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Year : 2022  |  Volume : 65  |  Issue : 3  |  Page : 724-725
Bulbar conjunctival rhinosporidiosis mimicking ocular surface squamous neoplasia


Ophthalmic Pathology Laboratory, LV Prasad Eye Institute, Hyderabad, Telangana, India

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Date of Submission16-Feb-2021
Date of Decision23-Dec-2021
Date of Acceptance23-Dec-2021
Date of Web Publication21-Jul-2022
 

How to cite this article:
Mishra DK, Bothra N. Bulbar conjunctival rhinosporidiosis mimicking ocular surface squamous neoplasia. Indian J Pathol Microbiol 2022;65:724-5

How to cite this URL:
Mishra DK, Bothra N. Bulbar conjunctival rhinosporidiosis mimicking ocular surface squamous neoplasia. Indian J Pathol Microbiol [serial online] 2022 [cited 2022 Aug 15];65:724-5. Available from: https://www.ijpmonline.org/text.asp?2022/65/3/724/351594




Rhinosporidiosis is a chronic granulomatous infection of animals and humans caused by Rhinosporidium seeberi whose taxonomy was debated in the last few decades.[1] Recently this microorganism was taxonomically domiciled in the Mesomycetozoea class also known as the Dermocystidium, rosette agent, Ichthyophonus, and Psorospermium (DRIP) clade, a heterogeneous group of microorganisms that share boundary in between fungi and animals.[2]

Ocular rhinosporidiosis presenting as a conjunctival mass is exceedingly rare. Herein, we report a Rhinosporidiosis of conjunctiva exhibiting a typical histological picture in a healthy 18-year-old man.

An 18-year-old male presented with a small fleshy elevated lesion in his right eye nasally which was associated with mild pain for the past 6-months. There was a history of bathing in stagnant water sources in the last 3 months. There was no history of bleeding from the nose or mouth. The patient had no prior history of any ocular trauma or surgery. The patient's visual acuity was 20/20, N6 in both eyes. The anterior and posterior segments in both eyes were quite unremarkable. There were no significant systemic illnesses or lymphadenopathies found. On examination, a nodular red, vascular fleshy mass measuring 4 × 3 mm was seen to be arising from the nasal side of bulbar conjunctiva near the limbus between 2 and 3 0' clock position with prominent feeder vessels [Figure 1]a and [Figure 1]b. The mass was excised with 2 mm margins and sent for histopathological analysis. The patient was started on topical antibiotics and steroids (Tobramycin eyedrops). The postoperative period was uneventful and at the last follow-up period after 12- weeks there was no evidence of recurrence.
Figure 1: (a and b) Clinical photographs show a nodular red, vascular fleshy mass at the nasal side of bulbar conjunctiva (c) Photomicrograph shows thick-walled spore with sporangium and surrounding stroma shows dense chronic inflammation (hematoxylin and eosin stain, 40×) (d) Photomicrograph highlights the greenish-black chitinous sporangium with sporangiospores; (Gomori's Methenamine silver stain, 40×) Inset; Periodic acid Schiff's stain shows magenta pink color sporangium with sporangiospores, 40×

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On gross pathological examination, a greyish pink mass measuring 5 × 4 × 1 mm was seen and microscopic examination of the excised mass showed stratified squamous epithelial lined tissue having dense chronic inflammatory cells composed of lymphocytes and plasma cells along with many spherical to round cyst-like structure in the stroma. Each cyst represented a thick-walled sporangium and contained numerous daughter spores in different stages of maturation [Figure 1]c. Special stains Periodic acid Schiff's and Gomori's Methenamine silver stain were also done to confirm and highlight the spores and chitinous wall of sporangium [Figure 1]d. The histopathological examination confirmed the diagnosis of Rhinosporidiosis [Figure 1]c and [Figure 1]d.

In the largest case series from the southwestern part of India which included 462 cases of rhinosporidiosis, the authors found that the nose and nasopharynix were involved in 81.1% of cases followed by eyes, which was involved in 14.2% of cases.[3]

Conjunctival rhinosporidiosis presented as a mass is very rare. Nair et al.[4] reported a case of rhinosporidiosis in an 8-year-old female who presented with red, vascular, fleshy pedunculated mass in the tarsal conjunctiva. Suh et al.[5] also reported a case of rhinosporidiosis of the conjunctiva in a 15-year-old contact lens wearer who presented as chronic follicular conjunctivitis.

It is hypothesized that human beings are infected from the contact of traumatized epithelium with contaminated stagnant water and the incidence of rhinosporidiosis is high among the sand workers of India and Srilanka. The sand particles with contaminated water cause abrasion causing an epithelial breach and creating a passage for the organism to gain entry and cause the resultant disease.[6] The cause of isolated conjunctival rhinosporidiosis is not known, but it is presumed that hematogenous spread might also play a role in the pathogenesis.[7]

Clinical differential diagnosis of conjunctival rhinosporidiosis includes papilloma, pyogenic granuloma, vascular tumor, and rarely ocular surface squamous neoplasia (OSSN). On careful clinical examination, the conjunctival mass reveal many pale, yellowish, tiny dots of rhinosporidium, but the gold standard for the diagnosis of rhinosporidiosis is a demonstration of thick-walled sporangium with sporangiospores in biopsied or excised tissue on, which can be observed through histopathological examination.

To conclude, rhinosporidiosis of bulbar conjunctiva mimicking OSSN is a rare and careful clinical examination and histopathological examination of excised tissue is mandatory for diagnosis and complete excision is necessary to prevent recurrences.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ahluwalia KB. New interpretations in rhinosporidiosis, enigmatic disease of the last nine decades. J Submicrosc Cytol Pathol 1992;24:109-14.  Back to cited text no. 1
    
2.
Mendoza L, Taylor JW, Ajello L. The class mesomycetozoea: A heterogeneous group of microorganisms at the animal-fungal boundary. Annu Rev Microbiol 2002;56:315–44.  Back to cited text no. 2
    
3.
Ghosh AK, De Sarkar A, Bhaduri G, Datta A, Das A, Bandyopadhyay A. Ocular rhinosporidiosis. J Indian Med Assoc 2004;102:732-64.  Back to cited text no. 3
    
4.
Nair AG, Ali MJ, Kaliki S, Naik MN. Rhinosporidiosis of the tarsal conjunctiva. Indian J Ophthalmol 2015;63:462-3.  Back to cited text no. 4
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5.
Suh LH, Barron J, Dubovy SR, Gaunt ML, Ledee DR, Miller D, et al. Ocular rhinosporidiosis presenting as chronic follicular conjunctivitis in a contact lens wearer. Arch Ophthalmol 2009;127:1076-7.  Back to cited text no. 5
    
6.
Arseculeratne SN. Recent advances in rhinosporidiosis and Rhinosporidium seeberi. Indian J Med Microbiol 2002;20:119-31.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Anoop TM, Rajany A, Deepa PS, Sangamithra P, Jayaprakash R. Disseminated cutaneous rhinosporidiosis. J R Coll Physicians Edinb 2008;38:123–5.  Back to cited text no. 7
    

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Correspondence Address:
Dilip K Mishra
Ophthalmic Pathology Laboratory, LV Prasad Eye Institute, Hyderabad Road No.02 Banjara Hills KAR Campus Hyderabad - 500 034, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpm.ijpm_179_21

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