OBJECTIVE/strong: To describe a case of juvenile angiofibroma with unusual protrusion out of the nasal cavity, and its management with surgery and radiotherapy.br /br /strongMETHODS:/strong br /strongDesign/strong: Case Report br /strongSetting/strong: Tertiary Public Referral Centre br /strongPatient/strong: Onebr /br /strongRESULTS/strong: A 17-year-old gentleman presented with a huge tumor protruding from his left nostril, diagnosed with juvenile angiofibroma stage IlIA by MRI and angiography. Following successful pre-operative embolization, the protruding mass was ligated and truncated, followed by surgical resection via external approach. Post-operative residual tumor was treated with adjuvant radiotherapy. There was no evidence of recurrence after nine months.br /br /strongCONCLUSION/strong: A high index of suspicion is of paramount importance in the diagnosis of JA and avoids the possibility of an unwarranted biopsy which could spell disaster. The most useful tools for diagnosis are MRI and arterial angiography. Treatment is primarily surgical. Irradiation therapy has been reported to achieve satisfactory outcomes, especially for unresectable residual disease and/or intracranial extension, where total surgical resection is unlikely to be attained without unacceptable morbidity./p
Human ; Male ; Adolescent ; Angiofibroma-diagnosis, radiotherapy, surgery ; Nasopharyngeal Neoplasms ; neoplasms ; Magnetic Resonance Imaging ; Nasal Cavity ; nose

Radiosurgery has been rarely applied for juvenile nasopharyngeal angiofibroma (JNA) and cumulative reports are lacking. The authors report a case of successful treatment of recurred JNA with gamma knife surgery (GKS). A 48-yr-old man was presented with right visual acuity deterioration and brain magnetic resonance images (MRI) disclosed a 3 cm-sized intraorbital mass in the right orbit. He underwent a right fronto-temporal craniotomy and the mass was subtotally removed to preserve visual function. Histological diagnosis confirmed JNA in typical nature. However, the vision gradually worsened to fail four years after operation. MRI then showed regrowth of the tumor occupying most of the right orbit. GKS was done for the re-curred lesion. A dose of 17 Gy was delivered to the 50% isodose line of tumor mar-gin. During the following four-year follow-up period, the mass disappeared almost completely without any complications. Usually JNA can be exclusively diagnosed by radiological study alone. So this report of successful treatment of JNA with GKS may provide an important clue for the novel indication of GKS.
Visual Acuity ; Treatment Outcome ; Radiosurgery/*methods ; Neoplasm Recurrence, Local ; Nasopharyngeal Neoplasms/diagnosis/*surgery ; Middle Aged ; Male ; Magnetic Resonance Imaging ; Humans ; Brain/radiography ; Angiofibroma/diagnosis/*surgery ; Adolescent

OBJECTIVE: Analyzing the prognostic factors in endoscopic surgery of juvenile nasopharyngeal angiofibromas (JNA). METHOD: Forty-seven records of JNA, treated with the endoscopic, from 2002 to 2008 were reviewed retrospectively. Previous surgery in other hospitals, sites involved, whether selective embolization was performed before surgery, feeding vessels, operative techniques and follow-up results were recorded. Evaluated factors include previous surgery for resection of JNA, vascular supply from carotid artery, surgery after selective embolization, involvement of cavernous bone in the root of pterygoid process, greater wing of sphenoid bone, interpterygoid fossa, infratemporal fossa and orbit. Chi-square test was used. RESULT: Operations were done under general anesthesia. The follow-up time was 12 to 87 month (median 35 month). During follow up, six patients presented recurrent lesions. Chi-square test showed that deep invasion of the cavernous bone in the root of pterygoid process was related to recurrence (P<0.05). There was no statistically significant difference between other factors and recurrence. Imaging examination showed that recurrent tumor was around the root of pterygoid process. CONCLUSION Deep invasion of the cavernous bone in the root of pterygoid process which was related to recurrence deserve close attention before and after endoscopic surgery.
Adolescent ; Adult ; Angiofibroma ; diagnosis ; pathology ; surgery ; Child ; Endoscopy ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnosis ; pathology ; surgery ; Prognosis ; Recurrence ; Retrospective Studies ; Treatment Outcome ; Young Adult

Angiofibroma ; metabolism ; pathology ; surgery ; Angiomyoma ; metabolism ; pathology ; Antigens, CD34 ; metabolism ; Diagnosis, Differential ; Female ; Fibroma ; metabolism ; pathology ; Follow-Up Studies ; Humans ; Leiomyoma ; metabolism ; pathology ; Middle Aged ; Mucin-1 ; metabolism ; Myxoma ; metabolism ; pathology ; Vimentin ; metabolism ; Vulvar Neoplasms ; metabolism ; pathology ; surgery