This is a case of a juvenile nasopharyngeal angiofibroma.

This patient was initially treated with preoperative embolization before being taken to the operating room for extensive surgical interventions including bilateral maxillary antrostomy, bilateral total ethmoidectomy, bilateral sphenoidotomy, left frontal sinusotomy, posterior septectomy, and bilateral middle and superior turbinate resections. Gross pathologic examination of the specimens revealed rubbery, irregular, tan-pink tissues which varied in size. Histopathologic examination of these tissues revealed inflamed sinonasal mucosa and fibrocollagenous stromal proliferation, consistent with angiofibroma. The tumor stained positively on immunohistochemical stain for beta-catenin, with weak positivity for androgen receptor and CD117, and negative staining for CD34 and ER.

The patient initially did well postoperatively but was found to have residual tumor on a follow-up MRI. Further endoscopic resection including a left-sided medial maxillectomy was performed. Postoperative MRI revealed that the residual tumor had been removed. The patient noted immediate and significant improvement in vision, but still endorsed mild blurry vision of the left eye. The patient continues to follow with otolaryngology for oncologic surveillance.

Co-authors:
Mason Soeder
Daniel Gewolb, MD