1.

AngiofibromaODUCTION DUCTION INTRODUCT

Juvenile nasopharyngeal angiofibroma (JNA) is one of the most common benign nasal cavity tumors of adolescence. It often acts in a malignant manner by eroding into the surrounding sinuses, orbit, or cranial vault. History of the Procedure: Although Hippocrates described lesions similar to JNAs, Chelius associated the tumor with adolescent males in 1847. A review by Martin et al in 1948 defined most of the associated features described below. The first successful surgical resection of a probable JNA is credited to Liston in 1841 at University College Hospital in London. Frequency: It is found almost exclusively in adolescent males (average age, 14-18 y). Young females given this diagnosis should undergo chromosomal studies or should have the diagnosis questioned. Incidence of JNA is 1 case per 5000-60,000 ear, nose, and throat patients and accounts for 0.5% of all head and neck tumors. The wide range of reported cases may stem from misdiagnosis and inclusion of other lesions. Incidence is reported to be higher in Egypt and India. Etiology: The cause has not been determined. The most accepted theory is that JNAs originate from sex steroidstimulated hamartomatous tissue located in the turbinate cartilage. The proposed hormonal influence may explain why (rarely) some JNAs involute after puberty. Recent studies by Bretani demonstrate estrogen and progesterone receptors in JNA, but gonadotropin levels in all patients are normal. Another proposed theory includes tumor originating from embryonal chondrocartilage of the occipital plate. Pathophysiology: The proposed origin of the JNA is located along the posterior-lateral wall in the roof of the nasopharynx, usually in the region of the superior margin of the sphenopalatine foramen and the posterior aspect of the middle turbinate. Fetal histology confirms large areas of endothelial Juvenile nasopharyngeal angiofibroma (JNA) is one of the most common benign nasal cavity tumors of adolescence. It often acts in a malignant manner by eroding into the surrounding sinuses, orbit, or cranial vault. tissue in this region. Rather than invading surrounding tissue, this tumor displaces and distorts, relying on pressure necrosis to destroy and push through its bony confines. Intracranial extension is noted in 10-20% of cases. Clinical: Signs and symptoms are present for an average of 6 months prior to the diagnosis, commonly with extension beyond the nasopharynx. Symptoms

Frequent epistaxis or blood-tinged nasal discharge Nasal obstruction and rhinorrhea Conductive hearing loss from eustachian-tube obstruction Diplopia, which occurs secondary to erosion into the cranial cavity and pressure on the optic chiasm Rarely anosmia, recurrent otitis media, and eye pain

Signs

Visible firm grayish-red mass in the posterior nasal pharynx; nonencapsulated and often lobulated; can be sessile or pedunculated Proptosis, a bulging palate, an intraoral buccal mucosa mass, cheek mass, or a swelling over the zygoma (common with local extension)

Differential diagnosis

Pyogenic granuloma Choanal polyp Angiomatous polyp Nasopharyngeal cyst Chordoma Carcinoma

Lab Studies:

Perform a CBC count for baseline hemoglobin and hematocrit and platelet count. Assess prothrombin time, activated partial thromboplastin time, and International Normalized Ratio to rule out any unforeseen coagulation problems. Patients with JNA are not associated with any higher risk than is found in the general population.

Imaging Studies:

Sinus films
o

Classic presentations show antral bowing (Holman-Miller sign) as the tumor pushes forward on the posterior wall of the maxillary sinus. Widening of the pterygomaxillary and the superior orbital fissures may be evident. Findings may show nasal septal deviation.

CT scan of the head and face with contrast in both axial and coronal planes is confirmatory and demonstrates the extent of the tumor. MRI may aid in better defining the extent of tumor, avoiding radiation exposure to the patient, and providing multiplanar images and superior 3-dimensional reconstruction capability. Bilateral external and internal carotid angiography

This study adds visualization of the feeder vessel, most commonly branches of the internal maxillary artery, and a means of preoperative embolization. Bilateral angiograms should be obtained because other feeder vessels can contribute significantly to larger tumors. The results improve preoperative planning, but the main use of the study is in preoperative embolization. It can be used to differentiate recurrent tumor from scar.

Diagnostic Procedures:

CT scan, MRI, and angiography are sufficient. Nasal mucosal biopsy, although advocated through the mid 1980s, should be avoided because CT scan and MRI allow diagnostic imaging and prevent resultant uncontrolled hemorrhage and the possibility of misleading histology from a superficial biopsy.

Histologic Findings: Findings include mature fibrous tissue containing variable amounts of thin-walled vessels. These vessels are lined with endothelium, but they lack the normal contractile muscular elements in their vessel walls. This may explain their propensity to bleed. Staging: Used for prognosis and therapeutic approaches, it was proposed by multiple surgeons. It is based on CT scan findings.

History of staging protocols

o o o o

Johns, 1980 - Not widely accepted Chandler et al, 1984 - Based on staging of nasopharyngeal cancer Sessions et al, 1981 - Revised by Radkowski et al in 1996 Fisch, 1983 - Revised by Andrews et al in 1989

Andrews staging classification is as follows:

o o o o o

I - Tumor limited to the nasal cavity II - Into pterygopalatine fossa or maxillary, sphenoid, or ethmoid sinuses IIIa - Into orbital or infratemporal fossa without intracranial involvement IIIb - Stage IIIa with extradural intracranial (parasellar) involvement IVa - Intradural without cavernous sinus, pituitary, or optic chiasm involvement

IVb - Involvement of the cavernous sinus, pituitary, or optic chiasm

Note: Surgery usually is recommended for stages I-IVa, and radiation, with or without surgery, is recommended for stage IVb JNAs. http://216.109.117.135/search/cache?p=angiofibroma&ei=UTF8&cop=mss&toggle=1&u=www.emedicine.com/med/topic2758.htm&w=angiofibroma&d=557 E5A9733&icp=1&.intl=us

Angiofibroma
Etiology Unknown Increases in size under the influence of testosterone Pathogenesis Unknown, Epidemiology Predilection for teenage boys (peak incidence at age 15) Rarely ever seen in girls, if at all General Gross Description Firm, fibrous masses Well circumscribed General Microscopic Description Numerous vascular spaces embedded in stroma which is collagenized Spaces generally lined by single layer of endothelium Clinical Correlation Present with nasal obstruction and bleeding, as arise from lateral nasopharynx May bleed profusely with surgery, which is treatment of choice May need chemotherapy if surgery cannot remove intracranial extension References Sternberg SS ed. Diagnostic Surgical Pathology, 2d edition, Lippincott-Raven; Philadelphia. 1996, pp. 874-5.

Angiofibroma
"juvenile nasopharyngeal angiofibroma"

benign vascular nasopharyngeal tumor adolescent males supplied by pterygopalatine br. of maxillary artery may extend into skull base, orbit, cranium nasal cavity --> sphenopalatine canal --> pterygopalatine fossa

findings:

persistent dense stain rarely, early-draining veins

DDx:

lymphoepithelioma fibrous dysplasia

Charles E. Kahn, Jr., MD - 5 July 1995 Last updated 26 May 2004

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Nasal tumor; Angiofibroma - juvenile; Benign nasal tumor

Definition

Return to top

Juvenile angiofibroma is a benign growth of the back of the nose or upper throat (nasopharynx) that contains many blood vessels. Causes, incidence, and risk factors Return to top

Juvenile angiofibroma is relatively uncommon. It typically is discovered in adolescent boys and is associated with nasal obstruction a visible nasal mass and nosebleeds (epistaxis). The tumor is locally invasive and capable of eroding bone. Symptoms Return to top

nosebleeds (epistaxis) o frequent o repeated nasal congestion, difficulty breathing through the nose nasal discharge, usually blood tinged hearing loss prolonged bleeding, bruising easily -- episodes are frequent or occur repeatedly (recurrent) Return to top

Signs and tests

Angiofibroma may be visible on examination of the nasopharynx.

An X-ray or a CT scan of the head (nose area) confirms the presence of angiofibroma. Nasal mucosal biopsy indicates tumor or polyp.

Treatment Return to top Treatment is required if the angiofibroma is enlarging, obstructing the airway, or causing chronic nosebleeds. In some cases, no treatment is necessary. Surgical treatment includes removal of the tumor. Removal is often difficult because the tumor is unencapsulated and may be deeply invasive. Recurrence of the tumor after surgical resection is common. Clotting of the vessels of the tumor (embolization) may cause the tumor to scar and stop bleeding. Embolization is performed by injecting a substance into the blood vessel to block blood flow through it. Embolization may be adequate by itself to correct the nosebleeds, or it may be followed by surgery to remove the tumor. Expectations (prognosis) Return to top

Although not cancerous, angiofibromas may continue to expand. They may disappear spontaneously. There is a high rate of recurrence after surgical removal. Complications

Return to top

expansion of the angiofibroma to the nose, the sinuses, and other structures anemia from chronic blood loss pressure on the brain from expansion of the angiofibroma (rare)

Calling your health care provider Return to top Call your health care provider if repeated or frequent nosebleeds occur. Prevention Return to top

There is no known way to prevent this condition. Update Date: 10/30/2003 Updated by: Philip L. Graham III, M.D., M.S., F.A.A.P., Department of Pediatrics, Children's Hospital of New York, Columbia University, New York, NY. Review provided by VeriMed Healthcare Network . http://216.109.117.135/search/cache?p=angiofibroma&ei=UTF8&cop=mss&toggle=1&u=www.nlm.nih.gov/medlineplus/ency/article/001572.htm&w=angiofi broma&d=79D53F6CE8&icp=1&.intl=us

Juvenile angiofibroma

Nasal mucosa

The mucosa, or mucous membrane, is a type of tissue that lines the nasal cavity. Mucous membranes are usually moist tissues that are bathed by secretions such as in the nose.
Review Date: 12/6/2001 12:00:00 AM Reviewed By: A.D.A.M. Medical Illustration Team

Definition: Juvenile angiofibroma is a benign growth of the back of the nose or upper throat (nasopharynx) that contains many blood vessels. Alternative Names: Nasal tumor; Angiofibroma - juvenile; Benign nasal tumor Review Date: 10/30/2003 Reviewed By: Philip L. Graham III, M.D., M.S., F.A.A.P., Department of Pediatrics, Children's Hospital of New York, Columbia University, New York, NY. Review provided by VeriMed Healthcare Network. http://216.109.117.135/search/cache?p=angiofibroma&ei=UTF8&cop=mss&toggle=1&xargs=0&pstart=1&b=11&u=www.pennhealth.com/ency/article/0015 72.htm&w=angiofibroma&d=EF257E31DB&icp=1&.intl=us

Juvenile angiofibroma
Alternative names:
nasal tumor; angiofibroma; angiofibroma - juvenile; benign nasal tumor

Definition:
A noncancerous growth of the back of the nose or upper throat (nasopharynx) that contains many blood vessels.

Causes, incidence, and risk factors:

Juvenile angiofibroma is relatively uncommon. It typically is discovered in adolescent boys and is associated with nasal obstruction a visible nasal mass and nosebleeds (epistaxis). The tumor is locally invasive and capable of eroding bone.

Prevention:
There is no known way to prevent this condition.

Symptoms:

nosebleeds (epistaxis) o frequent, o repeated nasal congestion, difficulty breathing through the nose nasal discharge, usually blood tinged hearing loss prolonged bleeding, bruising easily--episodes are frequent or occur repeatedly (recurrent)

Signs and tests:

Angiofibroma may be visible on examination of the nasopharynx.

An X-ray or a CT scan of the head (nose area) confirms the presence of angiofibroma. Nasal mucosal biopsy indicates tumor or polyp.

Treatment:
Treatment is required if the angiofibroma is enlarging, obstructing the airway, or causing chronic nosebleeds. In some cases, no treatment is necessary. Surgical treatment includes removal of the tumor. Clotting of the vessels of the tumor (embolization) may cause the tumor to scar and stop bleeding. Embolization is performed by injecting a substance into the blood vessel to block blood flow through it. Embolization may be adequate by itself to correct the nosebleeds, or it may be followed by surgery to remove the tumor.

Expectations (prognosis):
Although not cancerous, angiofibromas may continue to expand. They may disappear spontaneously.

Complications:

expansion of the angiofibroma to the nose, the sinuses, and other structures anemia from chronic blood loss pressure on the brain from expansion of the angiofibroma (rare)

http://216.109.117.135/search/cache?p=angiofibroma&ei=UTF8&cop=mss&toggle=1&xargs=0&pstart=1&b=11&u=www.healthcentral.com/mhc/top/001572 .cfm&w=angiofibroma&d=866D8E804E&icp=1&.intl=us

Disease - Juvenile angiofibroma

Definition: Juvenile angiofibroma is a benign growth of the back of the nose or upper throat (nasopharynx) that contains many blood vessels. Alternative Names: Nasal tumor; Angiofibroma - juvenile; Benign nasal tumor Causes And Risk: Juvenile angiofibroma is relatively uncommon. It typically is discovered in adolescent boys and is associated with nasal obstruction a visible nasal mass and nosebleeds (epistaxis). The tumor is locally invasive and capable of eroding bone. Prevention: There is no known way to prevent this condition. Symptoms:

nosebleeds (epistaxis) o frequent o repeated nasal congestion, difficulty breathing through the nose nasal discharge, usually blood tinged hearing loss prolonged bleeding, bruising easily -- episodes are frequent or occur repeatedly (recurrent)

Signs And Tests: Angiofibroma may be visible on examination of the nasopharynx.

An X-ray or a CT scan of the head (nose area) confirms the presence of angiofibroma. Nasal mucosal biopsy indicates tumor or polyp.

Treatment: Treatment is required if the angiofibroma is enlarging, obstructing the airway, or causing chronic nosebleeds. In some cases, no treatment is necessary.

Surgical treatment includes removal of the tumor. Removal is often difficult because the tumor is unencapsulated and may be deeply invasive. Recurrence of the tumor after surgical resection is common. Clotting of the vessels of the tumor (embolization) may cause the tumor to scar and stop bleeding. Embolization is performed by injecting a substance into the blood vessel to block blood flow through it. Embolization may be adequate by itself to correct the nosebleeds, or it may be followed by surgery to remove the tumor. Prognosis: Although not cancerous, angiofibromas may continue to expand. They may disappear spontaneously. There is a high rate of recurrence after surgical removal. Complications:

expansion of the angiofibroma to the nose, the sinuses, and other structures anemia from chronic blood loss pressure on the brain from expansion of the angiofibroma (rare)

Call Health Care Provider: Call your health care provider if repeated or frequent nosebleeds occur. Disclaimer:
Review Date: 10/30/2003 Reviewed By: Philip L. Graham III, M.D., M.S., F.A.A.P., Department of Pediatrics, Childrens Hospital of New York, Columbia University, New York, NY. Review provided by VeriMed Healthcare Network

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10. Case Example: Juvenile Nasopharyngeal Angiofibroma

An 8 year old boy presented with a long history of left sided nasal obstruction and a three month history of recurrent bilateral nosebleeds. Examination revealed a left nasal mass. A juvenile nasopharyngeal angiofibroma was confirmed after performing a CT scan. Surgical removal was carried out after pre-operative angiography with embolization of the tumour. The surgical course was without complication or need for perioperative blood transfusions. He is 7 years following removal with no evidence of recurrence.

Figure 2: Angiography showing highly vascular Figure 1: Coronal CT showing large lesion fed mainly by internal maxillary artery extracranial angiofibroma with extension into branches. The tumour is embolized prior to pterygomaxillary and infratemporal fossa. surgical excision.

Figure 3: Left lateral rhinotomy and lip split. Medial maxillary osteotomies performed.

Figure 4: Anterior maxillary segment and nasal turbinates removed to expose underlying tumour.

Figure 5: Anterior maxillotomy is extented laterally for access to lateral portion of tumour. Sphenoethmoidectomy performed and Figure 6: Large "dumbell" shaped tumour posterior wall of maxillary sinus is removed removed. for optimum exposure to safely remove tumour from skull base and pterygomaxillary/infratemporal fossa.

Figure 7: Dacrocystorhinostomy and medial canthopexy are performed. Cavity is packed with bismuth-iodoform-paraffin paste impregnated gauze. The medial maxillary Figure 8: The external and intraoral incisions are segment is returned and fixed with interosseous closed in layers. wires.The upper lateral nasal cartilage is sutured to bone to prevent collapse of the nasal valve. http://216.109.117.135/search/cache?p=angiofibroma&ei=UTF8&cop=mss&toggle=1&b=61&u=www.sickkids.on.ca/otolaryngology/angiofib.asp&w=angiof ibroma&d=95CB347537&icp=1&.intl=us

JUVENILE NASOPHARYNGEAL ANGIOFIBROMA

Clinical Information: CC: "massive nosebleeds with weakness and fainting" A previously healthy 8 year old male presented to the otolaryngology office after 2 bouts of severe epistaxis leading to weakness and syncope. Initial work-up was geared towards Von Willebrandt's disease due to a positive family history. On clinical exam, a nasal mass was noted. It was subsequently biopsied with equivocal results. In addition, nasal sinus culture was positive for GAS and the patient was placed on antibiotics. CT and MRI showed a large mass in the nasal cavity which was thought to be rhabdomyosarcoma given the young age of the patient and the aggressiveness of the tumor. A second biopsy was performed in the operating room with significant post-operational epistaxis requiring nasal packing and transfusion. Results of biopsy were consistent with juvenile nasopharyngeal angiofibroma (JNA). The patient was scheduled for embolization and removal of tumor 3 months after his first bout of severe epistaxis. Radiographic Findings: CT scan of the sinuses with axial and coronal scans shows a large right-sided mass centered around the pterygopalatine fossa and nasopharynx. The tumor extends laterally into the pterygopalatine fossa with widening of the pterygomaxillary fissure and expansion into the infratemporal fossa. Antero-medial progression of the mass results in the filling of a major portion of the nasal cavity with leftward displacement of the nasal septum. Anteriorly, expansion of the mass causes some antral bowing of the posterior wall of the maxillary sinus. Posteriorly, the tumor fills the nasopharynx and the sphenoid sinus. Disruption of the base of the pterygoid plates are also seen on the right. Superiorly, the roof of the sphenoid sinus appears to be eroded in addition to the bone between the middle fossa on the right side. Extension into the right orbit is also observed. Since bone destruction is present along with bony remodeling, the tumor appears to be intermediate in aggressiveness. Densities are seen occupying the ethmoid and right maxillary sinuses, but MRI is needed to distinguish between tumor invasion and retained secretions due to the tumor mass. MRI of the orbits and the face additionally shows strong enhancement of the mass after the administration of IV gadolinium contrast. Additional findings include tumor extension superiorly into the anterior cranial fossa and a cystic structure within the superior aspect of the mass. The ethmoid and sphenoid sinuses are filled with tumor whereas the right maxillary sinus is filled with retained secretions. A pre-operative arteriogram was performed prior to embolization shows the hypervascularity of the small tumor vessels supplied by the right sphenopalatine and right internal carotid artery branches. A post-embolization arteriogram shows the decreased blood supply to the tumor.

Pathologic Findings: This fibrovascular tumor appears benign and consists of the characteristic irregularly shaped blood vessels with a single layer of rounded endothelial cells within a uniform connective tissue stroma. The vessel walls are thin and do not have either a muscularis layer or elastic fibers. The stroma consists of elongated mature fibroblasts with plump nucleoli and dispersed collagen bundles. Unique to this case of JNA is a comparative abundance of fibrous stroma creating a histologically hypovascular appearance. Additionally, the use of pre-operative embolization causes vascular thromboses. Foreign particles implanted in the thrombus is observed. Visualization of the embolized tumor show areas of infarction and necrosis. Impression: Known As:

Juvenile nasopharyngeal fibroma Juvenile angiofibroma Myxofibroma Fibroids of the nasopharynx Nasopharyngeal angiofibroma

Discussion: JNA is a histologically benign vascular lesion which grows very slowly but can be locally aggressive. These tumors are found in young males between the ages of 5 to 25, with mean age being 15. This is the most common benign tumor of the nasopharynx although incidence is rare (0.05%). These fibrovascular tumors originate from sphenopalatine foramen in the lateral nasopharyngeal wall and commonly extends into and through foramina and fissures to adjoining cavities. Frank bone invasion does not occur due to the slow growth of the tumor, although osseous erosion and remodeling are often seen. Etiology: The etiology of JNA is unknown but it is postulated that there may be a relation to sex hormones. There is evidence of increased androgen receptors of tumors and successful tumor regression after anti-androgen therapy. Anatomic Spread of Tumor: tumor arises from sphenopalatine foramen on lateral nasopharyngeal wall and produces radiologic and clinical signs.

Direction of tumor spread Anatomic location of tumor extension Radiologic Correlation Medial nasal cavity via sphenopalatine foramen Displacement of nasal septum Lateral pterygopalatine fossa Widening of pterygomaxillary fissure infratemporal fossa via pterygomaxillary fissure Posterior via pterygoid (vidian) canal Distortion of roots of pterygoid plates Anterior maxillary sinus and orbit via inferior Antral bowing sign orbital fissure Cranial sphenoid sinus to sella turcica and cavernous sinus involving middle cranial fossa by extradural spread Signs and Symptoms: Signs and symptoms occur due to growth of tumor into the nose, paranasal sinuses, orbit and skull base. Common early symptoms include:

unilateral nasal obstruction recurrent spontaneous epistaxis nasal drainage

**This clinical triad is practically diagnostic for JNA in males between 5-25 years old Common late symptoms:

facial deformities ("frog face") proptosis cranial nerve palsies visual disturbance impaired hearing

Radiographic Differential Diagnosis: Differential includes other causes of nasal obstruction-- choanal polyp, angiomatous polyp, chordoma, nasopharyngeal carcinoma, rhabdomyosarcoma, nasopharyngeal cyst, pyogenic granuloma, lymphoma Diagnosis: Diagnosis is made by clinical and imaging findings together with gender and age of patient. Histologic exam of resected specimen is confirmatory. Suspected lesions should NOT be biopsied since they are very vascular and may bleed abundantly requiring nasal packing and transfusion. CT and MRI are used most commonly to show the extent of the lesion.

CT: Most important pre-operative test because it is useful for showing the destruction of bony structures and widening of foramen and fissures at the skull base due to spread of tumor. The following signs for JNA may be observed:

Mass in the pterygopalatine fossa Mass in the posterior nasal cavity Erosion of bone behind sphenopalatine foramen at root of medial pterygoid plate Bony remodeling or reshaping around tumor antral bowing sign: seen on axial CT due to anterior remodeling of the posterior wall of the maxillary sinus.

CT can also help recognize invasion of sphenoid and thus determine the aggressiveness of surgery. MRI: Useful to show presence of intracranial extension of the tumor. MRI also helps discern between sinus invasion, obstruction and retention of secretions. The following signs for JNA may be observed:

Intense tumor enhancement is shown after IV gadolinium administration due to vascularity of mass. Signal voids representing hypertrophic tumor vessels.

Angiography: Most frequently employed for preoperative identification of feeding vessels of tumor for embolization but can be used for radiologic confirmation of JNA if necessary. Demonstrates the prominent vascular supply commonly from the branches of the ipsilateral internal maxillary artery (a branch of the external carotid artery). A characteristic finding of JNA on angiogram is a dense homogeneous blushing or staining mass during the capillary phase. Findings suspicious for intracranial extension includes blood supply of tumor from internal carotid artery. Treatment: Stage tumor to determine surgical approach of tumor removal Clinical Staging Stage Extent of Tumor 1 confined to nasopharynx 2 into nasal cavity and / or sphenoid sinus into one or more of: antrum, ethmoid sinus, pterygomaxillary and 3 infratemporal fossae, orbit, cheek into cranial cavity-----presence or absence of intracranial extension is 4 used to divide patients into therapeutic and prognostic groups

Surgical resection with preoperative embolization is the preferred treatment. Complications include excess blood loss up to 5 L and death due to exsanguination . Pre-operative angiography is required to visualize the feeding vessels of the tumor in order to perform preoperative embolization. The use of embolization has been shown to decrease intraoperative hemorrhage and the rate of tumor recurrence. Radiotherapy is reserved for recurrent tumors. Complications include sarcomatous transformation, danger of inhibiting normal facial growth and risk of hemi-facial atrophy. Spontaneous regression is rare Recurrence:

6-60% recurrence rates can occur as early as 3-4 months after surgery main predictor of recurrence is invasion of sphenoid bone. postoperative radiological surveillance is important due to high rates of recurrence

Conclusions/ Key Points about JNA:

histologically benign but locally aggressive tumor the most common benign nasopharyngeal tumor although incidence is low (0.05%) occurs in males aged 8-25, mean age 15 most common symptoms include recurrent epistaxis and unilateral nasal obstruction NEVER biopsy this lesion imaging has an integral role in the diagnosis, treatment and follow-up surveillance of this tumor treatment includes surgery with pre-operative embolization

Links to other sites containing radiology case studies of Juvenile Nasopharyngeal Angiofibroma: Submitted by: Hannah S. Choi, MS-III http://216.109.117.135/search/cache?p=angiofibroma&ei=UTF8&cop=mss&toggle=1&b=21&u=cats.med.uvm.edu/cats_teachingmod/radiology/radiology_ht ml/teaching/radio_peds/jna/jna_frameset.htm&w=angiofibroma&d=C688D67144&icp=1&.intl =us

Juvenile angiofibroma
For more information...

Definition:
A benign growth of the back of the nose or upper throat (nasopharynx) that contains many blood vessels.

Alternative Names:
Nasal tumor; Angiofibroma - juvenile; Benign nasal tumor

Causes, incidence, and risk factors:

Juvenile angiofibroma is relatively uncommon. It typically is discovered in adolescent boys and is associated with nasal obstruction a visible nasal mass and nosebleeds (epistaxis). The tumor is locally invasive and capable of eroding bone.

Symptoms:

nosebleeds (epistaxis) o frequent o repeated nasal congestion, difficulty breathing through the nose nasal discharge, usually blood tinged hearing loss prolonged bleeding, bruising easily -- episodes are frequent or occur repeatedly (recurrent)

Signs and tests:

Angiofibroma may be visible on examination of the nasopharynx.

An X-ray or a CT scan of the head (nose area) confirms the presence of angiofibroma. Nasal mucosal biopsy indicates tumor or polyp.

Treatment:
Treatment is required if the angiofibroma is enlarging, obstructing the airway, or causing chronic</a><a class='library' href="http://www.meijer.com/pharmacy/Medi_cond_display.asp? urn=urn:content:ency:article:003106&amp;qu=nosebleeds">nosebleeds. In some cases, no treatment is necessary. Surgical treatment includes removal of the tumor. Removal is often difficult because the tumor is unencapsulated and may be deeply invasive. Recurrence of the tumor after surgical resection is common.

Clotting of the vessels of the tumor (embolization) may cause the tumor to scar and stop bleeding. Embolization is performed by injecting a substance into the blood vessel to block blood flow through it. Embolization may be adequate by itself to correct the nosebleeds, or it may be followed by surgery to remove the tumor.

Expectations (prognosis):
Although not cancerous, angiofibromas may continue to expand. They may disappear spontaneously. There is a high rate of recurrence after surgical removal.

Complications:

expansion of the angiofibroma to the nose, the sinuses, and other structures anemia from chronic</a><a class='library' href="http://www.meijer.com/pharmacy/Medi_cond_display.asp? urn=urn:content:ency:article:000045&amp;qu=blood loss">blood loss pressure on the brain from expansion of the angiofibroma (rare)

Calling your health care provider:

Call your health care provider if repeated or frequent nosebleeds occur.

Prevention:
There is no known way to prevent this condition. http://216.109.117.135/search/cache?p=angiofibroma&ei=UTF8&cop=mss&toggle=1&xargs=0&pstart=1&b=71&u=www.meijer.com/pharmacy/Medi_cond _display.asp%3Furn%3Durn%253Acontent%253Aency%253Aarticle%253A001572%26qu %3Dnasal+tumors&w=angiofibroma&d=B220B39F9C&icp=1&.intl=us