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the extranasopharyngeal angiofibroma ( enpa ) is histologically similar to juvenile nasopharyngeal angiofibroma ( jna ) , differing from the latter in clinical and epidemiologic characteristics.1 
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 3 prevalence , gender , age , affected site , pathogenesis , clinical and computed tomography characteristics , and recurrence are completely different,1 
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 3 which leads some authors to classify the enpa as a disease different from the jna.1 
  there are fewer than a hundred cases of enpa described in the literature , and the maxillary sinus is the most frequently affected site , followed by the ethmoid ; the entity is rare in the nasal septum and inferior turbinates.1 
 2 
 3 the objective of this study is to report a case of enpa with a rare presentation in the inferior turbinate .
angiofibromas that originate in or are localized in an area other than the nasopharynx are called extranasopharyngeal angiofibromas or atypical angiofibromas.2 
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  the jna is the most common benign neoplasm of the nasopharynx , despite representing less than 0.05% of tumors of the head and neck.1 
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 5 it affects almost exclusively males between 12 and 14 years of age.1 
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 5 but the enpa is even more unusual ; it is more common in females between 17 and 22 years , and its most common site is the maxillary sinus , followed by the ethmoid .
it is very rare in the nasal septum and inferior turbinates.1 
 2 
 3 angiofibromas that originate in the inferior turbinate are very rare ; to the best of our knowledge , only nine cases of enpa in nasal cavity have been previously reported in the english language literature . in seven cases ,
the tumor arose from the nasal septum , and only two from inferior turbinate.6 
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  the origin of the jna is at the top of the sphenopalatine foramen,1 
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 5 and its etiology is controversial.4 enpa 's etiology is associated with a migration error of the fascia basalis,1 justifying its presence in varied locations.2 
  the initial growth of the jna follows a well - defined pattern in the nasal cavity , nasopharynx , and pterygopalatine fossa,4 leading to the triad of nasal obstruction , recurrent epistaxis , and nasopharyngeal tumor.1 
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 5 the jna has characteristic radiologic signs : holman - miller ( anteriorization of the posterior wall of the maxillary sinus ) and enlargement of the sphenopalatine foramen and pterygopalatine fossa.1 
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  histologically , the enpa is similar to the jna , with connective tissue stroma and a matrix of dilated vessels without a muscular layer.2 
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 5 as for differential diagnosis , we have the hemangioma and the hemangiopericitoma.3 although the jna can be suspected based on known clinical and computed tomography ( ct ) chracteristics,2 
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 5 histopathologic examination is essential to confirm the enpa diagnosis.1 
  treatment is surgical in both diseases.2 although the enpa is nurtured by the maxillary artery4 ( just like the jna ) , it may not cause excessive intraoperative bleeding due to the predominance of fibrous stroma , unlike the jna.1 
 2 although benign , the jna is locally aggressive , with recurrence rates of 6 to 27.5%2 due to incomplete tumor removal.5 

the patient was a girl , 8 years and 6 months of age , who had constant bilateral nasal obstruction and recurrent epistaxis for 6 months , worse on the right side , with hyposmia and snoring .
the left nasal cavity and nasopharynx were normal , and no cervical lymphadenopathy was present .
ct showed a lesion with soft tissue density in the right nasal cavity ( figs . 1 , 2 , and 3 ) .
preoperative axial computed tomography scan showing the tumor in the right nasal cavity with contrast enhancement . 

preoperative coronal computed tomography scan showing the tumor in the right nasal cavity with contrast enhancement . 

preoperative sagittal computed tomography scan showing the tumor in the right nasal cavity with contrast enhancement .
we used an endoscopic approach , identifying the lesion inserted in the right inferior turbinate , doing a subperiosteal dissection and excision with a partial turbinectomy with a resection margin of 0.5 cm .
we did not perform preoperative embolization because the tumor was at an accessible location , and we expected that the bleeding could be easily controlled . however , the patient experienced excessive intraoperative bleeding ( 800 ml in 5 minutes ) . on gross inspection ,
the tumor was a 6    4-cm rubbery mass with smooth margins ( fig .
, it was composed of fibrous stroma and numerous thin - walled blood vessels ( fig .
the patient 's postoperative course was uneventful , and she showed no further symptoms . over postoperative follow - up of 6 months , no recurrence was noted . 

histologic examination : abundant fibrous component with thin - walled vascular structures ( hematoxylin - eosin staining , original magnification    400 ) .
enpas are usually found in the maxillary sinus.6 angiofibromas that originate in the inferior turbinate are very rare ; to the best of our knowledge , only nine cases of enpa in the nasal cavity have been previously reported in the english language literature . in seven cases ,
the tumor arose from the nasal septum and only two arose from the inferior turbinate.6 
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  the enpa can evolve with a variety of symptoms and radiologic signs , depending on its site.1 
 2 our patient reported nasal obstruction due to a rare location in the right inferior turbinate .
the enpa usually does not recur because its extrapharyngeal location facilitates total ressection.1 
 2 
 3 our patient did not complain of postoperative epistaxis , but had excessive intraoperative bleeding .
she is now 9 years old ; there has been no recurrence in 6 months .
our patient had age and location different from most enpas , confirming the rarity of this case .
therefore , although histologically similar , the enpa and the jna may be considered different diseases , due to totally different pathogenesis , epidemiology , and clinical and tomographic presentations.1 
  this case challenges all the pathogenetic and evolutionary characteristics of jna and enpa .
cavernous hemangioma , hemangiopericytoma , or pyogenic granuloma is more plausible and this is more likely with the radiologic findings .
although rare , enpa should be considered in the diagnosis of vascular tumors of the head and neck .
enpa 's clinical and epidemiologic characteristics are different from those of jna . in conclusion , enpa differs significantly from jna regarding clinical and radiologic presentations .
enpas lack typical clinical and radiologic features as they develop in all age groups and in females .
they arise from various sites , may be less vascularized , and produce a variety of symptoms depending on the point of origin .
introduction  the extranasopharyngeal angiofibroma is histologically similar to juvenile nasopharyngeal angiofibroma , differing from the latter in clinical and epidemiologic characteristics 
 . 
 objectives  we present a case of extranasopharyngeal angiofibroma originating in the inferior turbinate . 
 resumed report  the patient was a girl , 8 years and 6 months of age , who had constant bilateral nasal obstruction and recurrent epistaxis for 6 months , worse on the right side , with hyposmia and snoring . 
 nasal endoscopy showed a reddish lesion , smooth , friable , and nonulcerated . computed tomography showed a lesion with soft tissue density in the right nasal cavity . 
 we used an endoscopic approach and found the lesion inserted in the right inferior turbinate . 
 we did a subperiosteal dissection and excision with a partial turbinectomy with a resection margin of 0.5 cm . 
 histopathology reported it to be an extranasopharyngeal angiofibroma . 
 
 conclusion  although rare , extranasopharyngeal angiofibroma should be considered in the diagnosis of vascular tumors of the head and neck .