Adolescent Nasopharyngeal Carcinoma Mimicking Juvenile Nasopharyngeal Angiofibroma​

• Main Authors: Md Shamuddin, Mohammad Aizat Kamal, Haroon, Raihanah, A Wahab, Azwan Halim
• Format: Proceeding Paper
• Language: English; English
• Published: 2023
• Subjects: RD Surgery; RF Otorhinolaryngology
• Online Access: http://irep.iium.edu.my/111245/1/Aizat%20Poster%20edit%20%281%29.pptx; http://irep.iium.edu.my/111245/2/MRS%202023%20-%20Abstract%20Book-1.pdf.crdownload; http://irep.iium.edu.my/111245/

We hereby present a 14-year-old teenage male who complained of painless neck swelling. Nasoendoscopy then discovered a huge lobulated angry-looking mass occluding the entire left posterior choana, hence a provisional diagnosis of juvenile nasal angiofibroma (JNA) was made and biopsy was not immediately undertaken. Subsequent computed tomography (CT) demonstrated a large heterogenous mass at the left nasopharyngeal region extending to the oropharynx and posterior choana. Though the left sphenopalatine foramen was not widened, the mass was seen minimally extending into it. Given the patient’s age, size and location of the mass, combined clinical and radiological diagnosis concluded JNA as the primary diagnosis and endoscopic excision of the mass was planned. However, he presented about 1 month later in casualty with right nasal epistaxis whereby repeated nasoendoscopy showed a larger mass extending to the right nasopharynx with contact bleeding. The tissue biopsy performed was complicated with significant bleeding, further validating the suspicion of JNA. Histopathological diagnosis otherwise revealed undifferentiated carcinoma. The patient otherwise showed good response to chemoradiation. JNA is a rare benign but locally aggressive vascular tumor of nasopharynx which occurs almost exclusively in pediatric or adolescent population. NPC on the other hand, although rare in children; has a predilection for adolescents. Since the treatment approach for NPC and JNA varies greatly, it is crucial to distinguish between the two conditions on radiological imaging. JNA arises from sphenopalatine foramen though both tend to exhibit some bony changes. An endoscopic endonasal approach with optional pre-operative embolization is the treatment option for JNA as opposed to chemoradiation for NPC. We would like to highlight that age is not a dependent risk factor in any malignancy, particularly NPC. When the clinical manifestations of NPC and JNA are similar, NPC diagnosis requires a high clinical suspicion followed by imaging; regardless of age.