Sandbox: Maria 13
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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 [classification method] into [number] subtypes/groups:
- [group1]
- [group2]
- [group3]
- Other variants of nasopharyngeal angiofibroma include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
Pathophysiology
- The pathogenesis of nasopharyngeal angiofibroma is characterized by [feature1], [feature2], and [feature3].
- The [gene name] gene/Mutation in [gene name] has been associated with the development of nasopharyngeal angiofibroma, involving the [molecular pathway] pathway.
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of nasopharyngeal angiofibroma.
- On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of nasopharyngeal angiofibroma.
Causes
- Common causes of nasopharyngeal angiofibroma, include:
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
- Rhinorrhea
- Hearing loss
- Diplopia
- Rarely anosmia
- Eye pain
Physical Examination
- Patients with nasopharyngeal angiofibroma usually are well-appearing.
- Physical examination may be remarkable for:
- [finding 1]
- [finding 2]
- [finding 3]
- [finding 4]
- [finding 5]
- [finding 6]
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 CT, findings of nasopharyngeal angiofibroma, include:
- On MRI, findings of nasopharyngeal angiofibroma, include:
- The images below demonstrate findings of nasopharyngeal angiofibroma.
-
CT: Nasopharyngeal angiofibroma. Skull base invasionImage courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology
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MRI (T1): Nasopharyngeal angiofibroma. 1/3 Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology
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MRI (T1): Nasopharyngeal angiofibroma.Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology
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MRI (T1): Nasopharyngeal angiofibroma. 3/3 Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology
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MRI (T1): Nasopharyngeal angiofibroma. 3/3 (circled)Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology
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].