Nasopharyngeal angiofibroma: Rare presentations

December 1, 2008     Ramanuj Sinha, MS (ENT), DNB (ENT), Saumik Das, MS (ENT), DNB (ENT), Sanjay Ray, MBBS, Pranabashish Banerjee, MBBS, and Partha Sadhu, MS (ENT)


Nasopharyngeal angiofibromas are benign tumors of the nasopharynx that occur in adolescent boys. The extensive extensions and various clinical presentations of the tumor have been well documented in the literature. Very rarely, these tumors may extend outside the nasal cavity as a large polypoid mass. Two interesting cases of angiofibroma with atypical presentations, showing extensive spread in multiple directions, are reported here. In one case, the angiofibroma exited the right nostril as a large polypoidal mass and also presented as an intraoral tumor in the right upper gingivo-alveolar region. In the other case, in addition to polypoidal presentation through the anterior nares, the tumor produced severe respiratory obstruction resulting from extensive bulging of the soft palate.

Small-cell neuroendocrine carcinoma originating from the lateral nasopharyngeal wall

October 31, 2008     Shetty Deviprasad, MS (ENT), DLO, Aroor Rajeshwari, MS (ENT), Mohammed Tahir, MS (ENT), T.V. Adarsha, DLO, DNB (ENT), and Somayaji Gangadhara, MS (ENT)


A 40-year-old man presented with right-sided nasal blockage and epistaxis of 18 months' duration. Examination revealed a pinkish mass in the right nasal cavity and nasopharynx. Initial biopsy was suggestive of angiofibroma. Complete excision through a lateral rhinotomy approach was performed. The postoperative histopathologic report was suggestive of sinonasal neuroendocrine carcinoma, which was confirmed by immunohistochemistry. To the best of our knowledge, this is the first reported case of sinonasal neuroendocrine carcinoma arising from the lateral wall of the nasopharynx in the English literature. We describe its clinical presentation and management and provide a brief review of the literature.

Juvenile nasopharyngeal angiofibroma: Spontaneous resolution

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


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.

Ectopic nasopharyngeal pituitary adenoma resected with endoscopic technique

June 30, 2008     Alan A.Z. Alexander, MD, Nikta Niktash, MD, David E. Kardon, MD, and Nader Sadeghi, MD


We describe the case of an 80-year-old man with diabetes who presented with nonspecific dizziness. He was found on magnetic resonance imaging to have a 3.2-cm mass within the posterior and central aspect of the nasopharynx. Nasal endoscopy showed that the mass, which arose from the posterior edge of the nasal septum and was attached to the superior nasopharynx, was narrowing the patient's airway. Although initially the mass was suspected to be a minor salivary gland tumor, histopathologic analysis led to a diagnosis of pituitary adenoma. The ectopic tumor was removed via transnasal en bloc resection with partial adjacent septal resection. Final pathology confirmed the diagnosis. The patient had an uneventful recovery and no sequellae at 2-year follow-up.

Nasopharyngeal angiofibroma

April 30, 2008     Ryan Kau, BS, Mala Tanna, BA, Sasmita Misra, MD, and Alejandro Luina Contreras, MD

Endoscopic view of obstructing nasopharyngeal cysts (Tornwaldt's cysts)

September 30, 2007     Dewey A. Christmas Jr., MD; Eiji Yanagisawa, MD, FACS; Joseph P. Mirante, MD, FACS

A 66-year-old man was referred to us for evaluation of unusual masses of the nasopharynx, which had been found on magnetic resonance imaging (MRI) as part of a workup for constant nasal congestion and recurring headaches.

Endoscopic view of a nasopharyngeal tumor

June 30, 2007     Dewey A. Christmas Jr., MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

A 75-year-old man presented with left nasal congestion and severe left ear pain. His symptoms had persisted for a few weeks despite treatment with several medications prescribed by his primary care physician. The patient's history included successful radiation therapy for right maxillary sinus cancer 7 years earlier.


Tornwaldt's cyst: Incidence and a case report

January 1, 2007     Marcus W. Moody, MD; David H. Chi, MD; John C. Mason, MD; C. Douglas Phillips, MD; Charles W. Gross, MD; Rodney J. Schlosser, MD

The prevalence of colonization with drug-resistant pneumococci among adult workers in children's daycare

January 1, 2007     Frederick S. Rosen, MD; Matthew W. Ryan, MD

Endoscopic view of a hypermobile tongue in the nasopharynx

August 31, 2006     Adam J. LeVay, MD; Eiji Yanagisawa, MD

An unusual cause of nasal obstruction: A hair clip in the nasopharynx

April 1, 2006     Sandeep Berry, MRCS; Huey Tay, FRCS

Review of nasopharyngeal carcinoma

March 1, 2006     Anita Jeyakumar, MD; Todd M. Brickman, MD; Alwin Jeyakumar, MD; Timothy Doerr, MD
We review the literature on nasopharyngeal carcinoma that has been published within the past 5 years. Nasopharyngeal carcinoma is a highly morbid disease, and survival is poor. Its management remains extremely difficult, not just for otolaryngologists but for radiation oncologists and medical oncologists, as well. A clear understanding of its etiology is still lacking, but nasopharyngeal carcinoma is widely suspected to be the result of both a genetic susceptibility and exposure to environmental factors or Epstein-Barr virus infection. With no clear cause, treatment is controversial. For example, an optimal radiation regimen has not been determined, reports in the literature regarding the role of chemotherapy for advanced disease are conflicting, and treatment of local recurrences is unsettled. Still, advances in immunologic research and chemotherapy offer hope for better control of the disease. We hope that our assessment of the recent literature will provide otolaryngologists with a more clear understanding of the etiology and management of nasopharyngeal carcinoma.
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