A DE NOVO CASE OF EXTRANASOPHARYNGEAL ANGIOFIBROMA RESULTING IN RESPIRATORY FAILURE IN A 69-YEAR-OLD MALE

Abstract

SESSION TITLE: Medical Student/Resident Procedures Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Nasopharyngeal angiofibromas are highly vascularized, benign tumors located in the nasopharynx, typically found in young males aged 14-25 years old. These tumors account for less than 0.5% of all head and neck neoplasms. Typical locations for nasopharyngeal angiofibromas include the superior aspect of the sphenopalatine foramen in the posterolateral nasal cavity; however, atypical sites have been described. Incidence of these tumors in men older than 25 is also extremely rare (1, 2). We believe this to be the first report detailing a nasopharyngeal angiofibroma in the trachea. This case describes a 69 year old male admitted for respiratory failure found to have an extranasopharyngeal angiofibroma in his trachea. CASE PRESENTATION: A 69 year-old male with past medical history of morbid obesity, chronic obstructive pulmonary disease on home oxygen, and obstructive sleep apnea on continuous positive airway pressure was transferred from an outside hospital with acute on chronic hypoxic respiratory failure requiring intubation. While in the ICU he was treated for COPD exacerbation with broad spectrum antibiotics and steroids. Chest CT revealed a right para-tracheal mass. Bedside bronchoscopy revealed a large obstructing mass distal to the endotracheal tube in the trachea and right main stem bronchus. The patient underwent rigid bronchoscopy for biopsy and tumor excision. The mass was excised using a radiofrequency ablation catheter with complete restoration of airway patency. Pathology of the tracheal mass revealed benign extranasopharyngeal angiofibroma which was negative for malignancy or granulomas. His course was complicated by acute sub-massive pulmonary embolism and subacute left lower lobe infarct and progressive respiratory failure. After anticoagulation and aggressive diuresis he was able to be extubated with eventual discharge to a nursing home. DISCUSSION: The etiology of extranasopharyngeal angiofibromas are unknown. Given their predilection for young males, they are thought to be driven by the pituitary-androgen-estrogen axis (3). However, a small 7 patient study performed by Labra et al, proved there was no statistically significant difference in tumor size after treatment with androgen antagonism (3). Chemotherapy and radiation therapy to reduce tumor size prior to surgical removal to limit post-operative complications, most notably bleeding, has not proven beneficial (3). CONCLUSIONS: This tumor is rare even in the most popular subset of adolescent males. This case highlights the importance of maintaining a wide differential for upper airway masses to ensure proper planning for removal and to minimize significant bleeding complications that can arise. Our patient is currently being followed by endobronchial therapy to monitor for recurrence. Reference #1: Nomura K, Shimomura A, Awataquchi T, Kobayashi T. A case of angiofibroma originating from the inferior nasal turbinate. Auris Nasus Larynx. 2006 June;33(2):191-3. Reference #2: McGarey PJ, David AP, Payne SC. Nasopharyngeal angiofibroma in a 32-year old man. BMJ Case Reports. 2018 February 8,. Reference #3: Labra A, Chavolla-Magana R, Lopez-Ugalde A, Alanis-Calderon J, Huerta-Delgado A. Flutamide as a Preventive Treatment in Juvenile Angiofibroma (JA) with Intracranial Invasion: Report of 7 cases. Otolaryngology - Head and Neck Surgery. 2004 April 1,. DISCLOSURES: No relevant relationships by Amit Mahajan, source=Web Response No relevant relationships by Jessica McLaughlin, source=Web Response