Nasopharyngeal angiofibroma (also called juvenile nasopharyngeal angiofibroma) is a histologically benign

Benign

A benign tumor is a tumor that lacks the ability to metastasize. Common examples of benign tumors include moles and uterine fibroids.The term "benign" implies a mild and nonprogressive disease. Indeed, many kinds of benign tumors are harmless to human health...

 but locally aggressive vascular tumor that grows in the back of the nasal cavity. It most commonly affects adolescent males. Patients with nasopharyngeal angiofibroma usually present with one-sided nasal obstruction and recurrent bleeding.

Symptomology

- Frequent chronic epistaxis (Nose-Bleeds) or blood-tinged nasal discharge

- Nasal obstruction and rhinorrhea

Rhinorrhea

Rhinorrhea or rhinorrhoea is a condition where the nasal cavity is filled with a significant amount of mucous fluid. The condition, commonly known as "runny nose", occurs relatively frequently and is not usually considered dangerous. Rhinorrhea is a common symptom of allergies or certain diseases,...

- Conductive hearing loss from eustachian-tube obstruction

- Diplopia

Diplopia

Diplopia, commonly known as double vision, is the simultaneous perception of two images of a single object that may be displaced horizontally, vertically, or diagonally in relation to each other...

, which occurs secondary to erosion into the cranial cavity and pressure on the optic chiasma

- Rarely anosmia

Anosmia

Anosmia is a lack of functioning olfaction, or in other words, an inability to perceive odors. Anosmia may be either temporary or permanent. A related term, hyposmia, refers to a decreased ability to smell, while hyperosmia refers to an increased ability to smell. Some people may be anosmic for one...

, recurrent otitis media

Otitis media

Otitis media is inflammation of the middle ear, or a middle ear infection.It occurs in the area between the tympanic membrane and the inner ear, including a duct known as the eustachian tube. It is one of the two categories of ear inflammation that can underlie what is commonly called an earache,...

, and eye pain

Diagnosis

If nasopharyngeal angiofibroma is suspected based on physical exam (a smooth submucosal mass in the posterior nasal cavity), imaging studies such as CT

Computed tomography

X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...

 or MRI

Magnetic resonance imaging

Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...

 should be performed. Biopsy can lead to extensive bleeding since the tumor is composed of blood vessels without a muscular coat.

Differential diagnosis

• Antro-choanal polyp (benign neoplasm)
• Rhinosporidiosis
  Rhinosporidiosis
  -Classification:This organism was previously considered to be a fungus, and rhinosporidiosis is classified as a fungal disease under ICD-10.It is now considered to be a parasite, classified under Mesomycetozoea....
  
   (as bleeding point is here too)
• Malignancy - nasopharyngeal carcinoma
  Nasopharyngeal carcinoma
  Nasopharyngeal carcinoma is the most common cancer originating in the nasopharynx, the uppermost region of the pharynx , behind the nose where the nasal passages and auditory tubes join the remainder of the upper respiratory tract. NPC differs significantly from other cancers of the head and neck...
  
  , lymphoma
  Lymphoma
  Lymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...
  
  , plasmacytoma
  Plasmacytoma
  Plasmacytoma refers to a malignant plasma cell tumor growing within soft tissue or within the skeleton. The skeletal forms usually have other occult tumors and frequently disseminate to multiple myeloma over the course of 5–10 years. The soft tissue forms most often occur in the upper respiratory...
  
  , rhabdomyosarcoma
  Rhabdomyosarcoma
  A rhabdomyosarcoma is a type of cancer, specifically a sarcoma , in which the cancer cells are thought to arise from skeletal muscle progenitors. It can also be found attached to muscle tissue, wrapped around intestines, or in any anatomic location...
  
  
• Chordoma
  Chordoma
  Chordoma is a rare slow-growing malignant neoplasm thought to arise from cellular remnants of the notochord. The evidence for this is the location of the tumors , the similar immunohistochemical staining patterns, and the demonstration that notochordal cells are preferentially left behind in the...
  
  
• Nasopharyngeal cyst
• Pyogenic granuloma
  Pyogenic granuloma
  Pyogenic granuloma is a primarily oral disease which appears as an overgrowth of tissue due to irritation, physical trauma or hormonal factors...
  
  

Treatment

Medical treatment is usually given before surgery to reduce the blood loss - includes the usage of Diethylstilbestrol

Diethylstilbestrol

Diethylstilbestrol is a synthetic nonsteroidal estrogen that was first synthesized in 1938. Human exposure to DES occurred through diverse sources, such as dietary ingestion from supplemented cattle feed and medical treatment for certain conditions, including breast and prostate cancers...

 2-3 wks before surgery to make the surgery less vascular.

Nasopharyngeal angiofibroma is sometimes treated by surgery. Pre-surgery angiography may allow for embolization

Embolization

Embolization is a non-surgical, minimally-invasive procedure performed by an interventional radiologist and interventional neuroradiologists. It involves the selective occlusion of blood vessels by purposely introducing emboli.-Therapeutic applications:...

, reducing intraoperative blood loss. Hypotensive Anaesthesia is the usual modality followed to reduce blood loss. Patients with tumors that have extended into the cranial cavity or whose tumors can't be safely reached by surgery may receive radiation therapy

Radiation therapy

Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...

. Also Radiation therapy helps in case where recurrence is the main problem. Endoscopy

Endoscopy

Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...

has recently been used in patients with tumors of limited extension that have been pre-operatively embolized.