Journal of Otology & RhinologyISSN: 2324-8785

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Case Report, J Otol Rhinol Vol: 4 Issue: 3

Extranasopharyngeal Angiofibroma of Inferior Turbinate in a Young Female: A Very Rare Presentation

Santosh Debbarma*, Arki Daroi Langstang and Sathish J Kumar
Department of ENT, Regional Institute of Medical Sciences, Lamphelpat, Imphal,India
Corresponding author : Santosh Debbarma
Regional Institute of Medical Sciences, Dept of ENT, Lamphelpat, Imphal 795004, India
Tel: 91-9612173884
E-mail: [email protected]
Received: October 22, 2014 Accepted: April 11, 2015 Published: April 16, 2015
Citation: Debbarma S, Langstang AD, Kumar SJ (2015) Extranasopharyngeal Angiofibroma of Inferior Turbinate in a Young Female: A Very Rare Presentation. J Otol Rhinol 4:3. doi:10.4172/2324-8785.1000226

Abstract

Extranasopharyngeal Angiofibroma of Inferior Turbinate in a Young Female: A Very Rare Presentation

Juvenile Nasopharyngeal Angiofibroma is an uncommon tumour arising from the tissues within the Sphenopalatine foramen and is an exclusively adolescent male tumour. Angiofibroma not arising from vicinity of Sphenopalatine foramen are called extra-nasopharyngeal angiofibroma. The most common extra-nasopharyngeal angiofibroma is reported from the maxillary sinus. Here we report a case of extranasopharyngeal angiofibroma arising from the anterior end of left inferior turbinate in a 12 year old female child. This case is being reported for its rarity to occur outside nasopharynx and in a female child.

Keywords: Extranasopharyngeal angiofibroma; Sphenopalatine; Pterygopalatine; Inferior turbinate; Embolization; Treatment

Keywords

Extranasopharyngeal angiofibroma; Sphenopalatine; Pterygopalatine; Inferior turbinate; Embolization; Treatment

Introduction

Juvenile Angiofibroma is a rare, highly vascular benign tumour [1] arising from the tissues within the Sphenopalatine foramen [2]. Some authors believe that it arises from pterygopalatine foramen at the level of Vidian canal aperture [3]. It constitutes less than 0.5% of head and neck tumours [4]. It occurs exclusively in adolescent male [5]. The most common extra-nasopharyngeal site is the maxillary sinus [6]. There are reports of this tumour being found in children, the elderly, young and even pregnant women [7]. Herein we are reporting a rare case of angiofibroma arising from the inferior turbinate that too in a young female patient. This case is being reported for its rarity to arise from nasal cavity and also in a female patient of an otherwise exclusive male tumour.

Case report

A 12 year old female patient of North Eastern India reported to the OPD of Regional Institute of Medical Sciences, Imphal with a history of recurrent epistaxis from left nostril for past 6 months for which she has been taking treatment locally. She also complaint of progressively increasing nasal blockade on the same side for the past 3 months for which she reported to our OPD. On clinical examination there was a mass in the left nasal cavity. It did not shrink in size with the use of adrenaline nasal pack and on endoscopy it was found to be arising from the inferior turbinate. On computed tomography, a mass in the left anterior nasal cavity from the inferior turbinate was seen (Figure 1).
Figure 1: Showing mass in the anterior part of nasal cavity arising from the left inferior turbinate.
Since the patient was a female, diagnosis of angiofibroma was not thought of as a differential diagnosis. Under LA the tumour was resected and base cauterized under endoscopic guidance, and the tumour was sent for histopathological examination. The mass measured (1×1.5) cms (Figure 2).
Figure 2: Showing the excised mass.
Histopathologically it was found to be a case of nasal angiofibroma arising from inferior turbinate (Figure 3).
Figure 3: H & E Stain (A) 10X Low power; (B) 40X High power.
The patient was followed for 1 year with repeat CT and nasal endoscopic examination which showed no evidence of any recurrence.

Discussion

Extra-nasopharyngeal angiofibromas are rare but cases are being reported from various parts of the world. Angiofibroma not arising from vicinity of Sphenopalatine foramen are called Extranasopharyngeal angiofibroma [8]. The most common extranasopharyngeal angiofibroma is reported from the maxillary sinus [9]. Extra-nasopharyngeal angiofibroma is reported more in females when compared to the nasopharyngeal angiofibroma [10]. But some studies suggests the mean age being 22 and male to female ratio is 3:1 [11]. Classical angiofibroma occurs in adolescent male of age between 14 and 25 years.
There are various theories for the development of nasopharyngeal angiofibroma but none of them are proved. Nasopharyngeal angiofibroma is said to bean androgen dependent tumour because it is more commonly seen in adolescent male but the reason for more incidences of extra-nasopharyngeal angiofibroma in female patient is not known. Common presentation of nasopharyngeal angiofibroma is unprovoked painless epistaxis of substantial amount sometimes requiring blood transfusion1and it stands same for extranasopharyngeal angiofibroma as in our case which presented with recurrent epistaxis and unilateral nasal obstruction. Clinically it was presenting as a globular mass arising from the left inferior turbinate which does not shrink on adrenaline soaked nasal packs.
CT gives valuable information regarding the tumour extent and is a major predictor for the recurrence of this tumour. With the advent of Endoscope and endoscopic instruments the surgery of nose and paranasal sinuses [12] has been made easy and by far the management of this tumour has changed. Pre-operative embolization with use of endoscopes and laser has been reported to achieve better results [13]. Pre-operative embolization was not done in our case. The tumour was removed with surrounding normal tissue and the base was cauterized with the help of a bipolar cautery and there was no bleeding postoperatively. Laser is being recommended by some authors [14] but was not used in our case during surgery.
Generally the prognosis for nasopharyngeal angiofibroma is good, although recurrences rates of 10-61% have been reported. Most recurrences are symptomatic within the first year after treatment; beyond 2 years, recurrence is uncommon. Vascularity, age at onset, duration of symptoms and the site and extension of nasopharyngeal angiofibroma may influence recurrence. However, recurrence was not reported for patients with an extra-nasopharyngeal angiofibroma [15]. Considering the fact that nasopharyngeal angiofibroma is recurring in substantial number of patients this tumour has to be followed for long duration after surgery. In our case we have followed the case with repeated nasal endoscopic examination for more than one year and no recurrence was noted.

Conclusion

Even though extra-nasopharyngeal angiofibroma is rare it should be thought as a differential diagnosis in a bleeding mass of nose and paranasal sinuses even in females. Surgical excision is the treatment of choice for angiofibroma of nose and paranasal sinuses.

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