Inferior Turbinate Angiofibroma in a Middle-Aged Man

Nasopharyngeal angiofibromas (AF) are a benign but clinically aggressive tumor most commonly found in the nasopharynx, originating from the pterygopalatine fossa of adolescent males. ^1,2 Here, we present the unusual case of a 49-year-old Hispanic male with an AF originating from the left inferior turbinate (IT).

He initially presented to the Otolaryngology clinic with 5 months of left-sided epistaxis and nasal obstruction. On nasal endoscopy, a red polypoid mass obstructed the entire left nasal cavity. Biopsy demonstrated stromal fibrous tissue with vascular structures, suggestive of nasopharyngeal AF. Preoperative computed tomography (CT) imaging showed a left-sided heterogeneously enhancing expansile mass (5.9 × 2.6 × 4.0 cm³) filling the entire nasal cavity and sparing the nasopharynx (Figure 1). Angiography found anterior branches of the left internal maxillary artery supplying the mass in the nasal cavity, which were embolized preoperatively (Figure 2A and B). During resection, the mass was visualized filling the left nasal cavity, pedicled along the entire medial surface of the IT. The mass did not extend into the ethmoid air cells, maxillary sinus, or nasopharynx. Pathology once again confirmed AF. Postoperatively, the patient did well with resolution of his obstructive symptoms and no further epistaxis.

Figure 1.

Axial CT showing left-sided heterogeneously enhancing mass filling the entire nasal cavity but sparing the nasopharynx. Intraoperatively, the mass was seen arising from the medial surface of the inferior turbinate, and the nasopharynx was confirmed clear. CT indicates computed tomography.

Figure 2.

A and B shows angiography of the external carotid artery branches to the internal maxillary artery. B, The tumor blush in the left nasal cavity, supplied by 2 branches of the internal maxillary artery. After glue embolization, the tumor blush in the nasal cavity dramatically decreased.

Extranasopharyngeal AFs overall have a higher incidence in women and present at an older age than nasopharyngeal AFs. ³ Our literature review finds 10 total cases of IT AFs ranging from the ages of 9 to 70 years old. The mean age of presentation of these AFs is 37.2 years for males and 38.4 years for females. Thirty-eight percent occur in women and 30% occur over the age of 50. ^{3 –11} Our patient presented at a later age than average and the tumor arose along the entire medial surface of the IT, instead of being pedicled off of a discrete location as previously reported cases. In our case, angiography as well as CT and endoscopy confirmed the tumor’s origin from the IT and not the nasopharynx. Our IT AF was also larger (5.9 × 2.6 × 4.0 cm³) than previously reported (up to 3 cm). ⁹