An unusual case of urethral polyp

Abstract

Rhinosporidiosis is a chronic granulomatous disease caused by fungus Rhinosporidium seeberi affecting most commonly the anterior nares. Urethral involvement is extremely rare. We present such a case in a 61-year-old man with intermittent bleeding per urethra and fleshy mass coming through the urethral meatus. On histological examination of hematoxylin-eosin-stained smears, the lesion showed numerous sporangia mixed with inflammatory infiltrates and occasional giant cells, beneath the urethral squamous epithelium. The mass was excised and fulguration of the base with diathermy was offered for cure.

Keywords: Rhinosporidiosis, urethral polyp, bleeding per urethra

How to cite this article:
Chowdhury AR, Dey R, Bhattacharya P, Basu S. An unusual case of urethral polyp. Ann Trop Med Public Health 2012;5:530-1

 

How to cite this URL:
Chowdhury AR, Dey R, Bhattacharya P, Basu S. An unusual case of urethral polyp. Ann Trop Med Public Health [serial online] 2012 [cited 2020 Dec 5];5:530-1. Available from: https://www.atmph.org/text.asp?2012/5/5/530/105155

 

Introduction

Rhinosporidiosis is a chronic granulomatous disease caused by fungus Rhinosporidium seeberi. It usually affects the anterior nares and commonly found in India and Sri Lanka. [1] The lesions form sessile or pedunculated polypoidal masses, which are highly vascular and friable. The nasopharynx, conjunctiva, lachrymal sac, skin, larynx, vagina, and vulva are the other sites of occurrence. Urethral involvement is extremely rare and was first reported in 1941. [2]

Case Report

A 61-year-old man presented in the Urosurgery Out-patient Department with complaints of intermittent bleeding per urethra for the past 6 months. He also complained of a fleshy mass coming through the urethral meatus. On examination, a pinkish, fleshy, and vascular polyp of 2.5 cm in maximum diameter was noted on the urethral meatus, the base of which was attached to the terminal urethra. The mass bled to touch [Figure 1]. Both hematological and biochemical investigations of the patient were within normal range. The mass was excised; the base fulgurated with diathermy as an office procedure and sent for histopathological examination.

Figure 1: Cinical photograph showing a pinkish, fleshy, and vascular polyp of 2.5 cm in maximum diameter attached to the terminal urethra

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The mass was pink, fleshy, and granular and measured 2.5 cm in maximum diameter. Hematoxylin and eosin-stained paraffin-embedded section showed numerous cysts representing sporangia in different stages of development mixed with inflammatory infiltrates like lymphocytes, plasma cells, eosinophils, and occasional giant cells, beneath the squamous epithelium [Figure 2] and [Figure 3].

Figure 2: Photomicrograph showing numerous sporangia mixed with inflammatory infiltrates like lymphocytes, plasma cells, eosinophils, and occasional giant cells, beneath the squamous epithelium. (H and E, 100×)

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Figure 3: Another area of the lesion showing the same microscopic picture. (H and E, 400×)

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No antibiotic was prescribed to the patient and no recurrence was found at 1-year follow-up.

Discussion

Urethral rhinosporidiosis is an uncommon lesion usually affecting the younger age group (20-40 years) and is more frequent in males. [1] Females are rarely affected. The affected patients are of low socioeconomic status of rural background and frequent bathing in stagnant ponds contaminated with pathogens with abrasions in the urethra. [3]

This disease usually spread by endospores from polyps after trauma or surgery is thought to be followed by ‘auto-inoculation’ through the adjacent epithelium. However, there are also evidences for hematogenous spread to distant sites particularly to the multiple subcutaneous nodules without breach of the skin. [3] But the possibility of a lymphatic spread is controversial.

The definitive diagnosis of rhinosporidiosis is by histopathology on biopsies or resected tissues, with the identification of the pathogen in its diverse stages, rather than the stromal and cellular responses of the host. Classically, lesions in the nasal passages are polypoidal, red in color due to increased vascularity, with a surface containing yellowish pin-head-sized spots which represent underlying mature sporangia. Nasopharyngeal polyps are often multilobed with a variegated appearance, with typical strawberry-like regions and other areas that have relatively less vascular lobes with smooth surfaces. Polyps on the face and trunk could simulate verrucous warts and are either pedunculated or sessile on broad bases. Much less is known about the urethral lesion. There is few case reports documented in the literature. Many of them were from India. [4],[5]

The Splendore-Hoeppli (antibody-mediated) eosinophilic deposit, well described as occurring in (mycelial) mycotic infections as well as with a wide range of infecting bacteria are typically absent in rhinosporidiosis. This absence is all the more surprising because rhinosporidial patients show high titers of anti-rhinosporidial antibody. [6] Treatment of this condition is mainly surgical excision with fulguration of the base with diathermy to prevent recurrence. However, Dapsone was used in this condition with little influence. [7]

References

 

1. Sasidharan K, Subramanian P, Moni VN, Aravindan KP, Chally R. Urethral rhinosporidiosis – analysis of 27 cases. Br J Urol 1987;59:66-9.
2. Dhayagude RG. Unusual rhinosporidial infection in man. Indian Med Gazette 1941;76:513-5.
3. Arseculeratne SN. Recent advances in rhinosporidiosis and rhinosporidium seeberi. Indian J Med Microbiol 2002;20:119-31.
4. Bhat S, Thomas A, Cherian J, Reghunath, Shanmughadas. Urethral rhinosporidiosis. Indian J Urol 2002;18:188-9.
5. Pal DK, Mukherjee B, Hati GC, Chowdhry MK. Rhinosporidiosis in male urethra. Indian J Urol 2003;19:162-3.
6. Arseculeratne SN, Atapattu DN, Rajapakse RP, Balasooriya P, Fernando R, Wijewardena T. The humoral immune response in human rhinosporidiosis. Proc Kandy Soc Med 1999;21:9.
7. Job A, Venkateswaran S, Mathan M, Krishnaswami H, Raman R. Medical therapy of rhinosporidiosis with dapsone. J Laryngol Otol 1993;107:809-12.

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1755-6783.105155

Figures

[Figure 1], [Figure 2], [Figure 3]

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