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Pathology of Rhinosporidiosis        

Dr Sampurna Roy MD

 

Path Quiz Case 42 : Case history and images

Diagnosis: Rhinosporidiosis

 

                                                                                                                      

 

Rhinosporidiosis is a mucosal and cutaneous mycosis  caused by Rhinosporidium seeberi.

The disease is endemic in India and Sri Lanka but sporadic cases occur in the western hemisphere.

The lesion produces bulky, friable mucosal polyps in the nasal cavity and nasopharynx. 

Less frequently the infection involves the conjunctiva, mouth, larynx, genitalia and skin.

The infection results from a local traumatic inoculation with the organism while swimming or bathing in freshwater ponds, lakes or rivers.

Nasal rhinosporidiosis-  The patient complains of swelling and foreign body sensation in the nose accompanied by itching, sneezing and bleeding.

Initially the lesions are small and sessile but they progress to large and pedunculated 'strawberry-like'  polypoid mass.

The patients may also complain of dysphagia and dyspnea when lesions high in the turbinates protrude from the nares or into the nasopharynx.

Ocular rhinosporidiosis- The lesions involve the palpebral conjunctiva.

Early lesons are asymptomatic but eventually cause discharge, photophobia, redness and secondary infection.

Cutaneous rhinosporidiosis- The skin lesions begin as papillomas which become warty and exude myxomatous material.

Since Rhinosporidium Seeberi cannot be routinely cultured, the diagnosis is confirmed by biopsy.

Histopathological features:  

 

 

There is granulation tissue containing plasma cells, lymphocytes, focal collection of histiocytes and neutrophils.

The overlying epithelium is hyperplastic with focal thinning and occasional ulceration.

Rhinosporidium seeberi has a distinctive morphology in the tissue section.

The sporangia are located predomiantly in the stroma of  the mucosal polyp.

The largest sporangia are usually in a subepithelial location.

The size of the globular sporangia depend on the stage of maturation.

Young trophic forms (immature sporangia) are spherical , 10-100 micrometer in diameter and have a central  basophilic nucleus.

These develop into mature sporangia by a process of progressive enlargement and endosporulation.

Mature sporangia are 100 to 350 micrometer in diameter, have a thick chitinous wall and contain spores in different stages of development.

The spores are 8-10 micrometer in diameter and contain globular eosinophilic inclusions.

Spores are released through a pore or by rupture of the  wall at the site of the pore. 

The ruptured sporangia may elicit a foreign body reaction. The released spores incite a neutrophilic response in the tissue.

These spores are also passed in the nasal discharge.

The spores in the tissue develop into small trophic forms thus enlarging the lesion.

Special stains: Rhinosporidium Seeberi is visualized by fungal stains such as PAS, Gomori's methenimine silver and mucicarmine.  

The lesion is treated by surgical excision.

Recurrence is common and may require repeated excisions over a period of many years.

Further reading:

Cutaneous rhinosporidiosis.

Rhinosporidiosis: a study that resolves etiologic controversies. 

Lymphadenitis, trans-epidermal and unusual histopathology in human rhinosporidiosis. 

Rhinosporidiosis in India : a case report and review of literature.

Intranasal rhinosporidiosis : Presentation of the 1st case seen in the Congo.

Recent advances in rhinosporidiosis and rhinosporidium seeberi. 

Rhinosporidiosis an unusual cause of nasal masses gains prominence. 

Nasal rhinosporidiosis.

Rhinosporidiosis: what is the cause?

Culture of the organism that causes rhinosporidiosis.

Clinicopathological study of rhinosporidiosis

Histochemical studies of Rhinosporidium seeberi. 

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

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