Nasal Rhinosporidiosis Diagnosed by Cytology: A Case Report

Rhinosporidiosis is a chronic granulomatous inflammation of mucosal sites caused by the fungus Rhinosporidium seeberi. The most common site of involvement is the nasal mucosa, followed by the lips, palate, uvula, maxillary antrum, epiglottis, larynx, pharynx and trachea and bronchi. It usually presents as a polypoidal, reddish, friable, painless, pedunculated, hyperplastic soft-tissue mass in the nasal area, typically with an indolent and chronic progression. It can be confused clinically with other benign lesions such as inverted papillomas, primary sinonasal tuberculosis, angiofibromas and malignancies like nasopharyngeal carcinoma. Hence, accurate and final diagnosis is vital, which is achieved through histopathology. This is a case of rhinosporidiosis in a 44-year-old male patient who presented with a polypoidal nasal mass. Cytosmears revealed numerous endospores and few sporangia of Rhinosporidium seeberi, along with inflammatory cells and foreign body-type giant cells. Biopsy highlighted sporangia with endospores in different stages of maturation and thus confirmed the final diagnosis. Although cytology is a simple, preliminary, rapid and inexpensive method, histopathology is the gold standard for a definitive diagnosis. Surgical removal of the lesion with cauterisation of the attachment base is curative in the majority of cases. Recurrence is variable in endemic areas, especially in mucosal sites like the oropharynx and paranasal sinuses. Since there is inadequate literature on the cytodiagnosis of rhinosporidiosis, this case report highlights the significance and utility of cytology in the early diagnosis of nasal rhinosporidiosis.