Extranasopharyngeal Angiofibroma of Uncinate Process in a Female: A Rare Presentation
Rajesh Pandey, Pramod K Yadav
Keywords :
Angiofibroma, Extranasopharyngeal angiofibroma, Uncinate process
Citation Information :
Pandey R, Yadav PK. Extranasopharyngeal Angiofibroma of Uncinate Process in a Female: A Rare Presentation. Clin Rhinol An Int J 2017; 10 (3):150-153.
Aim: To present a rare case of extranasopharyngeal angiofibroma (ENA) in a female originating from uncinate process in nasal cavity.
Background: Nasopharyngeal angiofibroma is a rare vascular tumor affecting adolescent male. It is the most common benign tumor of nasopharynx. Angiofibroma located outside the nasopharyngeal area are extremely rare and, consequently, may be misdiagnosed. Unlike nasopharyngeal angiofibroma, symptoms of ENAs are nonspecific and depend on localization and extent of tumor. The occurrence of any nasopharyngeal angiofibroma in females is very rare. Also, ENA has been reported at various subsites in nasal cavity, but origin from uncinate process is not reported in world literature till date. So we are reporting this unique case.
Case description: A 40-year-old female presented with intermittent profuse bleeding diagnosed as ENA originating from uncinate process. Tumor is removed completely through lateral rhinotomy approach.
Conclusion: Extranasopharyngeal angiofibroma is a rare tumor but it should be kept in differential diagnosis of vascular tumor of nose and paranasal area. Surgical excision is the treatment of choice for angiofibroma of nose and paranasal sinuses.
Clinical significance: Extranasopharyngeal angiofibromas can originate from various subsites of nasal cavity including uncinate process. Patients affected are older, symptoms develop more quickly, and hypervascularity is less common.
Panesar J, Vadgama B, Rogers G, Ramsay AD, Hartley BJ. Juvenile angiofibroma of the maxillary sinus. Rhinology. 2004 Sep;42(3):171-174.
Zito J, Fitzpatrick P, Amedee R. Juvenile nasopharyngeal angiofibroma. J La State Med Soc 2001 Aug;153(8):395-398.
Gleeson, M. Juvenile angiofibroma. Scott-Brown's otorhinolaryngology, head and neck surgery. Vol. 2. 7th ed. Boca Raton (FL): CRC Press; 2008. p. 2437-2444.
Taggarshe D, Quraishi MS, Dugar JM. Inferior turbinate angiofibroma: an atypical presentation. Rhinology 2004 Mar;42(1):45-47.
Ungkanont K, Byers RM, Weber RS, Callender DL, Wolf PF, Goepfert H. Juvenile nasopharyngeal angiofibroma: an update of therapeutic management. Head Neck 1996 Jan- Feb;18(1):60-66.
Periæ A, Sotiroviæ J, Ceroviæ S, Ziviæ L. Immunohistochemistry in diagnosis of extranasopharyngeal angiofibroma originating from nasal cavity: case presentation and review of literature. Acta Medica (Hardec Kralove) 2013;56(4):133-141.
Windfuhr JP, Remmert S. Extranasopharyngeal angiofibroma: etiology, incidence and management. Acta Otolaryngol 2004 Oct;124(8):880-889.
Tasca I, Compadretti GC. Extranasopharyngeal angiofibroma of nasal septum. A controversial entity. Acta Otorhinolaryngol Ital 2008 Dec;28(6):312-314.
Pilch, BZ. Soft tissue pathology of head and neck. In: Keel SB, Rosenberg AE, editors. Head and neck surgical pathology. Chapter 10. Philadelphia (PA): Lippincott Williams & Wilkins; 2001. p. 389-430.
Szymañska A, Szymañski M, Morshed K, Czekajska-Chehab E, Szczerbo-Trojanowska M. Extranasopharyngeal angiofibroma: clinical and radiological presentation. Eur Arch Otorhinolaryngol 2013 Feb;270(2):655-660
Harrison DF. The natural history, pathogenesis, and treatment of juvenile angiofibroma. Personal experience with 44 patients. Arch Otolaryngol Head Neck Surg 1987 Sep;113(9): 936-942.
Akbas Y, Anadolu Y. Extranasopharyngeal angiofibroma of the head and neck in women. Am J Otolaryngol 2003 Nov- Dec;24(6):413-416.
Hyun DW, Ryu JH, Kim YS, Kim KB, Kim WS, Kim CH, Yoon JH. Treatment outcomes of juvenile nasopharyngeal angiofibroma according to surgical approach. Int J Pediatr Otorhinolaryngol 2011 Jan;75(1):69-73.
Hsieh ST, Guo YC, Tsai TL, Chen WY, Huang JL. Angiofibroma of the hypopharynx. J Chin Med Assoc 2004 Jul;67(7): 373-375.
Madana J, Yolmo D, Gopalkrishnan S, Saxena S. Extranasopharyngeal angiofibroma of the cartilaginous nasal septum: possible origin from ectopic tissue trapped during septal development. Internet J Otorhinolaryngol 2012;14(1):1-5.
Dobratz EJ, Tran V, Hilger PA. Comparison of techniques used to support the nasal tip and their long-term effects on tip position. Arch Facial Plast Surg 2010 May-Jun;12(3):172-179.
Friedman O, Koch CA, Smith WR. Functional support of the nasal tip. Facial Plast Surg 2012 Apr;28(2):225-230.
Mohebbi A, Jahandideh H, Faham Z, Jafari M. Defining the best nasal tip projection among Iranian women. Plast Surg Int 2016;2016:8549276.
Bhattacharyya N. Bacterial infection in chronic rhinosinusitis: a controlled paired analysis. Am J Rhinol 2005 Nov- Dec;19(6):544-548.
Boase S, Foreman A, Cleland E, Tan L, Melton-Kroft R, Pant H, Hu FZ, Ehrlich GD, Wormald PJ. The microbiome of chronic rhinosinusitis: culture, molecular diagnostics and biofilm detection. BMC Infect Dis 2013 May;13:210.
Mantovani K, Bisanha AA, Demarco RC, Tamashiro E, Martinez R, Anselmo-Lima WT. Maxillary sinuses microbiology from patients with chronic rhinosinusitis. Braz J Otorhinolaryngol 2010 Sep-Oct;76(5):548-551.
Brook I, Gober AE. Recovery of potential pathogens in the nasopharynx of healthy and otitis media-prone children and their smoking and nonsmoking parents. Ann Otol Rhinol Laryngol 2008 Oct;117(10):727-730.
Wu J, Peters BA, Dominianni C, Zhang Y, Pei Z, Yang L, Ma Y, Purdue MP, Jacobs EJ, Gapstur SM, et al. Cigarette smoking and the oral microbiome in a large study of American adults. ISME J 2016 Mar;10(10):2435-2446.
Ertel A, Eng R, Smith SM. The differential effect of cigarette smoke on the growth of bacteria found in humans. Chest 1991 Sep;100(3):628-630.
Reh DD, Higgins TS, Smith TL. Impact of tobacco smoke on chronic rhinosinusitis: a review of the literature. Int Forum Allergy Rhinol 2012 Sep-Oct;2(5):362-369.
Lee KI, Kim DW, Kim EH, Kim JH, Samivel R, Kwon JE, Ahn JC, Chung YJ, Mo JH. Cigarette smoke promotes eosinophilic inflammation, airway remodeling, and nasal polyps in a murine polyp model. Am J Rhinol Allergy 2014 May-Jun;28(3):208-214.
Kumar PS, Matthews CR, Joshi V, de Jager M, Aspiras M. Tobacco smoking affects bacterial acquisition and colonization in oral biofilms. Infect Immun 2011 Nov;79(11): 4730-4738.
Namiot Z, Namiot DB, Kemona A, Gołebiewska M, Bucki R. The effect of cigarette smoking and alcohol consumption on efficacy of Helicobacter pylori eradication. Pol Arch Med Wewn 2000 Sep;104(3):569-574.
Linder JA, Sim I. Antibiotic treatment of acute bronchitis in smokers: a systematic review. J Gen Intern Med 2002 Mar;17(3):230-234.
Lee WK, Ramanathan M Jr, Spannhake EW, Lane AP. The cigarette smoke component acrolein inhibits expression of the innate immune components IL-8 and human betadefensin 2 by sinonasal epithelial cells. Am J Rhinol 2007 Nov-Dec;21(6):658-663.
Kamath PM, Shenoy VS, Mittal N, Sharma NK. Microbiological analysis of paranasal sinuses in chronic sinusitis—a south Indian coastal study. Egypt J Ear Nose Throat All Sci 2013 Nov;14(3):185-189.
Bezerra TF, Pádna FG, Ogawa AI, Gebrim EM, Saldiva PH, Voegels RL. Biofilms in chronic rhinosinusitis with nasal polyps: pilot study. Braz J Otorhinolaryngol 2009 Nov- Dec;75(6):788-793.
Hashemi M, Sadeghi MMM, Omrani MR, Torabi MA. Microbiology and antimicrobial resistance in chronic resistant rhino sinusitis with or without polyp after functional endoscopic sinus surgery. J Res Med Sci 2005;10(3):167-171.
Farahani F, Youse Mashouf R, Hashemian F, Esmaeili R. Antimicrobial resistance patterns of aerobic organisms in patients with chronic rhinosinusitis in Hamadan, Iran. Avicenna J Clin Microb Infec 2014 Aug;1(2):e18961..