If it was not a sinusitis?

A 13-year-old girl presented at our hospital with a 3-month history of nasal obstruction, headache, hearing loss and severe weight loss. She also had nasal obstruction with occasional bleeding and a persistent ‘nasal twang’. These symptoms had previously been referred to as chronic sinusitis. Oral inspection showed a bulging soft palate and nasal examination by anterior rhinoscopy detected a soft mass totally obstructing choanae. No cervical lymphadenopathy was palpable. Blood examination showed leukocytosis, elevated C-reactive protein and erythrocyte sedimentation rate, and high titres of EpsteinBarr virus (EBV) antibodies. Cranial MRI revealed a nasopharyngeal mass, deeply vascularized and partially eroding the skull base. Differential diagnosis included lymphoma, rhabdomyosarcoma, juvenile angiofibroma, germ-cell tumor and epithelial carcinoma. Histopatologic examination was consistent with undifferentiated carcinoma, a subtype of nasopharyngeal carcinoma.