Presentation
Nasal obstruction.
Patient Data
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The mass centred on the sphenopalatine foramen is typical angiographic and imaging features for a juvenile nasopharyngeal angiofibroma, supplies by the sphenopalatine artery. There is no supply from the cavernous branches of the internal carotid artery or ophthalmic artery.
A 5-French guiding catheter was placed in the right external carotid artery, and a microcatheter placed selectively into the sphenopalatine artery and the more proximal branches of the internal maxillary artery and embolised with PVA.
Case Discussion
The patient went on to have surgery.
Histology
MICROSCOPIC DESCRIPTION: Fragments are covered by nasal respiratory type epithelium with underlying mucinous glands. Most of the deeper aspect consists of irregular variably-sized blood vessels within an abundant collagenous haphazardly deposited stroma of varying cellularity and with prominent necrosis. There is some underlying bone with variably-sized vessels some with surrounding smooth muscle which is infiltrating in and around the bone fragments. These latter areas reflect infiltration by juvenile angiofibroma. Intravascular foreign embolic debris is noted.
FINAL DIAGNOSIS: juvenile nasopharyngeal angiofibroma with focal necrosis.
It is crucial to recognise these tumours on imaging as a biopsy can be disastrous due to their high vascularity. Preoperative embolisation is also important to reduce intraoperative blood loss.
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