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Remaining Controversies

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Juvenile Angiofibroma

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Abstract

Juvenile angiofibroma (JA), rarely, can undergo involution and malignant transformation. Occasionally, the tumor may be encountered in female. Literature showed seven cases of involution of angiofibroma. It was postulated that when the patient reaches the age of 20–25 years, the tumor undergo resorption and disintegration. Among these seven patients, three underwent surgical excision (one with bilateral external carotid artery ligation with multivessel embolization and another with ipsilateral external carotid artery ligation), two refused any treatment, and one each underwent biopsy and maxillary artery embolization. Spontaneous resolution took place in two patients who opted for no treatment; regression of the tumor started after 3 years in one patient, and complete involution took place over a 12-year period in another.

Literature showed six cases of malignant transformation in juvenile angiofibroma. In three patients, JA was diagnosed at the fifth decade and in the rest in the second decade. Five out of six patients had multiple operations. The minimum time interval between operation and malignant transformation was 1 year. Five out of six patients received external irradiation, the dose of which was between 3,000 and 12,000 cGy. Two patients also received exogenous hormone therapy. The time interval between irradiation to malignancy was 11 months to 21 years. One patient developed malignant fibrous histiocytoma and the rest of them had fibrosarcoma.

Angiofibroma in female was found in the age between second and eighth decade. The tumor in this group of patients is usually localized in the nasal cavity with extension into the nasopharynx, maxillary antrum, ethmoid sinus, and oropharynx. In one patient the condition was diagnosed during pregnancy; the tumor was removed after delivery. Intranasal, Caldwell-Luc, lateral rhinotomy, midfacial degloving, and craniofacial resection were the various approaches by which these tumors were dealt with surgically. Two patients also received irradiation.

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Port Moresby General Hospital, Boroko, NCD, Papua New Guinea

    Siba P. Dubey MS

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  1. Siba P. Dubey MS
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Correspondence to Siba P. Dubey MS .

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Editors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Port Moresby General Hospital and School of Medicine and Health Sciences, University of Papua New Guinea, Boroko Port Moresby, Papua New Guinea

    Siba P. Dubey

  2. Department of Otolaryngology-Head and Neck Surgery, University of Saarlands Medical Center, Homburg/Saar, Saarland, Germany

    Bernhard Schick

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Dubey, S.P. (2017). Remaining Controversies. In: Dubey, S., Schick, B. (eds) Juvenile Angiofibroma. Springer, Cham. https://doi.org/10.1007/978-3-319-45343-9_22

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  • DOI: https://doi.org/10.1007/978-3-319-45343-9_22

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-45341-5

  • Online ISBN: 978-3-319-45343-9

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