Nasopharyngeal Fibroma Research Articles

Intraorbital Cavernous Hemangioma: Rare Cause of Exophthalmos

Nasopharyngeal angiofibroma refers to a locally aggressive benign vascular tumor composed of vasogenic and myofibroblastic elements, representing between 0.05% and 0.5% of all head and neck tumors. Here, we report a case of a 21-year-old patient with no particular personal or familial pathological history, who presented with recurrent epistaxis and anterior rhinorrhea and headaches for 1 year. Nasofibroscopy revealed a mass filling the entire left nasal cavity, streaked with blood. A face MRI revealed a highly vascularized and lytic nasopharyngeal tumor infiltrating the deep left lateral facial spaces with the beginning of endocranial infiltration, supplied by the homolateral maxillary artery, initially suggestive of a nasopharyngeal fibroma. Preoperative arteriography showed a voluminous vascular blush at the arterial time to the nasopharyngeal projection with branches arising from the left external and internal carotid arteries and multiple arterial shunts (between the left internal and maxillary carotid arteries), thus contradicting embolization. Early diagnosis is important as it is associated with a high risk of morbidity, but advances in imaging and surgical treatment methods have modified the sites associated with high morbidity risk.

Aggressive Tumor and Challenging Location: A Case Report of Nasopharyngeal Fibroma

Nasopharyngeal angiofibroma refers to a locally aggressive benign vascular tumor composed of vasogenic and myofibroblastic elements, representing between 0.05% and 0.5% of all head and neck tumors. Here, we report a case of a 21-year-old patient with no particular personal or familial pathological history, who presented with recurrent epistaxis and anterior rhinorrhea and headaches for 1 year. Nasofibroscopy revealed a mass filling the entire left nasal cavity, streaked with blood. A face MRI revealed a highly vascularized and lytic nasopharyngeal tumor infiltrating the deep left lateral facial spaces with the beginning of endocranial infiltration, supplied by the homolateral maxillary artery, initially suggestive of a nasopharyngeal fibroma. Preoperative arteriography showed a voluminous vascular blush at the arterial time to the nasopharyngeal projection with branches arising from the left external and internal carotid arteries and multiple arterial shunts (between the left internal and maxillary carotid arteries), thus contradicting embolization. Early diagnosis is important as it is associated with a high risk of morbidity, but advances in imaging and surgical treatment methods have modified the sites associated with high morbidity risk.

Clinico-Pathological Study of Juvenile Nasopharyngeal Angiofibroma

Introduction: Anigo-fibroma is vascular swelling arising in the nasopharynx of prepubertal and adolescent males and exhibiting strong tendency to bleed, also termed as nasopharyngeal fibroma or a nasopharyngeal angiofibroma. It accounts for less than 0.5% of all head & neck tumour. It occurs almost exclusively in adolescent male, though rarely found in children and elderly young. It is a rare <1% of head and neck tumors benign mesenchymal neoplasm composed of a vascular proliferation within a cellular, densely collagenizedstroma, typically originating in the nasopharynx, affecting adolescent males. It occurs most often in male adolescents with an average age at diagnosis of 14-16 years. Anyway, there are very few studies, regarding Juvenile Nasopharyngeal Angiofibroma in Bangladrsh and there is not much national data about this issue. Hence, the researcher purposively a total of 30 patients of juvenile nasophryngeal angiofibroma (JNA) included in this study from ENT department of Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh. The aim of this study was to find out the common mode of clinical presentation with their site of extension and different surgical approaches adopted for them. Methods & Materials: This prospective observational study was conducted in the Department of otolaryngology and head, neck surgery of Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh, which is the 2nd generation tertiary level medical service institution during the period from Jan 2017 to Dec 2019. All data were analyzed by using simple statistical data analyzed tools. Result: Almost all the present with recurrent epistaxis 28 (93.33%), following by nasal obstruction 26 (86.66%), nasal discharge 25 (83.33%), facial swelling 10 (33.33%), protrusion of the eyeball 4 (13.33%), aural symptoms 3 (10%) and head-ache 2 (6.66%). Majority of our patient presented with multiple symptoms. Analysis of the finding showed that 100% had nasopharyngeal mass, nasal mass 86.66% palatal bulging 66.66%, swelling of the cheek 33.33%, proptosis 13.33% and headache with blurring of vision 6.66%, these are obtained after thorough clinical examination both local and general. Extension of the tumour assessed on the basis C scan, MRI, as well as observation on the operation showed, nasal cavity 100% and into the pterygopalantine fossa 40%, infratemporal fossa 33.33%, orbit 13.33%, oropharynx 10% maxillary antrum 6.66%, sphenoid sinus 3.33%, ethmoidal sinus 3.33% and 6.66% infra oranial extension. Regarding treatment surgical resection was the most common principal mode of treatment offered to the 93.33% patient but radiotherapy given in 6.66% patient. Conclusion: All young males of this study with nasal obstruction or nose bleed (or both) should be suspected of having juvenile angiofibroma. Angiography to find out feeding vessel to do pre-operative embolization is helpful for surgery. This together with hypotensive anaesthesia and operated by a skilled surgeon having sound knowledge about nasopharynx can lessen the haemorrhage, thereby reduce the mortality and morbidity.

Intensity modulated radiotherapy (IMRT) in the treatment of children and Adolescents - a single institution's experience and a review of the literature

BackgroundWhile IMRT is widely used in treating complex oncological cases in adults, it is not commonly used in pediatric radiation oncology for a variety of reasons. This report evaluates our 9 year experience using stereotactic-guided, inverse planned intensity-modulated radiotherapy (IMRT) in children and adolescents in the context of the current literature.MethodsBetween 1999 and 2008 thirty-one children and adolescents with a mean age of 14.2 years (1.5 - 20.5) were treated with IMRT in our department. This heterogeneous group of patients consisted of 20 different tumor entities, with Ewing's sarcoma being the largest (5 patients), followed by juvenile nasopharyngeal fibroma, esthesioneuroblastoma and rhabdomyosarcoma (3 patients each). In addition a review of the available literature reporting on technology, quality, toxicity, outcome and concerns of IMRT was performed.ResultsWith IMRT individualized dose distributions and excellent sparing of organs at risk were obtained in the most challenging cases. This was achieved at the cost of an increased volume of normal tissue receiving low radiation doses. Local control was achieved in 21 patients. 5 patients died due to progressive distant metastases. No severe acute or chronic toxicity was observed.ConclusionIMRT in the treatment of children and adolescents is feasible and was applied safely within the last 9 years at our institution. Several reports in literature show the excellent possibilities of IMRT in selective sparing of organs at risk and achieving local control. In selected cases the quality of IMRT plans increases the therapeutic ratio and outweighs the risk of potentially increased rates of secondary malignancies by the augmented low dose exposure.

Computer-assisted navigation system in pediatric intranasal surgery.

To introduce a computer-assisted navigation system and to evaluate its application in pediatric sinusonasal surgery. A commercially available wireless passive marker system that allows the calibration and tracking of virtually any instrument was adapted to children and used during pediatric endoscopic sinusonasal surgery. The headset localizer that was initially used in computed tomographic scanning was not well accepted by children. Correlation of the preoperative computed tomographic scan to the actual patient was made possible by a laser device. Setup time was able to be decreased from an initial 20 minutes to 3 minutes. The average recording accuracy was 1.1 mm. The advantages of the system became apparent as experience increased in cases involving sinus polyposis, choanal atresia, nasopharyngeal fibroma removal, tumor biopsy, and minimally invasive maxillary, frontal, and sphenoidal surgery. The computer-assisted navigation system was used first as a control system and then, as experience increased, as a true surgical guide. Indications for its use also increased. Pediatric intranasal surgery was performed using 2 complementary guides: an endoscopic view and a computed tomographic view of the instrument's position.

Xanthoma of urinary bladder.

Sixty-three year-old-man presented with macroscopic haematuria and passage of debris per urethra. His prostate was suspicious of a T2a tumour and his PSA was 11.1 μg/l but his trans rectal ultra sound scan (TRUS) and biopsies were negative for malignancy. In the past, he had trans urethral resection (TUR) of prostate for benign hyperplasia, excision of nasopharyngeal fibroma and superficial spreading melanoma of the thigh and had supraventricular tachycardia but no ischaemic heart disease. Investigations for haematuria revealed normal upper tracts on USS. On urethroscopy, there was an annular bulbar stricture requiring urethral dilatation. Residual prostate was oedematous, vascular but non-occlusive. In the bladder, there was a yellowish white solitary plaque up to 1.5 cm on the posterior wall (Figure 1) Cold cup biopsy showed collection of macrophages with foamy cytoplasm (foam cells) in the lamina propria with a normal overlying urothelium. There was no dysplasia or neoplasia. Appearances were those of a xanthoma (Figure 2a, 2b) Blood counts, renal function, random blood sugar and LFTs were normal as was the thyroid and lipid profile. Urine cytology was normal. Follow-up cystoscopy at 6 months revealed no further lesions in the lower urinary tract and no change in the appearance of the original xanthoma. There was no evidence of transitional cell carcinoma of the bladder. There were no other xanthomatous lesions.

Juvenile nasopharyngeal fibroma: androgen receptors and their significance for tumor growth.

Since the publications of Martin, et al. (1948) and Schiff (1959), who were the first to report on the administration of sex hormones to juvenile nasopharyngeal fibroma (JNF) patients, several authors have described the different clinical effects and histologic changes after androgen and estrogen application. Since the mechanism of action of sex steroids in juvenile nasopharyngeal fibroma is almost unknown, the authors have studied androgen receptor binding in cultured tumor fibroblasts from three patients with JNF. Maximum androgen binding (Bmax) of the tumor fibroblasts approximated to that of genital skin fibroblasts, which served as a control androgen target tissue with high receptor density. Furthermore, in vitro experiments showed that the growth rate of tumor fibroblasts increased when testosterone was added to the culture medium, while the addition of two antiandrogens, cyproterone and flutamide, caused a reduction in growth rate. It is concluded from these results that JNF is a hormone-dependent tumor stimulated by testosterone whose growth rate may, at least in vitro, be reduced by antiandrogens such as cyproterone and flutamide.

A few points in the management of juvenile nasopharyngeal angiofibroma.

A few points based on our experience on 100 cases of nasopharyngeal angiofibroma are described, which are found very useful in the successful removal of nasopharyngeal fibroma. A new technique for the control of haemorrhage by a muscle graft immediately after the removal of an angiofibroma is advocated.

Pathogenesis of juvenile nasopharyngeal fibroma. (A new concept).

Fifteen cases of juvenile nasopharyngeal fibromata have been studied clinically and histologically, and their structure has been compared to that of genital erectile tissue obtained from autopsies of foetuses and children. A similarity in the structure of these two tissue could be observed. A concept of juvenile nasopharyngeal fibroma as arising from misplaced sequestrated genital erectile tissue during foetal development, is discussed; and support is given to this view by anatomical, clinical and histological data.

Electron microscopic findings in four cases of nasopharyngeal fibroma

Light and electron microscopic investigations of four cases of juvenile nasopharyngeal fibroma revealed characteristic structures; a fibrous stroma, an inclination to hyalinisation and formation of scar like tissue, a lacunar thin walled vascular component, large numbers of mast cells and of fibroblasts. The tumor fibroblasts contained different nuclear bodies and particles. There existed five different types of more or less complex spherical bodies. The previously described nuclear electron dense particles with an electron lucent halo could be divided into four groups measuring 60, 90, 150, and 300 nm in diameter. In addition to the previously described ultrastructural properties of the tumors, the nuclei of the tumor fibroblasts were found to contain virus like particles. These particles were less electron dense, measuring 40 to 55 nm in diameter and arranged in groups throughout the nucleoplasm; they were different from chromatin condensations and from perichromatin granules. The structure and the size of the smallest particles was not comparable with the other nuclear inclusions.

Die präoperative Embolisation gefäßreicher Tumoren des Kopfes

Trans-vascular, pre-operative embolisation in order to reduce blood flow was carried out with excellent results in a patient with a naso-pharyngeal fibroma, and with relatively good results in a patient with a pterion meningioma. This technique can be carried out following the diagnostic angiogram through the same catheter; it reduces operative blood loss, improves haemostasis and the surgeon's view of the operative field. The method can be used simply and without risk in any case where the tumour blood supply is derived exclusively or predominantly from branches of external carotid artery.

Nasopharyngeal fibroma with extrapharyngeal extensions.

Five cases of multiple extrapharyngeal extension of nasopharyngeal fibroma seen during the last 8 years were operated by a combined transzygomatic and transpalatal/or per via naturalis approach. The transzygomatic approach is excellent for exposing the lateral extension of this tumour and for efficient control of bleeding under direct vision. Salient features of its clinical behaviour, operative findings and pitfalls in the management are described.

Fibroma nasofaríngeo juvenil: relato de um caso com invasão das fossas cranianas anterior e média

O fibroma nasofaríngeo juvenil é um dos tumores mais raramente encontrados e sua propagação para o interior do crânio é excepcional. A etiopatogenia desta afecção é discutida, não sendo considerada por muitos autores uma verdadeira neoplasia benigna, mas sim uma hiperplasia reativa do tecido colágeno causada por estímulo genético ou hormonal. Relatamos um caso de fibroma nasofaríngeo juvenil em adolescente masculino de 15 anos de idade, o qual se propagava para as fossas cranianas anterior e média. O doente não apresentava sinais clínicos ou laboratoriais de hiperestrogenismo. Foi operado em dois tempos, sendo feita inicialmente exérese da porção intracraniana do tumor mediante craniotomia frontotemporal e, uma semana depois, o restante foi retirado por via transmaxilar. Um ano após o tratamento cirúrgico o paciente foi re-examinado, não havendo sinais clínicos ou radiológicos de recidiva do processo.

Nasopharyngeal fibroma : L. J. Hall, and S. A. Wilkins. Amer. J. Surg. 116:530–537 (October) 1968

Nasopharyngeal fibroma : L. J. Hall, and S. A. Wilkins. Amer. J. Surg. 116:530–537 (October) 1968

Nasopharyngeal fibroma

Fourteen cases of histologically diagnosed nasopharyngeal fibroma have been described. These patients were seen over seventeen years. They are reported with a discussion of treatment and results. A brief review of the literature and the therapeutic dilemmas of managing nasopharyngeal fibromas are also presented.

Carcinoma in recurrent nasopharyngeal fibroma.

Nasopharyngeal fibroma is considered to be essentially a benign lesion. In some cases spontaneous regression of this lesion has also been recorded. Repeated recurrences, after complete surgical excision has, however, created a controversy about the nature of nasopharyngeal fibroma. Willis (1953) and Harma (1959) regarded it as a hyperplastic tissue reaction rather than a tumour, and Erich (1955) also regarded nasopharyngeal fibroma as benign, whereas, Handousa, Farid and Elwi (1954) after reviewing their 70 cases felt that it is a true neoplasm. Ward and Handrick (1950) agreed with these workers and thought that it could grow and destroy the structures in its vicinity by direct extension. Several cases of unusual extension by this tumour have been reported (Weir and Doig, 1960; Rao, 1961; Hora and Aubreyk, 1962). After reviewing the literature, however, Martin, Ehrlich and Abels (1948) did not come across a single well-authenticated case of malignant transformation of this lesion. The purpose of this case...

Juvenile Nasopharyngeal Fibroma in Female Adult: Report of a Case

JUVENILE nasopharyngeal fibroma is typically a vascular fibrotic tumor of a benign nature found primarily in young male adults and invades by direct extension.¹It is reported in the literature that the tumor becomes less active and has a definite tendency to regress when the patient reaches sexual maturity.²Finerman³reported a case in a 13-year-old girl, and others have also reported isolated cases in women. Various modalities of treatment have been used including radiation alone or combined with surgery, and cryosurgery.⁵ Nasopharyngeal fibroma is generally considered to be a lesion which occurs exclusively in adolescent white boys. Recently we observed one of these lesions in an elderly Negro woman, and therefore, the case is reported. <h3>Report of a Case</h3> A 60-year-old Negro woman was seen for the first time at Misericordia Hospital on June 19, 1965, with a history of having a tumor of the

Benign nasopharyngeal tumours with special reference to angiofibroma

1. Nasopharyngeal Fibroma is a rare tumour, 25 cases recorded during the years 1955–1962 are reported. 2. Males were seen to be predominantly affected. 3. Even though Juvenile Nasopharyngeal Fibromas are rare the symptoms which the tumour produces makes the diagnosis easy. When symptoms such as progressive nasal obstruction, recurrent nose bleeds occuring in a school boy with a firm to hard nasopharyngeal mass a possibility of this disease should be considered. 4. Surgical treatment is the ideal treatment and transpalatal approach (Wilson) is the best for majority of tumours, transmandibular approach may be done for laterally extending tumours. 5. In our opinion spontaneous regression of tumour never occours. 6. Pre-operative irradiation reduces the vascularity and size of the tumour and thus facilitates the subsequent removal of tumour by surgery. We did not notice any adhesion formation between the tumour and the adjacent walls of nasopharynx folloing irradiation.

BRUITS AND TUMORS

<i>To the Editor:</i>I read, with a great deal of interest, Dr. Sardana's article "Nasopharyngeal Fibroma" in a recent edition of theArchives of Otolaryngology<b>81</b>:584 [June] 1965). I had the occasion to participate in the treatment of a similar case. This patient, an 18-year-old white male private patient of Dr. Walter P. Work, presented at the University of Michigan Hospital with nasal obstruction and bleeding from the right nostril. On physical examination, a recurrent angiofibroma was found presenting as a tumor mass in the right side of the nose and nasopharynx with a moderate size (3×3×2 cm) swelling beneath the zygoma in the right cheek. In routine examination, a stethescope was placed over the mass in the cheek, and a loud bruit was heard. The bruit was accentuated by exercise, but on prolonged bed rest, it became less audible. Carotid arteriograms showed the tumor to be extremely vascular

Nasopharyngeal Fibroma: Extension Into Cheek

Incidence NASOPHARYNGEAL | ASOPHARYNGEAL fibroma is not a very common disease; its extension into the cheek rarer still. Mishra and Sardana reported on seven patients with nasopharyngeal fibroma admitted to K. G. Medical College, Lucknow, between October 1952 and September 1955. None of these patients had an extension into the cheek. Between 1955 and 1956 I came across a very large nasopharyngeal fibroma without extension into the cheek. During my three years' stay at the Institute of Otology and Laryngology, London, I did not see a single case of nasopharyngeal fibroma with extension into the cheek. Since 1962 to date, six cases of nasopharyngeal fibroma have been seen, of which four showed extension into the cheek. It is just a chance that we have been able to see four consecutive cases of this complication in such a short time. Age and Sex All the patients were adolescent males. Signs and Symptoms