PMC6555899_01
CT scan of abdomen with contrast (A & B): Coronal and sagittal section showing large irregular circumferential mass involving mid and distal sigmoid colon (yellow arrows). C: Axial section showing a subcentrimetric (8mm) hypodense lesion in hepatic segment IV (red square).
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An abdominal computerized tomography (CT) scan (Fig. 1A & B) confirmed a large irregular circumferential mass (10 cm length X4.5 cm transverse diameter) involving the mid and distal sigmoid colon. A subcentrimetric (8 mm) hypodense lesion was detected in hepatic segment IV, likely representing metastatic deposits. (Fig. 1C) A sigmoid mass invading through the small bowel mesentery was seen during emergency exploratory laparotomy, so a Hartmann's procedure, involving resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy, was performed.
A: H&E STAIN, X200 magnification showing several broad fungal hyphae within necrotizing granuloma (red arrow). B: High-power magnification showing Splendore- Hoeppli phenomenon with abundant eosinophils (red arrow).
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Several broad septated fungal hyphae were noted with the characteristic Splendore-Hoeppli phenomenon. (Fig. 2A,B).
A: Periodic acid-Schiff (PAS) stain highlights a thin-walled fungal hyphae (PAS stain x 200 magnification) (red arrow). B: Positive GMS stain in the fugal walls (red arrows) (GMS stain x 400 magnification).
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These features were highly suggestive of colonic basidiobolomycosis (Fig. 3A,B).