Angiofibroma is a rare benign tumor that forms in the nose. It almost always affects teenage boys, but can occasionally be seen in adult men.
While the tumor isn't cancerous, it can spread to other tissues in the nose. This can cause issues with the sinuses, eyes, skull, or even brain.
The primary treatment for angiofibroma is surgery, which can be curative.
The UPMC Department of Neurosurgery uses the less-invasive endoscopic endonasal approach (EEA) to treat these tumors. We use special tools to access the tumor through the nose or sometimes hidden under the lip, meaning no visible incisions and a quick recovery.
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Angiofibroma is a tumor in the nasal cavity — the open space in the head between the mouth and the eyes. It's where air flows when you breathe in through your nose.
The tumor is not brain cancer but can cause symptoms from pressure on important structures and affect other tissues.
It mostly forms in boys between 7 and 19 years old. Doctors diagnose it most often between 10 and 19.
Juvenile nasopharyngeal angiofibroma is the most common type of benign tumor that forms in the nose but it is pretty rare. It accounts for only 0.5% of all head and neck tumors.
It isn't cancer, but it often grows into the sinuses, eyes, or skull cavity.
At UPMC, we treat angiofibroma with less-invasive surgery called the endoscopic endonasal approach (EEA). Our skull base surgeons have treated more than 100 children using EEA — more than at any other skull base center.
Untreated angiofibromas may keep growing, and symptoms will get worse.
People with these tumors may develop more issues, including:
The most common symptoms of angiofibroma are:
If the tumor presses on nerves, you may lose vision or feeling in your face.
Some people may also form facial defects, such as:
To help diagnose an angiofibroma, doctors will do a physical exam to look for a pale, smooth growth inside the nasal cavity.
They'll likely order imaging to understand better where the tumor has grown and what structures it impacts. Imaging studies could be an MRI or CT scan of the head and facial bones. The imaging will confirm the diagnosis and show how big the tumor is.
Doctors generally avoid taking a sample (biopsy) because of the nature of these tumors. They often have many blood vessels and are not surrounded by muscle. Taking a piece of it could lead to extensive bleeding.
The most common treatment for angiofibroma is surgery.
Surgeons can approach angiofibromas directly using the EEA. This state-of-the-art, minimally invasive approach allows surgeons to access the tumor through the natural corridor of the nose. They're able to remove the growth without making an open incision, but larger tumors may require a hidden incision under the upper lip or, rarely, next to the eye.
Before surgery, the doctor may perform an imaging test and a procedure called an angiogram. This test uses X-rays and a special dye to highlight blood vessels.
With the blood vessels highlighted, the doctor can cut off the blood going to the tumor. This tumor embolization decreases blood loss when the surgeon cuts out the growth.
Surgeons then remove the angiofibroma through the nose and nasal cavities. EEA offers the benefits of no incisions to heal, no scarring, and a faster recovery time.
If a person needs more treatments, such as radiation, they can start soon after surgery, although this is almost always avoidable.
Radiation is generally avoided for these tumors. Small tumor remnant can be watched and often does not cause a problem after puberty is complete. Doctors may rarely suggest radiation exposure to kill any tumor cells left in the nasal or skull cavity.
Angiofibroma tumors that may need radiation include those that:
Hormone therapy is a new type of treatment for angiofibroma. The drug flutamide is a hormone therapy that blocks proteins that bind to the male sex hormone testosterone.
These drugs seem to help shrink tumors. Doctors are currently testing it in clinical trials.
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