Abstract
IntroductionNasopharyngeal angiofibroma presents with symptoms of nasal obstruction and epistaxis. The treatment of choice is embolization followed by surgery.Case presentationA 52-year-old man underwent surgery for nasopharyngeal angiofibroma after adjuvant radiofrequency-induced thermotherapy. To the best of the authors' knowledge, this is the first case of angiofibroma with clinical follow-up after thermocoagulation therapy supported by quantitative, double immunohistochemistry. We found this case of angiofibroma to be of interest owing to the presentation of symptoms leading to biopsy, the pathohistological observations obtained with synchronous Ki67/cluster of differentiation 34 and Ki67/smooth muscle actin immunohistochemistry and high pericyte proliferation.ConclusionCoagulation of angiofibroma vessels followed by acquisition of a thick mantle of pericytes in a patient with a nasopharyngeal growth suggests that radiofrequency-induced thermotherapy could be a useful, palliative therapy for bleeding nasopharyngeal angiofibroma, supporting vessel maturation prior to surgical tumor removal.
Highlights
Nasopharyngeal angiofibroma presents with symptoms of nasal obstruction and epistaxis
Coagulation of angiofibroma vessels followed by acquisition of a thick mantle of pericytes in a patient with a nasopharyngeal growth suggests that radiofrequency-induced thermotherapy could be a useful, palliative therapy for bleeding nasopharyngeal angiofibroma, supporting vessel maturation prior to surgical tumor removal
The immunohistochemical analysis of all three angiofibroma biopsies was repeated with a double-staining technique for both Ki67/CD34 and Ki67/smooth muscle actin (SMA) to distinguish between endothelial cell and pericyte proliferation over time (Figure 4A, B and 4C)
Summary
We have presented a rare case of angiofibroma in a 52year-old man with pericyte proliferation, supporting the maturation of the vessel compartment and revealing active angiogenic machinery (cooperation between endothelial cells and pericytes). We observed the divergent behavior of endothelial cells and pericytes after RFITT adjuvant therapy prior to surgery. Further studies of RFITT related to vessel behavior are needed. We found thrombosis and coagulation resulting from RFITT to function as equivalent to embolization prior to surgical therapy for angiofibroma. An analysis of vessel cell proliferation in tissues treated with thermal ablation might have broader clinical impact across medicine. CD; Cluster of differentiation; CT: Computed tomography; EPI: Endothelial cell proliferation index; H&E: Hematoxylin and eosin; MVD: Microvessel density; PCI: Proliferating capillary index; PEPI: Pericyte proliferation index; RFITT: Radiofrequency-induced thermotherapy; SMA: Smooth muscle actin
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