Nasopharyngeal Angiofibroma-MRI

A 20-year-old male presents with epistaxis. CEMRI suggests large (approximately 5 cm) soft tissue signal intensity, intensely and heterogeneously enhancing SOL in spheno-palatine foraminal location with extension to paranasal sinuses including ethmoids and sphenoids with no intracranial & intraorbital extension, possibly representing juvenile nasopharyngeal angiofibroma.

Teaching points :  MGK Murthy, Mr Venkat & Ratnakar 

 The exact site of the origin is conjectural, possibly is in spheno-palatine foraminal location. It is benign tumor, highly vascular and with high mortality if not diagnosed before biopsy procedure.  Staging of the tumor helps in planning the treatment without biopsy.

The staging system proposed by Sessions et al  is the most commonly used and divides tumours into three stages:

 Stage I

Ia : limited to nasal cavity / nasopharynx

 Ib : extension into one or more paranasal sinuses

Stage II

IIa : minimal extension through sphenopalatine foramen into pterygomaxillary fossa

 IIb : fills pterygomaxillary fossa bowing the posterior wall of the maxiallary antrumanteriorly or extending into the orbit via the inferior orbital fissure.

IIc : extends beyond pterygomaxillary fossa into infratemporal fossa (modified by Radkowski )

Stage III : intracranial extension