Rhinosporidiosis is a chronic granulomatous disease that primarily affects the mucous membranes of the nose and nasopharynx. It is caused by the fungus Rhinosporidium seeberi. Typically it presents as a reddish, bleeding, polypoidal mass studded with greyish white specks on its surface giving it the characteristic strawberry-like appearance. It is imperative for clinicians in our setting to consider rhinosporidiosis as a differential diagnosis in any case of nasal mass. We report a case of rhinosporidiosis with atypical presentation as an oropharyngeal polyp.

1. Atypical presentation of
rhinosporidiosis as oropharyngeal polyp

2. Case Report
Atypical presentation of rhinosporidiosis
as oropharyngeal polyp
G. Vinod Kumar *, B. Ranganatha Reddy, Supriya Mohan Bhat,
Rakesh Vuppala
Department of ENT, Apollo Institute of Medical Sciences & Research, Hyderabad, India
1. Introduction
Rhinosporidiosis is a rare infective granulomatous disease
caused by Rhinosporidium seeberi, a fungus of the class
phycomycetes, family coccoidiodaceae.2
The disease predom-
inantly affects mucosal lining of the nose, naso-pharynx,
conjunctiva, palate and urethra. It can extend into oropharynx,
larynx and lacrimal sac.3
Lesions involving extranasal sites
such as brain, trachea, ear, skin and subcutaneous tissues
have been reported but are rather uncommon.1
Clinically it
presents as a reddish, bleeding, polypoidal mass with a
characteristic strawberry-like appearance caused by the
presence of mature sporangia.1
This report is aimed at
documenting an atypical presentation of rhinosporidiosis.
Also caution surgeons to have high index of suspicion when
evaluating patients with nasal masses.
2. Case report
We present a case of a 53-year-old male, who presented to our
OPD with complaints of mass in the throat for 2 months
duration. The mass was slow in progression and noticed by
patient himself. It was associated with cough, foreign body
sensation in throat and difficulty in swallowing. No history of
pain while swallowing, nasal obstruction and epistaxis. No
history of nasal surgeries. On examination, there was a
solitary, smooth surfaced, pale, polypoidal mass present just
behind soft palate to the left of uvula. It was non-tender, not
a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x
a r t i c l e i n f o
Article history:
Received 8 June 2015
Accepted 22 July 2015
Available online xxx
Keywords:
Endoscopic removal of
rhinosporidiosis
Oropharyngeal polyp
Granulomatous disease
Atypical presentation
Oropharyngeal rhinosporidiosis
a b s t r a c t
Rhinosporidiosis is a chronic granulomatous disease that primarily affects the mucous
membranes of the nose and nasopharynx. It is caused by the fungus Rhinosporidium
seeberi. Typically it presents as a reddish, bleeding, polypoidal mass studded with greyish
white specks on its surface giving it the characteristic strawberry-like appearance. It is
imperative for clinicians in our setting to consider rhinosporidiosis as a differential diagno-
sis in any case of nasal mass. We report a case of rhinosporidiosis with atypical presentation
as an oropharyngeal polyp.
# 2015 Indraprastha Medical Corporation Ltd. Published by Elsevier B.V. All rights
reserved.
* Corresponding author at: Department of ENT, Apollo Institute of Medical Sciences & Research, Jubilee Hills, Hyderabad, Telangana, India.
E-mail address: drvinnu2004@yahoo.co.in (G.V. Kumar).
APME-304; No. of Pages 3
Please cite this article in press as: Kumar GV, et al. Atypical presentation of rhinosporidiosis as oropharyngeal polyp, Apollo Med. (2015),
http://dx.doi.org/10.1016/j.apme.2015.07.008
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3. bleeding on touch and movable from side-to-side. Nasal
endoscopy was suggestive of mass arising from inferior aspect
of left inferior turbinate at the junction of anterior 1/3rd
and
posterior 2/3 rd
and extending into nasopharynx and orophar-
ynx. CT scan was done which confirmed the endoscopy
findings. The patient was posted for surgical excision of the
mass under GA. Endoscopic excision of mass was done en bloc
and the base was cauterized using bipolar cautery. No
significant bleeding was encountered intraoperatively. Speci-
men was sent for HPE. The size of the mass was approximately
3 Â 2 cm. Merocel packing was kept and removed the next
day. Post-operative period was uneventful. Histopathological
examination was suggestive of rhinosporidiosis. Patient was
followed up for 1 year and there was no recurrence (Figs. 1–3).
3. Discussion
Rhinosporidiosis is a chronic inflammatory disease caused by
Rhinosporidium seeberi which was first described by Seeber in
1900.4
Malbran saw the first case affecting the nose of an
Italian agriculture worker in 1892.5
Seeber described this
disease by way of dissertation in University of Buenos Aires,
Argentina. It is primarily a water borne disease. Water and soil
are believed to be the reservoir of infection, given the high
incidence of disease in sand workers, paddy cultivators and
people bathing in stagnant waters. The disease is endemic in
India and Sri Lanka and commonly seen in males.
Histologically the growths are granulomatous, myxoma-like
and haemorrhagic. They are associated with unusually large
sized, thick walled cyst called ‘‘sporangium’’ measuring up to
300 micronsinsizefilled withinnumerablespores.Insectionsof
rhinosporidial growth, papillary processes of the epithelium are
seen. Under the epithelium a stroma of delicate fibrous or
fibromyxomatous tissue is found, in which spores are present.
The subepithelial tissue is very vascular with newly developed
capillaries. Infiltration of polymorphs, lymphocytes, plasma
cells and red cells are seen. Giant cells are rarely seen. Paucity of
inflammatory reaction has been the most striking feature of the
tissues showing Rhinosporidium seeberi invasion.
Rhinosporidiosis commonly presents as a reddish, friable,
polypoidal mass which bleeds on touch and usually is
associated with epistaxis and nasal obstruction.2
In our case,
patient presented with a mass in the throat. On examination
mass was oval in shape, pale and had a smooth surface. The
classical strawberry appearance of the mass was absent. There
was no previous history of epistaxis and nasal obstruction. On
anterior rhinoscopy, no mass was seen in the nasal cavity.
As far as management is concerned, local treatment with
chemicals and medical treatment with oral drugs have no
significant role. The most effective treatment is wide excision
and cauterization of the base of the lesion. It is crucial to know
the extent of the disease before attempting any surgical
procedure. This is one of the few conditions where preoperative
diagnostic nasal endoscopy is avoided due to dread of mucosal
abrasion, as trivial trauma invites implantation. Removing
tissue piecemeal should be avoided to prevent haematogenous
spread. Endoscopes provide better visualization, thereby facili-
tating minimal trauma and complete removal. It is also
beneficial in the postoperative period as it helps in the early
detection of recurrences. Literature also mentions the use of
KTP-532laserinsteadofdiathermyforexcisingthemass.Besides
surgery, a variety of drugs such as griseofulvin, amphotericin B
and dapsone have been tried but without much success.
Conflicts of interest
The authors have none to declare.
Acknowledgements
Dr. Tejal Modi, Department of Pathology, Apollo Hospitals,
Hyderabad. Dr. Aditya, Department of Pathology, Apollo
Hospitals, Hyderabad
Fig. 1 – Excised mass.
Fig. 2 – Oropharyngeal polp.
Fig. 3 – HPE slide.
a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x2
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4. r e f e r e n c e s
1. Borlingegowda Vishwanatha. Rhinosporidiosis: an
unusual presentation. Ear Nose Throat J. 2014 July;93(7):E22.
2. Venkatachalam VP, Anand A. Bhooshan O Rhinosporidiosis
its varied presentations. Indian J Otolaryngol Head Neck Surg.
2007;59(2):142–144.
3. Marfatia HK, Kirtane MV. Management of rhinosporidiosis-
newer concept. IJO & HNS. 1997;49(1).
4. Seeber GR. Un Nuevo esporozoario parasite del Hombre. dos casos
encortrados en poliposnasales. [thesis] Universidad Nacional de
Buenos Aires; 1900.
5. Sonthya N, Singhal P, Mishra P. Naso oropharyngeal
Rhinosporidiosis: endoscopic removal. Indian J Otolaryngol
Head Neck Surg. 2005;57(4):354–356.
a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x 3
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