Indian Journal of Dental ResearchIndian Journal of Dental ResearchIndian Journal of Dental Research
HOME | ABOUT US | EDITORIAL BOARD | AHEAD OF PRINT | CURRENT ISSUE | ARCHIVES | INSTRUCTIONS | SUBSCRIBE | ADVERTISE | CONTACT
Indian Journal of Dental Research   Login   |  Users online: 57

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size         

 


 
SHORT COMMUNICATION Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 3  |  Page : 388-389
Rhinosporidiosis of parotid duct


Department of Oral and Maxillofacial Pathology, Meenakshi Ammal Dental College, Chennai, India

Click here for correspondence address and email

Date of Submission10-Jun-2008
Date of Decision16-Dec-2008
Date of Acceptance24-Mar-2009
Date of Web Publication30-Oct-2009
 

   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 2014 Oct 20];20:388-9. Available from: http://www.ijdr.in/text.asp?2009/20/3/388/57362

   Case Report Top


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 Top


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 Top

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.  Back to cited text no. 1      
2.Arseculeratne SN. Recent advances in rhinosporidiosis and Rhinosporidium seeberi. Indian J Med Microbiol 2002; 20:119-31.  Back to cited text no. 2  [PUBMED]  Medknow Journal  
3.Karunaratne WA. The pathology of rhinosporidiosis. J Pathol Bact 1934;42:193-202.  Back to cited text no. 3      
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.  Back to cited text no. 4      
5.Morelli L. Human nasal rhinosporidiosis: An Italian case report. Diagn Pathol 2006; 1:25-9.  Back to cited text no. 5      
6.Vijay Kumar M, Thappa DM, Karthikeyan K, Jayanthi S. A verrucous lesion of the palm. Postgrad Med J 2002;78:305-6.  Back to cited text no. 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.  Back to cited text no. 7      

Top
Correspondence Address:
B Sivapathasundharam
Department of Oral and Maxillofacial Pathology, Meenakshi Ammal Dental College, Chennai
India
Login to access the Email id


DOI: 10.4103/0970-9290.57362

PMID: 19884731

Get Permissions



    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

This article has been cited by
1 Rhinosporidiosis in the parotid duct: a rare case report
Swagatika Panda,Sthitaprajna Lenka,Subrat K. Padhiary,Sujit R. Sahoo,Gunjan Srivastava
Journal of Investigative and Clinical Dentistry. 2013; 4(4): 271
[Pubmed]
2 Rhinosporidiosis of the parotid duct presenting as a parotid duct cyst - A report of three cases
Sudarshan, V., Gahine, R., Daharwal, A., Kujur, P., Hussain, N., Krishnani, C., Tiwari, S.K.
Indian Journal of Medical Microbiology. 2012; 30(1): 108-111
[Pubmed]
3 Rhinosporidiosis isolated to the distal clavicle: a rare presentation clinicoradiologically mimicking a bone tumor
Pallavi Vishnu Suryawanshi, Bharat Rekhi, Saral Desai, Subhash M. Desai, Shashi L. Juvekar, Nirmala Ajit Jambhekar
Skeletal Radiology. 2011; 40(2): 225
[VIEW]



 

Top
 
 
  Search
 
 
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


    Abstract
    Case Report
    Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed1827    
    Printed55    
    Emailed0    
    PDF Downloaded255    
    Comments [Add]    
    Cited by others 3    

Recommend this journal