Nasopharyngeal

Angiofibroma:
Juvenile Nasopharyngeal Angiofibroma
(JNA)
highly vascular benign yet
unencapsulated tumor of adolescent
males.

Frequency: JNA accounts for 0.05% of all

head and neck tumors.

Sex: JNA occurs exclusively in males.

Age: range is 7-19 years. JNA is rare in

patients older than 25 years

Etiology: A hormonal theory has been

suggested due to the lesion's occurrence in
adolescent males.

Pathophysiology:
The tumor starts adjacent to the
sphenopalatine foramen. Large tumors
frequently are bilobed or dumbbell-shaped,
with one portion of the tumor filling the
nasopharynx and the other portion
extending to the pterygopalatine fossa.

Clinical: Symptoms:
Nasal obstruction (80-90%):
Epistaxis (45-60%):
Headache (25%):
Facial swelling (10-18%)
Other symptoms include unilateral
rhinorrhea, anosmia, hyposmia, rhinolalia,
deafness, otalgia, swelling of the palate, and
deformity of the cheek.

Signs:

Nasal mass (80%)

Orbital mass (15%)

Proptosis (10-15%)

Other signs may include

-Serous otitis due to eustachian tube blockage.
-Zygomatic swelling and trismus denote spread of the tumor to
the infratemporal fossa.

Differentials:

Other causes of nasal obstruction, (eg, nasal

polyps, antrochoanal polyp, teratoma,
encephalocele, dermoids, inverting papilloma,
rhabdomyosarcoma, squamous cell carcinoma)

Other causes of epistaxis, systemic or local

Other causes of proptosis or orbital swelling

CT scan

Medical therapy:

Surgical therapy
Hormonal therapy
Radiotherapy
Biopsy is prohibited because of severe bleeding

Nasopharyngeal malignancies
Nasopharyngeal carcinoma (NPC)
Lymphoma
Salivary gland tumors
Sarcomas

Nasopharyngeal
Carcinoma
More common in Asia

Anatomy

Anteriorly -- nasal cavity

Posteriorly -- skull base and vertebral
bodies
Inferiorly -- oropharynx and soft palate
Laterally - Eustachian tubes and tori
Fossa of Rosenmuller - most common location

Anatomy

Close association with skull base foramen

Mucosa
Epithelium - tissue of origin of NPC
Stratified squamous epithelium
Pseudostratified columnar epithelium

Salivary, Lymphoid structures

Epidemiology

Chinese native (
> Chinese immigrant > North American
nativeBoth genetic and environmental
factors
Genetic
HLA histocompatibility loci possible markers

Epidemiology

Environmental
Viruses
EBV- well documented viral fingerprints in tumor
cells and also anti-EBV serologies with WHO
type II and III NPC
HPV - possible factor in WHO type I lesions

Nitrosamines - salted fish

Others - chronic nasal infection, poor hygiene, poor
ventilation

Clinical Presentation

Often subtle initial symptoms

1. unilateral HL (SOM)
2. epistaxis
3. painless, slowly enlarging neck mass
Larger lesions
4. nasal obstruction
5. cranial nerve involvement

Clinical Presentation

Xerophthalmia - greater sup. petrosal n

Facial pain - Trigeminal n.
Diplopia - CN VI
Ophthalmoplegia - CN III, IV, and VI
cavernous sinus or superior orbital fissure

Horners syndrome - cervical sympathetics

CNs IX, X, XI, XII - extensive skull base

Clinical Presentation

Nasopharyngeal examination
Fossa of Rosenmuller most common location

Regional spread
Usually ipsilateral first but bilateral not
uncommon

Distant spread - rare (<3%), lungs, liver,

bones

Radiological evaluation

Contrast CT with bone and soft tissue

windows
imaging tool of choice for NPC

MRI
soft tissue involvement, recurrences

Chest CT, bone scans

TNM classification
Class 0: Tis N0 M0
Class I: T1 N0 M0
Class II A: T2a N0 M0
Class II B: T1 N1 M0 ; T2a N1 M0 ;
T2b N0, N1 M0
Class III: T1 N2 M0 ; T2a, T2b N1 M0 ;
T3 N0, N1, N2 M0

Class IV A: T4 N0, N1, N2 M0

Class IV B: any T N3 M0
Class IV C: any T any N M1

Treatment

External beam radiation

Dose: 6500-7000 cGy

Adjuvant brachytherapy
mainly for residual/recurrent disease

Treatment
Surgical management

Mainly diagnostic - Biopsy

Surgical treatment
primary lesion
regional failure with local control

Treatment
Surgical management

Primary lesion
consider for residual or recurrent disease
approaches

infratemporal fossa
transparotid temporal bone approach
transmaxillary
transmandibular
transpalatal

Treatment
Surgical management

Regional disease
Neck dissection may offer improved survival
compared to repeat radiation of the neck

Treatment

Chemotherapy

Immunotherapy

Congenital tonsillar masses

Teratoma
Hemangioma
Lymphangioma
Cystic hygroma

Treatment:
Laser therapy
Surgery

Malignant Neoplasms

Most common is lymphoma

Non-Hodgkins lymphoma
Rapid unilateral tonsillar enlargement
associated with cervical lymphadenopathy
and systemic symptoms

Treatment

Radiotherapy and chemical therapy