Juvenile primary extranasopharyngeal angiofibroma, presenting as cheek swelling

Abstract

Angiofibroma is a locally advancing immensely vascular tumor that essentially arises from the nasopharynx. The clinical characteristics of extranasopharyngeal angiofibroma (ENA) do not accord to that of nasopharyngeal angiofibroma and can present a diagnostic confront. We describe a case of primary juvenile ENA in a 19-year-old patient who presented with a rapidly enlarging mass of the cheek region. The case is unusual because of its anatomic location. The diagnostic and management particulars are sketched.

Keywords: Cheek swelling; extranasopharyngeal angiofibroma; masticator space; vascular tumor.

Figure 1

Clinical photograph of the patient showing swelling of the left cheek

Figure 2

(a) Ultrasonogram shows 4 cm hypoechoic foci. (b) Computed tomography shows soft-tissue mass with positive Holman–Miller sign in the lateral wall of the left maxillary sinus. (c) Magnetic resonance imaging shows isointense soft-tissue mass in T1-weighted images in the left masticator space

Figure 3

(a) Preoperative patient preparation. (b) Extraoral incision and exposure of the mass. (c) Soft-tissue mass after excision. (d) Cut section of the excised mass. (e) Postoperative profile after 2 months

Figure 4

(a and b) Histopathological picture showing fibrous tissues along with scattered vascular channels ×50 and ×100, respectively

Figure 5

(a) Immunohistochemical stain of angiofibroma showing vimentin-positive fibroblastic stroma ×100. (b) Immunohistochemical stain of angiofibroma showing CD 34 shows positive for vascular channels ×100