Juvenile Angiofibroma

Coronal CT scan of lesion filling left nasal cavity and ethmoid sinuses blocking maxillary sinuses and deviating septum to the right side.
Media type: CT

Media file 2: Axial CT scan of lesion involving the right nasal cavity and paranasal sinuses. Courtesy of J Otolaryngol 1999;28:145.
Media type: CT

Media file 3: Coronal MRI scan showing extension of the lesion to the cavernous sinus.

Angiofibromas are most common in adolescent boys. The average age being fifteen. There is a theory that it originates from hormonal activity. It is a non cancerous growth of the back of the nose or upper throat. The problem with an angiofibroma is that it continues to grow and can damage facial bones and sinuses. Symptoms of angiofibromas are frequent nosebleeds, stuffy nose or difficulty breathing, chronic nasal discharge and sometimes hearing loss. The best way to detect an angiofibroma is by CT. If the benign tumor is causing bone damage, surgery may be necessary to remove it. If chronic nosebleeds are the problem, embolization can be performed to prevent the tumor from bleeding. In some cases, the tumor can expand into the cranium or ocular orbit. Radiation therapy would be the treatment of choice to temporarily halt the growth of the tumor. Some angiofibromas disappear on their own. However, many continue to grow and can even return after surgery is performed.

Coat's Disease

I have never heard of Coat's Disease before this class. It is a rare condition of the eye. It is caused by abnormal development of the the blood vessels behind the retina. The retinal capillaries break open and leak serum from the blood into the back of the eye. This causes the retina to swell which can cause detachment of the retina. It is most common in males. It is a progressive disease that will affect a person's central vision. There is five stages of the disease and it almost always affects one eye, not both. Catching this disease early is very important. The later the stage, the more vision is lost. Treatments of the disease are Laser Therapy, Laser Photocoagulation or Cryotherapy. These treatments depend on the amount of leakage behind the eye. Patients in stages 1 through 3 can benefit from these treatments to restore some vision. Stages four and five have no possibility for vision recover because the amount of damage to the retina is too severe. With stage five, total blindness is usually the case and is not reversible. Currently there are various cancer drugs being used in clinical trials. Some doctors believe these drugs can stop new blood vessels from forming which could limit blood supply to the affected area. These studies are new and years away from being available to patients today.

Craniopharyngiomas

Craniopharyngioma

This is a picture of a craniopharyngioma. It is a benign tumor that grows near the pituitary gland in the area of the sella turcica. They can be solid or full of fluid. They are slow growing and can take years to discover or diagnose. They are mostly common in childhood and adolescence. They are congenital and what causes the grownth of a craniopharyngioma is unknown. Symptoms can include increased pressure on the brain, abnormal function of pituitary gland and vision problems. Some patients have no symptoms at all. CT and/or MRI are both recommended to determine the extent of the tumor. Surgery to remove the craniopharyngioma is the most common treatment. However, radiation therapy and some chemotherapy have been other options used in patients. Sometimes treatments are combined with surgery first, then radiation therapy in situations where small remnants of the tumor are left behind. Usually the patient's prognosis is good depending on ability to remove the tumor and the effects brought on by the tumor itself. Hormonal imbalance and neurological effects play a part in the recovery and prognosis.

Cholesteatoma

Cholesteatomas are a benign tumor that can form in the middle ear usually from infection. They can destroy the bones of hearing. They can erode the bones leading into the inner ear. The bone behind the ear is called the mastoid bone and it connects to the inner ear. In a healthy ear, it is filled with air. In the case of cholesteatoma, the mastoid bone is filled with irritated mucous membranes. This infection grows into the bone. This is a serious condition and the patient needs treatment right away. It can result in nerve loss, deafness , severe imbalance and dizziness. In extreme cases, it can lead to a brain infection. Doctors rely on CAT scans to determine how far into the ear the cholesteatoma has grown. It will also tell the doctor how much of the bones of hearing have been eroded. Antibiotics are used to clear up the infection. However, after the infection is better, surgery is required to remove the cholesteatoma completely.