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Felippu AWD, Fontes EB, Felippu AWD, Ellery BC, Oliveira ACSD, Guimarães AV, Cascio F, Felippu A. Juvenile Nasopharyngeal Angiofibroma: A Series of 96 Surgical Cases. Int Arch Otorhinolaryngol 2024; 28:e432-e439. [PMID: 38974625 PMCID: PMC11226290 DOI: 10.1055/s-0043-1777293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/15/2023] [Indexed: 07/09/2024] Open
Abstract
Introduction Juvenile nasopharyngeal angiofibroma (JNA) is a benign vascularized tumor that affects almost exclusively male adolescents. Surgery is the treatment of choice for JNA. Objectives The present study is a 42-year retrospective review of a series of JNA cases treated surgically without previous embolization. Methods The present is a retrospective, descriptive study based on medical records of 96 patients with JNA who underwent microscopic or endoscopic excision without previous embolization from 1978 to 2020 in a single institution. The patients were categorized according to the Andrews et al. stage, and data were collected on age, gender, tumor staging, surgical approach, affected side, and outcome. Results All patients were male, with an average age of 17 years. The predominant tumor stage consisted of type II, with 52.1%. A total of 33.3% of the patients were submitted to the microscopic technique and 66.7%, to the endonasal technique. The rate of intraoperative blood transfusion was of 17.7%. Conclusion The present study reinforces that resection of JNA in various stages is viable without previous artery embolization.
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Affiliation(s)
| | | | | | | | | | | | - Filippo Cascio
- Department of Otorhinolaryngology, Papardo Hospital, Messina, Italy
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Hoch CC, Knoedler L, Knoedler S, Bashiri Dezfouli A, Schmidl B, Trill A, Douglas JE, Adappa ND, Stögbauer F, Wollenberg B. Integrated Molecular and Histological Insights for Targeted Therapies in Mesenchymal Sinonasal Tract Tumors. Curr Oncol Rep 2024; 26:272-291. [PMID: 38376625 PMCID: PMC10920452 DOI: 10.1007/s11912-024-01506-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE OF REVIEW This review aims to provide a comprehensive overview of mesenchymal sinonasal tract tumors (STTs), a distinct subset of STTs. Despite their rarity, mesenchymal STTs represent a unique clinical challenge, characterized by their rarity, often slow progression, and frequently subtle or overlooked symptoms. The complex anatomy of the sinonasal area, which includes critical structures such as the orbit, brain, and cranial nerves, further complicates surgical treatment options. This underscores an urgent need for more advanced and specialized therapeutic approaches. RECENT FINDINGS Advancements in molecular diagnostics, particularly in next-generation sequencing, have significantly enhanced our understanding of STTs. Consequently, the World Health Organization has updated its tumor classification to better reflect the distinct histological and molecular profiles of these tumors, as well as to categorize mesenchymal STTs with greater accuracy. The growing understanding of the molecular characteristics of mesenchymal STTs opens new possibilities for targeted therapeutic interventions, marking a significant shift in treatment paradigms. This review article concentrates on mesenchymal STTs, specifically addressing sinonasal tract angiofibroma, sinonasal glomangiopericytoma, biphenotypic sinonasal sarcoma, and skull base chordoma. These entities are marked by unique histopathological and molecular features, which challenge conventional treatment approaches and simultaneously open avenues for novel targeted therapies. Our discussion is geared towards delineating the molecular underpinnings of mesenchymal STTs, with the objective of enhancing therapeutic strategies and addressing the existing shortcomings in the management of these intricate tumors.
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Affiliation(s)
- Cosima C Hoch
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
| | - Leonard Knoedler
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Samuel Knoedler
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum Munich, Munich, Germany
| | - Ali Bashiri Dezfouli
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
- Central Institute for Translational Cancer Research, Technical University of Munich (TranslaTUM), Department of Radiation Oncology, Klinikum rechts der Isar, Munich, Germany
| | - Benedikt Schmidl
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
| | - Anskar Trill
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
- Central Institute for Translational Cancer Research, Technical University of Munich (TranslaTUM), Department of Radiation Oncology, Klinikum rechts der Isar, Munich, Germany
| | - Jennifer E Douglas
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Fabian Stögbauer
- Institute of Pathology, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
| | - Barbara Wollenberg
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany.
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Parmar HA, Ibrahim M. Imaging of Anterior Skull Base. Semin Ultrasound CT MR 2021; 42:281-294. [PMID: 34147163 DOI: 10.1053/j.sult.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hemant A Parmar
- Department of Radiology, University of Michigan, Ann Arbor, MI.
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Choi JS, Yu J, Lovin BD, Chapel AC, Patel AJ, Gallagher KK. Effects of Preoperative Embolization on Juvenile Nasopharyngeal Angiofibroma Surgical Outcomes: A Study of the Kids' Inpatient Database. Skull Base Surg 2020; 83:76-81. [DOI: 10.1055/s-0040-1716676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
Abstract
Objectives The aim of the study is to evaluate the effect of preoperative vascular embolization (PVE) on juvenile nasopharyngeal angiofibroma (JNA) surgical outcomes using a national pediatric hospitalization database.
Methods The health care cost and utilization project Kids' Inpatient Database was queried for all cases of operative management of JNA between the years of 1997 and 2016. Cases were stratified based on whether the patient received PVE. A multiple linear regression was used to predict the effect of PVE on hospital length of stay (LOS) and total cost while controlling for patient demographic factors and comorbidities. The odds ratio (OR) of receiving a perioperative blood transfusion was computed using a binary logistic regression for PVE patients.
Results A total of 473 patients who underwent JNA surgical resection in this time period were identified. The use of PVE has increased from 0% in 1997 to 66% of all cases by 2016. PVE was found to decrease LOS by 1 day (p = 0.036) and decrease the odds of needing a perioperative blood transfusion (OR = 0.511, p = 0.041). Patients receiving PVE were charged an additional $35,600 (p < 0.001), but recent data in 2016 indicate that hospital costs for PVE are decreasing.
Conclusion PVE of JNA is becoming increasingly prevalent. Embolization results in decreased hospital LOS and lower odds of needing blood transfusions. While embolization increases the cost of management, this trend should be re-evaluated as this procedure is becoming more widespread.
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Affiliation(s)
- Jonathan S. Choi
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Justin Yu
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Benjamin D. Lovin
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Alyssa C. Chapel
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
| | - Akash J. Patel
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - K. Kelly Gallagher
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston Texas, United States
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
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Wang EW, Zanation AM, Gardner PA, Schwartz TH, Eloy JA, Adappa ND, Bettag M, Bleier BS, Cappabianca P, Carrau RL, Casiano RR, Cavallo LM, Ebert CS, El-Sayed IH, Evans JJ, Fernandez-Miranda JC, Folbe AJ, Froelich S, Gentili F, Harvey RJ, Hwang PH, Jane JA, Kelly DF, Kennedy D, Knosp E, Lal D, Lee JYK, Liu JK, Lund VJ, Palmer JN, Prevedello DM, Schlosser RJ, Sindwani R, Solares CA, Tabaee A, Teo C, Thirumala PD, Thorp BD, de Arnaldo Silva Vellutini E, Witterick I, Woodworth BA, Wormald PJ, Snyderman CH. ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 2020; 9:S145-S365. [PMID: 31329374 DOI: 10.1002/alr.22326] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Endoscopic skull-base surgery (ESBS) is employed in the management of diverse skull-base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull-base surgery have produced the International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR:ESBS). METHODS Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence-based review or evidence-based review with recommendations format. Subsequently, each topic was written and then reviewed by skull-base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull-base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. CONCLUSION A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence-based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull-base community to embrace these opportunities and collaboratively address these shortcomings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam J Folbe
- Michigan Sinus and Skull Base Institute, Royal Oak, MI
| | | | | | - Richard J Harvey
- University of Toronto, Toronto, Canada.,University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Charles Teo
- Prince of Wales Hospital, Randwick, Australia
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Doody J, Adil EA, Trenor CC, Cunningham MJ. The Genetic and Molecular Determinants of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review. Ann Otol Rhinol Laryngol 2019; 128:1061-1072. [DOI: 10.1177/0003489419850194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: Juvenile nasopharyngeal angiofibroma (JNA) is a rare vascular tumor of unknown etiology. Studies investigating the molecular and genetic determinants of JNA are limited by small sample size and inconsistent approaches. The purpose of this study is to examine all eligible JNA studies in aggregate, applying qualitative analysis to highlight areas of particular relevance, including potential targets for therapeutic intervention. Methods: The PubMed, MEDLINE, Embase, Web of Science, Cochrane, and CINAHL databases were screened with inclusion and exclusion criteria applied to all citations. Manuscripts investigating the genetic determinants, histopathogenesis, and heritability of juvenile nasopharyngeal angiofibroma were included. Non-English studies, case reports, and articles focusing on clinical management without original data were excluded. Full text articles were obtained. A qualitative synthesis of data was performed. Results: A total of 59 articles met criteria for inclusion. These were divided into 6 categories based on the primary topic or target discussed, (1) steroid hormone receptors, (2) chromosomal abnormalities, (3) growth factors, (4) genetic targets, (5) molecular targets, (6) Wnt cell signaling, and (7) studies that overlapped multiple of the aforementioned categories. Although relatively low n values prevent definitive conclusions to be drawn, a predominance of certain molecular targets such as vascular endothelial growth factor (VEGF) and Wnt/β-catenin pathway intermediaries is apparent. Conclusions: Although the etiology of JNA remains elusive, contemporary molecular genetic investigation holds promise for risk stratification and could form the basis of a modernized staging system. A multicenter clinical registry and linked tissue bank would further promote the search for JNA specific biomarkers.
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Affiliation(s)
- Jaime Doody
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Eelam A. Adil
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Cameron C. Trenor
- Division of Hematology/Oncology and Vascular Anomalies Center, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Michael J. Cunningham
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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Camilon PR, Rahbar R, Cunningham MJ, Adil EA. Juvenile nasopharyngeal angiofibroma in prepubertal males: A diagnostic dilemma. Laryngoscope 2018; 129:1777-1783. [DOI: 10.1002/lary.27633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2018] [Indexed: 11/09/2022]
Affiliation(s)
- P. Ryan Camilon
- Department of Otolaryngology; Boston Medical Center; Boston Massachusetts
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Michael J. Cunningham
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Eelam A. Adil
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
- Department of Otolaryngology; Harvard Medical School; Boston Massachusetts U.S.A
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Kumagami H. Estradiol, Dihydrotestosterone, and Testosterone in Juvenile Nasopharyngeal Angiofibroma Tissue. ACTA ACUST UNITED AC 2018. [DOI: 10.2500/105065893781976393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Seven cases of juvenile nasopharyngeal angiofibroma were studied in terms of the presence of estradiol, dihydrotestosterone, and testosterone in the juvenile nasopharyngeal angiofibroma tissue using the peroxidase-antiperoxidase method. Estradiol was positive in all cases, however, two cases showed reduced stainability. Dihydrotestosterone and testosterone were positive in two and five cases of the seven patients, respectively. Hormone receptors in the juvenile nasopharyngeal angiofibroma tissue seem to change by the activity of nasopharyngeal angiofibroma and by the patient's age.
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Cumulative sum analysis of the learning curve for endoscopic resection of juvenile nasopharyngeal angiofibroma. Surg Endosc 2018; 32:3181-3191. [PMID: 29368283 DOI: 10.1007/s00464-018-6035-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND To determine the learning curve with cumulative sum analysis for endoscopic resection of juvenile nasopharyngeal angiofibroma (JNA) and investigate whether the surgeon's expertise is a risk factor for recurrence. MATERIALS AND METHODS We reviewed the medical records of patients with JNA who underwent endoscopic or endoscopic-assisted surgery between 2006 and 2015. We used cumulative sum (Cusum) analysis to plot the learning curve for operation time versus chronological sequence, and verified the Cusum curve by risk-adjusted Cusum (RA-Cusum) analysis. We identified three phases of expertise. The recurrence rate was analyzed using the Kaplan-Meier method and log-rank tests. A multivariable Cox regression analysis was performed to identify the independent risk factors for recurrence. RESULTS We included 154 JNA patients with a median age of 16 years. The surgeon overcame the learning curve after case 80 with increasing surgical efficiency and competence. The learning curve plotted by Cusum analysis divided the cases into three phases: phase 1, accumulation of initial experience (cases 1-41); phase 2, further accumulation of experience (cases 42-117); and phase 3, mastering the procedure (cases 118-154). Pearson's χ2 tests showed that tumor stage (P = 0.021), blood loss (P = 0.001), operation time (P < 0.001), and phase (P < 0.001) were associated with recurrence. The log-rank test showed that time to recurrence was significantly shorter in phase 1 than in phases 2 and 3. Blood loss and phase were independently prognostic factors for time to recurrence, with P values of 0.023 and 0.009, respectively. The RA-Cusum analysis identified two inflection points of the curve at case 44 and 83, and verified the results of Cusum analysis. CONCLUSION Surgical experience and competence with endoscopic resection affect the recurrence rate in JNA patients. LEVEL OF EVIDENCE 4.
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Safadi A, Schreiber A, Fliss DM, Nicolai P. Juvenile Angiofibroma: Current Management Strategies. J Neurol Surg B Skull Base 2018; 79:21-30. [PMID: 29404237 DOI: 10.1055/s-0037-1615810] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Juvenile angiofibroma (JA) is a benign, highly vascular tumor which is diagnosed on the basis of clinical and imaging features. It has a characteristic pattern of spread commonly involving the pterygopalatine fossa and pterygoid base. The mainstay of treatment is surgery, while radiotherapy is rarely used for the treatment of recurrent lesion. Endoscopic endonasal surgery is currently the treatment of choice for small to intermediate size JAs, and is feasible even for advanced lesions; however, this should only be practiced in well-experienced centers.
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Affiliation(s)
- Ahmad Safadi
- Department of Otorhinolaryngology - Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alberto Schreiber
- Department of Otorhinolaryngology - Head and Neck Surgery, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Dan M Fliss
- Department of Otorhinolaryngology - Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Piero Nicolai
- Department of Otorhinolaryngology - Head and Neck Surgery, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
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Elmokadem A, Abdel Khalek A, Amer T. Preoperative transarterial particulate embolization of juvenile angiofibroma with intracranial extension: Technical and clinical outcomes. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
OBJECTIVE A modern imaging review is necessary to further define the anatomic origin of the juvenile nasopharyngeal angiofibroma. METHODS After institutional review board approval, a search from January 1998 to January 2013 yielded 33 male patients (aged 10-23 years) with pathologically proven juvenile nasopharyngeal angiofibroma lesions, as well as pretreatment computed tomography/magnetic resonance imaging. Juvenile nasopharyngeal angiofibroma involvement was assessed in the following regions: sphenopalatine foramen, pterygopalatine fossa, vidian canal, nasopharynx, nasal cavity, sphenoid sinus, choana, pterygomaxillary fissure/masticator space, orbit, and sphenoid bone. RESULTS The choana and nasopharynx were involved in all 33 patients. In contrast, only 22 lesions involved the pterygopalatine fossa, 24 lesions involved the sphenopalatine foramen, and 28 lesions involved the vidian canal. CONCLUSIONS Our results suggest that the juvenile nasopharyngeal angiofibroma origin is in the region of the choana and nasopharynx rather than the sphenopalatine foramen or pterygopalatine fossa.
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Variable expression of molecular markers in juvenile nasopharyngeal angiofibroma. The Journal of Laryngology & Otology 2017; 131:752-759. [DOI: 10.1017/s0022215117001372] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Molecular categorisation may explain the wide variation in the clinical characteristics of juvenile nasopharyngeal angiofibroma.Methods:Variations in molecular markers in juvenile nasopharyngeal angiofibroma in an Indian population were investigated and compared with global reports.Results:Variable molecular marker expression was demonstrated at the regional and global levels. A wide variation in molecular characteristics is evident. Molecular data have been reported for only 11 countries, indicating a clear geographical bias. Only 58 markers have been studied, and most are yet to be validated.Conclusion:Research into the molecular epidemiology of juvenile nasopharyngeal angiofibroma is still in its infancy. Although the molecular variation is not well understood, data obtained so far have prompted important research questions. Hence, multicentre collaborative molecular studies are needed to establish the aetiopathogenesis and establish molecular surrogates for clinical characteristics.
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Acharya S, Naik C, Panditray S, Dany SS. Juvenile Nasopharyngeal Angiofibroma: A Case Report. J Clin Diagn Res 2017; 11:MD03-MD04. [PMID: 28571176 DOI: 10.7860/jcdr/2017/23729.9630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/28/2016] [Indexed: 11/24/2022]
Abstract
Juvenile nasopharyngeal angiofibroma is tumour almost exclusively seen in adolescent males, constituting less than 1% of all neoplasms in head and neck. They are benign and locally spreading and are highly vascular in nature and thus prove to be a surgical challenge because of its complex anatomical location. Here, we present a case report of a 18-year-old male presenting with a mass in his left nasal cavity, with recurrent epistaxis and nasal obstruction. Computed tomography imaging revealed a non-encapsulated lobulated heterogeneous mass lesion in the naso-pharynx and left posterior choana of the nasal cavity, extending to pterygopalatine and infratemporal fossa, masseter space of left side. The approach to its surgical management was a combined multi-disciplinary effort of otorhinolaryngology surgeons and maxillofacial surgeons.
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Affiliation(s)
- Soubhagini Acharya
- Associate Professor, Department of Ear, Nose and Throat, VSS Institute of Medical Sciences and Research, Burla, Odisha, India
| | - Choubarga Naik
- Assistant Professor, Department of Dental Surgery, VSS Institute of Medical Sciences and Research, Burla, Odisha, India
| | - Siddharth Panditray
- Postgraduate Student, Department of Ear, Nose and Throat, VSS Institute of Medical Sciences and Research, Burla, Odisha, India
| | - Subha Soumya Dany
- Senior Resident, Department of Dentistry, VSS Institute of Medical Sciences and Research, Burla, Odisha, India
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Alshaikh NA, Eleftheriadou A. Juvenile nasopharyngeal angiofibroma staging: An overview. EAR, NOSE & THROAT JOURNAL 2016; 94:E12-22. [PMID: 26053985 DOI: 10.1177/014556131509400615] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Staging of tumors is very important in treatment and surgical decision making, as well as in predicting disease recurrence and prognosis. This review focuses on the different available classifications of juvenile nasopharyngeal angiofibroma (JNA) and their impact on the evaluation, management, and prognosis of JNA. The literature was reviewed, and publications on JNA staging were examined. Our MEDLINE search of the entire English-language literature found no review article on the current available staging systems for JNA. In this article, we review the common JNA classification systems that have been published, and we discuss some of their advantages and disadvantages. The most commonly used staging systems for JNA are the Radkowski and the Andrews-Fisch staging systems. However, some newer staging systems that are based on advances in technology and surgical approaches-the Onerci, INCan, and UPMC systems-have shown promising utility, and they will probably gain popularity in the future.
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Affiliation(s)
- Nada Ali Alshaikh
- Department of Otolaryngology, Dammam Medical Complex, PO Box 2471, Dammam 31451, Saudi Arabia.
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Pandey P, Mishra A, Tripathi AM, Verma V, Trivedi R, Singh HP, Kumar S, Patel B, Singh V, Pandey S, Pandey A, Mishra SC. Current molecular profile of juvenile nasopharyngeal angiofibroma: First comprehensive study from India. Laryngoscope 2016; 127:E100-E106. [DOI: 10.1002/lary.26250] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/13/2016] [Accepted: 07/25/2016] [Indexed: 01/25/2023]
Affiliation(s)
- Praveen Pandey
- Biochemistry and Endocrinology Divisions; Central Drug Research Institute; Lucknow India
| | - Anupam Mishra
- Department of Otorhinolaryngology; King George Medical University; Lucknow India
| | - Ashoak Mani Tripathi
- Department of Otorhinolaryngology; King George Medical University; Lucknow India
| | - Veerendra Verma
- Department of Otorhinolaryngology; King George Medical University; Lucknow India
| | - Ritu Trivedi
- Biochemistry and Endocrinology Divisions; Central Drug Research Institute; Lucknow India
| | | | - Sunil Kumar
- Department of Otorhinolaryngology; King George Medical University; Lucknow India
| | - Brijesh Patel
- Department of Otorhinolaryngology; King George Medical University; Lucknow India
| | - Vinay Singh
- Department of Otorhinolaryngology; King George Medical University; Lucknow India
| | - Shivani Pandey
- Department of Biochemistry; King George Medical University; Lucknow India
| | - Amita Pandey
- Department of Clinical Genetics; King George Medical University; Lucknow India
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Toplu Y, Can S, Sanlı M, Sahin N, Kizilay A. Middle turbinate angiofibroma: an unusual location for juvenile angiofibroma. Braz J Otorhinolaryngol 2016; 84:S1808-8694(16)00010-0. [PMID: 26922190 PMCID: PMC9442870 DOI: 10.1016/j.bjorl.2015.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/28/2015] [Accepted: 10/14/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Yuksel Toplu
- Inonu University Medical Faculty, Department of Otorhinolaryngology, Malatya, Turkey.
| | - Sermin Can
- Inonu University Medical Faculty, Department of Otorhinolaryngology, Malatya, Turkey
| | - Mukadder Sanlı
- Inonu University Medical Faculty, Department of Anesthesia and Reanimation, Malatya, Turkey
| | - Nurhan Sahin
- Inonu University Medical Faculty, Department of Pathology, Malatya, Turkey
| | - Ahmet Kizilay
- Inonu University Medical Faculty, Department of Otorhinolaryngology, Malatya, Turkey
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Renkonen S, Cardell LO, Mattila P, Lundberg M, Haglund C, Hagström J, Mäkitie AA. Toll-like receptors 3, 7, and 9 in Juvenile nasopharyngeal angiofibroma. APMIS 2015; 123:439-44. [PMID: 25912131 DOI: 10.1111/apm.12366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/23/2014] [Indexed: 01/22/2023]
Abstract
UNLABELLED Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign tumor affecting adolescent males. The etiology of JNA as well as the causes determining the variable growth patterns of individual tumors remains unknown. Toll-like receptors (TLRs) are part of the innate immune response to microbes; by recognition of distinct features, they link to induction of pro-inflammatory signaling pathways. We immunostained TLR 3, 7, and 9 in 27 JNA specimens of patients treated at the Helsinki University Central Hospital, Helsinki, Finland, during the years 1970-2009. RESULTS TLR 3, 7, and 9 expressions were found in stromal and endothelial cells of JNA, and their expression levels varied from negative to very strong positive. TLR 3 expression was found to have a significant correlation with the clinical stage of JNA. CONCLUSIONS The present results propose a putative role of TLRs in the growth process of JNA.
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Affiliation(s)
- Suvi Renkonen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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Lutz J, Holtmannspötter M, Flatz W, Meier-Bender A, Berghaus A, Brückmann H, Zengel P. Preoperative Embolization to Improve the Surgical Management and Outcome of Juvenile Nasopharyngeal Angiofibroma (JNA) in a Single Center: 10-Year Experience. Clin Neuroradiol 2015; 26:405-413. [DOI: 10.1007/s00062-015-0374-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
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Mutlu V. Angiofibroma from the tail of the inferior turbinate. Eurasian J Med 2014; 47:66-8. [PMID: 25745348 DOI: 10.5152/eajm.2014.44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 07/01/2013] [Indexed: 11/22/2022] Open
Abstract
Nasopharyngeal angiofibromas are benign and vascular neoplasms, which originate characteristically in the posterior lateral wall of the nasopharynx. They account for less than 0.5% of all head and neck tumours. Although angiofibromas extend beyond the nasopharynx usually, they rarely originate outside the nasopharynx. Reports of primary extranasopharyngeal angiofibromas have appeared sporadically in the literature. The maxillary sinus is the most common site involved, while the inferior turbinate represents an extremely rare localization. We report a case of angiofibroma which arising from the tail of the inferior turbinate in the right nasal cavity.
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Affiliation(s)
- Vahit Mutlu
- Ear Nose and Throat Clinic, Ataturk University Faculty of Medicine, Erzurum, Turkey
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Abstract
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.
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Szymańska A, Szymański M, Czekajska-Chehab E, Szczerbo-Trojanowska M. Two types of lateral extension in juvenile nasopharyngeal angiofibroma: diagnostic and therapeutic management. Eur Arch Otorhinolaryngol 2014; 272:159-66. [PMID: 24599598 PMCID: PMC4282713 DOI: 10.1007/s00405-014-2965-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/18/2014] [Indexed: 11/29/2022]
Abstract
Juvenile nasopharyngeal angiofibroma is a benign, locally aggressive nasopharyngeal tumor. Apart from anterior lateral extension to the pterygopalatine fossa, it may spread laterally posterior to the pterygoid process, showing posterior lateral growth pattern, which is less common and more difficult to identify during surgery. We analyzed the routes of lateral spread, modalities useful in its diagnosis, the incidence of lateral extension and its influence on outcomes of surgical treatment. The records of 37 patients with laterally extending JNA treated at our institution between 1987 and 2011 were retrospectively evaluated. Computed tomography was performed in all patients and magnetic resonance imaging in 17 (46 %) patients. CT and MRI were evaluated to determine routes and extension of JNA lateral spread. Anterior lateral extension to the pterygopalatine fossa occurred in 36 (97 %) patients and further to the infratemporal fossa in 20 (54 %) patients. In 16 (43 %) cases posterior lateral spread was observed: posterior to the pterygoid process and/or between its plates. The recurrence rate was 29.7 % (11/37). The majority of residual lesions was located behind the pterygoid process (7/11). Recurrent disease occurred in 3/21 patients with anterior lateral extension, in 7/15 patients with both types of lateral extensions and in 1 patient with posterior lateral extension. JNA posterior lateral extension may spread behind the pterygoid process or between its plates. The recurrence rate in patients with anterior and/or posterior lateral extension is significantly higher than in patients with anterior lateral extension only. Both CT and MRI allow identification of the anterior and posterior lateral extensions.
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Affiliation(s)
- Anna Szymańska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Jaczewskiego 8, 20-954, Lublin, Poland,
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Schick B, Dlugaiczyk J, Wendler O. Expression of sex hormone receptors in juvenile angiofibromas and antiproliferative effects of receptor modulators. Head Neck 2014; 36:1596-603. [PMID: 23996526 DOI: 10.1002/hed.23478] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/06/2013] [Accepted: 08/23/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Predilection of juvenile angiofibromas in adolescent boys has prompted the hypothesis of hormone-dependent tumor growth. However, knowledge on expression and function of sex hormone receptors in juvenile angiofibromas is still sparse and inconsistent. METHODS Transcript and protein expression of sex hormone receptors in juvenile angiofibromas was studied by quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) and immunohistology/fluorescence. A bromodeoxyuridine assay was used to assess the antiproliferative effects of flutamide (androgen receptor antagonist) and tamoxifen (estrogen receptor modulator). RESULTS Significantly increased transcript levels were observed for androgen receptor, estrogen receptor α, follicle-stimulating hormone receptor, and luteinizing hormone receptor in juvenile angiofibromas versus the stroma of nasal mucosa. Estrogen receptor β and progesterone receptor mRNA levels were low and similar for both tissues. Estrogen receptor α protein was detected in juvenile angiofibroma tumors and mesenchymal cell lines. Flutamide and tamoxifen inhibited proliferation of cultured juvenile angiofibroma mesenchymal cells. CONCLUSION These findings contribute to the understanding of juvenile angiofibroma pathophysiology and offer novel therapeutic options.
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Affiliation(s)
- Bernhard Schick
- Department of Otorhinolaryngology, Saarland University Medical Center, Homburg/Saar, Germany
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Wang JJ, Sun XC, Hu L, Liu ZF, Yu HP, Li H, Wang SY, Wang DH. Endoglin (CD105) expression on microvessel endothelial cells in juvenile nasopharyngeal angiofibroma: tissue microarray analysis and association with prognostic significance. Head Neck 2013; 35:1719-25. [PMID: 23471755 DOI: 10.1002/hed.23210] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2012] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The purpose of this study was to examine endoglin (CD105) expression on microvessel endothelial cells (ECs) in juvenile nasopharyngeal angiofibroma (JNA) and its relationship with recurrence. METHODS Immunohistochemistry was performed to detect CD105 expression in a tissue microarray from 70 patients with JNA. Correlation between CD105 expression on microvessel ECs and clinicopathological features, as well as tumor recurrence, were analyzed. RESULTS Immunohistochemistry revealed CD105 expression on ECs but not in stroma of patients with JNA. Chi-square analysis indicated CD105-based microvessel density (MVD) was correlated with JNA recurrence (p = .013). Univariate and multivariate analyses determined that MVD was a significant predictor of time to recurrence (p = .009). The CD105-based MVD was better for predicting disease recurrence (AUROC: 0.673; p = .036) than other clinicopathological features. CONCLUSIONS MVD is a useful predictor for poor prognosis of patients with JNA after curative resection. Angiogenesis, which may play an important role in the occurrence and development of JNA, is therefore a potential therapeutic target for JNA.
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Affiliation(s)
- Jing-Jing Wang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
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Khanna P, Ray BR, Sinha R, Kumar R, Sikka K, Singh AC. Anaesthetic management of endoscopic resection of juvenile nasopharyngeal angiofibroma: our experience and a review of the literature. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2013. [DOI: 10.1080/22201173.2013.10872947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- P Khanna
- Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - BR Ray
- Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - R Sinha
- Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - R Kumar
- Department of Ear, Nose and Throat, All India Institute of Medical Sciences, New Delhi, India
| | - K Sikka
- Department of Ear, Nose and Throat, All India Institute of Medical Sciences, New Delhi, India
| | - AC Singh
- Department of Ear, Nose and Throat, All India Institute of Medical Sciences, New Delhi, India
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Sun XC, Li H, Liu ZF, Hu L, Yu HP, Wang JJ, Liu Q, Liu J, Wang DH. Endoscopic assisted sublabial and buccolabial incision approach for juvenile nasopharyngeal angiofibroma with extensive infratemporal fossa extension. Int J Pediatr Otorhinolaryngol 2012; 76:1501-6. [PMID: 22832240 DOI: 10.1016/j.ijporl.2012.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 06/28/2012] [Accepted: 07/01/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate endoscopic assisted sublabial and buccolabial incision approach as treatment option for Juvenile nasopharyngeal angiofibroma (JNA) with extensive infratemporal fossa (ITF) extension. METHODS Seven patients diagnosed as JNA with extensive ITF extension and underwent surgery at our department between 2006 and 2010 were retrospectively reviewed. All patients underwent diagnostic arteriography followed by embolization preoperatively and intratumor injection with N-butyl cyanoacrylate (NBCA). Endoscopic assisted sublabial and buccolabial incision approach was used to remove the tumors. RESULTS Complete resections of the tumors were achieved in all patients. Mean blood loss was 700 ml. The follow-up period ranged from 9 to 20 months, with a mean of 14.3 months. One patient had a recurrent tumor six months after operation. CONCLUSIONS Endoscopic assisted sublabial and buccolabial incision is an optional approach to remove JNA with extensive ITF extension.
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Affiliation(s)
- Xi-Cai Sun
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
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Renkonen S, Kankainen M, Hagström J, Haglund C, Monni O, Mäkitie AA. Systems-level analysis of clinically different phenotypes of juvenile nasopharyngeal angiofibromas. Laryngoscope 2012; 122:2728-35. [PMID: 22965421 DOI: 10.1002/lary.23592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 05/02/2012] [Accepted: 06/22/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To explore the molecular genetic background of juvenile nasopharyngeal angiofibromas and to identify biological processes and putative factors determining the different growth patterns of these tumors. STUDY DESIGN By comparing copy number and gene expression level changes of two clinically different phenotypes of juvenile nasopharyngeal angiofibromas, we aimed to find processes essential in the growth and development of these tumors. Based on the results and prior knowledge of the proteins significance for growth, we studied the expression of tyrosine kinase SYK in 27 tumor samples. METHODS Comparative genomic hybridization and gene expression analyses were performed for the two tumor samples, and protein expression of SYK was studied in 27 samples by immunohistochemical staining. RESULTS Between low- and high-stage juvenile nasopharyngeal angiofibromas, 1,245 genes showed at least a two-fold change in expression. The corresponding proteins of these transcripts were enriched in different biological processes. Protein kinase SYK was expressed in all 27 samples, and its intensity significantly correlated with tumor stage. CONCLUSIONS Because the molecular genetic background of juvenile nasopharyngeal angiofibroma is unknown, our aim was to investigate genomic alterations that could associate to low- and high-stage tumors. We were able to identify gene expression changes that relate to particular biological processes, but assessing clinically relevant molecular profiles still requires further characterization. Due to the low incidence of juvenile angiofibroma, in the future a combination of molecular profiling data from several studies would be useful in understanding the molecular background of the disease.
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Affiliation(s)
- Suvi Renkonen
- Department of Otorhinolaryngology-Head and Neck Surgery, Haartman Institute and HusLab, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
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Lv MM, Fan XD, Su LX, Chen D. Preoperative Direct Puncture Embolization of Advanced Juvenile Nasopharyngeal Angiofibroma in Combination with Transarterial Embolization: An Analysis of 22 Consecutive Patients. Cardiovasc Intervent Radiol 2012; 36:111-7. [DOI: 10.1007/s00270-012-0404-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 04/17/2012] [Indexed: 11/28/2022]
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Gaikwad N, Sathe N, Bhatia A, Chiplunkar D, Patil M. Surgical management of juvenile nasopharyngeal angiofibroma using lateral rhinotomy: study of 80 cases. SURGICAL TECHNIQUES DEVELOPMENT 2011. [DOI: 10.4081/std.2011.e34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A series of 80 patients with histopathologically confirmed juvenile nasopharyngeal angiofibroma were treated surgically over a period of ten years (1995-2004). The lateral rhinotomy approach was used to expose the tumor and its extensions. Lateral rhinotomy with its extensions provides wide exposure of and access to the nose, nasopharynx, paranasal sinuses, pterygopalatine fossa, infratemporal fossa and temporal fossa. Most intracranial, extradural extensions can also be approached. There were no major operative or post-operative complications. Longterm follow up from one to ten years showed only 8 recurrences. The added advantage of this approach is that it can be combined with all the other anterior and lateral skull base approaches. The cosmetic outcome is satisfactory if nasal aesthetic subunits are taken into considerations while making the incision. The lateral rhinotomy approach is the most direct route to the body of the tumor and can be used to approach all the possible extensions of the tumor.
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Abstract
Juvenile angiofibroma is a rare benign lesion originating from the pterygopalatine fossa with distinctive epidemiologic features and growth patterns. The typical patient is an adolescent male with a clinical history of recurrent epistaxis and nasal obstruction. Although the use of nonsurgical therapies is described in the literature, surgery is currently considered the ideal treatment for juvenile angiofibroma. Refinement in preoperative embolization has provided significant reduction of complications and intraoperative bleeding with minimal risk of residual disease. During the last decade, an endoscopic technique has been extensively adopted as a valid alternative to external approaches in the management of small-intermediate size juvenile angiofibromas. Herein, we review the evolution in the management of juvenile angiofibroma with particular reference to recent advances in diagnosis and treatment.
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Liu ZF, Wang DH, Sun XC, Wang JJ, Hu L, Li H, Dai PD. The site of origin and expansive routes of juvenile nasopharyngeal angiofibroma (JNA). Int J Pediatr Otorhinolaryngol 2011; 75:1088-92. [PMID: 21719122 DOI: 10.1016/j.ijporl.2011.05.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 05/26/2011] [Accepted: 05/30/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Juvenile nasopharyngeal angiofibroma (JNA) is a rare vascular tumor of the nasopharynx occurring in young males. The aim of this study was attempt to find out the site of origin and the common expansion routes of JNA. METHODS The CT examinations of 46 untreated patients with histologically proven JNA were retrospectively analyzed. Evidence of tumor spreading of the locations are those following CT characteristics: (a) expansion and/or erosion of bony wall; (b) obliteration of normal fatty planes. In addition, three dimensional reconstruction technology was used to make further study. RESULTS The pterygoid canal was affected in all untreated cases and therefore was considered as the origin of JNA. Nineteen patients' tumors (41.3%) originated from the front part of pterygoid canal and the other 27 ones (58.7%) from the post part of pterygoid canal. Pterygoid canal, choanae and nasal cavity are the three most common sites of JNA. CONCLUSION The possible site of origin is pterygoid canal. After originating from this point, the tumor will invade sphenopalatine foramen, sphenoid sinus and pterygopalatine fossa first, and then into adjacent structure through aforementioned three sites.
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Affiliation(s)
- Zhuo-fu Liu
- ENT Department of Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
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Browne JD, Messner AH. Lateral orbital/anterior midfacial degloving approach for nasopharyngeal angiofibromas with cavernous sinus extension. Skull Base Surg 2011; 4:232-8. [PMID: 17171177 PMCID: PMC1661816 DOI: 10.1055/s-2008-1058960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A case of nasopharyngeal angiofibroma removed through a modified lateral approach for an infratemporal fossa resection is reported. This modification involved removing the bone of the lateral orbital apex and posterior middle fossa to expose the dura and periorbita and, when combined with a midfacial degloving approach, provided full access to the tumor abutting the cavernous sinus extradurally while preserving middle ear function.
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Barnes L, Weber PC, Krause J, Contis L, Janecka I. Angiofibroma: a flow cytometric evaluation of 31 cases. Skull Base Surg 2011; 2:195-8. [PMID: 17170866 PMCID: PMC1656377 DOI: 10.1055/s-2008-1057134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Angiofibromas are histologically benign but locally aggressive tumors that often extend beyond the nasopharynx to involve contiguous structures. In addition, attempts to remove the tumors surgically are often frustrated by local recurrences. We studied 31 angiofibromas by flow cytometry to determine if tumor ploidy could be used to identify those tumors that might behave more aggressively. The patients, all males between 5 and 23 years of age, were divided into two groups. The 21 patients with tumors confined to the nasopharynx or paranasal sinuses were regarded as having local disease, the ten with tumors involving the infratemporal fossa, orbit, cheek, or intracranial structures were regarded as having extensive disease. Of the ten with extensive disease, six bad intracranial involvement. All patients were treated with surgery and only one received postoperative irradiation. Follow-up was available in 24, eight of which developed local recurrences (33%). All tumors, including recurrences and those with intracranial extension, were found to be diploid. We therefore conclude that tumor ploidy cannot be used to predict the clinical course of angiofibromas.
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Bagatella F, Mazzoni A. Microsurgery in juvenile nasopharyngeal angiofibroma: a lateronasal approach with nasomaxillary pedicled flap. Skull Base Surg 2011; 5:219-26. [PMID: 17170962 PMCID: PMC1656523 DOI: 10.1055/s-2008-1058919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Thirty-four consecutive juvenile nasopharyngeal angiofibromas, mainly stage II or III, were removed using a transnasomaxillary approach with good tumor control and without complications or sequelae. A pedicled nasomaxillary osteomucocutaneous flap is lifted through a lateronasal skin incision, and reflected laterally to open the nasal fossa and the maxillary sinus. This approach is an improvement on the conventional approach of lateral rhinotomy, which entails nasomaxillary skeletal loss. The approach ensures early and direct exposure of the root of the tumor and its vascular peduncle and also allows removal of tumors with intracranial extradural extensions.
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Endoscopic embolization with onyx prior to resection of JNA: a new approach. Int J Pediatr Otorhinolaryngol 2011; 75:53-6. [PMID: 21051094 DOI: 10.1016/j.ijporl.2010.10.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 09/22/2010] [Accepted: 10/01/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To report a novel pioneering approach of endoscopic embolization (EE) and resection of juvenile nasopharyngeal angiofibroma (JNA) and describe all outcomes and results. METHODS Four patients presented to the University of Miami with repeated episodes of unilateral epistaxis diagnosed by fiberoptic and radiographic examination as nasal JNA. Subsequently, in conjunction with neurosurgery, endoscopic visualization was provided to perform intratumor needle insertion, through which the liquid embolic agent Onyx was infused to embolize the JNA's under fluoroscopic and endoscopic guidance. The day after EE, endoscopic resection was performed. Operating room time, estimated blood loss (EBL), and other intraoperative and post-operative results are reported and compared to published literature. RESULTS A total of 4 patients (all males), had EE of JNA and subsequent endoscopic resection between September 2008 and January 2009. Average EBL during surgery was 412.5 ml (range 150-800) with an average operating room time of 228 min (range 95-485). We experienced no bleeding from the tumor or its attachments, only from the approach. Two patients experienced mild numbness in the V2 distribution, which began to resolve one week post-operatively. No other complications were encountered. CONCLUSIONS This is the first published report of direct endoscopic embolization of JNA with Onyx. Although further studies are needed, it seems to provide a safe, less invasive alternative to traditional embolization and endoscopic resection, but must be done in cooperation with interventional neurosurgery to maximize its safety profile.
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Renkonen S, Hagström J, Vuola J, Niemelä M, Porras M, Kivivuori SM, Leivo I, Mäkitie AA. The changing surgical management of juvenile nasopharyngeal angiofibroma. Eur Arch Otorhinolaryngol 2010; 268:599-607. [PMID: 20848119 DOI: 10.1007/s00405-010-1383-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 09/02/2010] [Indexed: 11/28/2022]
Abstract
The management of juvenile nasopharyngeal angiofibroma (JNA) has changed during the last decades but it still continues to be a challenge for the multidisciplinary head and neck surgical team. The aim of this study was to review the used treatment approach and outcome of JNA in a single institution series of 27 patients diagnosed and treated during the years 1970-2009. All patients were male, with the median age of 17 years (range 11-33 years). Surgery was used as the primary treatment in every case. Surgical approaches varied, transpalatal approach (N = 14) being the most common approach used in this series. During the last decade various other techniques were applied, including endoscopic (N = 3) resection. Two patients were additionally treated with antiangiogenic agents and one patient with stereotactic radiotherapy. The primary recurrence rate was 37% and it seemed to correlate with vascular density of tumour and the surgical approach used. We suggest that the management of JNA should be planned by an experienced head and neck surgeon, as part of a multidisciplinary team, preferably in a tertiary referral setting, and the recent development of the available therapies should be taken into account to minimise the risk of recurrence.
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Affiliation(s)
- Suvi Renkonen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, P.O. Box 220, 00029, Helsinki, Finland
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Schlauder SM, Knapp C, Steffensen TS, Bui MM. AROMATASE MAY PLAY A CRITICAL ROLE IN THE PATHOGENESIS OF JUVENILE NASOPHARYNGEAL ANGIOFIBROMA. Fetal Pediatr Pathol 2009. [DOI: 10.1080/15513810903073724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Khalifa MA, Ragab SM. Endoscopic assisted antral window approach for type III nasopharyngeal angiofibroma with infratemporal fossa extension. Int J Pediatr Otorhinolaryngol 2008; 72:1855-60. [PMID: 18952302 DOI: 10.1016/j.ijporl.2008.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 08/22/2008] [Accepted: 09/02/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the efficacy and safety of endoscopic assisted antral window approach in advanced nasopharyngeal angiofibroma with infratemporal fossa extension. MATERIALS AND METHODS Sixteen cases diagnosed as juvenile nasopharyngeal angiofibroma type III with infratemporal fossa extension were surgically managed using endoscopic assisted antral window approach (group A) and compared with another group of similar number that were managed using endoscopic assisted midfacial degloving (group B). Inclusion criteria were type III JNA with infratemporal fossa extension and a minimum follow-up of 2 years. Operative time, blood loss, adverse events and recurrences were recorded in all cases. RESULTS The amount of blood lost in group A was significantly less than group B. The operative time of group A was significantly less than group B. No major complications were seen in both groups. Twenty-eight patients showed complete tumor clearance. Four recurrences were seen: two in group A and two in group B. CONCLUSION Endoscopic assisted antral window approach provides a safe, reliable, effective and minimally invasive technique in management of type III JNA with infratemporal fossa extension. Preoperative embolization is a safe measure in the experienced hands that helps to reduce intraoperative blood loss and improves the quality of the surgical field.
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Affiliation(s)
- Mohamed A Khalifa
- Department of Otolaryngology and Head & Neck Surgery, Tanta University Hospitals, Egypt
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Spielmann PM, Adamson R, Cheng K, Sanderson RJ. Juvenile Nasopharyngeal Angiofibroma: Spontaneous Resolution. EAR, NOSE & THROAT JOURNAL 2008. [DOI: 10.1177/014556130808700911] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Juvenile nasopharyngeal angiofibroma is a rare, benign tumor that occurs most often in adolescent males. Common practice is to excise the tumor with open or endoscopic surgery. We report the case of a 17-year-old male who presented in 1995 with a mass filling the left posterior nasal cavity. A diagnosis of juvenile nasopharyngeal angiofibroma was obtained with computed tomography and magnetic resonance imaging. The patient elected to have no treatment. On annual scans, the lesion changed little until 1998, when it began to gradually decrease in size. Although it is not well proven, the natural history of these tumors seems to be regression over time. This case supports the argument that a policy of watchful waiting with regular imaging studies may postpone or eliminate the need for surgery and its attendant risks.
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Affiliation(s)
| | - Richard Adamson
- Department of Otolaryngology, Western General Hospital, Edinburgh, Scotland
| | - Kenneth Cheng
- Department of Otolaryngology, Ninewells Hospital, Dundee, Scotland
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Coutinho-Camillo CM, Brentani MM, Nagai MA. Genetic alterations in juvenile nasopharyngeal angiofibromas. Head Neck 2008; 30:390-400. [PMID: 18228521 DOI: 10.1002/hed.20775] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign neoplasm of the nasopharynx that accounts for 0.5% of all head and neck tumors. Although histologically benign in appearance, JNAs are locally aggressive and destructive, spreading from the nasal cavity to the nasopharynx, paranasal sinuses, and orbit skull base with intracranial extension. The gender selectivity of JNA and the relatively young age at diagnosis suggest hormone-dependent development. Hormonal disorders have been reported in patients with JNA, and androgen and estrogen receptors have been identified in tumor tissue; however, a hormonal influence on JNA is controversial. Recent studies have attempted to further delineate the pathogenesis of JNA through analysis of genetic and molecular changes. Understanding of the molecular mechanisms involved in JNA might improve prevention, prognosis, and treatment of this tumor. In this review, we discuss published studies addressing the possible molecular pathways that might be involved in the development of JNA.
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Affiliation(s)
- Cláudia M Coutinho-Camillo
- Disciplina de Oncologia, Laboratório de Oncologia Experimental-24, Departamento de Radiologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Giavroglou C, Constantinidis J, Triaridis S, Daniilidis J, Dimitriadis A. [Angiographic evaluation and embolization of juvenile nasopharyngeal angiofibroma]. HNO 2007; 55:36-41. [PMID: 16775738 DOI: 10.1007/s00106-006-1410-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In juvenile nasopharyngeal angiofibroma (JNA), analysis of tumor extension and blood supply is useful for controlling intraoperative bleeding and helps in determining the appropriate surgical approach. The purpose of this study was to evaluate angiographic findings and the efficacy and benefits of preoperative embolization of JNA. PATIENTS AND METHODS Twenty-one male patients with JNA (mean age 13.3 years) were included in this study. The tumors were embolized with particles of gel foam. Surgical removal was achieved through transantral approach (n=2), lateral rhinotomy (n=13), midfacial degloving (n=4), and endonasally (n=2). RESULTS The blood supply was exclusively homolateral in 18 patients, deriving mainly from the external carotid artery, and bilateral in three. There were no connections between the branches of the internal and external carotid arteries. Intratumoral embolization was achieved in all patients. No major complications occurred. Mean blood loss during surgery was 560 ml. The recurrence rate was 14%. CONCLUSION Preoperative angiographic evaluation and embolization of JNA are important tools for planning surgical approach. Embolization reduces significantly the intraoperative blood loss, minimizes the need of blood transfusion, and makes resection easier.
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Affiliation(s)
- C Giavroglou
- Radiologisches Institut der Aristoteles-Universität Thessaloniki, AHEPA-Hospital, Griechenland
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43
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Subselective embolisation in management of JNA. Indian J Otolaryngol Head Neck Surg 2007; 59:43-4. [PMID: 23120383 DOI: 10.1007/s12070-007-0011-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Role of Embolisation in preoperative management of Nasopharyngeal angiofibroma is well established in present day therapeutic modalities. An improvised technique i.e., subselective embolisation has been provided by Interventional radiologists to fortify the therapeutic results. This study compares the final outcome of seven cases, four of which were embolised pre operatively. Each case was dealt with varying surgical approaches.
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Montag AG, Tretiakova M, Richardson M. Steroid hormone receptor expression in nasopharyngeal angiofibromas. Consistent expression of estrogen receptor beta. Am J Clin Pathol 2006; 125:832-7. [PMID: 16690481 DOI: 10.1309/w5cm-3a3n-h7p4-f5p2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Nasopharyngeal angiofibroma is an uncommon tumor arising in adolescent males, suggesting that the tumor may be hormonally responsive. Previous studies have found androgen receptor (AR) expression but variable expression of estrogen receptor (ER). The recently described ss receptor for estrogen has not been analyzed in angiofibroma. We analyzed 13 cases of nasal angiofibroma by immunohistochemical analysis for the presence of ARs, progesterone receptors (PR), and ER-a and ER-ss. All 13 cases were positive for ER-ss, in stromal pericytic and endothelial cells, and 12 of 13 stained strongly. Five cases were positive for AR in stromal cells, most staining weakly, and with no staining in endothelial or pericytic cells. None of the cases displayed staining for ER-a or PR. The findings confirm that nasopharyngeal angiofibromas express ER and suggest that new modulators of ER-ss activity may provide an alternative therapy for these lesions.
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Affiliation(s)
- Anthony G Montag
- Laboratory of Surgical Pathology, University of Chicago, Chicago, IL 60637, USA
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Montag AG, Tretiakova M, Richardson M. Steroid Hormone Receptor Expression in Nasopharyngeal Angiofibromas. Am J Clin Pathol 2006. [DOI: 10.1309/w5cm3a3nh7p4f5p2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Uslu C, Yildirim M, Uslu H, Sutbeyaz Y, Varoglu E, Seven B, Yildirim U, Kantarci M. 99mTc-labelled red blood cell single-photon emission computed tomography for the diagnosis and follow-up of juvenile nasopharyngeal angiofibroma. Nucl Med Commun 2006; 27:489-94. [PMID: 16710102 DOI: 10.1097/00006231-200606000-00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM To confirm the usefulness of blood pool scintigraphy with Tc-labelled red blood cells ((99m)Tc-RBCs) in the diagnosis and follow-up of juvenile nasopharyngeal angiofibroma. METHODS A prospective study design was used. (99m)Tc-RBCs were prepared by a modified in-vivo method. After the rapid intravenous injection of 370-740 MBq of (99m)Tc-RBCs, dynamic imaging of 1-min duration was performed. After dynamic imaging, static acquisitions at 5 min (second phase: blood pool phase) and 2 h (third phase: static image) were obtained. In addition, single-photon emission computed tomography (SPECT) imaging was performed at 2 h. SPECT images were obtained using a rotating gamma camera (GE-Starcam 4000 XR/T). RESULTS All patients showed no activity in the first phase and mild activity in the second phase (blood pool phase). All patients with juvenile nasopharyngeal angiofibroma showed a prominent increased activity in the third phase and in SPECT images. CONCLUSIONS This study shows that blood pool scintigraphy with (99m)Tc-RBC SPECT is very accurate, easy to perform and a suitable alternative to pre-operative and post-operative imaging techniques, including computed tomography scan, magnetic resonance imaging (MRI) and MRI angiography, for the detection of juvenile nasopharyngeal angiofibroma.
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Affiliation(s)
- Celil Uslu
- Department of Otorhinolaryngology, Haydarpasa Numune Hospital for Research and Education, Istanbul, Turkey.
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Saylam G, Yücel OT, Sungur A, Onerci M. Proliferation, angiogenesis and hormonal markers in juvenile nasopharyngeal angiofibroma. Int J Pediatr Otorhinolaryngol 2006; 70:227-34. [PMID: 16023739 DOI: 10.1016/j.ijporl.2005.06.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Accepted: 06/06/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular and locally invasive tumor that exclusively affects male adolescents. Sex hormones are first discussed to clarify the etiology of JNA. Recently with the advances in the field of cell biology angiogenetic markers, proliferation markers and growth factors are investigated to identify the molecular basis of JNA as all neoplasm. In this study we tried to evaluate the expression of proliferation, angiogenesis and hormonal markers in JNA. METHODS Immunohistochemical analysis were performed on paraffin-embedded 27 JNA samples which were obtained from the patients operated at University of Hacettepe Department of Otorhinolaryngology, a tertiary care center. Estrogen receptor (ER), progesterone receptor (PR), proliferating cell nuclear antigen (PCNA), vascular endothelial growth factor (VEGF) and transforming growth factor beta (TGF-beta) specific antibodies were used and evaluated by light microscopy RESULTS Two of 27 cases were ER positive. Nine of 27 cases were positive for PR. All of the cases were stained with PCNA. Twenty-four of 27 cases stained with VEGF. TGF-beta was positive in 14 of 27 cases. All recurrent cases were stained with PCNA and VEGF; just three of them were stained with TGF-beta. CONCLUSIONS Hormonal markers ER and PR did not seem to play a role in pathogenesis of JNA. PCNA, VEGF and TGF-beta may play a role in the pathogenesis of JNA by promoting angiogenesis and proliferation, but this role did not seem to have a relation with hormonal markers.
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Affiliation(s)
- Güleser Saylam
- Department of Otorhinolaryngology, University of Hacettepe, Ankara, Turkey.
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Abstract
Sinonasal disease is one of the most common clinical head and neck pathologies. The majority of sinonasal pathology is inflammatory with neoplasms comprising approximately 3% of all head and neck tumours. Although sinus tumours are rare, they portend a poor prognosis, often due to advanced disease at diagnosis. Like most neoplasms, early detection improves prognosis, therefore clinicians and radiologists should be aware of features separating tumours from inflammatory sinus disease. This article reviews the anatomy, clinical features, imaging findings, treatment and histopathology of selected sinonasal tumours. Benign neoplasms reviewed include osteoma, inverting papilloma, and juvenile nasal angiofibroma. Malignant neoplasms reviewed include squamous cell carcinoma, the minor salivary gland tumour, adenoid cystic carcinoma, adenocarcinoma, melanoma, lymphoma, and olfactory neuroblastoma (esthesioneuroblastoma).
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Affiliation(s)
- Sudip Das
- LAS Otolaryngology, Leicester Royal Infirmary, Leicester, UK
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Nomura K, Shimomura A, Awataguchi T, Murakami K, Kobayashi T. A case of angiofibroma originating from the inferior nasal turbinate. Auris Nasus Larynx 2005; 33:191-3. [PMID: 16310998 DOI: 10.1016/j.anl.2005.09.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Revised: 08/29/2005] [Accepted: 09/16/2005] [Indexed: 11/21/2022]
Abstract
Angiofibromas are nasopharyngeal tumors mostly seen in adolescent males. They account for less than 0.5% of all head and neck neoplasms. Extranasopharyngeal angiofibromas, although rare, have been reported. We report a case of extranasopharyngeal angiofibroma arising from the inferior turbinate of a 62-year-old male. The tumor was excised using the Denker approach. The patient is currently free of relapse 10 months after surgery. Previous extranasopharyngeal angiofibromas research was reviewed.
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Affiliation(s)
- Kazuhiro Nomura
- Department of Otolaryngology, Tohoku Employees' Pension Welfare Hospital, 1-12-1 Fukumuro, Sendai 983-8512, Japan.
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Pryor SG, Moore EJ, Kasperbauer JL. Endoscopic versus Traditional Approaches for Excision of Juvenile Nasopharyngeal Angiofibroma. Laryngoscope 2005; 115:1201-7. [PMID: 15995507 DOI: 10.1097/01.mlg.0000162655.96247.66] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Juvenile nasopharyngeal angiofibroma (JNA) is an uncommon neoplasm originating in the nasopharynx. The purpose of this study was to determine whether endoscopic approaches had been effective without increasing intraoperative blood loss, length of hospital stay, complications, and rate of recurrence as compared with traditional surgical approaches. STUDY DESIGN Retrospective chart review to compare outcomes in six consecutive patients who underwent endoscopic resection with outcomes of traditional external excision of JNA at Mayo Clinic between 1975 and 2004. METHODS The medical records of patients who underwent either endoscopic or external surgical resection of JNA were reviewed retrospectively. The main outcome measures were intraoperative blood loss, length of hospital stay, complications, and recurrence. We review the reasons why we developed our current endoscopic approach to resection and highlight some of the obstacles we have encountered. RESULTS We identified 65 patients treated for JNA during the studied interval. Their mean age was 15 (range 6-35) years. Six consecutive patients underwent successful resection of JNA by way of an endoscopic approach since 2001. Compared with the conventional surgery group, the endoscopic group had less intraoperative blood loss (225 vs. 1,250 mL), a lower occurrence of complications (1 patient vs. > or = 30 patients), shorter length of hospital stay (2 vs. 5 days), and lower rate of recurrence (0% vs. 24%). CONCLUSION Endoscopic removal of JNA tumor appears to be safe and effective. Recurrence was not appreciably affected by approach.
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Affiliation(s)
- Shepherd G Pryor
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota 55905, USA
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