Juvenile Nasopharyngeal Angiofibroma : Imaging Characteristics and Pre-Operative Embolization

Abstract

230JNA is a rare vascular tumor that accounts for 0.05% to 0.5% of all head and neck neoplasms; however, it is the most common tumor of the nasopharynx in young males 1 . The etiology of JNA remains unknown; however, the association with androgen receptors, chromosomal alterations and growth factors has been described 2-4 .The term angiofibroma was first used by Friedberg in 1940. The name indicates fibrous and vascular components, which of these is the origin, is a matter of debate 5 . CT and MRI imaging could achieve the diagnosis.The aim of this presentation is to report a case of Juvenile Nasopharyngeal Angiofibroma, which was managed by superselective embolization prior to endoscopic surgical resection. THE CASEA sixteen-year-old male presented with a one-month complaint of unilateral nasal blockage and frequent epistaxis. No other physical or laboratory abnormality detected. Plain paranasalsinuses and CT revealed left-sided posterior nasal polypoidal mucosal thickening occluding the left choanae and extending posteriorly through nasopharyngeal cavity and widening of left sphenopalatine foramen with bowing of posterior maxillary wall "Holman-Miller sign". Appreciable infiltration of the medial wall of the base of pterygoid plates was found, see figure 1.Enhanced MRI revealed a posterior nasopharyngeal mass measuring 3.2 cm x 2.2 cm, appearing iso intense on T1 weighed images and of heterogeneous intensity at T2WI with subtle hyperintense foci, and thin flow voids visible on T2 weighed images, see figure 1.Juvenile nasopharyngeal angiofibroma (JNA) is a benign highly vascular tumor. It almost exclusively affects male adolescents and young adults. Nasal blockage and recurrent epistaxis are the classic symptoms. Cross-sectional imaging is vital for accurate diagnosis and operative planning. Pre-operative embolization is frequently performed to decrease blood loss and has especially facilitated endoscopic resection.A sixteen-year-old male presented with one-month complaint of unilateral nasal blockage and frequent epistaxis. Angiofibroma was diagnosed by CT and MRI. Angiography followed by embolization was performed 24 hours prior to endoscopic surgical resection. The reported blood loss was less than 50 ml. No complications were encountered.

MRI features of sinonasal tract angiofibroma/juvenile nasopharyngeal angiofibroma: Case series and systematic review

“…Finally, 33 articles with 41 cases describing 44 lesions met the selection criteria for the systematic review (Figure 1). 10,26–57 With 13 additional cases from our institution (Table 1), the final study cohort comprised 54 cases with 57 lesions associated with STAs.…”

Juvenile nasopharyngeal angiofibroma tumor – Diagnosis and management in our tertiary hospital

“…Hippocrates described juvenile nasopharyngeal angiofibroma (JNA) tumor as a benign lesion with vigorous transformation. [1] It has 0.05-05% incidence of head and neck neoplasms. [1] Young adolescent males between 14 and 25 years are affected.…”

“…[1] It has 0.05-05% incidence of head and neck neoplasms. [1] Young adolescent males between 14 and 25 years are affected. [2] JNA orignates from the superior margin of the sphenopalatine foramen and will eventually invade into the bone, extend into the infratemporal fossa , orbit and middle cranial fossa.…”