Angiofibroma Group—Southeast Asia: Concept, research and outcome

Angiofibroma is a benign yet clinically aggressive vasoformative tumour that constitutes 0.5% of all head– neck tumours. It is highly prevalent in India, Egypt, Pakistan, Brazil, Mexico and Argentina – hot spots of angiofibroma (Ahluwalia, 1998) [1] – and in Turkey, Russia, Canada and the rest of Latin America. It is less prevalent in the USA, Middle East and Europe. Poland is an interesting country of Europe in context of angiofibroma. It is rare in Thailand, Australia and New Zealand.

The agenda of this group is to give impetus to basic research for angiofibroma, to have working groups for various controversies, to structure committees and to make them functional, to have a universal classification for angiofibroma, to have a global angiofibroma registry, to conduct angiofibroma world congress every 4 years, to start fellowship exchange programme and an official publication of the group, to publish a comprehensive monogram on juvenile nasopharyngeal angiofibroma ( JNA) and finally to have centre affiliation in the form of Regional Angiofibroma Centre, National Angiofibroma Centre, Advance Angiofibroma Centre and Satellite Angiofibroma Centres for intercentre collaboration to enhance an amalgamation of clinical and basic research to widen the horizon of angiofibroma research. The group is in the process of involving researchers and scientists of various specialities for collaboration and exchange of ideas and vision for angiofibroma to provoke a scientific interest in its possible aetiopathogenesis. Interested experts in histopathology, haematology, cellular pathology, anatomic pathology, immunology, immunotechnology, electron microscopy, cell transplants, cell therapy, genetics, biomedical engineering, molecular Angiofibroma Group-Southeast Asia: Concept, research and outcome

Hemant Ahluwalia a,c , Vandana Verma b
The Angiofibroma Group, Southeast Asia, is a global research group dedicated to innovations in angiofibroma. It was founded in 1994 with an inspiration from an angiofibroma patient. A major boost to the group came in 2008. The headquarters and secretariat of the angiofibroma group is in Agra, India. The aim of the group is to provide a platform to conduct, present, publish and promote research, exclusively in the field of angiofibroma.
biology, molecular technology, biochemistry, molecular physics, experimental oncology, nanotechnology, pathology, radiodiagnosis, anaesthesia, radiation oncology, neurosurgery, intervention neuroradiology and other allied specialities can contact us for a meaningful collaboration. These innovative minds are the pillars of angiofibroma research and are always an asset to the group.
Until now, we have worked on tumour attenuation coefficient in angiofibroma, hot spots, recurrence predictors [3], tumour embolization and immunotherapy for angiofibroma [4]. Presently, the areas of interest in angiofibroma are genetics, immunohistochemistry, hormones and stem cell therapy.
Specific genetic imbalances have been identified in angiofibroma by comparative genomic hybridization, but still genetic determiners involved in its pathogenesis remain unknown. The underlying dysregulated molecular mechanisms are unclear, and understanding of these may lead to its prevention. Congenital angiofibroma forwards the recent research that it is a result of developmental defect affecting the embryonic vascular network surrounding the sphenoid bone [5].
Angiofibroma development seems to be influenced by vascular endothelial growth factor, transforming growth factor-b1 and IGFI, though the real production stimulus of these mediators has not been completely understood. Vascular endothelial growth factor is secreted by JNA and contributes to strong vascularization of angiofibroma [6]. The incidence of microparticle arteriovenous shunts in JNA is much higher. Prominent collagen type VI expression exerts an important growth stimulus in angiofibroma.
Clonal alteration in the b-catenin oncogene and stromal component is the key neoplastic component in angiofibroma [7]. The study of genetic changes in primary tumours is necessary through 'high throughput' techniques with correlate gene grouping real-time expression analysis for the detection of possible recurrence risk predictors [8].
Biphasic nature of the origin of angiofibroma in vascular endothelial cells or fibroblasts is poorly understood. Immunohistochemistry may hold the future of research in angiofibroma [9]. Angiofibroma is labelled as angiogenic histogenetic tumour that leads to a scope of antiangiogenic therapy in the future treatment strategy. Specific angiogenesis blockers may represent a treatment protocol for unresectable and recurrent angiofibroma, as a retention and/or induction of receptor tyrosine kinase in ischaemic angiofibroma was observed. Somatostatin receptor is overexpressed in JNA cells. Somatostatin analogue, Tc-octreotide, is effectively bound to JNA cells. Somatostatin analogues might be used in the diagnosis and treatment of primary, recurrent and residual angiofibroma [10].
Hormonal disorders have been reported in angiofibroma patients. Androgen and oestrogen receptors have been identified in tumour tissue; however, a hormonal influence on JNA is controversial. Despite controversy, the hormonal stimulation may remain a possible therapeutic target for angiofibroma.

Preoperative
superselective embolization in conjunction with endoscopic angiofibroma surgery has markedly changed the surgical outcome in the recent past. The newer adjuvants to endoscopic sinus surgery are gamma knife surgery, coblation-assisted endoscopic resection, endoscopic surgery using lowtemperature plasma radiofrequency, harmonic scalpelassisted endoscopic surgery, endoscopic laser-assisted excision and robotic radiotherapy -cyber knife.
The lesser known facts about JNA are that people using anabolic steroids for various reasons are more prone to develop angiofibroma. Angiofibroma in HIV-positive patients has much aggressive course. Haemophilicdeficient and factor VII-deficient angiofibroma patients are at high risk for torrential bleeding. There is a concept of tumour embolization besides arterial embolization, when the facility of later is unavailable. Authentic cases of angiofibroma in female individuals have been reported from many centres of the world, which are histopathologically and immunohistochemically proven. We have the biggest series of angiofibroma in female individuals in the world. Angiofibroma has been reported even in a pregnant female from France. Extranasopharyngeal angiofibroma occurs in still older patients and has been seen at various sites of the head and neck, such as nasal septum, turbinate, larynx, ethmoid, maxillary sinus and hypopharnyx.
The representation in the Angiofibroma Group, Southeast Asia Board, and centre affiliation in Egypt are as follows. We are still in the process of adding experts and centres from various parts of Egypt to make it comprehensive and to give appropriate representation to the cross-section of Egypt.