Angiofibroma in children and adults: causes, treatment

The term "angiofibroma" is applied to any tumors that can be attributed to angiomas with the presence of connective tissue fibers in them, or to fibroids permeated with a vascular network. Such neoplasms can include, for example, fibrous papule, sebaceous adenoma, nail fibroma, pearl papule, Koenen tumor, etc.

[1], [2], [3], [4], [5], [6]

Epidemiology

• Angiofibroma is diagnosed relatively often.
• A tumor can develop, regardless of age, but more often it is found in patients older than 40 years.
• Angiofibroma occurs, regardless of race.
• The spread of neoplasm is the same, both in male and female patients. At the same time in adolescence, boys are more often sick.

[7], [8], [9], [10]

Causes of the angiofibroma

The exact cause of the development of such a disease as angiofibroma, specialists can not. There are several theories that are used to explain the causes of pathology:

• Hormonal theory.

Frequent diagnosis of the disease in children during adolescence suggested that a certain hormonal risk could be a disturbed hormonal background. Nevertheless, information on this assumption is contradictory: some scientists do not allow the possibility of a negative impact of hormonal imbalance, while others confirm the involvement of the function of the sex glands. The specialists have not yet made a final conclusion.

• Genetic theory.

This assumption is considered one of the most common. As confirmation, information is provided on the complete or incomplete absence or violation of Y and X chromosomes in neoplastic cells. Such conclusions are not definitive and require additional research.

• The theory of the influence of age.

Individual specialists are inclined to treat the disease as a result of age-related changes in the body.

In addition, there are assumptions about the influence on the development of the disease of certain factors.

The risk factors for the development of angiofibroma may be as follows:

• trauma to the face, head, nose, etc .;
• inflammatory diseases, in particular inflammations with chronic course (eg, chronic sinusitis, etc.);
• presence of harmfulness, bad ecology, unacceptable way of life, etc.

[11], [12], [13], [14]

Pathogenesis

Angiofibroma can occur at almost any age, in individuals of any gender and race.

The most common nasopharyngeal neoplasm: angiofibroma develops on the basis of the pharyngeal main fascia and is a basal or basosthenoidal type of tumor. The overgrowth covers the surface of the base bone, and / or the area of the posterior cells of the latticed bone (sphenoidmoidal view).

In some cases, the disease begins from the area of the wing-palatine fossa, extending into the nasal cavity and into the space behind the jaw. This type of growth of angiofibroma is diagnosed in the pterygo-maxillary variant of tumor development.

This neoplasm is considered to be benign, although it often has rapid growth, affecting a number of located tissues, cavities, sinuses. Particular danger differs angiofibroma, sprouted into the cavity of the cranium.

[15], [16], [17], [18]

Symptoms of the angiofibroma

Angiofibroma externally resembles a small (3-15 mm) single nodule that has clearly outlined contours and an elastic structure. The color of the formation can vary from pinkish-yellow to brown.

The nodule, as a rule, rises a little above the surrounding tissues.

In some cases, the nodule has a rich capillary network and has a translucent structure: this can be considered using a microscope.

The tumor is found in more cases on the mucous tissues of the upper respiratory tract, either on the upper or lower extremities, less often on the organs (eg, the kidneys).

The first signs of a neoplasm depend on its localization. For example, if a nasopharynx is affected, the patient complains of difficulty in nasal breathing, even until it is completely absent. Zalozhennost can occur only on one side, exacerbating gradually. In this case, no drops for the nose, this problem is not removed.

Over time, snoring occurs (even in a waking state), a feeling of dryness in the throat, one or two-sided hearing impairment. Frequent pain in the head, bleeding from the nose of a spontaneous nature are possible.

Angiofibroma at the initial stage is not always manifested by changes in the blood picture. In most patients, signs of anemia - a decrease in the number of erythrocytes and hemoglobin, are detected already at later pathological stages.

Angiofibroma in a child may resemble the signs of adenoids, so in childhood it is customary to differentiate these pathologies.

Children are most often diagnosed with non-classified fibroids and metaphyseal defects, these are relatively common skeletal pathologies in children.

As the neoplasm increases, the patient's state of health deteriorates. Sleep becomes restless, appetite is broken, facial features change (deformation and asymmetry possible).

[19], [20], [21]

Stages

Juvenile angiofibroma is conditionally divided into several stages:

1. Neoplasm has a limited growth that does not go beyond the nasal cavity.
2. The neoplasm develops into the foveal-palatine fossa or nasal sinuses.
3. The tumor extends through the orbit or the inframammary fossa without intracranial growth (stage) or with extradural growth (stage).
4. The tumor differs intradural growth without attracting the region of the cavernous sinus, pituitary gland, or visual crossover (stage), or with the involvement of the listed areas (stage).

[22], [23], [24], [25], [26], [27],

Forms

Specific classification of the disease is associated with the localization of the tumor, as well as some of its structural and pathogenetic features.

• Angiofibroma of the nasopharynx is a benign formation that consists of the vascular and connective tissue and develops in the nasopharyngeal cavity. Most often, such a disease, as angiofibroma of the nose, is found in boys of adolescence, so it is also called the term "juvenile, juvenile angiofibroma", this is the most common neoplasm in patients of childhood.
• Angiofibroma of the skin is often taken for hemangioma: it is a connective tissue formation that looks like a wart. Such a tumor in most cases is round, has a base and penetrates deep into the skin. It is most often found on the upper and lower extremities, as well as in the neck and face. Mostly women are sick for 30-40 years.
• Angiofibroma of the larynx is a benign formation occupying the area of the vocal cords. A similar term for the disease is angiofibroma of the vocal cords. The tumor is reddish or bluish, has an uneven structure and is located on the stalk. The first signs of the disease is the appearance of a characteristic hoarseness up to a complete loss of voice.
• Angiofibroma of the face are located in different parts of it. You can detect them at any age. The main clinical symptom of the disease is the sudden appearance of a small, dense or elastic build-up. Other symptoms, as a rule, no. If the tumor is constantly touched and damaged, it can bleed and rapidly increase. Often, education is detected in the nasal or ear cavity, on the eyelids.
• Angiofibroma of the face with tuberous sclerosis are typical manifestations in this pathology. Tuberous sclerosis is a hereditary neuroectodermal disease, the main signs of which are convulsive attacks, mental retardation, the appearance of neoplasms of the type of angiofibrom. Neoplasms are found in more than half of patients with tuberous sclerosis. You can detect them after 4 years of age.
• Angiofibroma of the base of the skull is the most rare and, at the same time, the most severe form of the disease, at which a benign formation is formed in the skeletal structure of the skull base. The disease is difficult to diagnose at an early stage, because of its similarity with hypertrophic and inflammatory pathologies of the nasal and pharyngeal region. Angiofibroma of this type is prone to rapid growth with the destruction of cranial bones and the spread in a number of located anatomical brain structures. The overwhelming majority of boys and young people are sick for 7-25 years.
• Angiofibroma of soft tissues often develops in patients on the skin, on the mammary glands, tendons. The soft tissues on the extremities, in the field of the trunk, on the face or neck are affected. In some cases, tumor processes develop in the area of internal organs - in the uterus, ovaries, lungs, mammary glands.
• Angiofibroma of the kidney is a benign formation that can last for a long time without manifesting any symptoms. Rarely the disease is detected due to the appearance of pain in the kidney. The disease is cured by a surgical method: with a small tumor size, a dynamic observation of the tumor is possible.

[28], [29], [30], [31], [32]

Complications and consequences

In itself, such a neoplasm as angiofibroma belongs to a number of benign, and only in very rare cases the disease can become malignant.

Nevertheless, often the development of the tumor proceeds swiftly. A rapid increase in education can trigger the destruction of nearby structures: even dense tissues, such as bones, are damaged. Therefore, rapid tumor growth can cause prolonged and massive bleeding (often recurring), facial deformation, frustration and respiratory visual function. To prevent complications of angiofibroma, it is very important to determine the presence of the neoplasm in a timely manner and begin treatment.

[33], [34], [35], [36], [37], [38]

Diagnostics of the angiofibroma

Diagnosis of the disease has its own characteristics. First of all, the doctor will pay attention to the number of pathological formations, their character. The patient will be asked questions about the presence of such pathologies in family members and relatives, about the detection of malignant diseases in close people, about possible violations from the central nervous system.

If multiple tumor sites are detected, the patient is recommended to undergo examination for tuberculous sclerosis or MEN I.

Blood tests will indicate the presence of anemia and inflammatory process in the body. Thus, a decrease in the level of hemoglobin up to 80 g / liter and erythrocytes to 2.4 per 10¹² / l may be observed. Biochemistry of the blood often shows a decrease in the total protein, albumin, as well as an increase in the amount of ALT, AST and alkaline phosphatase.

Tissue biopsy - the study of a part of the tissue with the help of a microscope, will allow to determine accurately the good quality of the tumor.

In addition, the doctor often prescribes a blood test for specific tumor markers to exclude malignant formation.

Additional instrumental diagnosis often involves the conduct of fibroscopy or endoscopy. Such procedures are done using a special device - an endoscope, which will detect and treat the tumor in the cavities, for example, in the nasopharynx. This method will help assess the superficial state of the tumor, visualize the vasculature, determine the presence of an inflammatory reaction.

Unfortunately, the X-ray method in this situation is not very informative. With the help of this method, one can see the presence of education, however, it will not be possible to perform a differential diagnosis of angiofibroma.

[39], [40], [41],

Differential diagnosis

Differential diagnosis is performed with syringoma, angioliomyomia, cavernous hemangioma, flat pigment nevus, Osler-Randu disease, angiokeratoma, squamous cell carcinoma, etc.

Treatment of the angiofibroma

In the vast majority of cases, patients with angiofibromas are prescribed surgical treatment. The scope and type of surgical intervention is selected taking into account the stage and localization of the pathological focus.

If the tumor process has a significant spread and is permeated with a large number of vessels, it may be necessary to pre-prepare the patient. This is done to reduce the risk of bleeding during and after surgery.

Treatment can include such methods:

• X-ray endovascular occlusion - used when it is impossible to conduct a full-fledged surgical intervention, as an initial stage of radiotherapy. Application of the method allows to reduce the volume of intraoperative blood loss.
• Radiation treatment - helps in about 50% of cases of angiofibromas, but can be accompanied by a large number of complications. For this reason, it is used only if it is impossible to perform a full surgical intervention.

Medications

Drug treatment is directed to the elimination of the main painful signs of angiofibroma, as well as to facilitate and prolong the life of patients.

• When you have pain, it is recommended to take Baralgin or No-shpa for 1-2 tablets. Up to three times a day. Duration of admission - from one to four weeks.
• To improve the work of the organs and strengthen the vessels Stimol is prescribed in the amount of 1 packet twice a day, as well as multivitamin complexes - for example, Duovit 2 tab. Daily for 4 weeks, or Vitrum for 1 tab. Daily for 4-12 weeks.

Combined chemotherapy is applied as needed, individually. Can be offered:

• a combination of Adriamycin, Sarcolysin and Vincristine;
• a combination of Vincristine, Decarbazine, Adriamycin, Cyclophosphamide.

For example, such treatment can be applied before and / or after surgery.

Vitamins

Qualitative treatment of angiofibroma can not be imagined without vitamin therapy. The use of certain vitamins in food does not affect the growth of the tumor, but it helps to strengthen the vessels, prevent anemia and normalize the function of the immune system.

• Vitamin A will serve to prevent secondary infection, improve the tissue turgor and speed up recovery. This vitamin can be obtained with the use of plant foods, or purchase in pharmacies capsules with an oily vitamin solution.
• Tocopherol prevents the formation of blood clots in the vessels, rejuvenates and renews tissues. The drug is available in any pharmacy without a prescription, and is also present in products such as cream and sunflower oil, nuts, seeds and milk.
• Ascorbic acid takes part in the regulation of restorative reactions in the body, normalizes the production of hormones. Ascorbic acid can be obtained from vitamin preparations or from food products, which include berries, apples, kiwi, citrus, greens, cabbage.
• B vitamins regulate the neuroendocrine function. They can be obtained in sufficient quantities by eating meat products, nuts, milk.
• Vitamin K improves blood clotting, eliminates small bleeding. Vitamin is a part of many multivitamin preparations and monopreparations.

Physiotherapeutic treatment

With angiofibroma, physioprocedures can be prescribed that enhance the effect of drugs on the tumor. Often prescribe oncodestructive effects: photodynamics, high-intensity laser therapy, decimeter therapy, ultrasound. Simultaneously, it is possible to use cytolytic techniques, which include, in particular, cytostatic electrophoresis.

Complex treatment of patients who underwent an operation to remove such a tumor, as angiofibroma, includes the following physiotherapy methods:

• immunosuppressive procedures (electrophoresis with immunosuppressants);
• chemo-modifying procedures (low-frequency magnetic therapy).

To normalize vegetative disorders, electro-therapy, transcranial electroanalgesia, low-frequency magnetic therapy, galvanization are used.

After complete removal of angiofibroma, contraindications to physiotherapy are of a general nature.

Alternative treatment

To get rid of the tumor - angiofibroma, it is recommended to pay attention to the diet: individual foods can help stop the spread of the disease.

• Tomatoes are frequent guests on our table. Experts advise to eat five large tomatoes daily, and also add tomato paste or juice to dishes.
• Beet juice is recommended to mix with honey in equal parts, and drink it three times a day before eating 100 ml each.
• Walnuts should be crushed with the shell, pour steep boiling water, insist for fifteen minutes. Proportion - 300 g of nuts per 1 liter of water. Infusion should be taken thrice a day for 1 tbsp. L.

In addition, it is strongly recommended to sharply limit the use of meat and salt.

[42], [43], [44], [45], [46], [47],

Herbal Treatment

Herbal treatment effectively complements the main drug therapy with angiofibroma. The most effective recipes for home use are:

• Ointment based on hemlock.

The inflorescence of the plant is ground and mixed with paraffin oil in equal parts. Lubricate the affected area once every three days.

• The medicine is made of celandine.

Squeeze the juice from celandine (1 tbsp.), Dilute in ¼ cup of water and take daily according to the scheme: once a day take on an ascending one, starting from one drop and bringing up to 25 drops. After this, one drop is taken down on a daily basis.

• Nettle.

Nettle is poured with boiling water and left to stand for two hours (3 liters of nettle will need 0.5 liters of boiling water). Take infusion four times a day for 100 ml.

Homeopathy

A list of homeopathic remedies for angiofibroma may include Abrotanum, Acidum Fluoricum, Calcium Fluoricum. Effective is considered a similar appointment for flat skin tumors and with small formations without the tendency to rapid growth.

With rapidly growing tumors, compulsory traditional treatment is required.

• Abrotanum is used in the form of a solution of D ₄ -C ₃₀.
• Acidum fluoride is taken in a solution of C ₆  (D ₁₂ ) -C ₃₀.
• Calcium fluoride is used in the series C ₆  (D ₁₂ ) - C ₂₀₀  in the form of tablets.

Less commonly, Carbo animalis and Natrium Sulfuricum are prescribed in tablets C ₆  (D ₁₂ ).

Such treatment can not be used alone. It is very important to consult a doctor - both with a specialist in traditional therapy, and with a homeopathic doctor.

Surgery

Surgical intervention is now practically the only reliable way to get rid of a tumor such as angiofibroma. The operation is carried out, as a rule, after a preliminary sclerosing course of treatment.

The variant of access to a neoplasm is selected depending on its localization. For example, with a swelling of the nasopharynx or the base of the skull, access through the soft or hard palate, through the nasal cavity, through the facial bones is possible.

If the angiofibroma sprouts deep into the skull, into the brain, the fossa or other inoperable areas (for example, extends to the optic nerve, cross and / or turtle saddle area), then the operation is not performed, or partial removal of angiofibroma is carried out. Unfortunately, such cases are not uncommon. With partial resection, repeated development of the tumor is observed in 10-40% of patients.

One of the possible consequences of removing the tumor in the head region is the formation of cosmetic deficiencies. Sometimes patients refuse surgery for this reason.

In addition to surgery, angiofibromas can also be used such methods as hormonal treatment, cryodestruction, laser coagulation and chemotherapy. By themselves, these methods are currently recognized as ineffective: they are used extremely rarely.

Prevention

To prevent the development of angiofibromas, it is recommended to adhere to a healthy lifestyle, competently and qualitatively to eat.

The human body has a characteristic feature: it can independently resist the growth of pathologically altered cells, if it becomes available for a full rest, quality sleep and the absence of irritating factors (stresses, bad habits, adverse radiation, etc.).

Regular preventive examinations at specialized doctors will allow to detect and eradicate the disease on time.

[48], [49], [50], [51], [52], [53], [54],

Forecast

It is unacceptable to independently invent and prescribe medicines. Alternative recipes can be used only as a supplement to the main treatment: by themselves such drugs are unlikely to help defeat the tumor.

Angiofibroma does not tend to regress. The tumor is removed by surgeons, with further monitoring of the patient, as there is a chance of a re-development of the disease.

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