What kind of tumor is this
Angiofibroma begins to grow in the area of the nasopharynx, near the sphenopalatine foramen, from where large vessels enter the nasal cavity. The combination of a fibrous base and many vascular cavities explains the main properties of the tumor: density, abundant blood supply and tendency to bleed. The tumor does not grow into the walls of blood vessels and does not spread to other organs, but spreads through natural cracks and openings, pushing apart and gradually destroying the bone. Due to its strong connection with adolescence and male gender, the influence of hormonal changes on its growth is discussed.
- Benign but locally aggressive tumor
- Originates from the nasopharynx
- Rich in blood vessels, bleeds easily
- Does not metastasize
- Occurs almost only in boys 10–20 years old
Symptoms
The first to appear is difficulty in nasal breathing on one side, which gradually becomes constant and does not go away with drops. Then nosebleeds begin: at first rare, then profuse and difficult to stop. Due to the blockage of the nasopharynx, the voice changes, a nasal sound appears, the ear becomes blocked and hearing decreases on one side. As the tumor spreads, swelling of the cheek, displacement of the eye, double vision, headache, and numbness in the cheek area develop. Repeated blood loss leads to anemia, weakness and pallor.
- Persistent unilateral nasal congestion
- Repeated heavy nosebleeds
- Nasal voice
- Congestion and hearing loss in one ear
- Cheek swelling, facial deformation
- Protrusion of the eyeball, double vision
- Weakness and pallor due to anemia
Diagnostics
Endoscopy of the nasal cavity shows a dense, reddish-bluish mass covering the choana. The main method is computed tomography with contrast: it demonstrates a characteristic intense accumulation of contrast, expansion of the pterygopalatine fossa and the boundaries of distribution in the bone. MRI with contrast better evaluates the soft tissue parts, the relationship to the base of the skull and the orbit. Before surgery, angiography is performed to find the feeding vessels. A biopsy on an outpatient basis is contraindicated: with this tumor it can cause life-threatening bleeding, and the picture on tomography is quite characteristic.
- Endoscopy of the nasal cavity and nasopharynx
- MSCT with intravenous contrast
- MRI with contrast
- Angiography before intervention
- CBC to evaluate anemia
- Biopsy outside a specialized hospital is unacceptable
Treatment
The main method is surgical removal of the tumor. One or two days before the operation, embolization of the feeding vessels is carried out: they are closed from the inside through a catheter, which significantly reduces blood loss. Most tumors today are removed endoscopically through the nose, without making incisions on the face; in case of widespread distribution, combined approaches are used. The completeness of removal is the main factor determining the likelihood of the disease returning. For residual tissue near the base of the skull, radiation therapy is used in selected cases. Treatment is carried out only in a specialized hospital.
- Preoperative embolization of feeding vessels
- Endoscopic removal through the nasal cavity
- Combined access with widespread distribution
- Reimbursement of blood loss and treatment of anemia
- Radiation therapy in selected cases
- Treatment only in a specialized center
Observation after treatment
Even with complete removal, the tumor can return, most often in the first two years, so observation after surgery is mandatory. Control MRIs with contrast are carried out according to a schedule drawn up by the doctor, supplemented by endoscopic examinations. Renewed unilateral nasal congestion or bleeding is a reason to contact us earlier than planned. With age, after puberty, the tendency for such a tumor to grow decreases. Special attention is paid to restoring hemoglobin levels and adequate nutrition for the teenager.
- Control MRI with contrast according to schedule
- Regular endoscopic examinations
- Immediate visit if bleeding resumes
- Hemoglobin control and anemia treatment
- Observation most often over several years
