Description

A 38-year-old man presented to our hospital with complaints of a foreign body sensation in throat and frequent spitting of blood-tinged saliva for 6 months duration. On examination, a reddish pedunculated mass studded with whitish spots was seen hanging in oropharynx just behind uvula (figure 1A). On nasal endoscopy, mass was seen attached along the under surface of left inferior turbinate, which bled on contact. The patient also gave history of taking frequent baths in local ponds. After a clinical diagnosis of rhinosporidiosis, he underwent complete excision of the mass after bipolar cauterisation of the base under local anaesthesia (figure 1B). Postoperative histopathology revealed multiple sporangia in various stages of maturation with dense inflammation suggestive of rhinosporidiosis (figure 1C). At 1-year follow-up, the patient had no recurrences.

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Figure 1

Rhinosporidiosis. Clinical image showing a ‘strawberry mass’ just behind the uvula (A). Excised specimen (B). Histopathology showing multiple spores in different stages of maturation (black arrows) along with sporangiospores (white arrows) suggestive of rhinosporidiosis (H&E ×40) (C).

Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi, which are mostly parasites of fish, in the class Mesomycetozoa.1 Disease is endemic to India and other Southeast Asian countries and is transmitted to people taking bath in contaminated water bodies like stagnant ponds.1 Primarily a disease of nose which usually presents as a reddish nasal mass that bleeds on touch, it can also affect the mucous membrane of nasopharynx, oropharynx, conjunctiva, rectum and external genitalia. Pharyngeal rhinosporidiosis is a rare disease, which can be an extension of nasal or nasopharyngeal lesion or an isolated lesion with very few reported cases in literature.2 It can present as dysphagia, nasal or oral bleeding and even respiratory distress in case of complete oropharyngeal involvement. Pharyngeal rhinosporidiosis must be differentiated from any bleeding nasal mass with oropharyngeal extension like angiomatous polyp, rhinoscleroma, angiofibroma, inverted papilloma and even malignancy. The diagnosis is clinical by its usual classical ‘strawberry appearance’ (reddish mass studded with white spots of sporangiospores) and can be confirmed by histopathology of excised specimen, which reveals typical sporangia and spores in the affected tissue. The treatment of choice is complete surgical excision along with cauterisation of base to prevent the recurrence as diathermy abate the endospore spilled in the adjacent mucosa. Although no adequate medical therapy exists, dapsone that interferes with maturation of spores has been used in preventing the recurrence.3 Rhinosporidiosis has a high recurrence rate requiring multiple surgeries resulting in increased morbidity.4