J Korean Soc Radiol.  2019 Jul;80(4):750-755. 10.3348/jksr.2019.80.4.750.

Extranasopharyngeal Angiofibroma of the Nasal Septum: A Case Report

• Lee GE
• Kim TG
• Bae KE
• Cho KR
• Sohn JH
• Kim BY
• Kim HJ
• Kang G

• KMID: 2457452
• DOI: http://doi.org/10.3348/jksr.2019.80.4.750

Abstract

Angiofibroma is benign hypervascular tumor that usually occurs in the nasopharynx of adolescent male patient and rarely originates from outside of the nasopharynx, called extranasopharyngeal angiofibroma. The clinical and radiologic findings of extranasopharyngeal angiofibroma are similar to other hypervascular tumors, which may delay diagnosis and treatment. We present a case of extranasopharyngeal angiofibroma arising from nasal septum of a 43-year-old male who complained of right nasal obstruction. Contrast enhancement CT revealed a hypervascular tumor of the nasal septum and the tumor was removed by endoscopic resection. Histopathologic examination confirmed the diagnosis of angiofibroma.

MeSH Terms

Adolescent
Adult
Angiofibroma*
Diagnosis
Humans
Male
Nasal Obstruction
Nasal Septum*
Nasopharynx
Vascular Neoplasms

Figure

• 

  Fig. 1 A 43-year-old male patient with right nasal obstruction. Pathology analysis revealed an angiofibroma. A. A 1.5 cm-sized round pinkish mass at the right anterior nasal septum on preoperative endoscopy. B–D. Axial view non-enhanced (B) paranasal sinus CT image showing an oval-shaped soft tissue density mass (arrow), measuring 1.8 × 0.9 × 1.4 cm, on the right side of the nasal septum. On axial (C) and coronal (D) views of contrast-enhanced images, the mass (arrows) shows intense and heterogeneous enhancement. No evidence of bony erosion is observed. Otherwise, the nasopharynx shows no definite abnormal findings. E, F. The histologic findings of the nasal mass show dilated vessels of varying sizes and abundant stromal cells. The stroma is loose and myxoid, with scanty collagen fibers (E, hematoxylin and eosin stain, × 100). The androgen receptor immunohistochemical staining discloses nuclear staining in the stromal tumor cells (F, androgen receptor, × 100).

Reference

1. Windfuhr JP, Remmert S. Extranasopharyngeal angiofibroma: etiology, incidence and management. Acta Otolaryngol. 2004; 124:880–889.

2. Windfuhr JP, Vent J. Extranasopharyngeal angiofibroma revisited. Clin Otolaryngol. 2018; 43:199–222.

3. Szymańska A, Szymański M, Morshed K, Czekajska-Chehab E, Szczerbo-Trojanowska M. Extranasopharyngeal angiofibroma: clinical and radiological presentation. Eur Arch Otorhinolaryngol. 2013; 270:655–660.

4. Tasca I, Compadretti GC. Extranasopharyngeal angiofi broma of nasal septum. A controversial entity. Acta Otorhinolaryngol Ital. 2008; 28:312–331.

5. Som PM, Curtin HD. Head and neck imaging. 5th ed. St. Louis: Mosby;2011. p. 316–323.

6. Ewe S, Dayana F, Fadzilah FM, Gendeh BS. Nasal septal angiofibroma in a post-menopausal woman: a rare entity. J Clin Diagn Res. 2015; 9:MD03–MD05.

7. Kim JH, Park SW, Kim SC, Lim MK, Jang TY, Kim YJ, et al. Computed tomography and magnetic resonance imaging findings of nasal cavity hemangiomas according to histological type. Korean J Radiol. 2015; 16:566–574.

8. Lee DG, Lee SK, Chang HW, Kim JY, Lee HJ, Lee SM, et al. CT features of lobular capillary hemangioma of the nasal cavity. AJNR Am J Neuroradiol. 2010; 31:749–754.

9. Persky M, Tran T. Acquired vascular tumors of the head and neck. Otolaryngol Clin North Am. 2018; 51:255–274.

10. Garcia-Rodriguez L, Rudman K, Cogbill CH, Loehrl T, Poetker DM. Nasal septal angiofibroma, a subclass of extranasopharyngeal angiofibroma. Am J Otolaryngol. 2012; 33:473–476.