**Question:** True about juvenile nasopharyngeal angiofibroma - a) Surgery is treatment of choice, b) It is malignant tumour, c) ↑ Incidence in females, d) Hormones not used in Rx, e) Miller's sign positive.

**Core Concept:** Juvenile nasopharyngeal angiofibroma is a benign tumor that occurs in the nasopharyngeal region, predominantly in male adolescents. It is named after the pediatrician William J. Miller, who described the syndrome in 1955.

**Why the Correct Answer is Right:**
- Surgery is the treatment of choice: Juvenile nasopharyngeal angiofibroma is a benign tumor, so surgical excision is the preferred treatment option to remove the tumor without causing significant damage to surrounding structures.
- It is not malignant (b) and has no gender bias (c): Juvenile nasopharyngeal angiofibroma is a benign tumor, so it is not malignant and does not follow the gender bias observed in other tumors.
- Hormones are not used in treatment (d): Since juvenile nasopharyngeal angiofibroma is a benign tumor, hormonal manipulation is not typically employed in its management.
- Miller's sign positive (e): This refers to the characteristic clinical finding of the tumor causing epistaxis (nosebleeds) due to its rich vasculature.

**Why Each Wrong Option is Incorrect:**

- A) Surgery is not the treatment of choice: As mentioned above, surgery is the preferred treatment option due to the benign nature of the tumor and its impact on surrounding structures.
- B) It is malignant: As the tumor is a benign fibroma, it is not malignant.
- C) Gender bias: Juvenile nasopharyngeal angiofibroma affects adolescents, predominantly males, but it does not follow the gender bias observed in other malignancies.
- D) Hormones can be used: As mentioned, hormonal manipulation is not typically employed for this benign tumor.
- E) Miller's sign negative: Miller's sign is positive in juvenile nasopharyngeal angiofibroma, not negative.

**Clinical Pearl:**

Juvenile nasopharyngeal angiofibroma is a clinical entity characterized by epistaxis (nosebleeds) due to its rich vasculature. This clinical sign helps differentiate it from other causes of epistaxis, which may have different etiologies.