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Clinical Problem Solving: Pathology
July 2009

Pathology Quiz Case 2: Diagnosis

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2009;135(7):720-723. doi:10.1001/archoto.2009.63-b

Eosinophilic angiocentric fibrosis is a rare cause of nonneoplastic mucosal thickening of the upper respiratory tract that predominantly affects the nasal airway. In 1985, Roberts and McCann1described the condition as a mucosal variant of granuloma faciale. Since then, there have been fewer than 30 cases of EAF reported in the world literature. Twenty-five of the cases involved the sinonasal airway; 2 cases involved only the larynx; and 1 case involved the orbit and the ethmoidal sinus unilaterally. The etiology of EAF is unknown. Allergy, atopy, and trauma have all been suggested as predisposing factors, but the evidence for any of these origins is slim.2,3In the series of cases reported by Thompson and Heffner,4there was no history of allergy, trauma, previous surgery, self-medication, or known immunological disease. The patient may present with nonspecific symptoms such as nasal obstruction, epistaxis, nasal discharge, facial pain, or the presence of a mass in the nasal airway. The disease is slowly progressive, and the patient will often describe a worsening of symptoms over a number of years.