Rhinosporidiosis is an inflammatory disease caused by Rhinosporidium seeberi, a protoctistan mesomycetozoa, member of a group of novel aquatic parasites, characterized by hyperplastic polypoid lesions of the nasal cavity and rarely other mucous membranes. We report an unusual presentation of rhinosporidiosis as an urethral polyp, which is only the second case of rhinosporidiosis reported from Pakistan

Ahmad, Zubairali

Azad, Najamul Sahar

Kayani, Naila

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eCommons@AKUDepartment of Pathology and Laboratory Medicine Medical College, PakistanMay 2008Rhinosporidiosis presenting as an urethral polypNajamul Sahar AzadAga Khan UniversityZubairali AhmadAga Khan UniversityNaila KayaniAga Khan UniversityFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiolPart of the Pathology CommonsRecommended CitationAzad, N., Ahmad, Z., Kayani, N. (2008). Rhinosporidiosis presenting as an urethral polyp. Journal of the College of Physicians andSurgeons Pakistan, 18(5), 314-5.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiol/14314 Journal of the College of Physicians and Surgeons Pakistan  2008, Vol. 18 (5): 314-315INTRODUCTIONRhinosporidiosis is an infectious condition pre-dominantly affecting the nasal mucosa. Rare cases ofinvolvement of other mucosal sites as well asdisseminated cutaneous involvement have beenreported.1 Although endemic in India and Sri Lanka,2only one case of nasal rhinosporidiosis is reportedfrom Pakistan.3 We report a case of rhinosporidiosispresenting as an urethral polypoidal lesion, which, tothe best of our knowledge, is the first case of its kindfrom Pakistan.CASE REPORTA 26-year-old male, resident of rural Balochistan,presented with a 3-month history of a polypoidal lesionat external urethral meatus. There was a history ofdysuria with bloody discharge from the lesion. Exceptfor these local symptoms, patient was otherwiseasymptomatic. No constitutional symptoms werepresent. The past and personal history was insignificantexcept for occasional bathing in stagnant rain waterponds. General physical examination and examinationof nose, oral cavity and eyes, which are common sitesfor rhinosporidiosis, was unremarkable. On localexamination, a small red, fleshy, sessile lesion was seenat the external urethral orifice measuring 0.8 x 0.5 cm,clinically resembling a caruncle. Urine DR examinationshowed presence of red cells and pus cells. The lesionwas completely resected under the local anaesthesia.Histopathology showed numerous globular sporangiafilled with spores, diagnostic of rhinosporidiosis.Mild non-specific chronic inflammation was seen insurrounding stroma along with edema and congestedvessels. There was no granulomatous reaction. No other treatment was given. Patient was well after 6months with no evidence of recurrence.DISCUSSIONRhinosporidiosis is a painless infectious conditioncaused by a protoctistan mesomycetozoa, Rhinospori-dium seeberi, which affects predominantly the mucousmembrane of the nose and nasopharynx. Previouslycategorized as a fungus, recent molecular biologicalanalysis of the ribosomal DNA of organism hasconfirmed beyond doubt its categorization as member ofa group of novel aquatic parasites that flourish in hot andhumid climate.4Definite mode of transmission and host or naturalreservoirs are largely unknown, but the disease ispresumed to be transferred through infected soil andABSTRACTRhinosporidiosis is an inflammatory disease caused by Rhinosporidium seeberi, a protoctistan mesomycetozoa, memberof a group of novel aquatic parasites, characterized by hyperplastic polypoid lesions of the nasal cavity and rarely othermucous membranes. We report an unusual presentation of rhinosporidiosis as an urethral polyp, which is only thesecond case of rhinosporidiosis reported from Pakistan.Key words: Rhinosporidiosis.   Urethral polyp.   Globular sporangia.   Spores.Department of Pathology and Microbiology,The Aga Khan University Hospital, Karachi.Correspondence: Dr. Najamul Sahar Azad, Flat No. F-1/II,Maymar Heights, Block-14, Gulshan-e-Iqbal, Karachi.E-mail: saharimran89@yahoo.comReceived  November 13, 2007; accepted  March 4, 2008.Rhinosporidiosis Presenting as an Urethral PolypNajamul Sahar Azad, Zubair Ahmad and Naila Kayani CASE REPORTFigure 1: (a) Polypoidal lesion arising from external urethral meatus showingsporangia in varying stages of maturation. H&E x 2. (b) Mature sporangiacontaining rounded endospores surrounded by mixed inflammation.H&E x 40. (c) Sporangia showing thick chitinous wall. Stratified squamousepithelium identified on the surface (arrow). H&E x 40.water. Stagnant water is also suggested as source ofinfection as most patients are from rural background.4This also explains the predilection of infection formucosal sites where the organism gains access throughtraumatized epithelium. Nasal mucosa is the mostfrequently infected site reported in the literature followedby ocular tissue.2 Rare cases of involvement of othermucosal sites, such as urethra,5,6 trachea,7 and solitaryor disseminated cutaneous disease1 have also beenreported. Cases of bone involvement, where it presentsas osteolytic lesions,2 and as soft tissue masses8 arealso on record. Urethral involvement is mostly limited to penile partwhere the lesion presents as a vascular sessile polypclinically resembling condyloma, caruncle or a vascularor neoplastic lesion.6The typical lesion of rhinosporidiosis is a fleshy, vascularpolypoidal growth with yellow or grey specks on it.Histology with haematoxylin and eosin stains isdiagnostic showing sporangia in varying stages ofmaturation. Mature sporangia have a thick chitinouswall, measure upto 200 µm in diameter and containrounded endospores. A variable inflammatory infiltrateis seen in the surrounding tissue showing mixed acuteand chronic inflammatory cells in different proportions. Agranulomatous response has also been seen in asignificant proportion of cases showing epithelioid cellcollections with multinucleated giant cells. Hyperplasticchanges are seen in overlying epithelium.2No systemic or local medical treatment is usuallyeffective. Complete surgical excision is the treatment ofchoice. Systemic Dapsone therapy has been usedprophylactically to prevent recurrence or disseminatedhaematological spread.9The disease was previously considered to be localizedto India and Sri Lanka,2 however, isolated cases havebeen reported from other parts of the world as well.10This may be the result of increased globalization asmost cases are still seen in patients of Indian origin.10Only a single case has been reported from Pakistan3 sofar, but the actual prevalence may be much higher thanreported as the climatic conditions in the country makeit a fertile soil for the organism.Rhinosporidiosis is a potentially curable infectiouscondition, which can behave in an aggressive manner ifleft untreated.1 It should be considered in the differentialdiagnosis of vascular, polypoidal lesions at unusual sites.REFERENCES1. Kumari R, Laxmisha C, Thappa DM. Disseminated cutaneousrhinosporidiosis. Dermatol Online J 2005; 11:19.2. Makannavar JH, Chavan SS. Rhinosporidiosis - a clinico-pathological study of 34 cases. Indian J Pathol Microbiol 2001;44:17-21.3. Rahat N, Sadiq S. Rhinosporidiosis. Pak J Med Sci 2005; 21:494-6.4. Fredricks DN, Jolley JA, Lepp PW, Kosek JC, Relman DA.Rhinosporidium seeberi: a human pathogen from a novel groupof aquatic protoctistan parasites. Emerg Infect Dis 2000; 6:273-82.5. Qureshi F, Abdulmannan MS, Eltayeb AA, Qadri S, Al-QahtaniH, Gabr A. Rhinosporidiosis of the male urethra. Ann Saudi Med2004; 24:299-300.6. Sasidharan K, Subramonian P, Moni VN, Aravindan KP,Chally R. Urethral rhinosporidiosis. Analysis of 27 cases. Br J Urol1987; 59: 66-9.7. Rekha P, Thomas B, Pappachan JM, Venugopal KP, JayakumarTK, Sukumaran P. Tracheal rhinosporidiosis. J Thorac CardiovascSurg 2006; 132:718-9.8. Houreih MA, Eyden B, Lucas SB, Roy S, Banerjee SS.Rhinosporidium seeberi: a case clinically mimicking a soft tissuesarcoma. Histopathology 2006; 49: 208-10.9. Job A, Venkateswaran S, Mathan M, Krishnaswami H, Ramar R.Medical therapy of rhinosporidiosis with dapsone. J Laryngol Otol1993; 107: 809-12.10. Chao SS, Loh KS. Rhinosporidiosis: an unusual cause of nasalmasses gains prominence. Singapore Med J 2004; 45:224-6.Journal of the College of Physicians and Surgeons Pakistan  2008, Vol. 18 (5): 314-315 315Rhinosporidiosis presenting as an urethral polypl l l l lOl l l l l

Rhinosporidiosis presenting as an urethral polyp

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Rhinosporidiosis presenting as an urethral polyp

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