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Nasopharyngeal Angiofibroma:

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1 Nasopharyngeal Angiofibroma:
Juvenile Nasopharyngeal Angiofibroma (JNA) highly vascular benign yet unencapsulated tumor of adolescent males.

2 Frequency: JNA accounts for 0.05% of all head and neck tumors.
Sex: JNA occurs exclusively in males. Age: range is 7-19 years. JNA is rare in patients older than 25 years Etiology: A hormonal theory has been suggested due to the lesion's occurrence in adolescent males.

3 Pathophysiology: The tumor starts adjacent to the sphenopalatine foramen. Large tumors frequently are bilobed or dumbbell-shaped, with one portion of the tumor filling the nasopharynx and the other portion extending to the pterygopalatine fossa.


5 Clinical: Symptoms: Nasal obstruction (80-90%): Epistaxis (45-60%): Headache (25%): Facial swelling (10-18%) Other symptoms include unilateral rhinorrhea, anosmia, hyposmia, rhinolalia, deafness, otalgia, swelling of the palate, and deformity of the cheek.

6 Signs: Nasal mass (80%) Orbital mass (15%) Proptosis (10-15%) Other signs may include -Serous otitis due to eustachian tube blockage. -Zygomatic swelling and trismus denote spread of the tumor to the infratemporal fossa.

7 Differentials: Other causes of nasal obstruction, (eg, nasal polyps, antrochoanal polyp, teratoma, encephalocele, dermoids, inverting papilloma, rhabdomyosarcoma, squamous cell carcinoma) Other causes of epistaxis, systemic or local Other causes of proptosis or orbital swelling

8 CT scan

9 Medical therapy: Surgical therapy Hormonal therapy Radiotherapy
Biopsy is prohibited because of severe bleeding

10 Nasopharyngeal malignancies
Nasopharyngeal carcinoma (NPC) Lymphoma Salivary gland tumors Sarcomas

11 Nasopharyngeal Carcinoma
More common in Asia

12 Anatomy Anteriorly -- nasal cavity
Posteriorly -- skull base and vertebral bodies Inferiorly -- oropharynx and soft palate Laterally -- Eustachian tubes and tori Fossa of Rosenmuller - most common location


14 Anatomy Close association with skull base foramen Mucosa
Epithelium - tissue of origin of NPC Stratified squamous epithelium Pseudostratified columnar epithelium Salivary, Lymphoid structures

15 Epidemiology Chinese native (广东,广西。湖南,福建)
> Chinese immigrant > North American nativeBoth genetic and environmental factors Genetic HLA histocompatibility loci possible markers

16 Epidemiology Environmental Viruses Nitrosamines - salted fish
EBV- well documented viral “fingerprints” in tumor cells and also anti-EBV serologies with WHO type II and III NPC HPV - possible factor in WHO type I lesions Nitrosamines - salted fish Others - chronic nasal infection, poor hygiene, poor ventilation

17 Clinical Presentation
Often subtle initial symptoms 1. unilateral HL (SOM) 2. epistaxis 3. painless, slowly enlarging neck mass Larger lesions 4. nasal obstruction 5. cranial nerve involvement

18 Clinical Presentation
Xerophthalmia - greater sup. petrosal n Facial pain - Trigeminal n. Diplopia - CN VI Ophthalmoplegia - CN III, IV, and VI cavernous sinus or superior orbital fissure Horner’s syndrome - cervical sympathetics CN’s IX, X, XI, XII - extensive skull base

19 Clinical Presentation
Nasopharyngeal examination Fossa of Rosenmuller most common location

20 Distant spread - rare (<3%), lungs, liver, bones
Regional spread Usually ipsilateral first but bilateral not uncommon Distant spread - rare (<3%), lungs, liver, bones

21 Radiological evaluation
Contrast CT with bone and soft tissue windows imaging tool of choice for NPC MRI soft tissue involvement, recurrences Chest CT, bone scans

22 TNM classification Class 0: Tis N0 M0 Class I: T1 N0 M0 Class II A: T2a N0 M0 Class II B: T1 N1 M0 ; T2a N1 M0 ; T2b N0, N1 M0 Class III: T1 N2 M0 ; T2a, T2b N1 M0 ; T3 N0, N1, N2 M0

23 Class IV A: T4 N0, N1, N2 M0 Class IV B: any T N3 M0 Class IV C: any T any N M1

24 Treatment External beam radiation Adjuvant brachytherapy
Dose: cGy Adjuvant brachytherapy mainly for residual/recurrent disease

25 Treatment Surgical management
Mainly diagnostic - Biopsy Surgical treatment primary lesion regional failure with local control

26 Treatment Surgical management
Primary lesion consider for residual or recurrent disease approaches infratemporal fossa transparotid temporal bone approach transmaxillary transmandibular transpalatal

27 Treatment Surgical management
Regional disease Neck dissection may offer improved survival compared to repeat radiation of the neck

28 Treatment Chemotherapy Immunotherapy

29 Congenital tonsillar masses
Teratoma Hemangioma Lymphangioma Cystic hygroma

30 Treatment: Laser therapy Surgery

31 Malignant Neoplasms Most common is lymphoma Non-Hodgkin’s lymphoma
Rapid unilateral tonsillar enlargement associated with cervical lymphadenopathy and systemic symptoms


33 Treatment Radiotherapy and chemical therapy

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