Angiofibroma is a benign nasal cavity tumor that almost exclusively affects adolescent boys. It also may be referred to as juvenile nasopharyngeal angiofibroma (JNA).
The age range for this disease is 7 to 19 years old, with most patients being diagnosed between 10 and 19 years old. Juvenile nasopharyngeal angiofibroma is the most common benign tumor of the nasopharynx, but has a relatively low incidence and accounts for only 0.5 percent of all head and neck tumors. Though benign, it often acts in a malignant manner by eroding into the surrounding sinuses, orbit, or cranial vault.
The preferred surgical treatment at UPMC for angiofibroma is the Endoscopic Endonasal Approach (EEA) to remove the tumor. This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors to access hard-to-reach or previously inoperable tumors. EEA offers the benefits of no incisions to heal, no disfigurement to the patient, and a faster recovery time. If complementary treatments such as radiation therapy and chemotherapy are needed, those therapies can begin soon after surgery.
The doctor will perform a physical exam and ask about any symptoms. The most common symptoms are nasal obstruction, epistaxis (nose bleeding) and rhinorrhea (runny nose).
Patients also may develop facial deformities or abnormalities, including:
- cheek swelling
- drooping eyelids
- bulging eyes
- cranial nerve palsies
Hearing loss may result from obstruction of the Eustachian tube. Double vision or blindness may result from pressure on the optic nerves and chiasm if there is erosion into the cranial cavity. Rarely, patients with a JNA may suffer anosmia — the loss of the sense of smell.
On physical exam, a pale, smooth mass may be visible inside the nasopharynx. Because the tumor is composed of blood vessels without a muscular coat, a biopsy could lead to extensive bleeding and generally is not performed.
An MRI or CT scan of the head and facial bones confirms the clinical diagnosis and shows the extension of the tumor.
Treatment options include:
Juvenile angiofibromas are treated most often by surgery. These tumors can be reached directly by using the Endoscopic Endonasal Approach (EEA). This state-of-the-art, minimally invasive surgical procedure uses the nose as a natural corridor to reach these lesions, without any incisions in the face or head.
An angiogram, which is an imaging test that uses x-rays to view blood vessels that have been injected with a contrasting dye, may be performed prior to surgery to allow for embolization of the tumor. Embolization involves cutting off the blood supply of the tumor and significantly reduces blood loss during surgery.
Radiation therapy may be used for patients with tumors that have extended into the cranial cavity, whose tumors can't be reached safely by surgery, or who have tumor recurrences.
Hormonal flutamide, which blocks testosterone receptors, has been shown to reduce tumor size effectively. The use of this medication is restricted to those enrolled in clinical trials.