Nasal cavity, paranasal sinuses, nasopharynx
Benign / nonneoplastic lesions: mesenchymal
Nasopharyngeal angiofibroma

Topic Completed: 1 November 2004

Minor changes: 2 March 2020

Copyright: 2004-2020,, Inc.

PubMed Search: Nasopharyngeal angiofibroma[TI] free full text[sb]

Nat Pernick, M.D.
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Cite this page: Pernick N. Nasopharyngeal angiofibroma. website. Accessed May 28th, 2020.
Definition / general
  • Rare tumor, usually adolescent males (10 - 25 years), rarely in older patients or women (may be misdiagnoses)
  • 75% have androgen receptors but not estrogen or progesterone receptors
  • Arises from erectile-like fibrovascular stroma in posterolateral wall of roof of nose
  • May grow into nasopharynx, orbit or cranial cavity
  • May regress after puberty, especially after incomplete surgical excision or radiation therapy
  • Benign but recurs in 40%, usually within one year, particularly if not completely removed
  • Rare sarcomatous transformation after radiation therapy
  • Surgery (difficult to excise), preoperative embolization or antiandrogen therapy
  • Chemotherapy or radiation therapy if advanced or aggressive
Gross description
  • Well circumscribed but unencapsulated polypoid fibrous mass, bleeds severely on manipulation and biopsy, may occlude nares
  • Spongy cut surface
Microscopic (histologic) description
  • Intricate mixture of stellate and staghorn blood vessels with variable vessel wall thickness ranging from single layer of endothelium to variable smooth muscle coat
  • Irregular fibrous stroma (loose, edematous to dense, acellular)
  • Stromal cells are stellate fibroblasts with small pyknotic to large vesicular nuclei
  • Larger vessels at base of lesion, smaller vessels with plump endothelial cells at growing edge of tumor
  • Multinucleated stromal cells are common
  • Mitotic figures are rare
  • Minimal inflammation
Positive stains
Electron microscopy description
  • Electron dense granules composed of tightly bound RNA protein complexes
  • Stromal cells are myofibroblasts
Differential diagnosis
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