An Unusual Location of Juvenile Angiofibroma: A Case Report and Review of the Literature

A 10-year-old boy presented with left-sided nasal obstruction and epistaxis. Endoscopic evaluation revealed a polypoid mass in the vestibule arising from the lateral wall of the nasal cavity anteroinferior to the left inferior turbinate. Computed tomography (CT) scan showed a soft tissue opacity in the vestibule of the left nasal cavity. After the endoscopic excision of the mass, postoperative and histopathological analyses confirmed the diagnosis of an angiofibroma. 1. Introduction Angiofibromas are highly vascular, nonencapsulated, and histologically benign but locally aggressive tumors which most commonly arise in the nasopharynx of adolescent males. It is a unique fibrovascular tumor with the specific histopathological finding of irregularly configured endothelial-lined vascular spaces embedded in a fibrous stroma. They usually arise from the posterolateral wall of the nasal cavity, where the sphenoidal process of the palatine bone meets the horizontal ala of the vomer and the pterygoid process. Angiofibromas constitute about 0.5% of all head and neck neoplasms [1]. These tumors may rarely localize in extranasopharyngeal sites. We report a case of angiofibroma in the left vestibule arising from the lateral wall of nasal cavity anteroinferior to the inferior turbinate. 2. Case Report A 10-year-old boy came to the outpatient department with a four month history of progressive left-sided nasal obstruction and intermittent epistaxis. He had history of fever 5 days back. The patient had no other health problems. The coagulation status was normal. Anterior rhinoscopy revealed a fragile, lobular, red-grayish-colored, smooth, and polypoidal mass, arising anteroinferiorly to the left inferior turbinate filling the vestibule (Figure 1). Posterior rhinoscopy was normal in appearance. Figure 1: Reddish-gray-colored polypoidal mass in the left vestibule. Computed tomography (CT) scan of the nose and paranasal sinuses demonstrated a soft tissue opacity that filled the vestibule of the left nasal cavity, without any sinus invasion and bony destruction. On postcontrast study, the soft tissue is showing intense enhancement (Figures 2(a), 2(b), and 2(c)). Figure 2: Axial, sagittal, and coronal CT images showing an intensely enhancing homogenous mass lesion in the left vestibule. The mass was later excised under general anaesthesia. It was lobular, smooth, red-grayish, about 12？mm long tumour, and with the diameter up to 8？mm. This was followed by profuse bleeding which was controlled with anterior intranasal packing. The mass was sent for histopathological analysis.