Fibroma

Extranasopharyngeal angiofibroma originating in the inferior turbinate

September 18, 2013     Jae Hoon Lee, MD; Ha Min Jeong, MD
article

An extranasopharyngeal angiofibroma should be differentiated from other vascular tumors, particularly a hemangioma.

Management of pterygoid venous plexus hemorrhage during resection of a large juvenile nasopharyngeal angiofibroma: A review of 27 cases

April 17, 2013     Lin Chang, MD; Yi Zixiang, MD; Fang Zheming, MD; Lin Gongbiao, MD; Li Zhichun, MD; Zhang Rong, MD; Zhou Aidong, MD; Lan Shuzhan, MD
article

Abstract

We retrospectively reviewed the cases of 27 patients who experienced intraoperative bleeding during resection of a large (Fisch type III or IV) juvenile nasopharyngeal angiofibroma (JNA). Of this group, 16 patients had a type III JNA and 11 had a type IV tumor. The degree of hemorrhaging during excision of these JNAs varied greatly among individual patients. The amount of blood lost ranged from 200 to 5,000 ml (mean: 1,800) in the type III cases and from 700 to 8,000 ml (mean: 2,850) in the type IV cases. In 5 of these cases, both intraoperative observations and imaging data suggested that an important factor in the blood loss was damage to the pterygoid venous plexus (PVP). The PVP communicates with the cavernous sinus, ophthalmic vein, maxillary vein, and facial vein; no valve exists between these veins. In patients with a large JNA, the PVP is usually compressed by or adherent to the tumor. When a PVP is seriously damaged during removal of a JNA, hemorrhaging can be very profuse. Therefore, a suitable surgical approach and appropriate hemostatic procedures should be used to prevent or manage PVP hemorrhage as effectively as possible. We also describe in greater detail 5 typical cases of JNA excision that did (n = 3) and did not (n = 2) involve PVP damage.

Chondromyxoid fibroma of the mastoid portion of the temporal bone: MRI and PET/CT findings and their correlation with histology

April 17, 2013     Noeun Oh, MD; Azita S. Khorsandi, MD; Sophie Scherl, BA; Beverly Wang, MD; Bruce M. Wenig, MD; Spiros Manolidis, MD; Adam Jacobson, MD
article

Abstract

We report a very rare case of a chondromyxoid fibroma of the mastoid portion of the temporal bone in a 38-year-old woman who presented with left-sided hearing loss. Magnetic resonance imaging identified an expansile mass in the left mastoid bone with a heterogeneous hyperintense signal on T2-weighted imaging and peripheral enhancement. Subsequent positron emission tomography/computed tomography identified erosive bony changes associated with hypermetabolism. The patient underwent an infratemporal fossa resection with a suboccipital craniectomy/cranioplasty. We briefly review the aspects of this case, including a discussion of the differential diagnosis and the correlation between histologic and imaging findings.

Endoscopic Coblation for the treatment of advanced juvenile nasopharyngeal angiofibroma

October 4, 2012     Brandon Pierson, MD; Rosser Powitzky, MD; G. Paul Digoy, MD, FAAP
article

Abstract

We present 2 cases of advanced juvenile nasopharyngeal angiofibroma (JNA) to illustrate the advantages of endoscopic Coblation-assisted resection of intranasal extensions of these masses. Both patients—an 11-year-old boy and a 14-year-old boy—presented with a large, extensive mass (Radkowski stage IIIb and Fisch stage IVb in both cases). After embolization was performed on each patient, his JNA was partially ablated via an endoscopic approach with the Coblator II Surgery System with an EVac Xtra Plasma Wand in conjunction with an image-guided navigation system. Both patients experienced resolution of their nasal obstruction with removal of the intranasal extension of the tumor. Coblation allowed for a controlled debulking of the tumors with less blood loss and without the need for multiple instruments. To the best of our knowledge, our report is one of the first to describe image-guided endoscopic Coblation of advanced JNA tumors. Future studies in adequately sized populations are needed to determine the safety and effectiveness of Coblation-assisted endoscopic removal of both advanced and lower-stage JNAs.

Myofibroma of the zygomatic bone in an older child: A case report

July 13, 2011     Engin Acıoğlu, MD, Gül Özbilen Acar, MD, Yalçın Alimoğlu, MD, Harun Cansız, MD, and Sergülen Dervişoğlu, MD
article

Abstract

Myofibroma/myofibromatosis is a rare mesenchymal disorder that is part of a heterogeneous group of approximately 20 disorders that are classified primarily according to the proliferation of benign fibrous elements. These lesions can arise during a wide range of ages, with many occurring in the first decade of life, and they are slightly more common in males than females. The etiology of this disease is not well understood. Clinically, patients with myofibroma/myofibromatosis present with various signs, ranging from superficial, cutaneous, purplish macules to freely movable subcutaneous masses to deep-seated fixed lesions. The definitive diagnosis is made on histopathologic grounds. The destructive clinical behavior of myofibroma/myofibromatosis in the setting of insufficient pre- or perioperative diagnostic evaluations (e.g., a failure to perform fine-needle aspiration or frozen-section biopsy) may guide the clinician toward a radical surgical procedure rather than a simple excision.

Odontogenic fibroma

April 30, 2010     Monica Hollowell, MD, David Gang, MD, and Liron Pantanowitz, MD
article

Successful elective surgery in a patient with a positive preoperative cocaine toxicology screen

February 1, 2010     Robert L. Witt, MD and Patrick Wilson, MD
article

Abstract

A positive result on preoperative cocaine toxicology screening has traditionally been a contraindication to immediate nonemergency surgery. We describe a case of major but not emergency head and neck surgery on a patient with a massive ossifying fibroma whose preoperative toxicology screen was positive for cocaine. The surgery was completed without complication, and the patient recovered uneventfully. The decision to proceed with surgery was based on the fact that the results of urine cocaine screening can remain positive long after the cocaine itself has become metabolically inactive, and thus the results may not reflect the actual presence of cocaine or the degree of current intoxication. Our institution has concluded that elective head and neck surgery may be safely performed in carefully selected, hemodynamically stable patients who have tested positive for cocaine ingestion provided that they have been closely observed for 8 hours preoperatively and that they have provided informed consent. Outcome studies are needed.

Extranasopharyngeal angiofibroma of the nasal septum: A case report

October 31, 2009     Satyawati Mohindra, MS, DNB, Gogia Grover, MS, and Amanjit Kaur Bal, MD, DNB
article

Abstract

Angiofibroma arising outside the nasopharynx is unusual. The nasal septum is an extremely rare site for the origin of angiofibroma, and to date only 6 such cases previously have been reported in the literature. We report here a case of a 22-year-old man with a vascular mass arising from his nasal septum. The histopathology report was consistent with angiofibroma. We also review other cases in the literature of angiofibroma arising from the nasal septum and discuss a theory of the likely origin of angiofibroma.

Aggressive fibromatosis of the oropharynx: A multidisciplinary approach to a benign disease

April 30, 2009     Eleftheria Kiverniti, MRCSEd, DO-HNS, Ulkem Cilasun, DDS, PhD, Arvind Singh, BSc, MRCS, DLO, Rehan Kazi, MS, Peter M. Clarke, BSc, FRCS, and Daniel J. Archer, FDSRCS, FRCS
article

Abstract

We present the case of a 23-year-old woman with aggressive fibromatosis of the oropharynx that was initially treated elsewhere as a peritonsillar abscess. We discuss the characteristics of this rare tumor and review the literature, stressing the importance of postoperative follow-up for peritonsillar abscesses to avoid missing other important diagnoses, such as the one described here.

Recurrent infantile myofibromatosis: A report of conservative management and discussion of treatment strategies

December 1, 2008     Charles S. Ebert Jr., MD, MPH, Carlton Zdanski, MD, Farhad Ardeshirpour, MD, Mihir Patel, MD, Craig F. Hart, MD, and Amelia F. Drake, MD
article

Abstract

Infantile myofibromatosis is a rare proliferative mesenchymal disorder that has a potential for rapid growth and recurrence. Approximately 30% of infantile myofibromatosis lesions present in the head and neck, and some of these can cause significant morbidity. We report a case of recurrent infantile myofibromatosis that persisted after surgery and chemotherapy and was managed conservatively. Treatment of infantile myofibromatosis varies according to the size, location, and extent of disease. Solitary lesions may be simply observed in view of their potential for regression, but surgical excision, radiotherapy, and/or chemotherapy should be considered on a case-by-case basis, especially for nonresectable, rapidly progressive, or symptomatic lesions.

Juvenile nasopharyngeal angiofibroma: Spontaneous resolution

August 31, 2008     Patrick M. Spielmann, MRCSEd, Richard Adamson, FRCS, Kenneth Cheng, MRCS, and Robert J. Sanderson, FRCS†
article

Abstract

Juvenile nasopharyngeal angiofibroma is a rare, benign tumor that occurs most often in adolescent males. Common practice is to excise the tumor with open or endoscopic surgery. We report the case of a 17-year-old male who presented in 1995 with a mass filling the left posterior nasal cavity. A diagnosis of juvenile nasopharyngeal angiofibroma was obtained with computed tomography and magnetic resonance imaging. The patient elected to have no treatment. On annual scans, the lesion changed little until 1998, when it began to gradually decrease in size. Although it is not well proven, the natural history of these tumors seems to be regression over time. This case supports the argument that a policy of watchful waiting with regular imaging studies may postpone or eliminate the need for surgery and its attendant risks.

Nasopharyngeal angiofibroma

April 30, 2008     Ryan Kau, BS, Mala Tanna, BA, Sasmita Misra, MD, and Alejandro Luina Contreras, MD
article
Page
of 2Next