Management of Juvenile Nasopharyngeal Angiofibroma: A Five Year Retrospective Study

Moorthy, Prayaga N. Srinivas; Reddy, Bhaskar; Qaiyum, Hamid Abdul; Madhira, Srivalli; Kolloju, Srikanth

doi:10.1007/s12070-010-0097-2

Cited by 12 publications

(8 citation statements)

References 14 publications

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“…This is because all stages of JNA express various types of SSTRs (SSTR 1, 2, 3, 5) in its stromal cells strongly compared to the proliferating new vessels 6 . A decreasing non‐significant trend for DOTANOC uptake was noticed with increasing age indicating that the age per se has some influence on tumor biology (Spearman correlation coefficient r = −0.19, P = .44) and its receptor expression similar to previous literature 9,21 …”

Section: Discussionsupporting

confidence: 83%

⁶⁸Ga DOTANOC PET/CT Scan in Primary Juvenile Nasopharyngeal Angiofibroma ‐ A Pilot Study

et al. 2020

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Objectives/Hypothesis Somatostatin receptors (SSTRs) are highly expressed in neuroendocrine tumors and is exploited for its imaging and treatment. SSTRs expression is also demonstrated in diverse benign and malignant tumor cell types and proliferating peri‐tumoral vessels. Similarly, Juvenile Nasopharyngeal Angiofibroma (JNA) expresses different SSTRs and may be utilized for its imaging and treatment using DOTA, 1‐Nal3‐octreotide (DOTANOC)‐PET/CT scan. Study Design Prospective cohort. Methods Nineteen clinico‐radiologically diagnosed primary JNA patients underwent a 68Ga‐DOTANOC PET‐CT scan. Using a dedicated PET/CT scanner, a low‐dose head and neck spot CT scan was performed after 45 to 60 minutes of intravenous injection of 2 to 3 mCi(74–111 MBq) of DOTANOC. The primary objective was to assess the intensity and pattern of DOTANOC uptake in these patients. Results DOTANOC expression was noted in all cases (n = 19) of primary JNA (100%). The mean (SD) DOTANOC SUVmax ratio of tumor and background was 6.9+/−1.4(range, 3.8–9.5). Intra‐cranial extension in all 13/19 patients was prominently visualized due to the absence of DOTANOC uptake in the brain. Compared to the background all stages of JNA showed significant DOTANOC uptake (P < .0001). No difference in uptake between advanced‐stage tumors and early tumors was noted (P = .47). A statistically non‐significant negative trend was noted for decreasing uptake with increasing age (Spearman correlation coefficient, r = −0.19). Conclusions This first study of 68Ga‐DOTANOC‐PET/CT scan in JNA demonstrates consistent and reliable uptake activity in all patients irrespective of age and stage. This opens up possibilities to physiological diagnostic imaging with a promise of greater specificity and sensitivity and may have applications in ambivalent diagnostic situations such as the detection of recurrence. Level of Evidence 3 Laryngoscope, 131:1509–1515, 2021

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Section: Discussionsupporting

confidence: 83%

⁶⁸Ga DOTANOC PET/CT Scan in Primary Juvenile Nasopharyngeal Angiofibroma ‐ A Pilot Study

et al. 2020

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“…JNA was the commonest benign nasopharyngeal tumour of the nasopharynx [5]. Planning of surgical approach depends on size and extent of the tumour as assessed by radiological investigations [8]. Surgical outcome of patients treated by external and endoscopic approaches is same with no complications or recurrences in a mean follow up period of 6.5 months.…”

Section: Resultsmentioning

confidence: 99%

Benign Tumours of Nasopharynx—Revisited

Mohanty

Gopinath

Subramanian

2011

Indian J Otolaryngol Head Neck Surg

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Benign tumours of nasopharynx are extremely rare; seen predominantly in children and young adults. Patients usually present with seemingly innocuous symptoms and an error in judgement can be catastrophic. This is a retrospective analysis of patients diagnosed to have benign tumours of nasopharynx by histopathological examination in our tertiary care referral centre. The period of study is from September 2009 to August 2010. Eight patients with complete clinical data were identified and included in the study. All the patients were males with a mean age of 21.37 years (range 10-43). Following surgical excision patients were followed up for a mean period of 6.5 months (range 3-14). The Clinical profile, investigation modalities, treatment options are being analysed here.

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“… 9 In a study of eight patients that underwent pre-operative embolization of the ipsilateral maxillary artery utilizing absorbable gelfoam, six experienced considerably less bleeding during surgical resection. 2 A recent systematic analysis of 131 cases within 57 studies over 21 years showed that the average blood loss in patients that underwent pre-operative embolization during purely endoscopic surgical resection averaged 406.7 mL compared to 828.3 mL in non-embolized patient undergoing purely endoscopic resection. 1 Furthermore, in open surgical cases there was less blood loss after preoperative embolization with an average of 685.0 mL compared to an average of 1912.1 mL lost in patients that did not undergo embolization.…”

Section: Discussionmentioning

confidence: 99%

“…Histopathologically, the tumor is comprised of haphazardly arranged vascular channels surrounded by dense paucicellular fibroblastic stroma, with the myofibroblast being the principal cell. 2,3 The bleeding propensity of these tumors is due to the findings that the smaller vessels in the center of the lesion tend to lack muscular elastic lamina, predisposing these vessels without a muscular surrounding layer that may otherwise assist in vasoconstriction to uncontrolled bleeding. 2 The blood supply to these lesions is derived from the internal maxillary artery, 8,9 a branch off the external carotid artery.…”

Section: Introductionmentioning

confidence: 99%

Microspheres embolization of juvenile nasopharyngeal angiofibroma in an adult

Parikh

Hennemeyer

2014

International Journal of Surgery Case Reports

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INTRODUCTIONJuvenile nasopharyngeal angiofibroma (JNA) is a benign though locally aggressive, highly vascular tumor primarily affecting adolescent males which has traditionally posed a significant intraoperative challenge during its resection due to the high risk of uncontrollable hemorrhage. Pre-operative angiographic embolization of the major feeding vessels to the tumor has become a valuable, even necessary, tool in the surgical treatment of these lesions.PRESENTATION OF CASEOur patient was a 32-year-old man with a chief complaint of recurrent left-sided epistaxis for one year, brisk and continuous for ten days prior to presentation, subsequently found to have a 4 cm vascular skull base tumor causing mild expansion of the pterygopalatine fossa. The patient underwent pre-operative embolization utilizing 300–500 micrometer microspheres injected into the ipsilateral maxillary artery. The following day, the patient underwent definite Stereotactical surgical resection of his JNA tumor. Estimated blood loss during the operation was 50 mL, and the patient was discharged the same day.DISCUSSIONJuvenile nasopharyngeal angiofibromas pose a significant bleeding risk for the surgeon due to their highly vascular nature. Pre-operative embolization of juvenile nasopharyngeal angiofibromas can reduce intraoperative blood loss while lessening the risk of massive hemorrhage, shortening operation times, increasing intra-operative visibility, and allowing for easier resection of lesions.CONCLUSIONPre-operative embolization of JNA is a safe, effective method to prevent against the risk of massive, sometimes fatal, hemorrhage that occurs with these highly vascular tumors.

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Management of Juvenile Nasopharyngeal Angiofibroma: A Five Year Retrospective Study

Cited by 12 publications

References 14 publications

⁶⁸Ga DOTANOC PET/CT Scan in Primary Juvenile Nasopharyngeal Angiofibroma ‐ A Pilot Study

⁶⁸Ga DOTANOC PET/CT Scan in Primary Juvenile Nasopharyngeal Angiofibroma ‐ A Pilot Study

Benign Tumours of Nasopharynx—Revisited

Microspheres embolization of juvenile nasopharyngeal angiofibroma in an adult

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Management of Juvenile Nasopharyngeal Angiofibroma: A Five Year Retrospective Study

Cited by 12 publications

References 14 publications

68Ga DOTANOC PET/CT Scan in Primary Juvenile Nasopharyngeal Angiofibroma ‐ A Pilot Study

68Ga DOTANOC PET/CT Scan in Primary Juvenile Nasopharyngeal Angiofibroma ‐ A Pilot Study

Benign Tumours of Nasopharynx—Revisited

Microspheres embolization of juvenile nasopharyngeal angiofibroma in an adult

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⁶⁸Ga DOTANOC PET/CT Scan in Primary Juvenile Nasopharyngeal Angiofibroma ‐ A Pilot Study

⁶⁸Ga DOTANOC PET/CT Scan in Primary Juvenile Nasopharyngeal Angiofibroma ‐ A Pilot Study