A 15-year-old boy presents with progressive nasal obstruction, unilateral nasal bleeding, and a pinkish-gray mass visible in the nasopharynx. Contrast CT shows a highly vascular mass centered at the sphenopalatine foramen with anterior bowing of the posterior maxillary sinus wall (Holman-Miller sign). The diagnosis is:

• A Juvenile nasopharyngeal angiofibroma (JNA) ✓
• B Nasopharyngeal carcinoma
• C Choanal polyp
• D Rhabdomyosarcoma

Explanation

Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally aggressive vascular fibrous tumor occurring exclusively in adolescent males. The classic presentation is unilateral nasal obstruction and recurrent epistaxis in a teenage boy. CT shows the Holman-Miller sign (anterior bowing of the posterior wall of the maxillary sinus due to mass expansion). The tumor arises at or near the sphenopalatine foramen. Biopsy is contraindicated due to risk of severe hemorrhage. Treatment is preoperative embolization followed by surgical excision.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.