Hippocrates described this tumor in the 5 th century bc, but friedberg first used the term angiofibroma in 1940. May, 2010 the preoperative diagnosis of nasopharyngeal angiofibroma can be a challenging task. It was first described by hippocrates, a greek physician, in the 5th century bc. Juvenile nasopharyngeal angiofibroma romanian journal of. Juvenile nasopharyngeal angiofibroma linkedin slideshare. Juvenile nasopharyngeal angiofibroma is a pathologically benign yet locally aggressive and destructive vascular lesion of head and neck region typically affecting adolescent boys. Juvenile nasopharyngeal angiofibromas staging dr jeremy jones and assoc prof frank gaillard et al. We report the case of a 17yearold male who presented in 1995 with a mass filling the left posterior nasal cavity. Twelve cases of angiofibromata of the nasopharynx are described. Jul 15, 2015 juvenile nasopharyngeal angiofibroma jna is a benign neoplasm of the nasopharynx. Nasopharyngeal angiofibroma introduction juvenile nasopharyngeal angiofibroma jna is a benign, but locally aggressive and extremely vascular head and neck neoplasm, occurring almost exclusively in the nasopharynx of adolescent males. The most common presenting symptom is painless nasal obstruction or epistaxis. Article information, pdf download for denker operation is an effective surgical approach in. Given the strict epidemiology, hormonal influences seem likely as investigators have revealed the presence of androgen, testosterone, and dihydrotestosterone receptors 3, 4 and.
Juvenile nasopharyngeal angiofibroma electronic journal of. Well circumscribed, variable pseudocapsule cellular tumor with fascicles or haphazard pattern. However, this case is not typical as it doesnt invade the nasal fossae. Management of juvenile nasopharyngeal angiofibroma. Frequently, the term juvenile is not included in the name of this tumor because this lesion may occur in adults occasionally, as well as in adolescents. Reddy ka, mendenhall wm, amdur rj, stringer sp, cassisi nj. It is the most common benign tumor of the nasopharnyx but only accounts for less than 0.
It most commonly affects adolescent males because it is a hormonesensitive tumor. It most commonly affects adolescent males and may grow into fissures of the. This is a histologically benign lesion with very aggressive local behavior. Juvenile angiofibroma is a rare benign lesion originating from the pterygopalatine.
Adolescents and young adults between 14 and 25 years are affected, and there is a distinct male predominance. Nasopharyngeal angiofibroma naf is a highly vascular, histologically benign, but sometimes locally aggressive tumor of the nasopharynx that occurs almost exclusively in males, usually between 10 and 20 years of age. Juvenile nasopharyngeal angiofibroma radiology case. Juvenile nasopharyngeal angiofibroma is a locally aggressive benign vascular neoplasm, composed of vasogenic and myofibroblastic elements, accounts for 0. Seven cases of nasopharyngeal angiofibroma treated surgically have been reported. Ppt journal juvenile nasopharynx angiofibroma free download as powerpoint presentation. Longterm results of radiation therapy for juvenile nasopharyngeal angiofibroma. Juvenile nasopharyngeal angiofibroma with orbital extension. Although a histopathologically benign tumor of vascular origin, jna behaves locally invasive and. As the tumor is largely spaceoccupying and highly vascular, patients typically. In fact, biopsy prior to definitive treatment is generally condemned as both unnecessary and hazardous.
Juvenile nasopharyngeal angiofibroma is a rare, benign tumor that occurs most often in adolescent males. Juvenile nasopharyngeal angiofibroma radiology reference. Juvenile nasopharyngeal angiofibroma jna onset most commonly is in the second decade. The nasopharyngeal component with submucosal spread is clearly evident black asterisk. Thirtythree male patients aged between 8 and 25 years mean 15. Pdf nasopharyngeal angiofibroma staging and selecting a. Juvenile nasopharyngeal angiofibroma jna is a rare tumor that predominantly occurs in adolescent males, the average age of occurence being 15. Do not attempt selfremoval of angiofibromas as that can often lead to permanent scars.
Juvenile nasopharyngeal angiofibroma is a benign, locally aggressive, vascular tumour of adolescent males. Another case of recurring nasopharyngeal angiofibroma with lateral extension to peterygomaxillary fossa and cheek removed successfully by transpalatal and. Juvenile nasopharyngeal angiofibroma is a highly vascularized tumor found almost exclusively in adolescent males and it arises in the majority of the cases from the. In the other type the vascular channels are made up. Pdf nasopharyngeal angiofibroma update on etiology. A juvenile nasopharyngeal angiofibroma jna is a noncancerous tumor made up of blood vessels that grow at the posterior aspect of the nose. Juvenile nasopharyngeal angiofibroma jna is a relatively rare tumor occurring mainly in adolescent boys. They often grow quickly during puberty, then slow down or stop growing entirely after adolescence. Jnas originate from the posterior choanal tissues and rapidly extend into the surrounding regions, including the nasopharynx, the orbits, and even the intracranial cavity. The diagnosis is predicated upon appropriate clinical history and the highly characteristic radiographic appearance. Juvenile nasopharyngeal angiofibroma for medical students. Juvenile nasopharyngeal angiofibromas occur almost exclusively in males and usually in adolescence 15 years. Juvenile nasopharyngeal angiofibroma jna is a benign neoplasm of the nasopharynx. The vascular component of the lesion is prone to bleeding and responsible for its clinical malignancy.
Pdf juvenile nasopharyngeal angiofibroma researchgate. Nasopharyngeal angiofibroma an overview sciencedirect topics. Jan 11, 2011 juvenile nasopharyngeal angiofibroma is a pathologically benign yet locally aggressive and destructive vascular lesion of head and neck region typically affecting adolescent boys. Due to aggressive local growth, skull base location and risk of profound hemorrhage, na is a challenge for surgeons. A rare case initially diagnosed as nasopharyngeal angiofibroma in an old patient and later diagnosed as pseudotumor by the careful histological and clinical observation was reported. Angiofibroma nasofaring juvenile free download as pdf file. Juvenile nasopharyngeal angiofibroma jna is a histologically benign, but locally.
The endoscopic resection is best indicated for small tumors confined to the nasopharynx, nasal cavity, ethmoid and sphenoid, and in some cases, tumors with extension into the pterygopalatine fossa 4. A 60yearold male who had a longstanding history of chronic sinusitis was found having anasopharyngeal tumor in the right nasal cavity and an ossified polyp in. Ten patients were adolescent males, 2 were females. Juvenile nasopharyngeal angiofibromas jna are a rare benign but locally aggressive vascular tumor. The development of minimally invasive techniques has led to the increased use of endoscopic surgery for the treatment of nasopharyngeal angiofibroma 21making it ideal for angioribroma confined to the nasopharynx, nasal cavity, and sphenoid sinus with minimal extension into the pterygopalatine fossa 10 12 15 18 all the contents of this journal, except where.
It is crucial to recognize these tumors on imaging as a biopsy can be disastrous due to their high vascularity. Staging of juvenile nasopharyngeal angiofibromas is performed with crosssectional imaging and relies on the identification of local tumor extent, and invasion of adjacent spaces. Toronto dermatology centre is located in toronto, ontario, and serves men and women in north york, vaughan, richmond hill, york, aurora. Hunt, in diagnostic immunohistochemistry third edition, 2011. In addition, the term nasopharyngeal is often used instead of nasal because angiofibromas that occur. In 1906 chareau revived the interest in the study of juvenile nasopharyngeal angiofibroma. Juvenile nasopharyngeal angiofibromas jna are a rare benign, but locally aggressive, vascular tumor. Juvenile nasopharyngeal angiofibroma 420 introduction juvenile nasopharyngeal angiofibroma jna represents 0. This is a classical presentation of juvenile nasopharyngeal angiofibroma. Juvenile nasopharyngeal angiofibroma jna is a rare, benign, but locally aggressive tumor occurring almost exclusively in adolescent males. The present article is a retrospective study of surgically treated patients of juvenile nasopharyngeal angiofibroma over a period of 5 years. Preoperative embolization is also important to reduce intraoperative blood loss.
Fortythree cases of jna were treated at our institution from 1975 to 1999. However, the extensions of the tumor seem to be independent, each one with distinct behavior. Juvenile nasopharyngeal angiofibroma knowledge for. Denker operation is an effective surgical approach in managing. It is not as invasive as to surgery that is almost free of acute complications in. Extranasopharyngeal angiofibromas ena arising exclusively from the nasal septum, nasal septal angiofibromas nsa, are extremely rare with only cases to date. Accordingly, we studied patients with this lesion seen at the princess margaret hospital, toronto, in order to draw conclusions about these inconsistencies and. Nasopharyngeal angiofibromas are rare vascular tumours seen in ent practice. Pdf download for facial palsy following embolization of a juvenile. Juvenile nasopharyngeal angiofibroma is a pathologically benign yet locally aggressive and destructive vascular lesion of head and neck. Call 4166330001 or email us today to find out the best angiofibroma treatment option for you. Although the clinical presentation of these tumors differs vastly from the classically described juvenile nasopharyngeal angiofibroma jna, the histopathology is similar. Facial palsy following embolization of a juvenile nasopharyngeal. Patients usually present with nasal obstruction and epistaxis.
Nasopharyngeal angiofibroma an overview sciencedirect. They are exclusively found in males and if diagnosed in a female patient, genetic testing. Juvenile nasopharyngeal angiofibroma has been documented since the time of hippocrates 4 bc. In this video, we are going to see about juvenile nasopharyngeal angiofibroma. Sep 01, 2008 juvenile nasopharyngeal angiofibroma is a rare, benign tumor that occurs most often in adolescent males. Interphase fish on cut sections from nine additional cases of soft tissue angiofibroma using pools of bacs covering ahrr and ncoa2 yielded fusion signals in at least 10% of the nuclei in three cases. Review article nasopharyngeal angiofibroma ashutosh hota s. The biopsy showed thin walled and angulated blood vessels and the blood vessels were lined by a single layer of endothelial cells and showed an incomplete muscular wall which was suggestive of nasopharyngeal angiofibroma fig. Surgical experience with juvenile nasopharyngeal angiofibroma. Ppt juvenile nasopharyngeal angiofibroma powerpoint.
The mass was free from septum, lateral wall and floor and was seen to be arising from the. Juvenile nasopharyngeal angiofibroma jna is a relatively rare tumor with an incidence of between 1. Juvenile nasopharyngeal angiofibroma is a benign but locally invasive tumor accounting for about 0. It invades the natural foramina and fissures usually present in the. Mean age at diagnosis is 14 years may regress in late teens but may persist into adulthood rare in patients older than 25 years.
Additional interphase fish using a breakapart probe for the ncoa2 gene in the six fusionnegative cases did not reveal any split signals. At the same time, it is the most common benign neoplasm of the nasopharynx. Nasopharyngeal angiofibroma is a histologically benign but locally aggressive vascular tumor of the nasopharynx that arises from the superior margin of the sphenopalatine foramen and grows in the back of the nasal cavity. Nasopharyngeal angiofibroma and cancer shyni dharipelly. Even in patients who received preoperative embolization, a bloodfree surgical field may not be obtained because of collaterals and variable origin of the vidian. Juvenile nasopharyngeal angiofibromas staging radiology. Nasopharyngeal angiofibroma is a benign, vascular, polypoid fibrous mass in located in the the posterolateral wall of the nasal cavity.
For a discussion of this entity please refer to the parent article. Infact hippocrates goes on to describe a polyp in the nose which weeped blood. It is almost exclusicely encountered in adolescent males 1. Review of the literature on the rare nasopharyngeal angiofibroma reveals a number of inconsistencies in the tumors spectrum, its behaviour and its response to treatment 15. The angiofibroma right abuts normal sinonasal respiratory mucosa left, supporting an extrapharyngeal location. Well circumscribed but unencapsulated polypoid fibrous mass, bleeds severely on manipulation and biopsy, may occlude nares. This is a concise presentation for medical students especially from india. Nasopharyngeal angiofibroma na is a rare vascular tumor, which represents 0. These features are compatible with juvenile angiofibroma, a benign but locally invasive tumor. Nasopharyngeal angiofibroma symptoms aurora health care.
Radiotherapy of nasopharyngeal angiofibroma springerlink. Angiofibromas are small, reddish brown or even fleshcolored, smooth, shiny, 0. The juvenile nasopharyngeal angiofibroma jna is a highly nasoangiofibroma youth is a highly vascularized tumor almost exclusively male. Review article nasopharyngeal angiofibroma ashutosh hota. Nasal septal angiofibroma, a subclass of extranasopharyngeal. Nasoangiofibroma youth is a highly vascularized tumor almost exclusively male adolescents presentation.
Extension to intracranial cavity is not uncommon and presents difficulties in management. This is a concise presentation for medical students especially from. Nasopharyngeal angiofibroma update on etiology, diagnosis, and management. Diagnosis and treatment of juvenile nasopharyngeal angiofibroma.
Ppt journal juvenile nasopharynx angiofibroma radiation. Juvenile nasopharyngeal angiofibroma jna jnas are wellvascularized benign lesions typically occurring in adolescent males. Accordingly, we studied patients with this lesion seen at the princess margaret hospital, toronto, in order to draw conclusions about these inconsistencies and reported our findings in 1967 and 1970 6,7. Angiofibroma removal in toronto dermatology centre is a commonly performed procedure with great results. Epidemiology juvenile nasopharyngeal angiofibromas. The aim of this retrospective study was to compare clinical and radiological findings and discuss optimal surgical approach in patients with juvenile nasopharyngeal angiofibroma jna.
The juvenile nasopharyngeal angiofibroma has a characteristic growth in all directions from its origin. Juvenile nasal angiofibroma jna is a rare sinonasal tumor that is found almost exclusively in adolescent and young adult males. Nasopharyngeal angiofibroma is an uncommon, benign, fibrovascular tumor which exhibits a distinct predilection for adolescent males and accounts for less than 1% of all head and neck neoplasms 1, 2. It is not as invasive as to surgery that is almost free of. Nasopharyngeal angiofibroma is a histologically benign tumor composed of stroma and vessels.
Common practice is to excise the tumor with open or endoscopic surgery. Diagnosis and treatment of juvenile nasopharyngeal. Juvenile nasopharyngeal angiofibroma with audio youtube. Though it is a benign tumor, it is locally invasive and can invade the nose, cheek, orbit. Intricate mixture of stellate and staghorn blood vessels with variable vessel wall thickness ranging from single layer of endothelium to variable smooth muscle coat.
There are many classification described although none is. Introduction uncommon, benign and extremely vascular tumour up to 0. Nasopharyngeal angiofibroma may be classified according to. We had recently a case of an extensive jna in the r nasal cavity extending from the anterior nares to the nasopha. Juvenile nasopharyngeal angiofibroma knowledge for medical. May 15, 2012 nasopharyngeal angiofibroma na is a rare, vascular tumor affecting adolescent males.
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