Epithelium of the respiratory system. Changes in the wall of the bronchi as their caliber decreases. Surfactant performs a number of functions

In adolescent children, hormonal changes are sometimes accompanied by the appearance of neoplasms, benign and malignant. They can be formed from different fabrics.

The great Hippocrates back in the 5th century BC. described the disease that modern medicine called angiofibroma. This is a benign tumor that appears in the nasopharynx. Its basis is tissue - fibroma (connective) and (vascular). It affects the nasopharynx of boys from 10 years of age and boys up to 21 years of age (after 20 years of age, as a rule, regression begins), which is why it is called “juvenile”. Very rarely the disease strikes men 28-30 years old.

This neoplasm can grow with deep tissue damage, spreading to the vessels. And this a big problem if necessary, remove it.

Forms of juvenile angiofibroma

Focusing on the direction of growth of juvenile angiofibroma of the nasopharynx, experts call its forms:

• the vault of the nasopharynx (beginning), develops into the base of the skull;
• the body of the sphenoid bone (origin), growing, affects the nasal cavity, eye orbit, sinuses, and ethmoid labyrinth;
• from the beginning - the pterygopalatine fossa - into the nasal cavity.

The growth trend of the tumor affects the distortion of tissues adjacent to the nasopharynx. A tumor that grows towards the eye socket is fraught with displacement of the eyeball, causes a disruption in the blood supply to parts of the brain, and puts pressure on the nerve endings.

In the clinical and anatomical classification, two forms of this disease are called: basal and intracranial widespread.

The development of neoplasms - angiofibromas of the nasopharynx - is benign in nature, however, due to the characteristics of growth and predisposition to recurrence, the neoplasm is considered to be malignant.

Symptoms

Since angiofibromas very quickly affect nearby tissues, the disease reveals itself with clear signs:

• sudden deterioration of hearing (one or two ears);
• (become more frequent and stronger as the tumor grows);
• nasality;
• difficulty breathing through the nose;
• debilitating headaches;
• decrease (often disappearance) of sense of smell.

Depending on the direction in which nasopharyngeal angiofibroma spreads, the clinical picture is complemented by:

• distortion facial skeleton, soft and hard tissues;
• weakening of the ability to distinguish the smallest details;
• limited mobility and damage to the eyeball (displacement or protrusion);
• diplopia;
• asymmetry of the face, drooping upper eyelids;
• swelling of the cheek (on the side affected by the tumor).

Recognizing the disease

Diagnosis of the pathology – angiofibroma of the nasopharynx – is the result of examining the patient, analyzing his complaints and conducting:

• MRI – the skull or nasopharynx is subject (to determine the size and border of the tumor);
• X-ray examination of arteries;
• endoscopy();
• biopsy (of affected tissue for examination) is fraught with bleeding and is carried out in cases of extreme necessity;
• a thorough examination of the nasal cavity using instruments (rhinoscopy) shows the surface (nature and color of the tissue) of the tumor;
• X-ray examination blood vessels shows whether it is affected carotid artery tumor (important to know in case of inevitable surgery).

Required general analysis blood to determine hemoglobin level. Sometimes a consultation with an oncologist is prescribed.

When making a diagnosis, it is important to distinguish angiofibroma from the clinical picture of adenoids, brain tumors, polyps, papillomas, and sarcoma.

Treatment

Angiofibroma of the nasopharynx requires decisive action in treatment - surgery. Radiation therapy is usually performed before surgical removal of the tumor. Because during operations big risk bleeding, the external carotid artery is often ligated.

Surgeries to remove angiofibromas are performed using an endoscope for a thorough examination of remote areas of the nasal cavity.

Surgical intervention under general anesthesia, is selected depending on the location of the malignancy through:

• approaching the tumor through the nose or oral cavity;
• in a facilitated way - with a dissection under the lip (through the nasal cavity and sinus of the upper jaw);
• unfolded passage - facial incision;
• access through the sky.

If during the operation the patient suffers a large loss of blood, it is necessary to donor transfusion. During the postoperative stage, the doctor prescribes:

• antibiotics (protection against possible infection);
• transfusion of solutions to replenish blood loss;
• medications that promote blood clotting.

Juvenile angiofibroma of the nasopharynx- a benign tumor that grows in the inner cavity of the nose; occurs almost exclusively in boys during puberty. It is based on connective tissue (fibroma) and vascular tissue of varying maturity (angioma).

Juvenile angiofibroma is one of the most common tumors of the nasopharynx in adolescents: 1 in 50–60 thousand ENT patients or 0.5% of all head and neck tumors.

Angiofibroma, formally being benign neoplasm, has the features of malignant tumors due to localization, tendency to relapse and germination into structures bordering the nasopharynx and nasal cavity (pterygopalatine fossa, anterior and middle cranial fossae, orbit).

Intracranial (intracranial) growth is observed in 10-20% of cases. The most dangerous and prognostically unfavorable is the spread of the tumor around the chiasm optic nerves and pituitary gland, which makes it inoperable.

Types of angiofibromas depending on the source of tumor growth:

1. Sphenoethmoidal (begins to grow from the sphenoid bone, ethmoid bone, pharyngeal-basic fascia).

2. Basal (nasopharyngeal vault) - most common.

3. Pterygomaxillary (pterygoid process of the sphenoid bone).

Classification of juvenile angiofibroma (Fisch, 1983; Andrews, 1989)

This classification is used by almost all modern authors who publish articles on this problem.

Stage I – the tumor is limited to the nasal cavity;

Stage II – spread to the pterygopalatine fossa or maxillary, ethmoid, or sphenoid sinuses;

Stage IIIa – spread into the orbit or infratemporal fossa without intracranial (intracranial) growth;

IIIb – stage IIIa with extradural (without involvement of the dura mater) spread;

Stage IVa – intradural spread without involvement of the cavernous sinus, pituitary gland or optic chiasm;

Stage IVb – involvement of the cavernous sinus, pituitary gland or optic chiasm.

Symptoms and course of juvenile angiofibroma of the nasopharynx

The earliest and most common signs are:

Recurrent nosebleeds;

Unilateral nasal congestion;

Increasing difficulty in nasal breathing;

Hyposmia and anosmia (decrease and disappearance of the sense of smell);

Nasality;

Hearing loss in one (usually) or both ears;

Increasing headaches;

Deformation of the facial skeleton (on late stages leads to displacement of surrounding tissues).

Depending on the direction of growth of angiofibromas, the following may occur:

Facial asymmetry;

Deformation of the soft and bone tissues surrounding the tumor;

Impaired blood supply to the brain;

Compression of nerve endings;

Visual impairment (decreased visual acuity, exophthalmos (displacement of the eyeball forward (bulging eyes), sometimes with a shift to the side), limited mobility eyeballs, double vision (diplopia), etc.).

If the tumor grows aggressively, it can grow into the cranial cavity, which can cause fatal outcome.

Diagnosis of juvenile angiofibroma of the nasopharynx:

1. Collection of complaints and medical history.

2. Rhinoscopy.

3. Endoscopy of the nasal cavity and nasopharynx.

4. Radiography

5. CT, MRI.

6. Bilateral carotid angiography.

7. Biopsy. A cytological test of the biopsy is necessary to clarify the diagnosis and type of tumor.

8. Examination by an ophthalmologist, neurologist, neurosurgeon and oncologist.

They try to carry out tissue biopsy analysis only in a hospital (in the operating room), because after taking a biopsy, bleeding from the vessels of the nose may occur.

Differential diagnosis of juvenile angiofibroma of the nasopharynx with diseases such as:

Adenoids in children;

Brain tumor;

Choanal polyps;

Sarcoma;

Papilloma.

Treatment of angiofibroma of the nasopharynx

Treatment is surgical only! To reduce trauma, angiofibroma is removed using endoscopic methods. The disease can progress over several years, but in some cases it manifests itself as malignancy, that is, it is characterized by rapid growth. Therefore, if angiofibroma of the nasopharynx is suspected and the diagnosis is established, surgery is performed as early as possible.

Types of operations:

Surgery using natural approaches to the tumor (through the nose or mouth);

An operation using gentle access through the maxillary sinus and nasal cavity (with an incision under the lip) - Denker operation;

Operation using expanded access through the maxillary sinus and nasal cavity (with a facial incision) - Moore operation, Weber-Fergusson operation;

Operation using access through the palate - Owens operation.

During surgery, there is usually severe bleeding, which requires massive blood transfusions. To reduce blood loss, ligation of the external carotid artery is often performed before tumor removal.

IN postoperative period The ENT doctor prescribes:

Antibiotics (protection against possible infection);

Transfusion of solutions to replenish blood loss;

Medicines that promote blood clotting.

Juvenile angiofibroma of the nasopharynx does not suggest preventive measures– tumor formation cannot be prevented. However, in order not to start the course of the onset of the disease, you should immediately contact an ENT doctor at the first characteristic manifestations.

Forecast at juvenile angiofibroma nasopharynx

The prognosis of the disease is usually favorable. Timely surgery in combination with radiation therapy leads to a complete cure for a cancer patient.

In rare cases, a negative result of antitumor treatment is observed in the form of relapse or malignancy (malignancy) of the tumor. Therefore, operated patients are recommended to undergo annual examinations by an otolaryngologist.

Take care of yourself and, if necessary, contact an ENT surgeon on time.

Nasopharyngeal fibroma is a fibrous tumor of dense consistency, characterized by significant bleeding, which is why it is called angiofibroma. This tumor has been known since the time of Hippocrates, who proposed the so-called transnasomedial approach by bifurcating the nasal pyramid to remove this tumor.

The place of origin of the tumor is most often the fornix of the nasopharynx, its pharyngeal-basal fascia (basilar type of tumor, according to A. G. Likhachev, 1954). Research recent years XX century showed the possibility of the development of juvenile fibromas of the nasopharynx from the pterygomaxillary and sphenoid-ethmoid areas.

What causes nasopharyngeal fibroma?

The etiology of this disease is virtually unknown. Existing “theories” of disembryogenesis and endocrine dysfunction have not completely solved the problem. The “endocrine theory” is based on the fact that the tumor develops simultaneously with the development of secondary sexual characteristics and the period of its development ends with the completion of puberty. It has also been noted that with nasopharyngeal fibroma, disturbances in the secretion of 17-ketosteroids and the ratio of androsterone and testosterone are observed.

Pathological anatomy of nasopharyngeal fibroma

Nasopharyngeal fibroma is a very dense tumor sitting on a wide base, closely fused to the periosteum. The strength of the fusion with the periosteum is so great that in other cases, when a tumor is removed by tearing it out, fragments of the underlying bone are also removed along with it. The surface of the tumor is covered with smooth papillary formations of pale pink or reddish light, depending on the degree of vascularization of the tumor. The density of the tumor is determined by its fibrous nature. The tumor has a pronounced extensive growth, dislocating and destroying all tissues and filling all neighboring cavities located along this path (choanae, nasal cavity, orbit, sphenoid sinus, lower parts of the nasopharynx, paranasal sinuses, zygomatic and temporal fossae, etc.) . As the tumor spreads anteriorly, it fills the nasal passages, destroying the vomer, nasal septum, superior and middle turbinates, penetrating the cells of the ethmoidal labyrinth, the frontal and maxillary sinuses, deforming the pyramid of the nose and disturbing the appearance of the face. When spreading posteriorly and downward, the tumor destroys the anterior wall of the sphenoid sinus and penetrates it, sometimes reaching the pituitary gland, spreading downward, often reaching the soft palate and oropharynx.

Thus, due to extensive growth and destructive effects on surrounding organs and tissues, nasopharyngeal fibroma can be clinically classified as “malignant”, but it does not metastasize and is histologically classified as benign tumors. Morphologically, it consists of varying severity of choroid plexuses and connective tissue stroma, consisting of collagen fibers and fibroblasts. The tumor is covered with epithelium, which in the nasopharynx has the character of a single-layer epithelium, and in the nasal cavity - a cylindrical ciliated epithelium - a fact explained by the fact that the tumor arises in the zone of transition of squamous epithelium to cylindrical. The vascular content of the tumor, especially with the venous plexuses, is very large. Veins, by resorption of their walls, merge with each other, forming entire “lakes” of blood with very fragile “shores”, the trauma of which (for example, when sneezing) or spontaneously cause profuse, difficult to stop nasal and pharyngeal bleeding. With the reverse development of the tumor in the vascular endothelium, phenomena of necrobiosis and hyalinization occur, and in the stroma - phenomena of an inflammatory nature. As a result, non-viable tumor tissue undergoes resorption, the tumor sharply shrinks and is replaced by scar tissue.

Symptoms of nasopharyngeal fibroma

Symptoms of nasopharyngeal fibroma develop slowly and are divided into subjective and objective. On initial stages As the tumor develops, a gradually increasing difficulty in nasal breathing occurs, sometimes causeless headaches and dull pain in the base of the nose, high mental and physical fatigue, due to which children begin to lag behind in mastering the school curriculum, in physical development, and often suffer from colds. Discharge from the nose is mucopurulent in nature. Complaints appear, first of minor ones, then of ever-increasing nosebleeds, due to which the child develops anemia. Subsequently, the tumor fills the nasal cavity, causing increasing difficulty in nasal breathing, up to complete absence his. The child's mouth is constantly open, his speech becomes nasal (rhinolalia operta), obstruction of the auditory tube causes hearing loss, and at the same time there is a loss of smell and a decrease in taste sensitivity. When the tumor comes into contact with the soft palate, patients complain of impaired swallowing function and frequent choking. Compression of sensitive nerve trunks causes neuralgic eye and facial pain.

During an objective examination, the doctor sees a pale child or young man with a constantly open mouth, blue stains under the eyes and a swollen base of the nose. In the nasal passages there is mucopurulent discharge, which the patient cannot remove by blowing his nose due to obstruction of the choanae (expiratory valve) by the tumor. After removing these secretions, a thickened, hyperemic mucous membrane and enlarged bluish-red nasal turbinates appear. After lubricating the mucous membrane of the nose with adrenaline and contracting the turbinates, the tumor itself becomes visible in the nasal passages in the form of a sedentary, smooth, grayish-pink or reddish formation that bleeds heavily when touched with a sharp instrument.

Often, a tumor filling the nasal canopy is combined with one or more common secondary nasal polyps.

With posterior rhinoscopy, the typical picture, in which the choanae, vomer and even the posterior ends of the nasal conchae are clearly visible, is not determined. Instead, a massive bluish-red tumor is determined in the nasopharynx, completely filling it and sharply different in appearance from banal adenoid vegetations. A digital examination of the nasopharynx, which should be carried out carefully so as not to cause bleeding, reveals a dense, immobile solitary tumor.

Associated objective symptoms may include lacrimation, exophthalmos, and dilatation of the nasal root. With the bilateral manifestation of these signs, the patient’s face takes on a peculiar appearance, which is called “frog face” in foreign literature. Oropharyngoscopy may reveal bulging of the soft palate due to the presence of a tumor in the middle parts of the pharynx.

An unremoved tumor grows to enormous sizes, filling the entire space of the nasal cavity, the orbit and, going beyond their limits, causing severe functional and cosmetic disorders. The most serious complication is the tumor perforating the cribriform plate and penetrating into the anterior cranial fossa. Initial signs this complication is manifested by the syndrome of increased intracranial pressure(drowsiness, nausea, vomiting, incurable headache), then signs of retrobulbar syndrome (loss of visual fields, ophthalmoplegia, amaurosis) appear. Frequent hemorrhages and unbearable headaches, vomiting and food aversion lead the patient to a severe general condition, cachexia, anemia, not much different from the condition in the presence of a malignant tumor. Often such advanced conditions, which occurred in former times in less civilized areas and countries, were complicated by meningitis and meningoencephalitis, inevitably leading to the death of patients.

Fibromyxoma, or choanal polyp

Fibromyxoma, or choanal polyp, originates in the choanal or ethmoidosphenoidal region. Externally, this benign tumor looks like a pedunculated polyp, which is easily removed without bleeding using a special hook. Compared to mucous polyps of the nasal cavity, the consistency of the choanal polyp is more dense. It grows towards the pharynx and nasal cavity. “Old” polyps become denser, acquire a reddish color and often simulate nasopharyngeal fibroma, however, unlike it, they do not bleed and do not grow extensively.

Treatment is surgical.

Sinochoanal polyp

The sinus-choanal polyp is actually a manifestation of polypous sinusitis, since it comes from maxillary sinus and prolapses through the choana into the nasopharynx. Less commonly, this “tumor” comes from the sphenoid sinus. Externally, the sinochoanal polyp can be compared to the tongue of a bell, which hangs into the nasopharynx and sometimes reaches the oropharynx, located between its posterior wall and the soft palate. The structure of this polyp is a pseudocystic formation of whitish- gray ovoid form, which completely fills the nasopharynx and causes difficulty in nasal breathing and tubular hearing impairment.

Treatment is surgical.

Nasopharyngeal cysts

Nasopharyngeal cysts arise either as a result of blockage of the duct of the mucous gland (retention cyst) or the pharyngeal pouch of Thornwald. Nasopharyngeal cysts are rare tumors characterized by long-term evolution and manifested by disturbances in nasal breathing and hearing due to blockage of the nasopharyngeal mouth of the auditory tube. Posterior rhinoscopy reveals a smooth, round, gray tumor with elastic consistency. The cyst is removed using an adenotomy.

Dermoid cysts of the nasopharynx

Dermoid cysts of the nasopharynx are very rare congenital benign tumors, most often observed in infants. They develop very slowly and produce minimal dysfunction, mainly a dry reflex cough and some discomfort when swallowing. As a rule, the stalk of this “polyp” comes from the lateral wall of the nasopharynx around the nasopharyngeal opening of the auditory tube and often reaches the pharyngeal-epiglottic fold. It is not detected during conventional pharyngoscopy, but with a gag reflex it can appear in the oropharynx in the form of an oblong solitary polyp of a whitish-gray color with a smooth surface. Its surface has a leathery appearance with papillae, sweat and fat glands, as well as hairs. Under this layer there is tissue penetrated by venous vessels. In the center of the tumor, a nucleus formed by a dense connective tissue, sometimes containing fragments of bone or cartilage tissue, as well as striated muscle fibers (a typical “set” of tissues for embryonal tumors). Treatment consists of cutting the pedicle of the cyst. Subsequently, dermoid cysts of the nasopharynx become sclerotic and after some time (months to several years) resolve.

Papillomas and lipomas of the pharynx

Papillomas and lipomas are benign tumors that are rarely found in the upper parts of the pharynx and are visually very difficult to distinguish from common adenoid tissue. Final diagnosis set at histological examination. They are removed using an adenotom.

Skull base meningoceles can sometimes occur in the nasopharynx and most often in children. It differs from other benign tumors in that it enlarges when the child cries. Such “tumors” cannot be treated, since they are accompanied by other severe anomalies in the development of the skull and other organs, usually incompatible with life.

Benign plasmacytoma

Benign plasmacytoma originates from reticuloendothelial tissue and occurs most often in the bone marrow; more than 80% of extramedullary tumors of this type are localized in the upper respiratory tract. By appearance resemble polypoid formations of a grayish or pinkish-violet color, do not ulcerate. The diagnosis is based on histological examination. Solitary plasmoditoma can be either benign or malignant. Benign plasmacytoma is rare and should not be confused with a simple granuloma consisting of a large number of plasma cells. Malignant plasmacytoma is excluded by the fact that X-rays do not reveal bone lesions and sternal puncture pathological changes bone marrow are not detected, myeloma cells are absent, Bence-Jones protein is not detected in the urine and, finally, when the tumor is removed, no relapse is observed. Protein fractions of blood are also studied, which in benign tumors persist for normal level. Most plasmacytomas are malignant tumors either of extramedullary localization or of the nature of “diffuse” myeloma, which constitutes the essence of multiple myeloma.

Benign plasmacytomas, if they cause certain functional disorders, depending on their size, are removed in different ways surgical methods, after which they do not relapse. Malignant plasmacytomas surgical treatment are not subject to Non-operative antitumor methods are used for them.

Diagnosis of nasopharyngeal fibroma

The diagnosis of nasopharyngeal fibroma is established mainly by clinical picture, the fact of the occurrence of nasopharyngeal fibroma in males in childhood and adolescence. The extent of the tumor is determined using X-ray or MRI or CT examination, as well as using angiography.

Differential diagnosis of nasopharyngeal fibroma becomes essential, since treatment tactics and, possibly, prognosis depend on its result. Nasopharyngeal fibroma is differentiated from adenoids, cysts, fibromyxoma, cancer and sarcoma of the nasopharynx. The main distinguishing feature of fibromas is their early and frequent bleeding, which is not observed at all with all other benign tumors of this localization, and with malignant tumors bleeding is observed only at a developed clinical and morphological stage.

Treatment of nasopharyngeal fibroma

Numerous attempts to use non-operative treatment methods (physiotherapeutic, sclerosing, hormonal) did not provide a radical cure; the only method that often resulted in complete recovery, especially in combination with non-surgical methods, was surgery. However, the classical method of tumor extraction, used in earlier times by tearing it off from its attachment site using special forceps via oral access, was not justified due to the impossibility of removing the fibrous base of the tumor, firmly fused to the periosteum (hence the inevitable relapses) and severe, difficult to stop intraoperative bleeding. To facilitate access to the tumor, the French rhinosurgeon Nelaton proposed splitting the soft and hard palates. Other approaches to the tumor have also been developed, for example, the use of a rhinotomy method using Moore's para-lateral-nasal incision or Denker's sublabial rhinotomy.

Denker's operation is a preliminary surgical intervention to create wide access to the internal pathological formations of the nasal cavity and, in particular, to the maxillary sinus, the middle and posterior parts of the nasal cavity and the base of the skull (nasopharynx, sphenoid sinus). In advanced cases, when the tumor grows into the zygomatic region, paranasal sinuses, orbit or retromaxillary region, it is removed after creating preliminary approaches. According to A.G. Likhachev (1939), the most advantageous access to the tumor is the transmaxillary one according to Denker. But in some cases, depending on the histological features and extent of the tumor, the use radiation therapy leads to a delay in tumor growth, its reduction and compaction, which helps reduce intraoperative bleeding and facilitates its surgical removal. The same effect is achieved by tumor infiltration 96% ethyl alcohol. In some cases, surgery is performed several times until puberty is completed, when relapses stop, the tumor stops developing and develops backwards.

Surgical intervention requires careful preoperative preparation (improving general condition body, normalization of blood counts, vitamin supplementation, prescription of calcium supplements to strengthen the vascular wall, measures to increase hemostatic parameters). Preparation for surgery should include the possibility of performing during it resuscitation measures, blood transfusions and blood substitutes. Surgery is performed under intratracheal anesthesia. In the postoperative period, the same measures are carried out as during the preoperative preparation of the patient.

Non-operative treatment methods as independent means do not always provide positive result; It is advisable to carry them out as preoperative preparation or as an attempt at non-operative treatment.

For small tumors, diathermocoagulation can be used using an endonasal approach in people 18-20 years old with the expectation that they will soon complete puberty and will no longer experience a relapse. At the same age, diathermy can be used for minor postoperative relapses.

Radiation treatment is indicated mainly as a protective measure, since fibromatous tissue is X-ray insensitive, but it stabilizes the growth of young cells and new choroid plexuses that become obliterated, thereby limiting access nutrients to the tumor and its growth slows down. Typically, the course of treatment lasts for 3-4 weeks with a total dose of 1500 to 3000 rubles.

Treatment with radioactive elements introduced into the tumor is currently practically not used due to possible secondary complications (atrophy of the mucous membrane of the nose and nasopharynx, necrotizing ethmoiditis, perforation of the palate, etc.). Currently, radium and cobalt are replaced by radon, which is placed in gold capsules. The latter are implanted into the tumor at a distance of 1 cm from each other in an amount of 5-6. The procedure can be repeated after a month; this method does not cause such serious complications as with the application of radium or cobalt.

Main hormonal agent in the treatment of nasopharyngeal fibroids is testosterone, which has androgenic, antitumor and anabolic effects. It regulates the development of male genital organs and secondary sexual characteristics, accelerates puberty male persons, and also performs a number of other important biological functions in a developing organism. It is used in various dosage forms(capsules, tablets, intramuscular and subcutaneous implants, oil solutions individual esters or their combinations). For nasopharyngeal fibroma, use 25 to 50 mg/week of the drug for 5-6 weeks. Treatment is carried out under the control of the content of 17-ketosteroids in the urine - normally, the excretion of 17-ketosteroids in men averages (12.83±0.8) mg/day (from 6.6 to 23.4 mg/day), in women - (10.61±0.66) mg/day (6.4-18.02 mg/day) and can be repeated with normal content of this excretion in the urine. An overdose of testosterone can lead to testicular atrophy, early appearance of secondary sexual characteristics in children, disorders of osteonesis and psyche, as well as an increase in the content of 17-ketosteroids in the urine.

A) Causes. is a rare benign tumor of the posterior nasal cavity and nasopharynx. It occurs only in males, most often during puberty. Initially develops from the junction of the middle turbinate with the sphenopalatine foramen.

Accurate etiology of tumor unknown, but it has been proven that androgens and estrogens influence its development. Nasopharyngeal angiofibroma accounts for only 0.05% of all head and neck tumors. Young people from India or the Middle East are more often affected.

Pathophysiology and pathogenesis. Juvenile angiofibroma of the nasopharynx grows from the posterior parts of the nasal cavity, from the area of ​​the sphenopalatine foramen. Then it slowly increases in size, gradually occupying the entire nasal cavity and nasopharynx. Large tumors grow into the pterygopalatine fossa, taking on the appearance of a “dumbbell”.

Increasing in sizes, large tumors destroy the surrounding bone structures of the maxillary and sphenoid sinuses, and the base of the skull. In some cases, they are able to grow into the orbit. They are usually supplied with blood from the internal maxillary artery and its branches.

It is a benign tumor consisting of thin-walled vessels, mostly devoid of smooth muscle. This explains the difficulty of controlling bleeding during surgery.

b) Symptoms and clinical picture of juvenile angiofibroma of the nasopharynx. Most often, boys of prepubertal and pubertal age are affected. Typical symptoms are difficulty breathing through the nose (unilateral or bilateral, depending on the size of the tumor) and nosebleeds, which sometimes lead to massive blood loss. As the tumor grows, there may be a change in the resonance of the voice and bulging of the soft palate.

V) Diagnosis of juvenile angiofibroma of the nasopharynx. When examining the nasal cavity, a reddish soft tissue formation with smooth edges is determined, lined with mucous membrane. It can cause displacement of the nasal septum in the opposite side, obstruct the nasopharynx, leading to the impossibility of nasal breathing on this side. Due to the risk of significant bleeding, a biopsy should not be performed.

First of all, a CT scan with contrast is required, which makes it possible to determine the degree of bone destruction. MRI is additional method, allowing to evaluate the soft tissue characteristics of the tumor. Diagnosis is made based on history, clinical findings, and imaging studies.

G) Treatment. Determining the stage of the disease depends on the extent of the tumor, primarily on the involvement of the orbit and base of the skull. This information also helps plan surgical treatment.

Preoperative embolization allows complete removal of angiofibroma with minimal intraoperative blood loss. The choice of surgical approach depends on the size of the tumor and its growth into surrounding tissues. In many cases, angiofibroma can be completely removed using an endoscopic endonasal approach. It is also possible to use transpalatal lateral rhinotomy or combined otorhinolaryngological and neurosurgical approaches.

Radiation therapy is used for severe forms diseases when the tumor recurs repeatedly or cannot be completely removed.

d) Complications. Juvenile angiofibroma of the nasopharynx is benign tumor, which can cause destruction of surrounding structures, such as the orbit, due to their compression. The vascular origin of the tumor often causes repeated nosebleeds, and it is often necessary to resort to blood transfusions. Surgical complications depend on tumor growth in a specific anatomical area.

e) Prognosis of juvenile angiofibroma of the nasopharynx. If the tumor is completely removed, the cure rate is 100%. The figure decreases in the case of large tumors with several lobes, as well as tumors with intracranial distribution. In the literature, there are descriptions of cases of malignancy of juvenile angiofibroma of the nasopharynx, but in most of them, malignancy was preceded by radiation therapy.

and) Key points:
Juvenile angiofibroma of the nasopharynx is a severe, life-threatening disease that occurs predominantly in young people during puberty.
Tumor biopsy should not be performed on an outpatient basis, as severe nosebleeds may result. To make a diagnosis, it is necessary to compare medical history data with the results of radiological diagnostic methods. It is recommended to remove the tumor completely.

Currently, the number of people with diagnosed neoplasms does not cease to grow, and cases of morbidity have often begun to be recorded among adolescents. For example, among ENT patients, the most common people are diagnosed with formations in the nasopharynx, called angiofibromas.

Angiofibroma (juvenile) of the nasopharynx is a benign tumor that occurs mainly in male adolescents due to hormonal imbalance. Morphologically, it consists of connective and vascular tissues. The tumor is fed by the external carotid artery.

Despite its benign structure, clinical course this pathology considered as malignant, which is associated with rapid progression and frequent exacerbations of the disease, as well as destructive damage to surrounding tissues.

The reasons why angiofibroma of the nasopharynx could occur are not fully understood. There are suggestions that this disease is formed as a result of a disruption in the development of embryonic tissue in the nasopharynx, which was the reason for the creation of the embryonic theory of the occurrence of pathology. In addition to it, there are also hormonal (decrease in androgens, excess testosterone), pituitary, traumatic, mesenchymal, inflammatory and genetic theories of development.

However, to prove their influence, it is necessary to conduct a large number of additional research.

Classification

Selection different forms Juvenile angiofibroma is carried out depending on the anatomical location and direction of growth of the neoplasm. According to localization, a tumor is distinguished at the base of the sphenoid bone, in the area back wall ethmoid bone, in the pharyngeal fascia. The development of education can occur in various directions:

• From the vault of the nasopharynx to the base of the skull.
• From the base of the sphenoid bone - into the nasal sinuses, the labyrinth of the ethmoid bone and the orbit.
• Into the pterygopalatine fossae and nasal cavity.

The direction of development determines the degree of deformation of adjacent tissues. Its germination can lead to many different complications: blurred vision, limited movement of the eyeballs, their protrusion and many other pathologies. Cases of tumor growth around the optic nerves (in the area of ​​their decussation) and the pituitary gland lead to serious consequences, including death, and are not subject to surgical treatment.

When making a diagnosis, the attending physician must determine the prevalence of the process:

• Stage 1 – tumor without spreading to other parts.
• Stage 2 – there is growth in the area of ​​the pterygopalatine fossa or nasal sinuses.
• Stage 3A – germination into the eye sockets or into the area of ​​the infratemporal fossa.
• Stage 3B – the lesion spreads outward from the dura mater.
• Stage 4A – tumor growth under the dura mater without involving other structures.
• Stage 4B – damage to the cavernous sinus, pituitary gland, optic nerves in the chiasm area.

These data must be taken into account by the attending physician when determining further tactics for managing the patient.

Symptoms of the disease

Angiofibroma of the nasopharynx at the initial stages of its development does not have specific clinical manifestations. But thanks to its rapid growth, a person begins to be bothered by the following symptoms:

• Difficulty in nasal breathing.
• Nasal voice.
• Deterioration of hearing and smell.
• Intense headaches.

Nosebleeds may often occur, which tend to intensify as the size of the tumor increases.

When a tumor grows in a person, visible changes appear in the form of deformation of the facial skeleton and facial asymmetry.

In case of damage to the maxillary sinus, symptoms of dental diseases are observed. With intracranial tumor growth, signs of neurological symptoms appear: increased periosteal and decreased skin reflexes, nystagmus, pain along the course of the trigeminal nerve.

Since the disease does not have early specific manifestations, and the deterioration develops quite quickly, Special attention When studying symptoms, you should pay attention to a runny nose, which cannot be cured by conservative methods.

Diagnostics

When a person complains about the above complaints, medical care, an otolaryngologist, to confirm the alleged diagnosis, prescribes a list of additional studies. Thus, juvenile angiofibroma is detected in the presence characteristic features diseases on x-rays, CT and MRI studies, as well as during angiography and biopsy. The diagnostic features are as follows:

• CT, in addition to visualizing the formation itself, determines the extent of damage to other structures. It is also carried out to evaluate the effectiveness of surgical treatment.


• The advantages of MRI in this case lie in its ability to assess the degree of blood supply to the tumor. Also, unlike CT, it allows for more detailed visualization of low-density formations.
• Angiography also makes it possible to identify the sources of vascularization of the formation, which is taken into account during surgical intervention.
• A biopsy definitively confirms the diagnosis, as it allows one to visualize the characteristic morphological structure of the tumor.

All of the above methods are quite informative, but you should not undergo certain examinations yourself, since only an experienced specialist can correctly interpret the results obtained.

Therapeutic measures

The main goal of therapy when identifying angiofibroma of the nasopharynx is complete removal formation and prevention of its further relapses. Because the surgical intervention may be complicated by massive bleeding (depending on the degree of vascularization of the neoplasm), it is important to carefully carry out preoperative preparation.

The type of surgery depends on the location, size and growth of the tumor. To reduce the risk of disease relapse after surgical removal of the tumor, specialists in some cases prescribe additional courses of radiation therapy.

If the tumor grows into vital anatomical structures, surgical intervention is strictly contraindicated. In such cases, the patient undergoes only courses of radiation therapy. It is very important to identify the disease at the initial stages of its development, therefore, at the first appearance of alarming symptoms, you must immediately consult your doctor and not self-medicate.