Ans. is 'a' i.e.. Biopsy for diagnosis o Biopsy should be avoided as it causes severe bleeding.Juvenile nasopharyngeal angiofibromao Juvenile nasopharyngeal angiofibroma (JNA) is a benign, but locally aggresive, tumor of nasopharynx seen in prepubertal and adolescent males.o It is the most common benign neoplasm of nasopharynx.o It is a highly vascular tumor and blood supply of the tumor most commonly arises from the internal maxillary artery.o Juvenile nasopharyngeal angiofibroma (JNA) occurs almost exclusively in males.o Female with Juvenile nasopharyngeal angiofibroma (JNA) should undergo genetic testing,o Onset is most commonly in the second decades, the range is 7-19years.o The exact cause is unknown. As the tumour is predominantly seen in adolescent males in the second decade of life, it is thought to be testosterone dependent.o The most common site is posterior part of nasal cavity close to the margin of sphenopalatine foramen.o The tumor starts adjacent to the sphenopalatine foramen.o Large tumors are frequently bilobed or dumbbel shaped, with one portion of tumor filling the nasopharynx and the other portion extending to the pterygopalatine fossa.Clinical featureso Symptoms depend on spread of tumour to nasal cavity, paranasal sinuses, pterygomaxillary fossa, infratemporal fossa, cheek, orbits (through inferior orbital fissure), cranial cavity' (most common site is middle cranialfossa).o Nasal obstruction (80-90%) is the most common symptom, especially in the initial stages. This results in denasal speech, hyposmia, broadening of nasal bridge,o Spontaneous profuse & recurrent ep is taxis is the second most common symptomo Otalgia, conductive hearing loss, serous otitis media, due to eustachian tube obstruction,o Pink or purplish mass obstructing one or both chonae in nasopharynx.o Tumour in the orbit causes : proptosis; and frog-face deformity; diplopia and diminshed vision,o Tumour in infratemporal fossa can cause trismus and bulge of parotid.o II, III, IV, V, VI cranial nerve can be involved.o Splaying of nasal bones.o Swelling of cheek and fullness of face.Diagnosis and treatmento Contrast CT is the investigation of choice.o Biopsy should be avoided as it can cause severe bleeding.o Surgical excision is the treatment of choice.