Nasopharyngeal Angiofibroma in a Female

Case 3: Extra-nasopharyngeal Angiofibroma (ENPA)

A 21 year old female was seen with complaints of right-sided nasal obstruction with a history of epistaxis aggravated by minor trauma to the nose. Her CT scan showed a mildly enhancing hypodense mass occupying the right anterior nasal cavity.

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Figure 1: Preop picture showing the appearance of the mass in the right nasal cavity.
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Figure 2: Axial CT Scan of Nasopharyngeal Angiofibroma Click on Pictures to Enlarge

Diagnostic nasal endoscopy showed a grayish white mass with a brisk episode of hemorrhage on probing the medial side. The mass was removed, endoscopically, and was sent for histopathological examination.

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Figure 3: Histological Appearance of Nasopharyngeal Angiofibroma Click on Pictures to Enlarge

The histopathology showed vascular channels lined by a single layer of endothelial cells devoid of muscle layer in wall separated by loose fibrous tissue. Therefore, the lesion was reported as an angiofibroma.

As ‘angiofibroma in females’ is virtually unknown to the medical world, a second opinion was sought. Differentials of “vascular mass in nasal cavity“ viz. hemangiopericytoma, solitary fibrous nodule, cavernous haemangioma, capillary haemangioma were kept in mind.

The immunohistochemistry showed angiomatous tissue surrounded by a fibrous layer and devoid of muscle fibers and confirmed it as angiofibroma and hence was labeled as ‘extra-nasopharyngeal angiofibroma in a female’ attached to the nasal septum. Among the cases of our article Case 1 diagnosed to be Capillary Hemangioma and Case 3 after ruling out other differentials was labeled as Extra-nasopharyngeal angiofiibroma

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Figure 4: Histological Appearance of Nasopharyngeal Angiofibroma Click on Pictures to Enlarge