PMC4367050_01
Extraoral patient photograph. (column width)
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F1
A 28-year-old male patient hailing from rural background presented to the dental out-patient department with a chief complaint of difficulty in swallowing and a foreign body sensation in posterior part of tongue and throat with occasional cough since 6 months [Figure 1].
Intraoral mass in right tonsillar and lateral pharyngeal wall (arrow) with yellow flecks on surface. (column width)
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F2
It had yellowish white dotted spots on the surface, which was nonpulsatile and did not bleed on physical examination [Figure 2].
Globular cysts showing developmental stages of R. seeberi in rhinosporidial tissue. 1 - mature sporangium with surrounding cell infiltrate. 2 - Intermediate sporangium, 3 - juvenile sporangium (H and E stain, x4). (column width)
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F3
The patient reported back after 1 week with no regression of symptoms despite therapy. The following differential diagnosis were considered: nasopharyngeal angiofibroma, vascular polyp, nasopharyngeal carcinoma and mycotic granuloma, and incision biopsy of the oropharyngeal mass was performed, which revealed numerous stromal double-walled sporangial cysts containing endospores in different developmental stages, present below a stratified squamous epithelium and surrounded by polymorphonuclear leukocytes and eosinophils [Figure 3].
Sagittal section of MRI showing hyperintense mass (arrow) in nasal cavity, nasopharynx and oropharynx. (column width)
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F4
On contrast magnetic resonance imaging (MRI) of the face and neck, a large lobulated soft tissue mass showing intense enhancement in right nasal cavity, nasopharynx and oropharynx, extending to the anterior surface of epiglottis, with fluid accumulation in right maxillary sinus was observed [Figures 4 and 5].
Coronal MRI section depicting hyperintense mass in right nasal cavity (red arrow) and fluid accumulation in right maxillary sinus (yellow arrow). (column width)
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F5
On contrast magnetic resonance imaging (MRI) of the face and neck, a large lobulated soft tissue mass showing intense enhancement in right nasal cavity, nasopharynx and oropharynx, extending to the anterior surface of epiglottis, with fluid accumulation in right maxillary sinus was observed [Figures 4 and 5].
Excised fleshy, polypoidal gross specimen with both smooth and fungating warty surface. (column width)
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F6
The gross specimen was in the form of elongated, polypoidal soft friable mass measuring 7.5 x 4.5 cm, with one surface appearing whitish, smooth and mucoid and other surface in the form of fungating exophytic verrucous growth [Figure 6].
Double walled sporangia surrounded by polymorphs and eosinophils (PAS stain, x10). (column width)
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F7
Periodic acid schiff (PAS) stained sections revealed conspicuous sporangia in a fibromyxoid stroma [Figure 7].
Late stage of transepidermal elimination of mature sporangia into the tissues (arrow) (H and E stain, x4). (column width)
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F8
Additionally, transepithelial elimination of sporangia and giant cells were observed [Figure 8].