Page 52 - Revista Portuguesa - SPORL - Vol 49. Nº3

FIGURE 1 The tumour measured 3 x 2,5 cm and it was round in
Saggital MRI plane showing vascular neoplasm occupying shape. Histological analysis showed an angiofibroma
almost the half posterior of nasal cavity.
with characteristic erectile tissue appearance containing
more fibrous tissue than capillary hemangiomas (figure
3). The tumour was composed of stellate or spindle
fibrocytes in a varying amount of connective tissue
stroma with many wide, thin-walled vessels.
Three years following surgery the patient remains
tumour free.

DISCUSSION
Reports of extranasopharyngeal angiofibroma have
appeared sporadically in the literature. From these it is
evident that extranasopharyngeal angiofibromas occur in
an older age group than nasopharyngeal angiofibromas.
Also, the male sex preponderance of the nasopharyngeal
angiofibromas is not shared by the extranasopharyngeal
angiofibromas. Extranasopharyngeal angiofíbromas have
heen reported from many sites in the head and neck
FIGURE 2
Coronal MRI image demonstrates a 3 cm mass (line 1), arising region, a comprehensive list of which has been compiled
in the nasal septum. by Sarpa and Novelly . The commonest site of origin is
3
the maxillary sinus.
Imaging is extremely important in the diagnosis and
management of these tumours. The characteristic
pattern of spread, angiographic appearance, and clinical
situation generally obviates the need for a biopsy.
CT, MRI, and angiography are the primary imaging
modalities for the identification of these tumours.
Although this lesion is microscopically benign, it may
have an aggressive clinical course extending out of
the bony vault of the nasopharynx to compromise
vital structures if untreated. In the clinical setting, it is
important to distinguish angiofibromas from capillary
hemangiomas because of the different natural history
FIGURE 3 of both lesions.
Histologic section at 250x magnification, demostrating the
characteristic thin-walled vascular network surrounded by Primary radiation therapy for nasal angiofibroma was
fibrous stroma a common approach earlier in the 1990s . Because of
7
the excellent results with modern surgical techniques,
the addition of CT-based tumour mapping, and
concerns regarding the late effects of radiation therapy,
the standard of care has become surgical excision
of resectable tumours. The use of primary radiation
therapy is usually described only for tumours that
are considered to be unresectable on the basis of CT
criteria.
To date few reports of angiofibromas arising in the nasal
cavity have appeared in the literature, and the nasal
septum represents an extremely rare localization.

removal without disruption of the tumour with minimal
bleeding. The endoscopic view demonstrated the septal
pedicle and his real origin.

178 REVISTA PORTUGUESA DE OTORRINOLARINGOLOGIA E CIRURGIA CÉRVICO-FACIAL