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Angiofibroma:
Juvenile Nasopharyngeal Angiofibroma
(JNA)
highly vascular benign yet
unencapsulated tumor of adolescent
males.
Pathophysiology:
The tumor starts adjacent to the
sphenopalatine foramen. Large tumors
frequently are bilobed or dumbbell-shaped,
with one portion of the tumor filling the
nasopharynx and the other portion
extending to the pterygopalatine fossa.
Clinical: Symptoms:
Nasal obstruction (80-90%):
Epistaxis (45-60%):
Headache (25%):
Facial swelling (10-18%)
Other symptoms include unilateral
rhinorrhea, anosmia, hyposmia, rhinolalia,
deafness, otalgia, swelling of the palate, and
deformity of the cheek.
Signs:
Proptosis (10-15%)
Differentials:
CT scan
Medical therapy:
Surgical therapy
Hormonal therapy
Radiotherapy
Biopsy is prohibited because of severe bleeding
Nasopharyngeal malignancies
Nasopharyngeal carcinoma (NPC)
Lymphoma
Salivary gland tumors
Sarcomas
Nasopharyngeal
Carcinoma
More common in Asia
Anatomy
Anatomy
Epidemiology
Chinese native (
> Chinese immigrant > North American
nativeBoth genetic and environmental
factors
Genetic
HLA histocompatibility loci possible markers
Epidemiology
Environmental
Viruses
EBV- well documented viral fingerprints in tumor
cells and also anti-EBV serologies with WHO
type II and III NPC
HPV - possible factor in WHO type I lesions
Clinical Presentation
Clinical Presentation
Clinical Presentation
Nasopharyngeal examination
Fossa of Rosenmuller most common location
Regional spread
Usually ipsilateral first but bilateral not
uncommon
Radiological evaluation
MRI
soft tissue involvement, recurrences
TNM classification
Class 0: Tis N0 M0
Class I: T1 N0 M0
Class II A: T2a N0 M0
Class II B: T1 N1 M0 ; T2a N1 M0 ;
T2b N0, N1 M0
Class III: T1 N2 M0 ; T2a, T2b N1 M0 ;
T3 N0, N1, N2 M0
Treatment
Adjuvant brachytherapy
mainly for residual/recurrent disease
Treatment
Surgical management
Surgical treatment
primary lesion
regional failure with local control
Treatment
Surgical management
Primary lesion
consider for residual or recurrent disease
approaches
infratemporal fossa
transparotid temporal bone approach
transmaxillary
transmandibular
transpalatal
Treatment
Surgical management
Regional disease
Neck dissection may offer improved survival
compared to repeat radiation of the neck
Treatment
Chemotherapy
Immunotherapy
Teratoma
Hemangioma
Lymphangioma
Cystic hygroma
Treatment:
Laser therapy
Surgery
Malignant Neoplasms
Treatment