Juvenile angiofibroma. Causes and complications of nasopharyngeal angiofibroma. Symptoms of cutaneous angiofibroma

Benign tumors. The most common benign tumors of the nasopharynx are papilloma and juvenile angiofibroma.

Papilloma most often localized on the posterior surface of the soft palate, less often on the lateral and posterior walls of the nasopharynx. Its appearance resembles small-lumpy growths on a broad base; the tumor has a soft consistency. IN childhood Nasopharyngeal papillomas are more often combined with laryngeal pathology; in adults, single forms can occur.

Treatment is surgical. Papillomas can be removed using an ultrasonic disintegrator or a laser beam.

Juvenile angiofibroma– one of the most common tumors of the nasopharynx, histologically benign, has locally destructive, progressive growth and is prone to recurrence without the formation of metastases.

This tumor develops in boys and young men from 14 to 25 years old and is located on the roof of the nasopharynx. It has a spherical surface, bluish-pink color, a wide base and a very dense consistency.

The clinical picture is quite typical. The tumor grows relatively quickly. Nasal breathing progressively worsens, along with which hearing gradually decreases in one, less often in both ears. Angiofibromas are characterized by nosebleeds. As the tumor grows, the intensity and frequency of bleeding increases. From the nasopharynx, angiofibroma penetrates into the nasal cavity and paranasal sinuses, primarily into the sinus of the sphenoid bone. The tumor can cause destruction of the base of the skull and penetrate into its cavity. In this case, headache is added to the listed symptoms.

Differential diagnosis must be made with adenoid growths, papilloma, cancer, fibrosarcoma.

Treatment surgical. The main difficulty that arises when performing operations for angiofibroma is profuse, life-threatening bleeding. To prevent this complication, the external carotid artery on the side of the tumor (sometimes both external carotid arteries) is first ligated. The tumor is removed from a wide external approach: a Moore incision is made with a dissection of the upper lip along the midline (Fig. 1d).

Malignant tumors. This pathology of the nasopharynx is characterized by a wide age range, although the disease predominates in old age. At a young age, sarcomas and lymphoepitheliomas are more common. Cancer predominates in elderly and elderly patients. Men get sick 3-4 times more often than women.

Based on the histological structure, malignant tumors of the nasal pharynx are divided into epithelial and non-epithelial neoplasms. Ratio cancer And sarcomas, according to most modern authors, is 2:1. Among epithelial tumors of the nasopharynx, squamous cell and transitional cell carcinomas are the most common.

Nasopharyngeal cancer most often has the form of an asymmetrical infiltrate, localized on the posterior or lateral walls, characterized by an endophytic-ulcerative shape of the nose.

Clinical picture. Symptoms malignant tumors The nasopharynx can be divided into early (nasal) and late (Fig. 2).

TO early symptoms include - gradually increasing impairment of nasal breathing, impairment of auditory function (conductive type) on the affected side, nosebleeds, concomitant sinusitis, headache.

Late symptoms indicate damage to the nerve structures.

When the tumor penetrates into the middle cranial fossa, damage occurs to the III, IV, VI pairs of cranial nerves and is manifested by the following symptoms: ptosis, convergent strabismus, abduction disturbance eyeball outward, exophthalmos, diplopia. In severe cases - complete immobility - ophthalmoplegia.

When penetrating the anterior cranial fossa, the second pair of cranial nerves (n. opticus) is affected - decreased vision, loss of visual fields.

Penetration pathological process into the pterygopalatine fossa is characterized by Troter's syndrome - neuralgia in the temporofacial region, paresis of the soft palate, hypoesthesia or anesthesia of the cheek on the affected side.

When the parapharyngeal space is damaged, signs of damage to the IX, X, XI, XII pairs of cranial nerves appear - deviation of the tongue first to the healthy, then to the diseased side (XII), impaired mobility of the larynx (X), prolapse of the soft palate (IX), prolapse of the shoulder on the affected side (XI).

Fig.2. Diagram of the spread of malignant tumors of the nasopharynx (Abyzov R.A., 2004)

Metastases to regional cervical nodes, according to most authors, are often the only sign of a malignant tumor of the nasopharynx at the first visit of the patient. It should be noted that regional metastasis is observed equally often in both cancer and sarcoma. Most often, regional metastases appear in the superior jugular lymph node under the digastric muscle and in the lymphadenoid tissue of the retropharyngeal space. In addition, the submandibular, mental, and supraclavicular lymph nodes are affected, which is caused by massive invasion of the jugular lymph nodes. Often metastases occur in the lymph nodes of the opposite side, which is due to the presence of numerous anastomoses between the lymphatic vessels of the neck.

Treatment. Among all ENT oncology, the nasopharynx remains an organ “non grata” (inviolable) for surgical intervention. This is due to the anatomical structure of this organ, the growth of neoplasms towards the cranial cavity or into the parapharyngeal space with the destruction of surrounding tissues, as well as early and regional metastasis. The main methods remain radiation and drug (chemotherapeutic) treatment.

The diagnosis of “juvenile angiofibroma of the nasopharynx” is most often voiced to the parents of teenage boys. This disease occurs against the background of hormonal changes in the body. But sometimes it is discovered at a later age - up to thirty years. What are the reasons for angiofibroma in children? How can doctors help a patient?

Juvenile angiofibroma of the nasopharynx (JAN) is a benign tumor. It is believed that it occurs due to a hormonal surge. This is why the disease is detected in adolescence in most cases. However, some experts believe that the development of the disease is provoked by a developmental anomaly that occurs in the embryonic period.

Although the tumor is benign, it poses a threat to the health and even life of the child. Because the disease progresses rapidly, destroying surrounding tissues. It is very important to undergo a timely examination and begin treatment by detecting the first signs of the disease:

labored breathing;
deterioration of the sense of smell up to complete disappearance;
nasal voice;
hearing impairment.

The difficulty is that similar symptoms are observed with a common runny nose or adenoids. Therefore, not all parents sound the alarm when they discover such phenomena. However, the tumor grows rapidly, eventually primary signs angiofibromas are joined by others:

headache;
changes facial skeleton.

Further, the disease can manifest itself in different ways, depending on the location of the tumor. It is found in different areas of the nasopharynx. For example, if an angiofibroma grows toward the eyes, vision may deteriorate and the eyeballs may bulge or become immobilized. It is no less dangerous when pathology is detected in the brain area.

Forms of the disease and diagnosis

Juvenile angiofibroma of the nasopharynx can direct its growth in different directions. For example, sometimes a tumor is found on the vault itself, and eventually it begins to press into the base of the skull. Another form - the process originates on the sphenoid bone. Then the ethmoid labyrinth, nasal sinuses and orbits are affected. Formations in the area of the pterygopalatine fossa are also possible: the tumor penetrates into the nasal cavity.

It helps the doctor to accurately determine the form of the disease. clinical picture. It appears differently, depending on the specifics of the pathology. If the basal layer is affected, the patient experiences the following symptoms:

he has difficulty breathing;
the nose does not smell;
the voice is nasal;
hearing loss;
inflamed sinuses;
seeing double;
eyeballs protrude.

The tumor may spread intracranially: in the cranial cavity. Then the damage to the trigeminal nerve is added to the above-mentioned symptoms. The patient's cheek swells on the side where the pathology is observed. Drooping or swelling of the eyelid occurs.

During the diagnostic process, the doctor may use x-rays. This method allows you to see the tumor and estimate its size. Specialists also have CT scan and angiography. A biopsy may be necessary, but this is not always done. The fact is that after such a procedure the risk of bleeding increases.

Therapy and prognosis

Such is the specificity of angiofibroma of the nasopharynx that the doctor will not be able to offer any treatment other than removal of the formation. With this diagnosis, surgery is not postponed, since the tumor grows very quickly, affecting neighboring tissues and organs. The sooner surgery is performed, the more favorable the prognosis the doctor will make. However, due to the nature of the disease, it is not always possible to solve the problem at the stage of its inception.

Surgical intervention

The operation to remove angiofibroma is carried out under endoscopic control. This allows the surgeon to see cavities that are inaccessible to the naked eye. There are different ways to remove a tumor. Whenever possible, the specialist intervenes directly through natural openings. That is, he performs the operation by penetrating the patient's mouth or nose.

However, more often it is necessary to make incisions in the tissue. They are gentle and extended. For example, surgery is possible through a small hole made under the lip. But just as often, doctors cut the patient’s palate or face.

Possible complications

Juvenile angiofibroma is not a disease for which you can think about whether to have surgery or not. When predicting the development of the disease, it is worth remembering the risk of transforming a benign tumor into a malignant one. And pathology itself is fraught with serious consequences, since it significantly affects the body as a whole and its most important functions in particular.

What complications are possible with angiofibroma? Since the tumor body in this disease consists of different tissues, including vascular tissues, the likelihood of bleeding is high. Doctors warn of neurological consequences that become irreversible for the patient. For example, a young man may lose certain fields of vision.

Unfortunately, this disease cannot be prevented. However, parents can stop the pathological process by early stage. To do this, it is important to monitor the child’s health and, when the first alarming symptoms consult a doctor.

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.

(a) Juvenile angiofibroma of the nasopharynx, endoscopic picture of the nasal cavity.
(b) CT scan of a patient with juvenile angiofibroma. (c) MRI of a patient with juvenile angiofibroma.

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 invasion into a specific anatomical region.

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.

A neoplasm of connective tissues and blood vessels is considered a rather rare disease. In oncological practice it is very common angiofibroma considered in combination with dermatofibroma. The localization of this benign tumor is the skin and the nasopharynx area.

Causes and epidemiology of the disease

Angiofibroma of the nasopharynx was first described by Hippocrates in the 5th century BC. e. But the disease began to be called this term after 1940. Mutation of cells of the nasopharyngeal space is mainly diagnosed in male patients aged 7-14 years, which is obviously associated with puberty.

Angiofibroma of the skin develops with the same frequency in both men and women. This skin lesion is the result of photoaging of the dermis. That is why older people are considered the most susceptible category.

Angiofibroma of the larynx: clinical picture

Symptoms of the disease include the following:

Chronic nasal congestion, which manifests itself in 80-90% of cancer patients in the early stages of the malignant process.
Periodic nosebleeds. Bloody discharge, as a rule, are one-sided and intense. This symptom is observed in 45% of clinical cases.
Frequent headaches, which are provoked by constant congestion of the paranasal sinuses.
Swelling of facial tissues.
Juvenile angiofibroma with significant spread, it can provoke impairment of auditory and visual functions.

Symptoms of cutaneous angiofibroma

The pathological focus has the appearance of a dense node, the size of which does not exceed 3 mm in diameter. The color of the tumor can vary from light to dark brown. Such thickening of the epidermis in most cases does not cause subjective complaints in the patient and may long time be in a stable condition.

Diagnosis of the disease

Atypical dermal tissue proliferation is diagnosed based on visual examination, which can be improved by dermoscopy. Final diagnosis in this case, it is established based on the results of histological analysis. To perform a biopsy, a small area of the cancer lesion is removed from the patient and laboratory analysis biopsy.

Juvenile angiofibroma detected using the following methods:

Instrumental examination of the nasal cavity and pharynx.
Computer and magnetic resonance imaging. Layer-by-layer radiological scanning of an atypical area of the body identifies the boundaries, localization and spread of the tumor.
Biopsy. A cytological test of the biopsy is necessary to clarify the diagnosis and type of tumor.

Differential diagnosis

The cutaneous form of the pathology has a very similar clinical picture to and.

Angiofibroma in a child differentiated from polypous growth, sinusitis and nasopharyngeal cancer.

Angiofibroma of the nasopharynx: treatment

Therapy for angifibromic lesions of the nasopharyngeal space is carried out using the following methods:

Hormone therapy

Drug treatment includes the use of testosterone, which blocks tumor growth and causes a tumor reduction by 44%.

Radiotherapy

Some cancer centers report a positive result of radiological exposure in 80% of cancer patients. Application has some limitations due to high frequency radiological complications. In this regard, oncologists recommend using the stereotactic technique, which involves highly precise and dosed delivery of radiation to the affected area of the body.

Surgery

Removal of angiofibroma is very often complicated by the presence of a dense network of blood vessels. Surgical access to the pathological focus of the nasopharynx is carried out depending on the characteristics of the localization of oncology. For example, lateral dissection of the nose is indicated for tumors at stages 1 and 2; the infratemporal tract is used for significant expansion of angiofibroma. IN Lately wide application received intranasal endoscopic surgery, with the help of which the surgeon excises the tumor with minimal trauma to nearby healthy tissue.

Consequences and complications after removal

Despite the key importance of surgical tumor removal, radical excision is contraindicated in 10% of clinical cases due to tumor invasion benign neoplasm into the bony structures of the base of the skull. The main complications of such treatment are associated with (30% frequency) surgical bleeding and traumatic damage to adjacent tissues.

Consequences radiation therapy are as follows:

The development of radiological inflammation of the mucous membranes, in particular, oral stomatitis.
Decrease in the concentration of leukocytes and erythrocytes in the blood.
Skin complications such as dermatitis, itching and swelling.
Systemic manifestations of radiation intoxication (insomnia, loss of appetite).

Long-term consequences of radiotherapy include skin atrophy, asymmetry of the facial skeleton, progressive osteoporosis and the formation of secondary osteoporosis.

Life forecast

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 anticancer treatment is observed in the form of relapse or malignancy of the tumor. According to statistics, angiofibroma after resection, undergoes cancer transformation in the second or third year rehabilitation period. For timely diagnosis of therapeutic complications, patients are recommended to undergo annual examinations with an otolaryngologist.

Juvenile angiofibroma of the nasopharynx is 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 a benign neoplasm, has the features of malignant tumors due to its localization, tendency to relapse and germination into structures bordering the nasopharynx and nasal cavity (pterygopalatine fossa, anterior and middle cranial fossa, 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 intersection of the optic nerves and the 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 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);

Hearing loss in one (usually) or both ears;

Increasing headaches;

Deformation of the facial skeleton (in later stages leads to displacement of surrounding tissues).

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

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 of the eyeballs, double vision (diplopia), etc.).

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

Diagnosis of juvenile angiofibroma of the nasopharynx:

1. Collection of complaints and medical history.

3. Endoscopy of the nasal cavity and nasopharynx.

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;

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 carried out as early as possible.

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

Operation using gentle access through 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 before tumor removal, external ligation is often performed. carotid artery.

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.

Prognosis for juvenile angiofibroma of the 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.

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.

General information

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, according to the 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:

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. Since surgery can be complicated by massive bleeding (depending on the degree of vascularization of the tumor), 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.

Angiofibroma of the nasopharynx - symptoms, treatment, differential diagnosis with adenoids

Children during the period of hormonal changes (in the second decade of life) sometimes develop benign and malignant neoplasms, which are formed from a wide variety of tissues. Angiofibroma refers to those benign tumors, the basis of which is connective tissue (fibroma) and vascular tissue of varying maturity (angioma). If such a tumor is located in the area of the nasopharynx, it is called nasopharyngeal angiofibroma.

Causes of angiofibroma of the nasopharynx

By the nature of the process, such a tumor is considered benign, but the peculiarity of its growth and development resembles a malignant process. This disease is different in that it occurs more in boys aged 9-10 years, which is why it has a different name - juvenile angiofibroma (juvenile). At the age of 20, it usually undergoes reverse changes and regresses. The disease is much less common in young men under age.

Currently, there is no specific opinion on why angiofibroma of the nasopharynx occurs, but many scientists agree that the main reason for the development of the tumor is the remnants of undeveloped embryonic tissue that are located in the nasopharynx. The basis of the tumor is made up of vessels of different sizes and thicknesses, which are located in a chaotic manner, as well as connective tissue. The vascular tumor is fed from the external carotid artery. Juvenile angiofibroma is located in the following places of the nasopharynx:

Base of the sphenoid bone (body).
Posterior wall of the ethmoid bone.
Pharyngeal fascia.

Of these anatomical formations nasopharynx tumor can grow into organs located nearby, namely the nasal passages, orbits, ethmoidal labyrinth, sphenoid and ethmoid sinuses, causing many problems and discomfort. This disease is prone to recurrence or recurrence of the development of pathological tumor growth into surrounding tissues even after therapy.

Clinical picture and diagnosis of angiofibroma of the nasopharynx

What does angiofibroma of the nasopharynx visually look like?

The clinical picture of the disease is quite characteristic and is distinguished by a number of pronounced symptoms. This occurs due to the rapid growth of the tumor into neighboring tissues. The clinical picture largely depends on the location where the vascular and connective tissues grow. Symptoms of angiofibroma of the nasopharynx include:

Sudden hearing loss (in one or both ears).
Difficulty breathing through the nose.
Nosebleeds that get worse as the tumor grows.
Nasal congestion.
Severe migraine-like headaches.
Deformation of soft and hard tissues of the face and skull.
Protrusion (exophthalmos) or displacement of the eyeball.
Facial asymmetry and drooping upper eyelids.

Diagnosis of the disease is made based on the following tests and data:

Examination of the patient and collection of complaints.
Arteriography (angiography) of the carotid arteries.
Computer (magnetic resonance) tomography of the nose or skull.
Tissue biopsy (during endoscopic examination of the nasal cavity).

Be sure to carry out differential diagnosis with diseases such as adenoids in children, brain tumors, choanal polyps, sarcoma, papilloma. 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.

Treatment of angiofibroma of the nasopharynx

Considering the fact that the disease often leads to relapses, treatment is always surgical and, if possible, radical. The disease can progress over several years, but in some cases it manifests itself as a malignant neoplasm, that is, it grows rapidly. Therefore, if angiofibroma of the nasopharynx is suspected and the diagnosis is established, surgery is performed as early as possible.

Nosebleeds may occur during surgery, so the carotid artery (external) is often ligated before surgery. Usually used general anesthesia and, depending on the location of the tumor, choose one of the following approaches:

Endooral, when access to the nasal cavity is through the mouth.
Endonasal - access is carried out through the nasal passages.
Transaxillary access, which requires endoscopic control.

During surgery, in some cases, when there is massive blood loss, a donor blood transfusion is performed. In the period after surgery, the following medications are prescribed:

Transfusion of solutions that improve blood rheology and replenish blood loss.
Antibiotic therapy (reduces the risk of infection).
Therapy aimed at increasing blood clotting.

To reduce the number of relapses, many ENT-oncologists advise taking a course of radiation therapy after surgery. In rare cases, the disease can develop into a malignant neoplasm, but in general the prognosis is favorable.

Juvenile angiofibroma of the nasopharynx

Risk factors and first manifestations of the disease

labored breathing;
deterioration of the sense of smell up to complete disappearance;
nasal voice;
hearing impairment.

The difficulty is that similar symptoms are observed with a common runny nose or adenoids. Therefore, not all parents sound the alarm when they discover such phenomena. However, the tumor grows rapidly, and as a result, the primary signs of angiofibroma are joined by others:

Forms of the disease and diagnosis

The clinical picture helps the doctor accurately determine the form of the disease. It appears differently, depending on the specifics of the pathology. If the basal layer is affected, the patient experiences the following symptoms:

he has difficulty breathing;
the nose does not smell;
the voice is nasal;
hearing loss;
inflamed sinuses;
seeing double;
eyeballs protrude.

During the diagnostic process, the doctor may use x-rays. This method allows you to see the tumor and estimate its size. Specialists also have computed tomography and angiography. A biopsy may be necessary, but this is not always done. The fact is that after such a procedure the risk of bleeding increases.

Therapy and prognosis

Surgical intervention

Possible complications

Unfortunately, this disease cannot be prevented. However, parents can stop the pathological process at an early stage. To do this, it is important to monitor the child’s health and, if you notice the first alarming symptoms, consult a doctor.

Angiofibroma: symptoms and treatment

Angiofibroma - main symptoms:

Headache
Nasal congestion
Hoarseness of voice
Nosebleeds
Hearing loss
Decreased vision
Difficulty in nasal breathing
New growths on the skin
The appearance of nodules on the skin
Nasal speech
Smell disorder
Facial swelling
Facial asymmetry
The difference between the color of the tumor and the color of the skin
Neoplasms on the oral mucosa
Neoplasms in the nose
Nodules in the mouth
Nodules on the face
Violation of sound pronunciation
Eyeball displacement

Angiofibroma is quite rare disease, characterized by the formation of a benign neoplasm, including blood vessels and connective tissue. Most often, the pathology affects the skin and nasopharynx, less often the base of the skull is affected. The exact reasons for the formation of the disease remain unknown today, however, clinicians have developed several theories regarding the possible mechanism of its occurrence.

The symptomatic picture will differ depending on the area in which such a neoplasm is localized. The main features are considered to be pain syndrome, facial deformation, the appearance of brown or yellowish nodules on the skin.

The correct diagnosis is made on the basis of data obtained during a thorough physical examination of the patient and a series of instrumental procedures. Laboratory studies in this case are of an auxiliary nature.

Treatment of the pathology is carried out only surgically and consists of excision of the tumor. In the vast majority of situations, the operation is performed using endoscopy. The prognosis of the disease is almost always positive.

Etiology

It is currently generally accepted that angiofibroma is a consequence of abnormal development of the fetus in the embryonic period, however, experts in the field of oncology have made several assumptions regarding the pathogenesis and reasons for the formation of such a neoplasm.

Thus, we distinguish:

genetic theory is considered the most common. This is due to the fact that all patients who are subsequently diagnosed with this condition have chromosomal abnormalities;
hormonal theory - the frequent diagnosis of such pathology in children during adolescence suggests that the most probable cause hormonal imbalance occurs;
age theory - some doctors argue that the risk of such a disease increases with age and directly depends on the natural aging process of the human body.

In addition, there are also assumptions about the impact of such predisposing factors:

a wide variety of injuries to the face, nose, and head;
chronic course inflammatory diseases of the larynx, for example, sinusitis;
addiction to bad habits;
living in poor environmental conditions.

The main risk group is males aged 9 to 18 years. It is for this reason that the disease is also called juvenile or juvenile angiofibroma. It is extremely rare for such a tumor to be found in people over 28 years of age.

Classification

Based on the location of the focus of the pathological process, there is:

angiofibroma of the skin - mainly found among mature patients;
angiofibroma of the face;
juvenile angiofibroma of the base of the skull – is a consequence of damage to the larynx;
formation in the kidneys - diagnosed in isolated cases;
juvenile angiofibroma of the nasopharynx - considered the most common type of pathology;
soft tissue education.

Depending on the clinical and anatomical features, it is customary to distinguish:

When the nasopharynx is affected by such a benign tumor, the disease goes through several stages of progression:

Stage 1 – the tumor does not extend beyond the nasal cavity;
Stage 2 – there is a proliferation of pathological tissues in the pterygopalatine fossa, as well as in some sinuses, in particular the maxillary, ethmoid and sphenoid;
Stage 3 – occurs in two versions. The first is the spread of the pathological process to the orbit and to the subtemporal region. The second is the involvement of the dura mater of the brain in the disease;
Stage 4 – also has two forms of occurrence. The first is damage to the dura mater, but without involving parts such as the cavernous sinus, pituitary gland and optic chiasm. The second is that the tumor spreads to all of the above areas.

Symptoms

As mentioned above, the clinical picture will completely depend on the localization of the focus of such a benign neoplasm in the larynx. It follows that the following symptoms are characteristic of skin lesions:

formation of a single convex node;
the formation may have a brown, yellow or pale pink tint;
dense consistency of the tumor;
bright manifestation of capillaries;
slight skin itching.

The most common places of localization are the upper and lower limbs, as well as the neck and face. This form of the disease is most typical for females aged 30 to 40 years.

Juvenile angiofibroma of the nasopharynx has the following clinical manifestations:

displacement of the eyeball;
decreased visual acuity;
chronic nasal congestion;
facial asymmetry;
frequent attacks of severe headaches;
weakened sense of smell;
nasal voice;
hemorrhages from the nasal cavity;
swelling of the face;
hearing impairment;
difficulty in nasal breathing.

Facial angiofibroma can be located in any part of the face. The main symptom is the sudden appearance of a small dense or elastic growth. When it is constantly injured, bleeding and a rapid increase in the size of the node are observed. Often neoplasms are found in the nose, in auricle or on eyelids.

A tumor at the base of the skull is the most severe form of the disease (since the tumor is prone to rapid growth), which affects boys and men aged 7 to 25 years. By clinical manifestations similar to lesions of the nose or larynx.

In case of soft tissues pathology is often localized to:

This form of the disease does not have specific symptoms.

the occurrence of the formation of an uneven structure located on the leg;
reddish or bluish tint of the tumor;
hoarseness of voice;
complete inability to pronounce sounds.

In cases of kidney damage, symptoms may be completely absent.

Diagnostics

The diagnosis in a child or adult is confirmed only after the patient undergoes a series of instrumental procedures.

However, the first stage of diagnosis includes:

studying the medical history - to search for a provoking factor;
collection and analysis of life history;
a thorough physical examination and palpation of the affected area of the skin;
assessment of hearing and visual acuity;
a detailed survey of the patient or his parents - to compile a complete symptomatic picture.

The instrumental procedures necessary to confirm the diagnosis are presented:

anterior and posterior rhinoscopy;
radiography;
ultrasonography;
CT and MRI;
fiberoscopy;
biopsy;
angiography.

TO laboratory research in this case include:

general clinical blood test;
hormonal tests;
blood biochemistry.

In addition to the otolaryngologist, the following also takes part in the diagnostic process:

Treatment

You can get rid of any type of disease only with the help of surgical intervention, which involves excision of the tumor. This can be done:

minimally invasive methods - used only when an illness occurs skin. For this purpose, laser radiation, cryodestruction, vaporization, coagulation are used;
endoscopically - through several small incisions;
cavity method - through one large incision.

After tumor removal, treatment must include:

Prevention and prognosis

Specific preventive measures There is no way to prevent the development of such a disease. This is explained by the fact that today the reasons for the formation of angiofibroma are not fully known.

However, you can reduce the likelihood of developing the disease by:

maintaining active and healthy image life;
proper and balanced nutrition;
avoiding nervous and physical fatigue, as well as any injuries;
spending enough time outdoors;
regular comprehensive preventive examination in the clinic with visits to all specialists.

The prognosis in the vast majority of cases is favorable - the danger of such a disease lies only in extensive bleeding, which can lead to anemia, as well as a tendency to frequent relapses. Fatal outcome not recorded.

If you think that you have Angiofibroma and the symptoms characteristic of this disease, then doctors can help you: a dermatologist, a therapist, a pediatrician.

We also suggest using our online disease diagnostic service, which selects probable diseases based on the entered symptoms.

Chronic rhinitis is a disease characterized by repeated manifestations of symptoms of acute rhinitis - difficulty inhaling air through the nose, copious discharge of varying consistency, decreased sense of smell.

Adenoids in children are an inflammatory process that occurs in the pharyngeal tonsils and is characterized by an increase in their size. This disease is typical only for children aged from one to fifteen years, the most frequent exacerbations occur between three and seven years. With age, such tonsils decrease in size and then completely atrophy. Manifests various forms and degrees depending on factors and pathogens.

Hypertrophic rhinitis is predominantly chronic inflammatory process affecting the nasal cavity. Against the background of such pathology, significant growth occurs connective tissue. Such a disorder has its own significance in international classification diseases of the tenth convocation - ICD 10 code - J31.0.

Sinusitis is a disease characterized by acute or chronic inflammation, concentrated in the area of the sinuses (paranasal sinuses), which, in fact, determines its name. Sinusitis, the symptoms of which we will consider below, mainly develops against the background of an ordinary viral or bacterial infection, as well as allergies and, in some cases, against the background of microplasma or fungal infection.

Nasal polyps are benign, round-shaped growths that are the result of hyperplasia of the nasal mucosa. Their sizes can vary from 1 to 4 cm. Medical statistics are such that nasal polyps are a common complication of chronic rhinitis. They are diagnosed in 1–4% of the population. Men suffer more often from the pathology. Polyps in a child’s nose (antrochoanal) are often diagnosed.

With help physical exercise and abstinence, most people can do without medicine.

Symptoms and treatment of human diseases

Reproduction of materials is possible only with the permission of the administration and indicating an active link to the source.

All information provided is subject to mandatory consultation with your attending physician!

Questions and suggestions:

Juvenile angiofibroma of the nasopharynx

Or: Juvenile angiofibroma

The disease is typical for males from puberty (from 10 years of age) to 21 years of age (according to some sources, up to 30 years of age).

This tumor is characterized high speed progression, has locally destructive (destroying surrounding tissues) growth, and a tendency to relapse. For this reason her clinical course regarded as malignant.

Symptoms of juvenile angiofibroma of the nasopharynx

Increasing difficulty in nasal breathing.
Hyposmia and anosmia (decrease and disappearance of the sense of smell).
Nasality.
Hearing loss in one or both ears.
Nosebleeds; As the disease progresses, their intensity and frequency increase.
Headache.
Deformation of the facial skeleton (in later stages leads to displacement of surrounding tissues).

If the tumor spreads to the eye area, visual impairment may occur (decreased visual acuity, exophthalmos (displacement of the eyeball forward (bulging eyes), sometimes with a shift to the side), limited mobility of the eyeballs, double vision (diplopia), etc.).

Forms

the tumor can begin to grow on the roof of the nasopharynx and grow from there into the base of the skull;
a tumor from the body of the sphenoid bone grows into the ethmoid labyrinth, sinuses, nasal cavity and orbit;
angiofibroma can also begin to grow in the area of the pterygopalatine fossa and grow into the nasal cavity.

The type of deformation of the surrounding tissue depends on the direction of growth of angiofibroma; for example, an angiofibroma growing in the direction of the orbit will cause displacement of the eyeball; its growth can also disrupt the blood supply to various parts of the brain and compress nerve formations.

basal-widespread: it is characterized by such clinical symptoms, such as difficulty in nasal breathing, anosmia (lack of recognition of odors), nasal sound, hearing impairment (decreased hearing in one, less often both ears), inflammation in the paranasal sinuses, signs of compression II and III branches trigeminal nerve, exophthalmos (bulging of the eye) and diplopia (double vision);
intracranial-extended: with it the picture is supplemented by signs of damage to the first branch of the trigeminal nerve, disc edema optic nerve, swelling of the cheek from the side of the tumor spread, damage to the II, III and VI pairs of cranial nerves - ptosis (drooping of the eyelid), swelling of the eyelid, decreased vision.

Classification by stages:

Stage I – the tumor is limited to the nasal cavity;
Stage II – tumor spread to the pterygopalatine fossa or maxillary, ethmoid or sphenoid sinuses;
Stage IIIa – tumor spread to the orbit or infratemporal fossa without intracranial growth;
stage IIIb – stage IIIa with extension from the outside of the dura mater;
Stage IVa - tumor spread under the dura mater without involving the cavernous sinus (large vein at the base of the brain), pituitary gland (coordinator of the activity of all endocrine glands of the body) and optic chiasm (area of intersection of the optic nerves);
Stage IVb – involvement of the cavernous sinus, pituitary gland or optic chiasm in the tumor process.

Causes

An ENT doctor (otolaryngologist) will help in treating the disease

Diagnostics

Analysis of complaints and medical history:
- progressive difficulty in nasal breathing;
- hyposmia and anosmia (decreased or complete absence sense of smell);
- nasality;
- hearing loss in one or both ears;
- nosebleeds;
- headache;
- visual disturbances (decreased visual acuity, bulging eyes, double vision, etc.).
Anterior and posterior rhinoscopy allow you to see a round, smooth or bumpy surface of the tumor of a bright red or bluish color; When palpated with a probe, the tumor begins to bleed.
X-ray (sometimes does not allow you to accurately determine the size of the tumor and the space it occupies).
Computed tomography is a more accurate method of determining the boundaries of the tumor and its size.
Nasal endoscopy or fiberoscopy. Endoscopy is performed after local anesthesia, which relieves the patient of discomfort during the procedure. The doctor inserts an endoscope into the nasal cavity through the nostril and examines the nasal cavity.
Taking a biopsy (of a tumor area for further histological examination) accompanied high risk development of bleeding, so it is not always used.
Angiography allows you to visualize the relationship of the tumor with the carotid artery system (important when planning surgical treatment).
A complete blood count will show anemia due to frequent nosebleeds.
A consultation with an oncologist is also possible.

Treatment of juvenile nasopharyngeal angiofibroma

operations using access to the tumor through natural routes (through the nose or mouth);
surgery using gentle access through the maxillary sinus and nasal cavity (with an incision under the lip);
surgery using expanded access through the maxillary sinus and nasal cavity (with a facial incision);
operation using access through the palate.

Before surgery, to reduce the risk of bleeding, it is advisable to perform embolization (artificial blockage) of tumor vessels.

Complications and consequences

The development of heavy, difficult to stop bleeding and irreversible neurological complications(for example, loss of visual fields) when the tumor grows into the cranial cavity.
Spread of tumor into the nasal cavity.
Anemia as a result of frequent heavy nosebleeds (a condition in which there is a low content of red blood cells in the bloodstream or an insufficient amount of hemoglobin in them).

Prevention of juvenile nasopharyngeal angiofibroma

Prevention of this disease does not exist.
When the first signs appear (increasing difficulty in nasal breathing, decreased sense of smell until it disappears completely, frequent nosebleeds) indicating the presence of this disease, you should immediately consult a doctor.

Additionally

Sources

"Pediatric otorhinolaryngology" M.R. Bogomilsky, V.R. Chistyakova; Moscow GEOTAR-MVD 2002

"Otorhinolaryngology" Guide for doctors V.T. Palchun, A.I. Kryukov; Moscow "Medicine" 2001

"Otorhinolaryngology: a national guide" edited by V.T. Palchuna GEOTAR-Media 2008

"The importance of angiography in diagnosis and surgical treatment patients with juvenile angiofibroma nasopharynx" R. M. Rzaev Bulletin of Otorhinolaryngology 2003

What to do with juvenile angiofibroma of the nasopharynx?

Choose a suitable ENT doctor (otolaryngologist)
Get tested
Get a treatment plan from your doctor
Follow all recommendations