A 12 year adolescent male presents with unilateral mass in nose with recurrent spontaneous bleeding. On examination a pink mass covered with mucosa is found in the nasopharynx. Which of the following is not to be done?
Correct Answer: Biopsy is done for diagnosis
Description: (a) Biopsy is done for diagnosisRef: Scott Brown, 7th ed., pg, 2438Juvenile Nasal AngiofibromaImportant points to note:* Sex incidence: Generally accepted as a tumor exclusively of males. If diagnosis is made in female, chromatin studies are indicated.* Age Incidence: Varies -7-19 yr with avg of 14 yr* Grossly: Well-circumscribed, lobulated purple red mass.* Covered by intact mucosa on their nasopharyngeal surface* Teenage or young adult male* Recurrent epistaxis&Nasal obstructionStaging system:Radkowski staging: (most universally accepted system)* Stage IA: limited to nose or nasopharynx* Stage IB: extension into at least one paranasal sinus* Stage IIA: minimal extension through thesphenopalatine foramen; includes a minimal part of themedial pterygomaxillary fossa* Stage IIB: full occupation of pterygomaxillary fossa with Holman-Miller sign (bowing of the posterior wall of themaxillary sinus on CT); lateral or anterior displacement of maxillary artery branches; may have superiorextension with orbital bone erosion* Stage IIC: extension through the pterygomaxillary fossa into the cheek, temporal fossa, or posterior to the pterygoids* Stage IIIA: skull-base erosion with minimal intracranialextension* Stage IIIB: skull-base erosion with extensive intracranialextension +- cavernous sinusIn the past, the exact nature of these tumours was suggested by the plain lateral skull radiographic appearance that would show anterior bowing of the posteriorwall of the maxillary sinus.Nowadays, thediagnosis is based on the CT and MR appearances that are sometimes confirmed by angiography.A trans-nasalbiopsy is not necessary and can provoke brisk haemorrhage.The exacc extent or stage of the tumour can only bedetermined by a combination of CT and MR imaging andthis is vital when planning the surgical resection.Juvenile angiofibromas present as well-defined, lobulatedtumours that are covered by nasopharyngeal mucosa. Thetumour consists of proliferating, irregular vascular channels within a fibrous stroma. Tumour blood vesselstypically lack smooth muscle and elastic fibres, this featurecontributing to its reputation for sustained bleeding. Thestromal compartment is made up of plump cells that canbe spindle or stellate in shape and give rise to varying amounts of collagen.
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