Nasopharyngeal Angiofibroma, an Angiographic Evaluation

Nasopharyngeal angiofibroma is a relatively uncommon tumor of adolescence which is usually manifested by massive nosebleeds and nasal obstruction. In addition to its usefulness in the diagnosis of this entity, arteriography also has therapeutic implications. From a series of 5 cases studied arteriographically, 2 will be reported in some detail to illustrate these points. Some synonyms for this tumor include myxofibroma, juvenile basal fibroma, fibroid of the nasopharynx, and juvenile angiofibroma (7, 12). The roentgen findings in routine films consist of a soft-tissue mass in the nasopharynx with expansion into adjacent bony cavities. Anterior bowing of the posterior wall of the maxillary sinus, when present, is almost pathognomonic of the tumor (S). To the authors' knowledge, only a single report by Thibaut (11) (in French) is concerned with selective internal and external carotid angiography. Characteristics Nasopharyngeal angiofibroma makes up about 0.1 per cent of the cases admitted to an active head and neck service (9), although it is the most common benign tumor of the nasopharynx (7). Typically, the tumor has its onset in childhood, the ages of the patients ranging from seven to nineteen years, although cases in patients up to fifty years of age (6) have been reported. The histological appearance is composed of a vascular network with a connective-tissue matrix (10). Harma (7) believes this condition represents a hyperplastic fibroangiomatous tissue reaction regulated by hormonal factors. Malignant transformation is not commonly associated with this tumor; however, cases of sarcomatous change have been reported (1, 3). This course of events is somewhat clouded by extensive radiation therapy given to areas of recurrence. Case Histories Case I: R. F., a 12-year-old boy, was in good health until about five weeks prior to admission when a massive nosebleed occurred. Examination of the nasopharynx revealed a large reddish mass filling the entire nasopharynx, and no attempt was made to biopsy or remove it. The tumor was estimated to be 3 to 4 cm in diameter. The remainder of the examination was within normal limits. Sinus series and contrast study of the nasopharynx confirmed that the soft-tissue mass extended from the soft palate to the nasal concha. Under local anesthesia bilateral selective internal and external carotid angiographic examinations were performed. By gross visual evaluation of the area of tumor stain on the angiograms, it could be estimated that the vascular contributions to the right external, left external, and right internal carotid arteries were 60 per cent, 20 per cent, and 20 per cent, respectively. The left internal carotid was normal (Fig. 1). At surgery the base of a 4 × 4 cm vascular peduncular tumor, which was exposed, was attached to the roof of the nasopharynx. A cryoprobe was placed at the base of the mass, and the entire tumor was frozen solid and then sheared off at its base.