Differential Diagnosis for a 20-year-old Male with Nasal Obstruction and a Reddish Mass

• Single most likely diagnosis:

  • Juvenile Nasopharyngeal Angiofibroma (JNA): This is a highly vascular tumor that typically occurs in adolescent males, presenting with nasal obstruction and a mass in the nasal cavity that can extend into the nasopharynx and oropharynx. The fact that it doesn't bleed on touch but is described as a dull faint reddish mass is consistent with JNA, although the lack of reported nosebleeds is somewhat atypical.

• Other Likely diagnoses:

  • Nasopharyngeal Carcinoma: Although less common in young adults, nasopharyngeal carcinoma can present with a mass in the nasopharynx and nasal obstruction. The absence of nasal discharge or bleeding is not uncommon in early stages.
  • Antrochoanal Polyp: A benign growth that can cause nasal obstruction and has a stalk that can extend into the choana. However, it's less likely to be described as a reddish mass.
  • Inflammatory Nasal Polyps: Can cause obstruction and may have a reddish appearance if inflamed, but they are usually associated with nasal discharge and are less likely to extend into the oropharynx.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed):

  • Rhabdomyosarcoma: A rare but aggressive tumor that can occur in the head and neck region of young adults, presenting with a mass and obstruction. It's crucial to consider due to its potential for rapid growth and metastasis.
  • Lymphoma: Both Hodgkin and non-Hodgkin lymphoma can present with masses in the nasopharynx and oropharynx, although they are less common in this age group and location.
  • Melanoma: Although rare, a melanoma in the nasal cavity or nasopharynx could present with a pigmented mass and needs to be considered due to its aggressive nature and poor prognosis if not caught early.

• Rare diagnoses:

  • Hemangioma: A benign vascular tumor that could present as a reddish mass but is less likely to cause significant obstruction or extend into multiple cavities.
  • Papilloma: Including inverted papilloma, which is a benign tumor but has the potential for malignant transformation. It's less common in young adults and might not typically present with a reddish color.
  • Granulomatosis with Polyangiitis (formerly known as Wegener's Granulomatosis): An autoimmune disorder that can cause destruction of the nasal passages and sinuses, potentially presenting with masses or obstruction, but it's usually accompanied by other systemic symptoms and findings.