WordNet

of or relating to or located near the nasopharynx

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/07/10 01:03:04」(JST)

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Nasopharyngeal angiofibroma (also called juvenile nasopharyngeal angiofibroma)^[1]^[2] is a histologically benign but locally aggressive vascular tumor that grows in the back of the nasal cavity. It most commonly affects adolescent males.^[3] Patients with nasopharyngeal angiofibroma usually present with one-sided nasal obstruction and recurrent bleeding.

Signs and symptoms

Frequent chronic epistaxis or blood-tinged nasal discharge
Nasal obstruction and rhinorrhea
facial dysmorphism (when locally invasive)
Conductive hearing loss from eustachian-tube obstruction
Diplopia, which occurs secondary to erosion into superior orbital fissure and due to third and sixth nerve palsy,
proptosis when having intraorbital extension.
Rarely anosmia, recurrent otitis media, and eye pain.

Diagnosis

If nasopharyngeal angiofibroma is suspected based on physical examination (a smooth vascular submucosal mass in the posterior nasal cavity of an adolescent male), imaging studies such as CT or MRI should be performed. Biopsy should be avoided as to avoid extensive bleeding since the tumor is composed of blood vessels without a muscular coat.

Antral sign or Holman-Miller sign (forward bowing of posterior wall of maxilla) is pathognomic of angiofibroma.

DSA (digital subtraction angiography) of carotid artery to see the extension of tumors and feeding vessels

Differential diagnosis

Antro-choanal polyp (benign neoplasm)
Rhinosporidiosis (as bleeding point is here too)
Malignancy—nasopharyngeal carcinoma, lymphoma, plasmacytoma, rhabdomyosarcoma
Chordoma
Nasopharyngeal cyst
Pyogenic granuloma

Treatment

Treatment for Nasopharyngeal angiofibroma (JNA) is primarily surgical. The tumor is primarily excised by external or endoscopic approach. Medical treatment and radiation therapy are only of historical interest.

External approaches:

transpalatine approach
transpalatine + sublabial (Sardana's) Approach
infratemporal Approach
nasal endoscopic Approach
transmaxillary Approach

Endoscopic approach is an excellent tool in primary and recurrent JNA, it allows visualisation and precise removal of the lesion. Preoperative embolisation of tumour may be of some use in reducing intraoperative bleeding.

Direct visualization is not common.

Prognosis

Prognosis for nasopharyngeal angiofibroma is favorable. Because these tumors are benign, metastasis to distal sites does not occur. However, these tumors are highly vascularized and grow rapidly. Removal is important in preventing nasal obstruction and recurrent epistaxis. Mortality is not associated with nasopharyngeal angiofibroma.^[4]

References

^ 00021 at CHORUS
^ "juvenile nasopharyngeal angiofibroma" at Dorland's Medical Dictionary
^ Raphael Rubin; David S. Strayer; Emanuel Rubin (2008). Rubin's Pathology: clinicopathologic foundations of medicine. Lippincott Williams & Wilkins. pp. 1071–. ISBN 978-0-7817-9516-6. Retrieved 29 June 2010.
^ Textbook of Family Medicine, 8th Edition. Chapter 19 p.329. Rakel, MD. ISBN 978-1-4377-1160-8

External links

SinusTumor.org—an educational site that provides information about sinus tumors

UpToDate Contents

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1. 頭頸部腫瘍の病理 pathology of head and neck neoplasms
2. 小児における鼻出血のマネージメント management of epistaxis in children
3. 小児における鼻出血の疫学および病因 epidemiology and etiology of epistaxis in children
4. 家族性腺腫性ポリポーシスの臨床症状および診断 clinical manifestations and diagnosis of familial adenomatous polyposis
5. 遺伝性皮膚症 the genodermatoses

English Journal

Trigeminocardiac reflex during endoscopic juvenile nasopharyngeal angiofibroma surgery: an appraisal.

Sharma SB1, Janakiram TN2, Baxi H1, Chinnasamy B1.
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery.Eur Arch Otorhinolaryngol.2017 Mar 21. doi: 10.1007/s00405-017-4521-z. [Epub ahead of print]
PMID 28324181

Update From The 4th Edition of the World Health Organization Classification of Head and Neck Tumours: Nasopharynx.

Stelow EB1, Wenig BM2.
Head and neck pathology.Head Neck Pathol.2017 Mar;11(1):16-22. doi: 10.1007/s12105-017-0787-0. Epub 2017 Feb 28.
PMID 28247232

Imaging in Juvenile Nasopharyngeal Angiofibroma: Clinical Significance of Ramharan and Chopstick Sign.

Janakiram TN1, Sharma SB1, Samavedam UC1, Deshmukh O1, Rajalingam B2.
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India.Indian J Otolaryngol Head Neck Surg.2017 Mar;69(1):81-87. doi: 10.1007/s12070-016-1039-4. Epub 2016 Dec 23.
PMID 28239585

Japanese Journal

内視鏡下鼻副鼻腔手術におけるコブレーター<sup>®</sup> の使用経験

弦本惟郎,飯村慈朗,光吉亮人,森恵莉,浅香大也,中島庸也,小島博己,鴻信義
耳鼻咽喉科展望 60(6), 311-315, 2017
… The first case is resection of juvenile nasopharyngeal angiofibroma (JNA) tumor. …
NAID 130007531119

鼻内内視鏡による若年性血管線維腫の治療

西池季隆
頭頸部外科 24(1), 33-37, 2014
若年性血管線維腫は，ほぼ若年男性に発症するまれな良性の血管性腫瘍である。これに対する内視鏡下切除術は，皮切を伴う手術に比較して出血量や合併症は少なく，入院期間も短い。しかし，側頭下窩や海綿静脈洞への過度の浸潤がある場合には外切開アプローチの適応である。術前の選択的血管塞栓療法は有用である。しかし，内頸動脈系の栄養血管の塞栓は困難であり，その対処には2人の術者による3手あるいは4手操作が有用である。 …
NAID 130004688332

若年性鼻咽腔血管線維腫 : 翼突管への進展の評価

西池季隆,識名崇,前田秀典,日尾祥子,猪原秀典
日本耳鼻咽喉科學會會報 115(11), 965-970, 2012-11-20
過去3年間にわれわれはJNA手術例を3例経験した. 術前の画像診断では, すべての腫瘍は蝶口蓋孔付近に存在したが, 同時にその翼突管方向への進展と同部の拡大を認めた. 全例で手術に先立ち選択的動脈塞栓療法を行っているが, 1例では内頸動脈系の栄養血管の塞栓は困難であった. 全例で鼻内内視鏡下切除術を行った. 2例は内視鏡単独で切除したが, 残りの1例は犬歯窩切開の併用が必要であった. 術中には内頸 …
NAID 10031130047

「鼻咽腔血管線維腫」

Nasopharyngeal angiofibroma
	Micrograph of a nasopharyngeal angiofibroma H&E stain.
Classification and external resources
DiseasesDB	32229
MedlinePlus	001572
eMedicine	ent/470
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