RESUMO
Juvenile nasopharyngeal angiofibroma (JNA) is a rare histologically benign tumor, highly vascularized, with usually aggressive behavior, and can extend from the nasal cavity to neighboring structures. We present the case of a 14-year-old male harboring a JNA, presenting with an active severe and persistent epistaxis. Two previous surgical attempts of removal were unsuccessful, because of profuse intraoperative bleeding. Angiography showed a highly vascularized neoplasm with multiple branches arising from both internal carotid arteries, with absence of branches from the external carotid due to previous surgical ligation. Direct puncture tumor embolization was not possible because removal of nasal packing triggered major hemorrhage. The only option for embolization was a technique of non-superselective embolization with particles under transient occlusion of the internal carotid artery. The procedure was performed uneventfully from either side, the tumor was subsequently removed, and the patient had no recurrence 2 years after the initial treatment.
Assuntos
Angiofibroma/terapia , Oclusão com Balão , Perda Sanguínea Cirúrgica/prevenção & controle , Artéria Carótida Interna , Embolização Terapêutica/métodos , Neoplasias Nasofaríngeas/terapia , Hemorragia Pós-Operatória/prevenção & controle , Adolescente , Angiofibroma/irrigação sanguínea , Angiofibroma/complicações , Angiofibroma/diagnóstico , Angiofibroma/cirurgia , Angiografia Digital , Epistaxe/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Nasofaríngeas/irrigação sanguínea , Neoplasias Nasofaríngeas/complicações , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/cirurgia , Hemorragia Pós-Operatória/etiologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Nasopharyngeal angiofibroma (NA) is a rare vascular benign nonencapsulated neoplasm, characterized by local aggressiveness and destructive potential, typically diagnosed in adolescent males. We report a case of NA affecting a 15-year-old male that presented with a persistent nasal obstruction and epistaxis with 1 year of evolution. Clinical and radiological patterns pointed out a differential diagnosis of NA. Arteriography demonstrates the vascular support of the tumor and evinces the embolization of the internal maxillary artery. The surgical approach was procedure by Le Fort I osteotomy exposing the tumor and promoting easy access for posterior removal. The surgery was carried out without hemorrhagic problems. The maxilla was fixed in the original position with 4 L-shape plaques. Histopathological findings supported the diagnosis of NA. The patient presented after 8 months of postoperative follow-up, without clinical signs of recurrence or residual tumor and without palatal or maxillary teeth paresthesia.
Assuntos
Angiofibroma/cirurgia , Neoplasias Nasofaríngeas/cirurgia , Osteotomia de Le Fort/métodos , Adolescente , Angiofibroma/irrigação sanguínea , Artéria Carótida Externa , Embolização Terapêutica/métodos , Humanos , Masculino , Artéria Maxilar , Neoplasias Nasofaríngeas/irrigação sanguíneaRESUMO
OBJECTIVES: Juvenile nasopharyngeal angiofibroma is a rare benign tumor that affects young male patients and shows a characteristic development from its origin. It is not a true neoplasm, but shows features of vascular processes, developing into a more fibrous condition. The aim of this study was to correlate the clinical manifestations and the histologic findings of the tumor. METHODS: Thirty-six patients without previous treatment were studied. We correlated the incidence and duration of the clinical manifestations (nasal obstruction, epistaxis, nasal and/or pharyngeal tumor, and facial deformity) and morphometric histologic analyses of the central region of the tumor (number, caliber, and presence of muscle cells in the vessel wall, and tissue maturity and cellularity). RESULTS: The duration of nasal obstruction, the presence of nasal and/or pharyngeal tumor, and facial deformity were significantly correlated with the number of vessels, the tissue maturation, and the cellularity of the tumor. Epistaxis showed a strong correlation with the presence of muscle fibers in the vessels. CONCLUSIONS: There are correlations between the duration of the clinical manifestations and histologic maturation in the central portion of the tumor.