Angiofibroma arising from the olfactory epithelium

Angiofibromas are rare benign vascular tumors, with juvenile nasopharyngeal angiofibroma (JNA) being the most common clinical presentation. Even more rarely, histologically similar tumors can develop outside of nasopharynx, known as extranasopharyngeal angiofibromas (ENAs), and are considered distinct entities owing to their unique clinical features.

A 42-year-old man presented with a 12-month history of epistaxis and right nasal obstruction. Computed Tomography and Magnetic Resonance Imaging of the face revealed expansile solid lesion centered within the right nasal cavity, without involvement of sphenopalatine foramen. During endoscopic endonasal surgery to resect the tumor, its insertion into the olfactory epithelium was identified, at the transition between the nasal septum and the roof of the nasal cavity, in the most posterior portion of the olfactory fossa. Histopathological analysis and immunohistochemical study confirmed the diagnosis of angiofibroma.

ENAs affect all age groups, including women, are generally less vascularized and grow more rapidly than JNAs. ENAs are typically diagnosed in early stages and are less locally aggressive; furthermore, complete surgical resection is generally feasible for ENAs and the associated recurrence rate is low.

Although rare, angiofibromas should be considered in the differential diagnosis of vascularized tumors outside the nasopharynx, irrespective of patient's sex or age.