Estrogen receptors in nasopharyngeal angiofibromas.

Nasopharyngeal angiofibromas, which occur exclusively in pubescent males, are frequently treated with estrogens in an effort to decrease their size and vascularity. It has been presumed by some that estrogen has a direct effect on the tumor itself. Others have felt that hormone acts by affecting the pituitary-gonadal axis. In this study, six male patients with nasopharyngeal angiofibromas had their tumors analyzed for estrogen receptors and none were found. Despite this fact, two of these patients treated with estrogens showed clinical evidence of a decrease in tumor size and vascularity. This response occurring in the absence of estrogen receptors suggests that the action of estrogen on nasopharyngeal angiofibromas is indirect. Alternatively these tumors may be testosterone dependent and the administration of estrogen suppresses the normal male testosterone levels, with a resultant reduction in tumor size and vascularity. Twenty-four patients with nasopharyngeal angiofibroma have been treated at the University of Virginia in the past 22 years. The average blood loss at operation was 1900 cc. When estrogens were administered preoperatively in 3 patients, the average blood loss was 1135 cc. Those patients who received no estrogens averaged 2000 cc blood loss. These figures do not reflect the size or extent of the disease, both of which greatly influence blood loss.