Parapharyngeal Space Angiofibroma: A Diagnostic Surprise

Document Type : Case Report

Authors

1 Department of Otolaryngology and Head and Neck Surgery, PGIMER, Chandigarh, India.

2 Department of Histopathology, PGIMER, Chandigarh, India.

Abstract

Introduction:
Angiofibromas classically develop in the lateral wall of the nasopharynx from the sphenopalatine region. Extra-nasopharyngeal angiofibromas are rare entities, with the maxillary sinus being the most common site. Parapharyngeal angiofibroma is an extremely rare entity, being seldom reported in English literature.
 
Case Report:
We present a case of parapharyngeal angiofibroma, which came as a diagnostic surprise in a young adult 25-year-old male. The radiological picture showed a highly vascular lesion, which did draw our attention for not going for a direct or guided FNAC, and upfront excision was planned through the transcervical route.  A firm 5 * 7 cm mass was excised and sent for histopathologic examination. The histopathology showed angiofibroma like features as a diagnostic surprise as angiofibroma of parapharyngeal space is a known but rare entity.
 
Conclusion:   
The knowledge of angiofibroma as a differential in parapharyngeal space will help the clinicians to properly deal with these disorders during preoperative evaluation and definitive surgery and thus prevent the chances of vascular injuries and complications associated with an FNAC.  A high level of suspicion regarding this differential as a possible lesion in the parapharynx is required for the entity's diagnosis.

Keywords

References

                Mohindra S, Grover G, Bal AK. Extranasopharyngeal angiofibroma of the nasal septum: a case report. Ear, nose, & throat journal. 2009; 88(11):E17-19.
2.             Mutlu V. Angiofibroma from the tail of the inferior turbinate. The Eurasian journal of medicine. 2015;47(1):66-68.
3.             Handa KK, Kumar A, Singh MK, Chhabra AH. Extranasopharyngeal angiofibroma arising from the nasal septum. International journal of pediatric otorhinolaryngology. 2001; 58(2):163-166.
4.             Bhagat S, Verma RK, Panda NK. Extranasopharyneal angiofibroma in an adult: a rare presentation. Indian journal of otolaryngology and head and neck surgery.  2011; 63(Suppl 1):25-26.
5.             Windfuhr JP, Remmert S. Extranasopharyngeal angiofibroma: etiology, incidence and management. Acta oto-laryngologica. 2004;124(8):880-889.
6.             Lee BH. Parapharyngeal Angiofibroma: A Case Report. Iranian journal of radiology. 2015; 12(3):e 17353.
7.             Panesar J, Vadgama B, Rogers G, Ramsay AD, Hartley BJ. Juvenile angiofibroma of the maxillary sinus. Rhinology. 2004;42(3): 171-174.
8.             Hsieh ST, Guo YC, Tsai TL, Chen WY, Huang JL. Angiofibroma of the hypopharynx. Journal of the Chinese Medical Association. 2004;67(7):373-5.
9.             Renukananda GS, Basavaraja PK, Naik AS, Maheshwari M, Balaji NK, Thangavelu G. Atypical angiofibroma of larynx - a case report. Indian journal of otolaryngology and head and neck surgery. 2008; 60(1):51-52.
10.          Huang RY, Damrose EJ, Blackwell KE, Cohen AN, Calcaterra TC. Extranasopharyngeal angiofibroma. International journal of pediatric otorhinolaryngology. 2000;56(1):59-64.
11.          Johnson JE, Yang PJ, Koopmann CF, Jr, Heffner DK. Parapharyngeal angiofibroma.  American journal of neuroradiology.1987; 8(6): 1152-1153.
12.          Gonzalez-Perez LM, Sanchez-Gallego F, Haro-Luna JJ, Infante-Cossio P. Giant cell angiofibroma of parapharyngeal space: a report of a new location for a rare tumour. International journal of oral and maxillofacial surgery. 2010; 39(10):1024-1027.
13.          Li W, Ni Y, Lu H, Hu L, Wang D. Current perspectives on the origin theory of juvenile nasopharyngeal angiofibroma. Discovery medicine. 2019;27(150):245-254.
14.          Schlauder SM, Knapp C, Steffensen TS, Bui MM. Aromatase may play a critical role in the pathogenesis of juvenile nasopharyngeal angiofibroma. Fetal and pediatric pathology. 2009; 28(5):232-238.
15.          Schiff M. Juvenile nasopharyngeal angiofibroma. a theory of pathogenesis. Laryngoscope. 1959;69:981-1016.
16.          Starlinger V, Wendler O, Gramann M, Schick B. Laminin expression in juvenile angiofibroma indicates vessel's early developmental stage. Acta oto-laryngologica. 2007; 127(12): 1310-5.
17.          Renkonen S, Hayry V, Heikkila P, Leivo I, Haglund C, Mäkitie AA, et al. Stem cell-related proteins C-KIT, C-MYC and BMI-1 in juvenile nasopharyngeal angiofibroma--do they have a role? Virchows Archiv.2011;458(2):189-195.
18.          Doody J, Adil EA, Trenor CC, Cunningham MJ. The Genetic and Molecular Determinants of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review. The Annals of otology, rhinology, and laryngology. 2019; 128(11):1061-72.
 
Iranian Journal of Otorhinolaryngology
Volume 33, Issue 2
March and April 2021
Pages 107-111

Files

Share

How to cite

Statistics