Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words.
##

14 years old Saudi male medically free and without any previous surgical intervention, complaining of bilateral nasal obstruction and mouth breathing with snoring during sleep. No prior history of nasal bleeding or discharge, no history visible or palpable head or neck swelling, no current symptoms of fever, weight loss, ear fullness or decreased hearing. On examination, patient was alert and vitally stable, nasal examination showed a normal overlying skin, nasal mucosa and septum, without any signs of bleeding, discharge, ulceration or obvious mass. no visible external or internal nasal deformity except for bilateral hypertrophied turbinate.

On examination, normal head and neck finding without any visible or palpable swelling, deformities, or evidence of cranial nerves pathology. Grade III palatine tonsil but without any atypical other oral finding. On otoscopic examination, there is no evident abnormalities regarding external ear, external auditory canal and tympanic membrane. Audiometry and tympanometry showed a bilateral preserved hearing function. Fibroscopic examination of the upper respiratory tract showed a large purplish nasopharyngeal mass more on the right side of nasopharyngeal vault, soft consistency with regular shape, smooth surface lobulated and partially obstructs the right choanae, well defined edges, with a scattered spots of hypervascularity, no visible current bleeding.

A computerized tomography (CT) scan of the neck demonstrate a 24x37 mm mild enhancement mass that occupied the right nasopharyngeal cavum space extended to the right posterior nasal cavity causing nasal airway narrowing as well as nasopharynx.

Immunohistochemistry showed positivity for HLA DR, CK19, and EMA, without reactivity for CK7 and CK20. Epstein-Barr virus (EBV) panel and polymerase chain reaction (PCR) were requested but both were negative.

Based on the patient's symptoms and examination findings, I predict the top 2 disease causes to be:

1. **Nasopharyngeal Carcinoma**: The presence of a large, purplish nasopharyngeal mass with soft consistency, regular shape, and smooth surface, partially obstructing the right choanae, suggests a malignant tumor. The immunohistochemistry results showing positivity for HLA DR, CK19, and EMA, without reactivity for CK7 and CK20, are consistent with nasopharyngeal carcinoma.
2. **Adenoid Hypertrophy**: The patient's symptoms of bilateral nasal obstruction, mouth breathing, and snoring, along with the finding of grade III palatine tonsil, suggest adenoid hypertrophy. The CT scan showing a mild enhancement mass in the right nasopharyngeal cavum space could be consistent with adenoid tissue.

Both conditions require further evaluation and management, including biopsy and histopathological examination to confirm the diagnosis.

Please predict possible top 2 disease causes for this patient case, provide brief explanation, limit to <100 words.
##

14 years old Saudi male medically free and without any previous surgical intervention, complaining of bilateral nasal obstruction and mouth breathing with snoring during sleep. No prior history of nasal bleeding or discharge, no history visible or palpable head or neck swelling, no current symptoms of fever, weight loss, ear fullness or decreased hearing. On examination, patient was alert and vitally stable, nasal examination showed a normal overlying skin, nasal mucosa and septum, without any signs of bleeding, discharge, ulceration or obvious mass. no visible external or internal nasal deformity except for bilateral hypertrophied turbinate.

On examination, normal head and neck finding without any visible or palpable swelling, deformities, or evidence of cranial nerves pathology. Grade III palatine tonsil but without any atypical other oral finding. On otoscopic examination, there is no evident abnormalities regarding external ear, external auditory canal and tympanic membrane. Audiometry and tympanometry showed a bilateral preserved hearing function. Fibroscopic examination of the upper respiratory tract showed a large purplish nasopharyngeal mass more on the right side of nasopharyngeal vault, soft consistency with regular shape, smooth surface lobulated and partially obstructs the right choanae, well defined edges, with a scattered spots of hypervascularity, no visible current bleeding.

Based on the patient's symptoms and examination findings, I predict the top 2 possible disease causes to be:

1. **Adenoid Hypertrophy**: The patient's symptoms of bilateral nasal obstruction, mouth breathing, and snoring during sleep, along with the finding of a large purplish nasopharyngeal mass on fibroscopic examination, suggest adenoid hypertrophy. The mass's soft consistency, regular shape, and smooth surface are consistent with adenoid tissue.
2. **Nasopharyngeal Carcinoma**: Although less likely in a 14-year-old patient, the presence of a large nasopharyngeal mass with scattered spots of hypervascularity and well-defined edges raises concern for a malignant process, such as nasopharyngeal carcinoma. The patient's symptoms of nasal obstruction and snoring could be secondary to the mass effect of the tumor.