Answer for BIR CoW 30 Nov 2025
Juvenile nasopharyngeal angiofibroma
Findings
Evidence of T1 isointense T2 STIR heterointense relatively well defined lesion noted epicentered at left sphenopalatine foramen showing diffusion restriction. The lesion is seen extending laterally upto left pterygoid plates infiltrating the pterygoid muscles. Superiorly, the lesion extending upto skull base, Inferiorly and posteriorly extending upto left nasopharynx reaching the midline. Medially upto the nasal septum. Anteriorly extending upto retro maxillary fat pad. The lesion measures~ 2.6(anteroposterior) x 2.2 (transverse) x 2.5cm (cranio caudal). On contrast administration, the lesion shows avid enhancement. Post-operative FESS changes noted. Evidence of multiple enlarged cervical lymph nodes in left level Ib and bilateral level II, largest measuring~1.4 x 1 cm in left level Ib. Impression: Known case of, Juvenile Nasopharyngeal Carcinoma. Status Post Tran nasal Endoscopic Excision of Juvenile Nasopharyngeal mass, Present study shows, -Relatively well defined lesion epicentered at left sphenopalatine foramen with above mentioned extensions showing avid contrast enhancement – suggestive of recurrent Juvenile Nasopharyngeal Angiofibroma.
Discussion
JNA is an uncommon, highly vascular, locally invasive, unencapsulated tumor with a distinct predilection for origin in the nasopharynx of adolescent males. It is a disease of the young and occurs almost exclusively in adolescent males. Occurs in the second decade usually between the ages of 5 and 25 and a mean age of 15 years. MRI Features: T1: intermediate signal T2: heterogeneous signal: flow voids appear dark T1 C+ (Gd): shows prominent enhancement The presence of prominent flow voids leads to a salt and pepper appearance on most sequences and are characteristic Differentials: 1. Antrochoanal Polyp 2. Nasopharyngeal Carcinoma 3. Rhabdomyosarcoma 4. Angiofibroma-like Hemangioma / Hemangiopericytoma
References:
RADIOLOGICAL FEATURES OF JUVENILE NASOPHARYNGEAL ANGIOFIBROMA -JE Ikubor, NE Okolugbo, AL Okhakhu, PMCID: PMC4437236 PMID: 26046027 Imaging in the Diagnosis of Juvenile Nasopharyngeal Angiofibroma-Satyaranjan Mishra,, N. M. Praveena, Rajat Golakh Panigrah, Y Mogit Gupta. CASE REPORT 2013:3;1,doi:10.4103/2156-7514.109469 Imaging findings of juvenile nasopharyngeal angiofibroma invading orbital apex and middle cranial fossa: a case report. Egyptian Journal of Radiology and Nuclear Medicine volume 54, Article number: 160 (2023)
Findings
Evidence of T1 isointense T2 STIR heterointense relatively well defined lesion noted epicentered at left sphenopalatine foramen showing diffusion restriction. The lesion is seen extending laterally upto left pterygoid plates infiltrating the pterygoid muscles. Superiorly, the lesion extending upto skull base, Inferiorly and posteriorly extending upto left nasopharynx reaching the midline. Medially upto the nasal septum. Anteriorly extending upto retro maxillary fat pad. The lesion measures~ 2.6(anteroposterior) x 2.2 (transverse) x 2.5cm (cranio caudal). On contrast administration, the lesion shows avid enhancement. Post-operative FESS changes noted. Evidence of multiple enlarged cervical lymph nodes in left level Ib and bilateral level II, largest measuring~1.4 x 1 cm in left level Ib. Impression: Known case of, Juvenile Nasopharyngeal Carcinoma. Status Post Tran nasal Endoscopic Excision of Juvenile Nasopharyngeal mass, Present study shows, -Relatively well defined lesion epicentered at left sphenopalatine foramen with above mentioned extensions showing avid contrast enhancement – suggestive of recurrent Juvenile Nasopharyngeal Angiofibroma.
Discussion
JNA is an uncommon, highly vascular, locally invasive, unencapsulated tumor with a distinct predilection for origin in the nasopharynx of adolescent males. It is a disease of the young and occurs almost exclusively in adolescent males. Occurs in the second decade usually between the ages of 5 and 25 and a mean age of 15 years. MRI Features: T1: intermediate signal T2: heterogeneous signal: flow voids appear dark T1 C+ (Gd): shows prominent enhancement The presence of prominent flow voids leads to a salt and pepper appearance on most sequences and are characteristic Differentials: 1. Antrochoanal Polyp 2. Nasopharyngeal Carcinoma 3. Rhabdomyosarcoma 4. Angiofibroma-like Hemangioma / Hemangiopericytoma
References:
RADIOLOGICAL FEATURES OF JUVENILE NASOPHARYNGEAL ANGIOFIBROMA -JE Ikubor, NE Okolugbo, AL Okhakhu, PMCID: PMC4437236 PMID: 26046027 Imaging in the Diagnosis of Juvenile Nasopharyngeal Angiofibroma-Satyaranjan Mishra,, N. M. Praveena, Rajat Golakh Panigrah, Y Mogit Gupta. CASE REPORT 2013:3;1,doi:10.4103/2156-7514.109469 Imaging findings of juvenile nasopharyngeal angiofibroma invading orbital apex and middle cranial fossa: a case report. Egyptian Journal of Radiology and Nuclear Medicine volume 54, Article number: 160 (2023)
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!