Asian Journal of Modern and Ayurvedic Medical Science

Research Paper

Nasopharyngeal angiofibroma in an Elderly male: a rare case report

Author: Nischal Gupta1, R. K. Jain2, Mohan Kumar3

(1) Dr. Nischal Gupta M.B.B.S., M.S. Department of E.N.T. Institute of Medical Sciences and Sir Sunder Lal Hospital Banaras Hindu University Varanasi, U. P. India (2) Dr. R.K. Jain, M.B.B.S., M.S. Professor and head Department of E.N.T. Institute of Medical Sciences and Sir Sunder Lal Hospital Banaras Hindu University Varanasi, U. P. India (3) Dr. Mohan Kumar M.B.B.S., M.D. Professor Department of Pathology Institute of Medical Sciences Banaras Hindu University Varanasi, U. P. In

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Introduction:

 

Nasopharyngeal Angiofibroma (NPF) though only 0.05% of all head and neck tumors, is the commonest benign tumor of the nasopharynx. (1). This tumor of the nasopharynx is a slow growing tumor but is locally invasive and may become life threatening at times due to its propensity to bleed. Classical description of this tumor describes it as a tumor of the young adult male occurring almost exclusively in the puberty, adolescence, and adulthood in the age varying between 10 to 25 years (2). In our search for the other cases we found the oldest reported case to be in a 79 year old man (3) and a 71 year old woman (4). This paper presents a rare case of nasopharyngeal angiofibroma occurring in a 80 year old male.

 

Case report:

 

Patient SJ, an 80 year old male from Sasaram, Bihar, India presented to our ENT OPD with the chief complaint of progressively increasing right sided nasal obstruction for past 11 months which gradually increased to total obstruction of the right nostril over period of 2 months. At this patient noticed a mass inside his right nasal cavity. He consulted a local practitioner who put him on some medications and biopsied the mass and sent it for histopathological examination. The histopathological report suggested it to be the nasal polyp. The patient was sent to our centre with this report. During this whole course of illness the patient didn’t have any episode of bleeding, visual disturbances, and headache. There was no history of trauma or any other surgical intervention other than the biopsy.

 

On examination a large polypoidal mass with a blackened external surface was seen hanging from the right nostril. Posterior rhinoscopy revealed the mass to be completely occluding the right choanae. No bleeding was present. The computed tomographic scan of the patient revealed a mass ocuupying the nasal, nasopharyngeal and maxillary antral spaces (Figure -1 & 2).

 

A biopsy was taken from the mass and sent for histopathological examination. The histopathological examination showed the mass as an inflammatory polyp. Following this an excision of the mass under general anaesthesia was planned. The mass was excised completely from the nasal cavity and nasopharynx and the maxilary antrum was cleared.

This tissue was sent for histopathological examination and this time it was diagnosed to be nasopharyngeal angiofibroma.

 

The patient had improvement after the surgery and at 2, 6 & 12 months post operatively he was free of any symptoms.

 

Discussion:

 

Nasopharyngeal angiofibroma has been classically defined as the most common benign tumor of the nasopharynx affecting almost exclusively the young males in their puberty, adolescence or early adulthood. These patients classically present with symptoms of nasal obstruction associated with bouts of bleeding.

This case varied from the classical presentation in many ways. Firstly, occurrence of angiofibroma in an elderly male is a very rare event. Secondly, unlike the classical presentation of other cases this case didn’t give any history of nasal bleed during the whole course of illness. Third, the identification of the mass as an inflammatory polyp during the first biopsy could have due to the long standing nature of the disease. During this time the superficial layers of the mass could have undergone polypoidal change giving a false impression.

 

The diagnosis was finally confirmed on the histopathological examination of the excised mass which showed numerous vascular channels of various calibers and irregular shape intermixed with the connective tissue stroma.

 

This case report suggests that nasopharyngeal angiofibroma though a rare occurrence in the elderly should be kept in mind when evaluating the patients presenting with nasopharyngeal mass.

 

References:

 

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