Sandbox: Maria 13: Difference between revisions

Jump to navigation Jump to search
Line 13: Line 13:


==Classification==
==Classification==
*Nasopharyngeal angiofibroma may be classified according to [classification method] into [number] subtypes/groups:
*Nasopharyngeal angiofibroma may be classified according to Radkowski Classification System into 3 categories:
:*[group1]
*'''Stage I'''
:*[group2]
:*Ia: limited to nasal cavity/nasopharynx
:*[group3]
:*Ib: extension into one or more paranasal sinuses
*Other variants of nasopharyngeal angiofibroma include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
*'''Stage II'''
:*IIa: minimal extension through sphenopalatine foramen into pterygomaxillary fossa
:*IIb: fills pterygomaxillary fossa bowing the posterior wall of the maxiallary antrum anteriorly or extending into the orbit via the inferior orbital fissure.
:*IIc: extends beyond pterygomaxillary fossa into infratemporal fossa (modified by Radkowski 4)
*'''Stage III'''
:*Stage IIIA: intracranial extension
 
==Pathophysiology==
==Pathophysiology==
*The pathogenesis of nasopharyngeal angiofibroma is characterized by the following features:  
*The pathogenesis of nasopharyngeal angiofibroma is characterized by the following features:  

Revision as of 20:58, 14 April 2016

WikiDoc Resources for Sandbox: Maria 13

Articles

Most recent articles on Sandbox: Maria 13

Most cited articles on Sandbox: Maria 13

Review articles on Sandbox: Maria 13

Articles on Sandbox: Maria 13 in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Sandbox: Maria 13

Images of Sandbox: Maria 13

Photos of Sandbox: Maria 13

Podcasts & MP3s on Sandbox: Maria 13

Videos on Sandbox: Maria 13

Evidence Based Medicine

Cochrane Collaboration on Sandbox: Maria 13

Bandolier on Sandbox: Maria 13

TRIP on Sandbox: Maria 13

Clinical Trials

Ongoing Trials on Sandbox: Maria 13 at Clinical Trials.gov

Trial results on Sandbox: Maria 13

Clinical Trials on Sandbox: Maria 13 at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Sandbox: Maria 13

NICE Guidance on Sandbox: Maria 13

NHS PRODIGY Guidance

FDA on Sandbox: Maria 13

CDC on Sandbox: Maria 13

Books

Books on Sandbox: Maria 13

News

Sandbox: Maria 13 in the news

Be alerted to news on Sandbox: Maria 13

News trends on Sandbox: Maria 13

Commentary

Blogs on Sandbox: Maria 13

Definitions

Definitions of Sandbox: Maria 13

Patient Resources / Community

Patient resources on Sandbox: Maria 13

Discussion groups on Sandbox: Maria 13

Patient Handouts on Sandbox: Maria 13

Directions to Hospitals Treating Sandbox: Maria 13

Risk calculators and risk factors for Sandbox: Maria 13

Healthcare Provider Resources

Symptoms of Sandbox: Maria 13

Causes & Risk Factors for Sandbox: Maria 13

Diagnostic studies for Sandbox: Maria 13

Treatment of Sandbox: Maria 13

Continuing Medical Education (CME)

CME Programs on Sandbox: Maria 13

International

Sandbox: Maria 13 en Espanol

Sandbox: Maria 13 en Francais

Business

Sandbox: Maria 13 in the Marketplace

Patents on Sandbox: Maria 13

Experimental / Informatics

List of terms related to Sandbox: Maria 13

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Synonyms and keywords: Juvenile nasopharyngeal angiofibroma; angiofibroma of the nasopharynx;

Overview

Nasopharyngeal angiofibroma (also called juvenile nasopharyngeal angiofibroma) is a histologically benign but locally aggressive vascular tumor that grows in the back of the nasal cavity. It almost exclusively affects adolescent males. Patients with nasopharyngeal angiofibroma usually present with one-sided nasal obstruction and recurrent bleeding.

Historical Perspective

  • Nasopharyngeal angiofibroma was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].

Classification

  • Nasopharyngeal angiofibroma may be classified according to Radkowski Classification System into 3 categories:
  • Stage I
  • Ia: limited to nasal cavity/nasopharynx
  • Ib: extension into one or more paranasal sinuses
  • Stage II
  • IIa: minimal extension through sphenopalatine foramen into pterygomaxillary fossa
  • IIb: fills pterygomaxillary fossa bowing the posterior wall of the maxiallary antrum anteriorly or extending into the orbit via the inferior orbital fissure.
  • IIc: extends beyond pterygomaxillary fossa into infratemporal fossa (modified by Radkowski 4)
  • Stage III
  • Stage IIIA: intracranial extension

Pathophysiology

  • The pathogenesis of nasopharyngeal angiofibroma is characterized by the following features:
  • Vascular neoplasm
  • Originates from the pterygopalatine fossa
  • Genetic alterations associated with the development of nasopharyngeal angiofibroma, include:[1]
  • Overexpression PDGF-B
  • Overexpression bFGF
  • Overexpression bFGF
  • Deletion of chromosome 17
  • Tumor suppressor gene p53
  • Overexpression of Her-2/neu oncogene
  • On gross pathology, characteristic findings of nasopharyngeal angiofibroma, include:
  • Unencapsulated
  • Polypoid fibrous mass
  • Bleeding on manipulation
  • On microscopic histopathological analysis, characteristic findings of nasopharyngeal angiofibroma, include:
  • Fibroblastic cells with plump (near cuboidal) nuclei
  • Fibrous stroma
  • Abundant capillaries

Causes

  • There are no known causes of nasopharyngeal angiofibroma.

Differentiating Nasopharyngeal Angiofibroma from Other Diseases

  • Nasopharyngeal angiofibroma must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
  • Antro-choanal polyp (antral-choanal polyp)
  • Rhinosporidiosis
  • Malignancy
  • Chordoma
  • Nasopharanageal cyst
  • Pyogenic granuloma

Epidemiology and Demographics

  • Nasopharyngeal angiofibroma is rare
  • Nasopharyngeal angiofibroma accounts for 0.05% of all head and neck tumors.
  • The prevalence of nasopharyngeal angiofibroma is approximately 1 per 100,000 individuals worldwide.

Age

  • Nasopharyngeal angiofibroma is more commonly observed among patients aged 7-19 years
  • Nasopharyngeal angiofibroma is more commonly observed among children and adolescents .

Gender

  • Males are more commonly affected with nasopharyngeal angiofibroma than females.
  • The male to female ratio for nasopharyngeal angiofibroma is approximately 4 to 1.

Race

  • There is no racial predilection for nasopharyngeal angiofibroma.
  • Nasopharyngeal angiofibroma usually affects individuals of the [race 1] race.
  • [Race 2] individuals are less likely to develop nasopharyngeal angiofibroma.

Risk Factors

  • Common risk factors in the development of nasopharyngeal angiofibroma are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

  • The majority of patients with nasopharyngeal angiofibroma are symptomatic at diagnosis.
  • Early clinical features include epistaxis, facial pain, and headache.
  • If left untreated, the majority of patients with nasopharyngeal angiofibroma may progress to develop
  • The most common complication of nasopharyngeal angiofibroma is
  • Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with nasopharyngeal angiofibroma is approximately [#%].

Diagnosis

Diagnostic Criteria

  • The diagnosis of nasopharyngeal angiofibroma is made when at least [number] of the following [number] diagnostic criteria are met:
  • [criterion 1]
  • [criterion 2]
  • [criterion 3]
  • [criterion 4]

Symptoms

  • Common symptoms of nasopharyngeal angiofibroma, may include:
  • Epistaxis or blood-tinged nasal discharge
  • Unilateral nasal obstruction
  • Rhinorrhea
  • Hearing loss
  • Diplopia
  • Rarely anosmia
  • Eye pain

Physical Examination

  • Patients with nasopharyngeal angiofibroma usually are well-appearing.
  • Physical examination may be remarkable for:
  • A smooth submucosal mass in the posterior nasal cavity

Laboratory Findings

  • Laboratory findings consistent with the diagnosis of nasopharyngeal angiofibroma, include:



Imaging Findings

  • Computed tomography is the imaging modality of choice for nasopharyngeal angiofibroma.
  • On conventional radiography, findings of nasopharyngeal angiofibroma, include:
  • Visualisation of a nasopharyngeal mass
  • Opacification of the sphenoid sinus
  • Anterior bowing of the posterior wall of the maxillary antrum
  • Holman-miller sign: the anterior bowing of the posterior wall of the maxillary antrum which is seen on lateral skull film or cross-sectional imaging
  • Widening of the pterygomaxillary fissure and pterygopalatine fossa
  • Erosion of the medial pterygoid plate
  • On CT, findings of nasopharyngeal angiofibroma, include:
  • Bony changes
  • Non-encapsulated soft tissue mass
  • Bowing the posterior wall of the maxillary antrum anteriorly
  • On MRI, findings of nasopharyngeal angiofibroma, include:
  • T1: intermediate signal
  • T2: heterogeneous signal: flow voids appear dark
  • T1 C+ (Gd): shows prominent enhancement
  • The images below demonstrate findings of nasopharyngeal angiofibroma.

Other Diagnostic Studies

  • Nasopharyngeal angiofibroma may also be diagnosed using [diagnostic study name].
  • Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

  • There is no treatment for nasopharyngeal angiofibroma; the mainstay of therapy is supportive care.
  • The mainstay of therapy for nasopharyngeal angiofibroma is [medical therapy 1] and [medical therapy 2].
  • [Medical therapy 1] acts by [mechanism of action1].
  • Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

  • Surgery is the mainstay of therapy for nasopharyngeal angiofibroma.
  • [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of nasopharyngeal angiofibroma.
  • [Surgical procedure] can only be performed for patients with [disease stage] nasopharyngeal angiofibroma.

Prevention

  • There are no primary preventive measures available for nasopharyngeal angiofibroma.
  • Effective measures for the primary prevention of nasopharyngeal angiofibroma include [measure1], [measure2], and [measure3].
  • Once diagnosed and successfully treated, patients with nasopharyngeal angiofibroma are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

References

  1. Coutinho-Camillo CM, Brentani MM, Nagai MA (2008). "Genetic alterations in juvenile nasopharyngeal angiofibromas". Head Neck. 30 (3): 390–400. doi:10.1002/hed.20775. PMID 18228521.