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| Year : 2009 | Volume
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| Issue : 3 | Page : 388-389 |
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| Rhinosporidiosis of parotid duct |
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B Sivapathasundharam, TR Saraswathi, K Manjunath, G Sriram
Department of Oral and Maxillofacial Pathology, Meenakshi Ammal Dental College, Chennai, India
Click here for correspondence address and email
| Date of Submission | 10-Jun-2008 |
| Date of Decision | 16-Dec-2008 |
| Date of Acceptance | 24-Mar-2009 |
| Date of Web Publication | 30-Oct-2009 |
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 Abstract | | |
Rhinosporidiosis is a benign chronic granulomatous infection caused by Rhinosporidium seeberi. Rhinosporidiosis is endemic in south Asia, notably in southern India and Sri Lanka. Majority of the cases have been reported to occur in upper respiratory sites, notably anterior nares, nasal cavity, nasopharynx, larynx and soft palate. Only two rare cases of involvement of parotid duct, have been reported in literature. Hence, this case will probably be the third to be reported. Keywords: Parotid duct, rhinosporidiosis, sialolithiasis
How to cite this article:
Sivapathasundharam B, Saraswathi T R, Manjunath K, Sriram G. Rhinosporidiosis of parotid duct. Indian J Dent Res 2009;20:388-9 |
How to cite this URL:
Sivapathasundharam B, Saraswathi T R, Manjunath K, Sriram G. Rhinosporidiosis of parotid duct. Indian J Dent Res [serial online] 2009 [cited 2015 Jan 26];20:388-9. Available from: http://www.ijdr.in/text.asp?2009/20/3/388/57362 |
| Case Report | |  |
A 73-year-old male complained of recurrent painless swelling in the right middle third of the face since two years. The swelling was intermittent in nature, increased in size during meal time and reduced in size on external pressure. Patient was refractory to conventional antibiotic therapy.
On local examination, there was a cystic mass in the right middle third of the face measuring about 12 cm × 13 cm [Figure 1]. Skin over the swelling was smooth, stretched and glossy with no rise in local temperature. Routine laboratory investigation revealed eosinophilia (40%).
Aspiration of the swelling yielded a clear fluid similar to saliva. Microscopic examination of the aspirate fluid revealed a few neutrophils and epithelial cells in a clear background. Since the aspirate was inconclusive and the swelling grew in size it was decided to excise to explore the lesion surgically. Surgical exposure revealed a huge cystic cavity with saliva like fluid. The cystic cavity was in communication with an opening in the parotid duct (probably acting as the source of fluid). So the lesion was excised in toto along with the parotid duct.
On histological examination the lesion showed a cystic cavity lined predominantly by parakeratinised stratified squamous epithelium and in a few areas by pseudostratified columnar epithelium. The subepithelial connective tissue showed multiple globular cysts of varying sizes (200 to 1000 µm in diameter). The cystic spaces were made of a thick wall and the lumen contained numerous granular materials measuring about 30 to 50 µm in size. These cysts represent the thick walled sporangium of Rhinosporidium seeberi containing numerous daughter spores in different stages of development [Figure 2]. The connective stroma was heavily infiltrated with mixed inflammatory infiltrate. The immature sporangium and sporangiospores were periodic acid-Schiff (PAS) positive and mucicarmine negative, while the mature sporangium and sporangiospores were PAS and mucicarmine positive [Figure 3] and [Figure 4].
| Discussion | | |
Rhinosporidiosis is a benign chronic granulomatous infection caused by Rhinosporidium seeberi. [1] Rhinosporidiosis is endemic in south Asia, notably in southern India and Sri Lanka. [2] Humans are presumed to acquire R. seeberi through traumatized epithelium (trans epithelial infection) most commonly through nasal mucosa. [3] Majority of the cases occur in upper respiratory sites, notably anterior nares, nasal cavity, nasopharynx, larynx, and soft palate. [2] Involvement of parotid duct is a rare finding, with only two cases reported in the literature. [4] Hence, this case will probably be the third to be reported.
Clinical diagnosis was difficult to establish in the present case as the manifestations were similar to that of a sialolithiasis. As the swelling was anterior to the posterior border of ramus of the mandible and tragus of the ear, parotid swellings were not considered in the differential diagnosis. Hence, the clinical diagnosis of sialolithiasis was questioned. However, inflammatory and neoplastic involvement of accessory parotid and parotid duct should be considered in the differential diagnosis.
Diagnosis in the present case was established by histopathology. The mature stage of R. seeberi consists of large, thick- walled spherical structures called 'sporangia' (50-1000 µm) containing smaller daughter cells called 'sporangiospores' (20-80 µm). The sporangia and sporangiospores can be visualized with haematoxylin and eosin, fungal stains such as Gomori methenamine silver and PAS, and mucicarmine.
R. seeberi should be distinguished from Coccidioides immitis. C. immitis has similar mature stages represented by large, thick-walled, spherical structures containing endospores, but the spherules are smaller (diameter of 20-80 ìm versus 50- 1000 ìm) and contain small endospores (diameter of two to four ìm). Moreover, C. immitis does not stain with the mucicarmine. [5]
Differentiation of R. seeberi from C. immitis is important as rhinosporidiosis is refractory to antibiotic therapy. Dapsone is the only drug that has been reported with some success. It acts by arresting maturation of sporangia and accelerating their degenerative changes. [6] Treatment of choice is meticulous excision, as most recurrences occur due to spillage of endospores on adjacent mucosa. [7]
| References | | |
| 1. | Sivapathasundharam B, Gururaj N. Mycotic infections of the oral cavity. In: Rajendran R, Sivapathasundharam B, editors. Shafer's text book of oral pathology. 6 th ed. India: Elsevier Publications; 2009. p. 369.  |
| 2. | Arseculeratne SN. Recent advances in rhinosporidiosis and Rhinosporidium seeberi. Indian J Med Microbiol 2002; 20:119-31. [PUBMED]  |
| 3. | Karunaratne WA. The pathology of rhinosporidiosis. J Pathol Bact 1934;42:193-202. |
| 4. | Mahapathra S, Tripathy S, Rath G, Misra G. Rhinosporidiosis of parotid duct: A rare case report. Indian J Pathol Microbiol 2002; 50:320-2. |
| 5. | Morelli L. Human nasal rhinosporidiosis: An Italian case report. Diagn Pathol 2006; 1:25-9. |
| 6. | Vijay Kumar M, Thappa DM, Karthikeyan K, Jayanthi S. A verrucous lesion of the palm. Postgrad Med J 2002;78:305-6. |
| 7. | Harissi-Dagher M, Robillard N, Corriveav C, Mabon M, Allaire GS. Histopathologically confirmed ocular rhinosporidiosis in two Canadians. Can J Ophthalmol 2006; 41:226-9. |
Correspondence Address:
B Sivapathasundharam
Department of Oral and Maxillofacial Pathology, Meenakshi Ammal Dental College, Chennai
India
  | 3 |
DOI: 10.4103/0970-9290.57362 PMID: 19884731
[Figure 1], [Figure 2], [Figure 3], [Figure 4] |
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