A Study On GLUT-1 And PCNA Expression And Blood Supply System In Juvenile Nasopharyngeal Angiofibroma

Juvenile nasopharyngeal angiofibroma(JNA)is a rare,benign tumor of the nasopharynx,exclusively affecting males in their teens and twenties.While histologically benign,these tumors are locally aggressive,frequently involving the paranasal sinuses,pterygopalatine fossa,infratemporal fossa,orbit or intracranial cavities.The tumour is chiefly supplied by branches of the external carotid artery(ECA)with contribution from the internal carotid artery(ICA)in some patients.Traditionally,these tumors have been surgically excised via open procedures through transfacial lateral rhinotomy or infratemporal approaches.In the last decade,tumors confined to the nasal cavity and paranasal sinuses,as well as some more extensive lesions,have been successfully removed endoscopically.The tumor gets bleeding easily and is hard to get removed completely through surgery.Control of intraoperative bleeding is essential to the success of resections of such highly vascularized lesions,and preoperative embolization of JNAs has become standard.Surgery is the most important treatment of JNA,but post-operative recurrence is very high.Many researchers are trying to find some clues about etiology of JNA,but so far there is no generally accepted conclusion.Part ⅠObjective:To investigate the nature of juvenile nasopharygeal angiofibroma through compared the different expression of glucose transporter-1(GLUT-1)and proliferating cell nuclear antigen(PCNA)between hemangioma,vascular malformation and rhinopolyp.Methods :20 cases of juvenile nasopharygeal angiofibroma,9 cases of head and neck hemangioma,20 cases of head and neck vascular malformation and 15 cases of rhinopolyp admitted to the First Affiliated Hospital of Fujian Medica l University during the period from July 1,2006 to December 31,2017 were a massed.HE stain and optical microscopy were used to reconfirm the diagnosis.Immunohistochemical technique(En Vision)was used to detect the expression o f GLUT-1 and PCNA in juvenile nasopharygeal angiofibroma,hemangioma,vas cular malformation and rhinopolyp cases.Results: 1.The positive rates of GLUT-1,PCNA expression in the endothelial cells of JNA were 5%(1/20),10%(2/20),lower than those in hemangioma which were 88.9%(8/9),55.6%(5/9),there were extraordinary significant difference(P<0.05).2.The positive rates of GLUT-1,PCNA expression in the endothelial cells of JNA were 5%(1/20),10%(2/20),in vascular malformation which were 0%(0/20)、5%(1/20),in rhinopolyp which were 6.7%(1/15)、0%(0/15),there were no significant difference between JNA and vascular malformation(P>0.05).There were also no significant difference between JNA and rhinopolyp.Conclusions:The expression of GLUT-1,PCNA in JNA were lower than those in hemangioma.There were no significant difference between JNA and vascular malformation in the expression of GLUT-1,PCNA.This show us the nature of JNA could be vascular malformation.PART ⅡObjective: To explore the value of feeding arteries in the preoperative assess ment of juvenile nasopharygeal angiofibroma through Digital Subtraction Angiography(DSA).Methods: 31 cases of juvenile nasopharygeal angiofibroma admitted to the First Affiliated Hospital of Fujian Medical University during the period from July 1,2006 to December 31,2017 were amassed.The 31 cases of JNA proved b y surgery and pathology and examined by Digital subtraction angiography were analyzed retrospectively.The clinical staging of tumors were proved by surger y.The feeding arteries of tumors were determined by DSA.Results:1.Eight of the 31 cases also acquire feeding vessels from the internal carotid artery.Twenty three of the 31 JNAs receives blood supply via branches of the external carotid.Compare JNAs at different stages,there were significant difference between external carotid vascular supply and the contribution also from internal carotid artery.(P<0.05).2.Twenty three of the 31 patients have unilateral feeding vasculature and 8 of the 31 patients have tumor blood supply from bilateral vascular systems.Com-p are JNAs at different stages,there were no significant difference between uni-l atera vascular supply and bilateral vascular supply(P>0.05).Conclusions:The blood supply of tumors included the intemal carotid artery system showed a close relationship with tumor staging.Our study highlights the fact that surgical planning cannot be dependent on staging alone and shoul d include preoperative assessment of tumour vasculature by angiography.