery (66.7%), endoscopic surgery (24.2%), and radiotherapy (9.1%). Recurrence was evident in 30%. Radkowski stage and type of treatment did not differ significantly within the EOJNA group (p = 0.440 and p = 0.659, respectively).

CONCLUSION

This systematic review suggests that rare cases of EOJNA have distinct disease characteristics. Patients in this cohort appeared to have more advanced disease and higher recurrence rates when compared with reported averages. We hope that this review prompts increased clinical awareness of this potentially more aggressive subtype of JNA. As more cases of EOJNA are reported, a more powered statistical analysis of this cohort would be feasible.

Maxillary Sinus Angiofibroma: A Rare Entity

Juvenile Nasopharyngeal Angiofibroma (JNA) is an unusual benign, although destructive fibrovascular tumor of the nasopharynx which rarely present itself at other sites. Maxilla is the most frequent extranasopharyngeal site of origin. We report a case of Extranasopharyngeal Angiofibroma (ENA) arising from maxillary sinus in an adult patient which was excised into successfully.

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.

Case Series of Pre-Operative Endovascular Embolization of Nasopharyngeal Angiofibroma Using Polyvinyl Alcohol Foam Particle: A Single Centre Experience

BACKGROUND

Nasopharyngeal Angiofibroma is a rare neoplasm in the sphenopalatine foramen. This tumour is histologically benign, but clinically malignant because it can erode the bone and surrounding structures, such as the pterygopalatine fossa, paranasal sinuses, and nasal cavity. It is a highly vascular tumour, sometimes from multiple Feeding arteries, and tends to bleed easily.

CASE PRESENTATION

In these cases, series, we reported four cases of nasopharyngeal angiofibroma in children and one case in an elderly patient. The diagnosis was made by history taking, physical examination and Cerebral MSCT Angiography, as well as Digital Subtraction Angiography (DSA). After identification of the Feeding artery, we performed transarterial embolisation using polyvinyl alcohol (PVA) foam particles.

CONCLUSION

Preoperative embolisation in the highly vascular tumour, such as nasopharyngeal angiofibroma, is very useful to reduce peri-operative complication of surgery. This procedure can reduce blood loss during resection of the tumour and gives better outcomes.

Update on nonmalignant lesions of the inferior turbinate

PURPOSE OF REVIEW

The inferior turbinates are routinely examined by otolaryngologists on anterior rhinoscopy and nasal endoscopy. Most lesions of the inferior turbinate are benign but can often be confused with malignancy. This review highlights the broad differential of nonmalignant lesions of the inferior turbinates and their management.

RECENT FINDINGS

A variety of infectious, inflammatory, neoplastic, and vascular lesions may affect the inferior turbinates. The most common nonmalignant lesions of the sinonasal region are nasal polyps, inverted papillomas, hemangiomas, and angiofibromas. Early lesions are often asymptomatic and discovered incidentally on routine examination. As these lesions grow they present with nonspecific signs that can be seen in benign, malignant, and infectious etiologies. The most common signs and symptoms are nasal obstruction, rhinorrhea, epistaxis, sinusitis, and hyposmia. Most nonmalignant lesions have characteristic appearances but definitive diagnosis is achieved with biopsy or culture. If the lesions are small the biopsy itself is often curative.

SUMMARY

Lesions of the inferior turbinates are rarely isolated to these structures alone. Careful examination can noninvasively assist in early diagnosis of extensive lesions. Once malignancy and processes such as invasive fungal sinusitis or inverted papillomas have been ruled out, treatment of these lesions is ordinarily noncomplicated and definitive.

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.

Elevated Glucose and Interleukin-1β Differentially Affect Retinal Microglial Cell Proliferation

Diabetic retinopathy is considered a neurovascular disorder, hyperglycemia being considered the main risk factor for this pathology. Diabetic retinopathy also presents features of a low-grade chronic inflammatory disease, including increased levels of cytokines in the retina, such as interleukin-1 beta (IL-1β). However, how high glucose and IL-1β affect the different retinal cell types remains to be clarified. In retinal neural cell cultures, we found that IL-1β and IL-1RI are present in microglia, macroglia, and neurons. Exposure of retinal neural cell cultures to high glucose upregulated both mRNA and protein levels of IL-1β. High glucose decreased microglial and macroglial cell proliferation, whereas IL-1β increased their proliferation. Interestingly, under high glucose condition, although the number of microglial cells decreased, they showed a less ramified morphology, suggesting a more activated state, as supported by the upregulation of the levels of ED-1, a marker of microglia activation. In conclusion, IL-1β might play a key role in diabetic retinopathy, affecting microglial and macroglial cells and ultimately contributing to neural changes observed in diabetic patients. Particularly, since IL-1β has an important role in retinal microglia activation and proliferation under diabetes, limiting IL-1β-triggered inflammatory processes may provide a new therapeutic strategy to prevent the progression of diabetic retinopathy.

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.