angiofibrome nasopharyngé juvenile
07/07/18 13:28
Pathophysiology
Juvenile nasopharyngeal angiofibroma is a benign, locally invasive, highly vascular, unencapsulated, fibrous tissue proliferation. It originates from tissue at the sphenopalatine foramen and enters the nasal cavity, causing destructive changes due to mass effect. Epidemiology
It is rare, comprising less than 1% of head and neck neoplasms. It is nearly exclusive to men and very rare in women. Typical age range is 15 to 25 years old. Clinical presentation
Epistaxis (most common) Sequelae of nasal or sinus obstruction, including recurrent episodes of sinusitis Gradual-onset anosmia Imaging
CT: Appears as a soft-tissue density mass contiguous with the sphenopalatine foramen and extending into the nasal cavity with resultant destructive changes from local mass effect, including bony remodeling and erosion. MRI: Is hypointense to isointense (to muscle) on T1-weighted imaging, hyperintense on T2-weighted imaging, and avidly enhancing. Angiography: Appears as a highly vascular lesion with a proliferation of vessels and ipsilateral enlarged feeding vessels. The most common vascular supply is the internal maxillary artery. Palatine arteries and the ascending pharyngeal arteries are commonly demonstrated as recruited vessels. Care must be taken to evaluate for shunts to prevent nontarget embolization. Differential diagnoses
Esthesioneuroblastoma Antrochoanal polyp Nasopharyngeal carcinoma Hypervascular polyp Treatment
Treatment is preoperative embolization followed by surgery with wide resection. Recurrence is common with large or infiltrative lesions due to residual postoperative tissue. Radiation therapy may be used preoperatively or for recurrent lesions