A female patient presents with recurrent epistaxis and a unilateral nasal cavity mass. CT scan reveals localised bony erosion. Among the following differential diagnoses, which is the LEAST likely cause of these findings?

1. A

   A. Inverted papilloma with malignant transformation

2. B

   B. Olfactory esthesioneuroblastoma

3. C

   C. Antrochoanal polyp

4. D

   D. Juvenile nasopharyngeal angiofibroma

Appeared in: INI-CET EXAM -2026

Explanation

• Antrochoanal polyps are benign, inflammatory growths originating from the maxillary sinus.
• Their growth pattern involves expanding and remodeling surrounding bone due to pressure, rather than invading and destroying it.
• The presence of frank bony erosion on a CT scan is atypical for an antrochoanal polyp, making it the least probable diagnosis among the choices.
• The other conditions listed are all known for their potential to be locally aggressive or malignant, commonly causing bone destruction.

Why Other Options Were Wrong

• Option A: Inverted papillomas, although benign, are known to be locally aggressive and have a potential for malignant transformation. Bony erosion is a common finding associated with this tumor.
• Option B: This is a malignant (cancerous) tumor arising from olfactory neuroepithelium. Malignant processes are characterized by invasion and destruction of adjacent tissues, including bone, making bony erosion an expected finding.
• Option D: Although typically found in adolescent males, this benign tumor is highly vascular and notoriously locally aggressive. Significant bony erosion is a hallmark feature of JNA.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Differential diagnosis of a unilateral nasal mass based on clinical and radiological findings to guide bedside assessment, documentation, and the next nursing action.
• A unilateral nasal mass in an adult, especially with epistaxis or bony erosion, must be considered malignant until proven otherwise. This high index of suspicion is a critical patient safety principle.
• Nurses play a key role in obtaining a thorough history, including onset and frequency of symptoms like epistaxis and obstruction, which helps the diagnostic process.
• A biopsy is essential for definitive diagnosis, but imaging (CT/MRI) is crucial for pre-operative planning and assessing the extent of the disease.

How to Approach the Question

• This is an analytical question requiring differentiation based on clinical and radiological findings.
• First, identify the key findings from the stem: a unilateral mass, recurrent epistaxis, and the most crucial clue, 'localised bony erosion'.
• Note the lead-in phrase 'LEAST likely'. This means you are searching for the diagnosis that does NOT fit the clinical picture.
• Systematically evaluate each option's typical behavior regarding bone involvement.
• Recall or deduce that malignant and locally aggressive tumors (Inverted papilloma, Olfactory esthesioneuroblastoma, JNA) commonly cause bony erosion.
• Identify that inflammatory polyps (Antrochoanal polyp) typically cause pressure-based remodeling or expansion, but not frank erosion.

Concept Tested & Keywords

• Concept Tested: Differential diagnosis of a unilateral nasal mass based on clinical and radiological findings.
• Stem keywords: unilateral nasal cavity mass, recurrent epistaxis, localised bony erosion, CT scan
• Lead-in keywords: LEAST likely
• Clinical cues: The presence of 'localised bony erosion' is the most critical clue, as it points towards an aggressive or malignant process, helping to exclude benign, non-invasive conditions.
• Negative lead-in flag: The question asks for the LEAST likely diagnosis, which is a negative framing.

Question ID

QlVZ3tQ7pQJ5YpdZkKO4Cr

Copy ID

Reference Book

E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 742-744

E6 Pathology-Textbook of PATHOLOGYHarsh Mohan Part 3 (515-969) p. 1