Question

A 16-year-old boy presented with recurrent epistaxis. There is no history of trauma associated with it. On examination, there is a firm purplish mass on the left posterior choanae. Which of the following is the most appropriate for managing this patient?

• A. Needle biopsy
• B. FNAC
• C. Radiotherapy
• D. Surgical excision

Hint:

In cases of juvenile nasopharyngeal angiofibroma, early surgical intervention is crucial to prevent complications such as significant bleeding and airway obstruction.

Answer 1

The Correct Option is D

The presentation of recurrent epistaxis (nosebleeds) in a 16-year-old with a firm purplish mass in the posterior choanae is concerning for a juvenile nasopharyngeal angiofibroma (JNA), a benign but highly vascular tumor that typically occurs in adolescent males. The key features of JNA include:
Recurrent epistaxis: JNA is known for causing frequent and severe nosebleeds due to its highly vascular nature.
Purplish mass: On examination, these tumors can appear as a reddish or purplish mass due to the blood vessels they contain.
Location in the posterior choanae: JNA commonly occurs in the nasopharynx, often extending into the nasal cavity and paranasal sinuses. The appropriate management for juvenile nasopharyngeal angiofibroma is surgical excision, as these tumors do not respond well to medical therapies like radiotherapy or biopsy alone. Surgical removal is typically performed by endoscopic or open surgery, depending on the tumor’s size and location.
Needle biopsy and FNAC are not recommended in this case, as the tumor is highly vascular and biopsy could result in significant bleeding.
Radiotherapy is not typically used as first-line treatment for JNA, though it may be used in cases where surgical excision is not feasible or as an adjunct. Thus, the most appropriate management is Surgical excision.