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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research
Jihan Mudrika Rahmi
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

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Angiofibroma Beyond the Nasopharynx: Diagnostic Challenges and Endoscopic Management of Two Atypical Cases Arising from the Ethmoid and Sphenoid Sinuses Dolly Irfandy; Bestari Jaka Budiman; Jihan Mudrika Rahmi; Auzy Yoana Khalisha; Hippocrates Kam
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1500

Abstract

Background: Angiofibroma is a histologically benign but locally aggressive vascular neoplasm almost exclusively associated with the nasopharynx of adolescent males (Juvenile Nasopharyngeal Angiofibroma, JNA). Extranasopharyngeal angiofibroma (ENA) is an exceptionally rare variant that originates outside the sphenopalatine foramen, posing significant diagnostic and management challenges due to its atypical locations, age of presentation, and clinical mimicry of other sinonasal pathologies. Case presentation: We present two sophisticated cases of ENA managed at our tertiary center. Case 1: A 35-year-old male presented with unilateral nasal obstruction. Endoscopy and imaging revealed a hypervascular mass centered in the posterior ethmoid sinus, destroying the basal lamella and abutting the skull base. Histopathological analysis was initially confounded by features resembling a solitary fibrous tumor (SFT), requiring a comprehensive immunohistochemical panel (IHC) including STAT6 and nuclear beta-catenin to confirm the diagnosis of angiofibroma. Case 2: A 17-year-old male presented with symptoms and imaging (non-contrast CT) highly suggestive of a benign sphenochoanal polyp. An initial attempt at routine endoscopic removal was aborted due to unexpected, profuse hemorrhage. Subsequent advanced imaging (CTA/MRI) revealed a hypervascular sphenoid-based angiofibroma. Both patients underwent preoperative superselective embolization followed by successful, purely endoscopic tumor resection with no recurrence at 12 and 18-month follow-up, respectively. Conclusion: ENA is a critical, albeit rare, diagnostic consideration for any vascular sinonasal mass, regardless of patient age or tumor location. These cases underscore the unreliability of "classic" clinical and radiological signs, the diagnostic pitfalls of histopathological mimics like SFT and polyps, and the critical role of advanced IHC (nuclear beta-catenin) for definitive diagnosis. A modern, multidisciplinary approach combining preoperative embolization with endoscopic resection offers a safe and effective pathway to cure.
Angiofibroma Beyond the Nasopharynx: Diagnostic Challenges and Endoscopic Management of Two Atypical Cases Arising from the Ethmoid and Sphenoid Sinuses Dolly Irfandy; Bestari Jaka Budiman; Jihan Mudrika Rahmi; Auzy Yoana Khalisha; Hippocrates Kam
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1500

Abstract

Background: Angiofibroma is a histologically benign but locally aggressive vascular neoplasm almost exclusively associated with the nasopharynx of adolescent males (Juvenile Nasopharyngeal Angiofibroma, JNA). Extranasopharyngeal angiofibroma (ENA) is an exceptionally rare variant that originates outside the sphenopalatine foramen, posing significant diagnostic and management challenges due to its atypical locations, age of presentation, and clinical mimicry of other sinonasal pathologies. Case presentation: We present two sophisticated cases of ENA managed at our tertiary center. Case 1: A 35-year-old male presented with unilateral nasal obstruction. Endoscopy and imaging revealed a hypervascular mass centered in the posterior ethmoid sinus, destroying the basal lamella and abutting the skull base. Histopathological analysis was initially confounded by features resembling a solitary fibrous tumor (SFT), requiring a comprehensive immunohistochemical panel (IHC) including STAT6 and nuclear beta-catenin to confirm the diagnosis of angiofibroma. Case 2: A 17-year-old male presented with symptoms and imaging (non-contrast CT) highly suggestive of a benign sphenochoanal polyp. An initial attempt at routine endoscopic removal was aborted due to unexpected, profuse hemorrhage. Subsequent advanced imaging (CTA/MRI) revealed a hypervascular sphenoid-based angiofibroma. Both patients underwent preoperative superselective embolization followed by successful, purely endoscopic tumor resection with no recurrence at 12 and 18-month follow-up, respectively. Conclusion: ENA is a critical, albeit rare, diagnostic consideration for any vascular sinonasal mass, regardless of patient age or tumor location. These cases underscore the unreliability of "classic" clinical and radiological signs, the diagnostic pitfalls of histopathological mimics like SFT and polyps, and the critical role of advanced IHC (nuclear beta-catenin) for definitive diagnosis. A modern, multidisciplinary approach combining preoperative embolization with endoscopic resection offers a safe and effective pathway to cure.
Intratympanic Corticosteroid Salvage for Pediatric Bilateral Sudden Sensorineural Hearing Loss Complicated by Methylprednisolone-Induced Hypertensive Urgency in an Obese Adolescent Jihan Mudrika Rahmi; Rossy Rosalinda
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1531

Abstract

Background: Bilateral sudden sensorineural hearing loss (SSNHL) is a rare otologic emergency, accounting for less than 5% of sudden deafness cases and occurring even less frequently in pediatric populations. Unlike unilateral cases, bilateral involvement strongly implicates systemic etiologies such as autoimmune inner ear disease (AIED). Systemic high-dose corticosteroids are the standard first-line therapy but pose significant risks of toxicity, including hypertensive crisis, particularly in adolescents with metabolic risk factors. Case presentation: We report the case of a 17-year-old male (BMI 29.0 kg/m²) presenting with acute, simultaneous bilateral hearing loss (Pure Tone Average [PTA]: Right 82.5 dB, Left 81.25 dB) and severe tinnitus (Tinnitus Handicap Index [THI]: 78). Initial management with high-dose intravenous methylprednisolone (500 mg/day) was complicated on Day 7 by hypertensive urgency (Blood Pressure 150/95 mmHg) and neurological symptoms, necessitating immediate cessation of systemic therapy. Diagnostic investigation was limited by resource availability; however, elevated inflammatory markers supported a presumptive immune-mediated etiology. A salvage protocol was initiated using four weekly cycles of intratympanic Triamcinolone Acetonide. Following therapy, the patient demonstrated slight audiological recovery (PTA stabilized at 65 dB bilaterally) but achieved complete resolution of tinnitus (THI: 0). Conclusion: This case highlights the critical role of intratympanic corticosteroids as a safe salvage modality when systemic therapy is contraindicated due to toxicity. The dissociation between modest audiometric gain and complete tinnitus resolution suggests successful mitigation of cochlear synaptopathy. The case underscores the necessity of cardiovascular monitoring and BMI-adjusted risk stratification in adolescents receiving high-dose steroids.
Intratympanic Corticosteroid Salvage for Pediatric Bilateral Sudden Sensorineural Hearing Loss Complicated by Methylprednisolone-Induced Hypertensive Urgency in an Obese Adolescent Jihan Mudrika Rahmi; Rossy Rosalinda
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1531

Abstract

Background: Bilateral sudden sensorineural hearing loss (SSNHL) is a rare otologic emergency, accounting for less than 5% of sudden deafness cases and occurring even less frequently in pediatric populations. Unlike unilateral cases, bilateral involvement strongly implicates systemic etiologies such as autoimmune inner ear disease (AIED). Systemic high-dose corticosteroids are the standard first-line therapy but pose significant risks of toxicity, including hypertensive crisis, particularly in adolescents with metabolic risk factors. Case presentation: We report the case of a 17-year-old male (BMI 29.0 kg/m²) presenting with acute, simultaneous bilateral hearing loss (Pure Tone Average [PTA]: Right 82.5 dB, Left 81.25 dB) and severe tinnitus (Tinnitus Handicap Index [THI]: 78). Initial management with high-dose intravenous methylprednisolone (500 mg/day) was complicated on Day 7 by hypertensive urgency (Blood Pressure 150/95 mmHg) and neurological symptoms, necessitating immediate cessation of systemic therapy. Diagnostic investigation was limited by resource availability; however, elevated inflammatory markers supported a presumptive immune-mediated etiology. A salvage protocol was initiated using four weekly cycles of intratympanic Triamcinolone Acetonide. Following therapy, the patient demonstrated slight audiological recovery (PTA stabilized at 65 dB bilaterally) but achieved complete resolution of tinnitus (THI: 0). Conclusion: This case highlights the critical role of intratympanic corticosteroids as a safe salvage modality when systemic therapy is contraindicated due to toxicity. The dissociation between modest audiometric gain and complete tinnitus resolution suggests successful mitigation of cochlear synaptopathy. The case underscores the necessity of cardiovascular monitoring and BMI-adjusted risk stratification in adolescents receiving high-dose steroids.
Co-Authors Auzy Yoana Khalisha Bestari Jaka Budiman Dolly Irfandy Hippocrates Kam Rossy Rosalinda