Angiofibroma
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Angiofibroma (AGF) is a descriptive term for a wide range of benign skin or mucous membrane (i.e. the outer membrane lining body cavities such as the mouth and nose) lesions in which individuals have: 1) benign papules, i.e. pinhead-sized elevations that lack visible evidence of containing fluid; 2) nodules, i.e. small firm lumps usually >0.1 cm in diameter; and/or 3) tumors, i.e. masses often regarded as ~0.8 cm or larger. AGF lesions share common macroscopic (i.e. gross) and microscopic appearances. Grossly, AGF lesions consist of multiple papules, one or more skin-colored to erythematous, dome-shaped nodules, or usually just a single tumor. Microscopically, they consist of spindle-shaped and stellate-shaped cells centered around dilated and thin-walled blood vessels in a background of coarse bundles of
collagen Collagen () is the main structural protein in the extracellular matrix found in the body's various connective tissues. As the main component of connective tissue, it is the most abundant protein in mammals, making up from 25% to 35% of the whole ...
(i.e. the main fibrous component of
connective tissue Connective tissue is one of the four primary types of animal tissue, along with epithelial tissue, muscle tissue, and nervous tissue. It develops from the mesenchyme derived from the mesoderm the middle embryonic germ layer. Connective tiss ...
). Angiofibromas have been divided into different types but commonly a specific type was given multiple and very different names in different studies. The following list gives a brief description of the AFG types and their alternate names. Cutaneous angiofibroma: These papule, nodule, and/or tumor lesions occur on the: 1) face and are typically termed fibrous papules; 2) penis and are typically termed pearly penile papules; and 3) underneath a fingernail or toenail and are typically termed periungual angiofibromas. Some of these cutaneous AGF lesions occur in individuals with one or more of 3 different genetic diseases:
tuberous sclerosis Tuberous sclerosis complex (TSC) is a rare multisystem autosomal dominant genetic disease that causes non-cancerous tumours to grow in the brain and on other vital organs such as the kidneys, heart, liver, eyes, lungs and skin. A combination ...
, multiple endocrine neoplasia type 1, and Birt-Hogg-Dube syndrome. The following are examples of these cutaneous angiofibromas and their alternate names. * Fibrous papules are also termed facial angiofibromas and were formerly and incorrectly termed adenoma sebaceum (fibrous papules are unrelated to sebaceous glands). They develop in up to 8% of the general adult population and occur as 1 to 3 pink to red, dome-shaped papules in the central areas of the face, nose, and/or lips. About 75% of individuals with tuberous sclerosis present with fibrous papules in their infancy or early childhood; when associated with this rare disease, the lesions often occur as multiple papules in symmetrical, butterfly-shaped patterns over both cheeks and the nose. Fibrous papules also occur in individuals with multiple endocrine neoplasia type 1 (a study done in Japan found that 43% of individuals with this genetic disease bore facial angiofibromas) and, uncommonly, in individuals with Birt-Hogg-Dube syndrome. * Pearly penile papules are also termed hirsuties coronae glandis, papillae coronae glandis, papillomatosis corona penis, corona capillitii, and hirsutoid papillomas. These lesions develop in up to 30% of males during their puberty or, less commonly, early adulthood. They typically occur as numerous white-colored to skin-colored papules located circumferentially around the corona of the penis or, less commonly, the ventromedial aspect of the corona near the penis's frenulum. (
Vestibular papillomatosis Vestibular papillomatosis (VP) are normal small bumps in the genital area of females. They appear in multiple numbers, are rounded and are not painful, itchy or uncomfortable. They are analogous to pearly penile papules, which occur in males. The ...
, also named hirsutoid vulvar papillomas, vulvar squamous papillomatosis, micropapillomatosis labialis, and squamous vestibular micropapilloma, is the female equivalent of pearly penile papules in men. It has not been formally termed an angiofibroma.) * Periungual angiofibromas are also termed Koenen's tumors, periungual fibromas, and subungual fibromas. In addition, these tumors were formerly regarded as a type of acral angiofibroma (see below description). These lesions present as multiple nodules or tumors under multiple finger and/or toe nails of individuals with tuberous sclerosis or in one case the Birt-Hogg-Dube syndrome. Periungual angiofibromas have also been reported to occur in individuals that do not have these genetic diseases. Periungual angiofibromas tumors can be highly mutilating finger/toe-nail lesions. Oral fibromas are also termed irritation fibromas, focal fibrous hyperplasia, and traumatic fibromas. Topic Completed: 26 October 2020. Minor changes: 26 October 2020 These lesions are nodules that occur on the buccal mucosa (i.e. mucous membranes lining the cheeks and back of the lips) or lateral tongue. They may be irritating or asymptomatic and are the most common tumor-like lesions in the oral cavity. Oral fibromas are not
neoplasm A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
s; they are hyperplastic (i.e. overgrowth) reactions of fibrous tissue to local trauma or chronic irritation. Nasopharyngeal angiofibromas, also termed juvenile nasopharyngeal angiofibromas, fibromatous hamartomas, or angiofibromatous hamartoma of the nasal cavity, are large benign tumors (average size 5.9 cm in one study) that develop almost exclusively in males aged 9 to 36 years old. They commonly arise in the nasopharynx (i.e. upper part of the throat that lies behind the nose) and typically have attachments to the sphenopalatine foramen, clivus, and/or root of the pterygoid processes of the sphenoid bone. These tumors may expand into various other nearby structures including the
cranial cavity The cranial cavity, also known as intracranial space, is the space within the skull that accommodates the brain. The skull minus the mandible is called the ''cranium''. The cavity is formed by eight cranial bones known as the neurocranium that in ...
. Nasopharyngeal angiofibromas are highly vascularized tumors consisting of
fibroblast A fibroblast is a type of cell (biology), biological cell that synthesizes the extracellular matrix and collagen, produces the structural framework (Stroma (tissue), stroma) for animal Tissue (biology), tissues, and plays a critical role in wound ...
s (i.e.
connective tissue Connective tissue is one of the four primary types of animal tissue, along with epithelial tissue, muscle tissue, and nervous tissue. It develops from the mesenchyme derived from the mesoderm the middle embryonic germ layer. Connective tiss ...
cells) in a dense collagen
matrix Matrix most commonly refers to: * ''The Matrix'' (franchise), an American media franchise ** ''The Matrix'', a 1999 science-fiction action film ** "The Matrix", a fictional setting, a virtual reality environment, within ''The Matrix'' (franchis ...
(i.e. tissue background). Studies have suggested that these tumors are due to the expression of male sex hormones (i.e. androgens and
progesterones Progesterone (P4) is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. It belongs to a group of steroid hormones called the progestogens and is the major ...
), genetic factors, molecular alterations (i.e. changes in the normal characteristics of cells that lead to abnormal cell growth), and/or human papillomavirus infection.
Angiofibroma of soft tissue Angiofibroma of soft tissue (AFST), also termed angiofibroma, not otherwise specified, is a recently recognized and rare disorder that was classified in the category of benign fibroblastic and myofibroblastic tumors by the World Health Organization ...
is also named angiofibroma, not otherwise specified, by the World Health Organization, 2020. The Organization also classified these lesions as in the category of benign
fibroblastic and myofibroblastic tumors Fibroblastic and myofibroblastic tumors (FMTs) develop from the mesenchymal stem cells which differentiate into fibroblasts (the most common cell type in connective tissue) and/or the myocytes/myoblasts that differentiate into muscle cells. FMTs ...
. These tumors more often afflict females, typically occur in adults (median age 49 years), have a median size of ~3.5 cm, and develop in a leg near to, and may invade, a large joint. Less uncommonly, they occur in the back, abdominal wall, pelvic cavity, or breast. Angiofibroma of soft tissue tumors consist of uniform, bland, spindle-shaped cells and a prominent vascular network consisting of small thin-walled branching blood vessels in a variably collagenous tissue background. Its tumor cells contain an '' AHRR-
NCOA2 NCOA may refer to: *National Change Of Address database (see United States Postal Service) *National Chamber Orchestra of Armenia *National Council on Aging * The Non-commissioned officer, Noncomissioned Officer Academy in the United States Air For ...
'' fusion gene in 60% to 80% of cases and a ''
GTF2I General transcription factor II-I is a protein that in humans is encoded by the ''GTF2I'' gene. Function This gene encodes a multifunctional phosphoprotein, TFII-I, with roles in transcription and signal transduction. Haploinsuffiency (deletio ...
-
NCOA2 NCOA may refer to: *National Change Of Address database (see United States Postal Service) *National Chamber Orchestra of Armenia *National Council on Aging * The Non-commissioned officer, Noncomissioned Officer Academy in the United States Air For ...
'' or ''
GAB1 GRB2-associated-binding protein 1 is a protein that in humans is encoded by the ''GAB1'' gene. Function The protein encoded by this gene is a member of the IRS1-like multisubstrate docking protein family. The encoded protein is an important me ...
''-''
ABL1 Tyrosine-protein kinase ABL1 also known as ABL1 is a protein that, in humans, is encoded by the ''ABL1'' gene (previous symbol ''ABL'') located on chromosome 9. c-Abl is sometimes used to refer to the version of the gene found within the mammalian ...
'' fusion gene in rare cases.
Cellular angiofibroma Cellular angiofibroma (CAF) is a rare, benign tumor of superficial soft tissues that was first described by M. R. Nucci et al. in 1997. These tumors occur predominantly in the distal parts of the female and male reproductive systems, i.e. in the v ...
is usually a small, slow-growing tumor arising in the
vulva The vulva (plural: vulvas or vulvae; derived from Latin for wrapper or covering) consists of the external sex organ, female sex organs. The vulva includes the mons pubis (or mons veneris), labia majora, labia minora, clitoris, bulb of vestibu ...
-
vaginal In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hyme ...
areas of adult woman and the
inguinal In human anatomy, the inguinal region refers to either the groin or the lower lateral regions of the abdomen. It may also refer to: * Conjoint tendon, previously known as the inguinal aponeurotic falx, a structure formed from the transversus abdo ...
-
scrotal The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum co ...
areas of adult men although some of these tumors, especially in men, can grow up to 25 cm. Affected men are usually older (7th decade) than women (5th decade). Less commonly. cellular angiofibromas have occurred in various other superficial soft tissue areas throughout the body. These tumors are edematous (i.e. abnormally swollen with fluid), highly vascular, spindle-shaped cell lesions with a variable amount of fibrous stroma. In 2020, the World Health Organization classified cellular angiofibroma tumors in the category of benign
fibroblastic/myofibroblastic tumors Fibroblastic and myofibroblastic tumors (FMTs) develop from the mesenchymal stem cells which differentiate into fibroblasts (the most common cell type in connective tissue) and/or the myocytes/myoblasts that differentiate into muscle cells. FMTs ...
. The tumor cells in these lesions contain chromosome and gene abnormalities including a loss of one of the two '' RB1'' genes. It has been suggested that the loss of this gene contributes to the development of cellular angiofibroma tumors. Acral angiofibromas are also termed superficial acral fibromyxomas, digital fibromyxomas, acquired digital fibrokeratomas, acquired periungual fibrokeratomas, garlic clove fibromas, digital fibromas, and cellular digital fibromas. At one time, periungual angiofibromas were regarded as a type of acral angiofibroma (see above description). Acral refers to distal sites of the ears, nose, hands, fingers, feet, and toes. Acral angifibromeae occur primarily in areas close to the nails of fingers and toes (~80% of cases) or, less commonly, palms of the hands or soles of the feet. The tissues of this tumor consists of bland spindle-shaped and star-shaped cells within a collagen fiber-rich stroma containing prominent blood vessels and
mast cells A mast cell (also known as a mastocyte or a labrocyte) is a resident cell of connective tissue that contains many granules rich in histamine and heparin. Specifically, it is a type of granulocyte derived from the myeloid stem cell that is a par ...
.


See also

*
List of cutaneous conditions Many skin conditions affect the human integumentary system—the organ system covering the entire surface of the body and composed of skin, hair, nails, and related muscle and glands. The major function of this system is as a barrier against t ...
*
Tuberous sclerosis Tuberous sclerosis complex (TSC) is a rare multisystem autosomal dominant genetic disease that causes non-cancerous tumours to grow in the brain and on other vital organs such as the kidneys, heart, liver, eyes, lungs and skin. A combination ...
* multiple endocrine neoplasia type 1 * Birt-Hogg-Dube syndrome


References


External links

{{Vascular tumors Cutaneous conditions Dermal and subcutaneous growths Connective and soft tissue neoplasms Benign neoplasms