Synchronous nasal rhinosporidiosis and inverted papilloma in a paediatric patient in Dodoma, Tanzania: Case report

INTRODUCTION

Nasal rhinosporidiosis refers to a rare chronic granulomatous disease caused by Rhinosporidium seeberi. It affects the mucous membrane of sites such as nasopharynx, conjunctiva and palate. Inverted papillomas are relatively rare and are benign epithelial tumors of the nasal cavity that are locally aggressive, exhibit recurrence tendency and malignant transformation. Both entities are very rare in our setting and this is perhaps the first documented case in Tanzania.

CASE PRESENTATION

The patient was a 7-year old boy with a 1-year history of left-sided nasal obstruction and intermittent epistaxis for 6 months. He had no history of cheek swelling, pain or numbness, loss or loosening of teeth or alveolar ridge fullness. There were no ophthalmological, otological or neurological complaints reported. Endoscopic excision of the nasal mass was done and histopathological analysis confirmed co-existence of rhinosporidiosis and inverted papilloma. Postoperatively, the patient was kept on oral dapsone at a dose of 50 mg/day for 6-months and with no residual disease recurrence noted after 6-months follow up.

CLINICAL DISCUSSION

The patient underwent endoscopic excision of the nasal mass and histopathological analysis confirmed co-existence of rhinosporidiosis and inverted papilloma. Postoperatively, the patient was kept on oral dapsone at a dose of 50 mg/day for 6-months and with no residual disease recurrence noted after 6-months of follow up.

CONCLUSION

Nasal rhinosporidiosis and inverted papilloma lesions may resemble the routinely encountered nasal polyps thus important for both clinicians and pathologists to have a high index of suspicion when managing patients with nasal masses even from non-endemic areas.

Management of Rhinosporidiosis: by Coblation

Rhinosporidiosis is a granulomatous disease commonly affecting the mucous membrane. It is caused by Rhinosporidium seeberi, an aquatic parasite & seen affecting the nose, paranasal sinuses most commonly. A retrospective study was conducted at a tertiary care hospital situated in Indian peninsula and five patients who were diagnosed and treated for rhinosporidiosis were analysed. Surgical excision by coblator along with medical management using Dapsone 100 mg once daily for 6 months given promising results in view of reducing recurrence. Combined approach of management including surgical excision using coblator and medical therapy with dapsone is effective in managing the rhinosporidiosis with no recurrence.

Rhinoplasty Surgical Technique for Nasal Dermoid Cyst Removal in Adult: Case Report

Nasal dermoid cyst is a rare benign lesion. The mainstay of treatment for a nasal dermoid cyst is surgical excision, which aims to remove the cyst and associated structures to prevent recurrence. We report a case of a 30-year-old man with nasal dermoid cyst, without intranasal or intracranial extension. The patient underwent open rhinoplasty technique for dermoid cyst excision. He had an uneventful postoperative recovery and was discharged well. The cyst and associated structure were successfully removed. There was no evidence of recurrence and complications postoperatively after 2 years of follow-up.

Solitary Extramedullary Plasmacytoma of Nasal Cavity

Solitary extramedullary plasmacytoma (SEP) of the nasal cavity is a rare neoplastic condition characterized by the localized proliferation of abnormal plasma cells. We present a case of SEP involving the nasal cavity in a 40-year-old male patient who presented with nasal obstruction and recurrent epistaxis. The diagnosis was confirmed through clinical evaluation, imaging studies, and histopathological examination of excised specimen. The patient underwent trans-nasal endoscopic excision of nasal mass without any adjuvant therapy, which resulted in successful local control. This case report highlights the clinical presentation, diagnostic approach, treatment modalities, and favourable prognosis associated with solitary extramedullary plasmacytoma of the nasal cavity.

An Inflammatory Polyp-Like Benign Sinonasal Mass Lesion - Respiratory Epithelial Adenomatoid Hamartoma: A Case Report

Respiratory epithelial adenomatoid hamartoma (REAH) is an uncommon, benign glandular proliferation that arises from the surface epithelium of the nasal cavity and paranasal sinuses. Here we report a case, wherein a 62-year male from northern Kerala presented with bilateral nasal obstruction, loss of sense of smell, and bilateral nasal discharge. On examination, a polypoidal lesion was observed in the left nasal cavity, filling the entire left middle meatus. Diagnostic nasal endoscopy revealed a multilobulated polypoidal mass in the left nasal cavity extending posteriorly into the nasopharynx and causing partial occlusion of the (R) choana. Computerized tomography(CT) imaging was suggestive of a mass in (L) nasal cavity extending from the frontal sinus to the inferior turbinate and posteriorly extending into the nasopharynx. The patient underwent Endoscopic endonasal excision of the (L)nasal mass and intraoperatively the mass was seen to arise from the septum in the (L) nasal cavity posteriorly. Histopathological examination confirmed the diagnosis of REAH. This case report emphasizes the significance of including REAH in the differential diagnosis of sinonasal masses as it simulates other inflammatory disorders. Appropriate diagnosis by biopsy prevents unnecessary aggressive surgery as this benign condition mimics malignant lesions. More research is needed to understand the etiopathogenesis and diagnostic usefulness of immunohistological staining in REAH.

Middle Turbinate Pyocele, an Uncommon Differential for Nasal Mass: A Case report

Mucoceles are respiratory epithelium-lined cystic lesions found in the paranasal sinuses. Pyocele occurs when a mucocele becomes infected. Mucoceles develop as a result of obstruction of the normal sinus drainage tract with superadded infection. Inflammatory mediators are secreted, which lead to bone resorption and expansion of the mucocele. Concha bullosa is one of the most common anatomical variations in the nasal cavity. It refers to an air-filled cavity within the middle turbinate. Obstruction of the concha bullosa can rarely lead to the formation of a mucocele which may be secondarily infected forming a mucopyocele. The mucocele of the middle turbinate may present as an uncommon cause of nasal obstruction, headache, and other nasal or ocular symptoms, which, if correctly diagnosed, can be completely reversed by endoscopic surgery.

Common Tumor in an uncommon location: Pleomorphic Adenoma of nasal cavity - a case Report

Pleomorphic adenoma (PA) is the most common benign salivary gland tumor of which parotid gland involvement is the most common. PA may arise from minor salivary glands as well, however, PA is very rare in the sinonasal and nasopharyngeal areas. It usually affects middle aged females. They are frequently misdiagnosed due to high cellularity and myxoid stroma, leading to delay in diagnosis & further appropriate management. Here we present a case report of a female who presented with gradually progressive nasal obstruction, on examination found to have a nasal mass in right nasal cavity. Imaging was done and the nasal mass was excised. Histopathological report revealed a PA. Common tumor in an uncommon location: Pleomorphic adenoma of the nasal cavity - a case report.

Entomophthoromycosis Presenting as a Nasal Mass

Entomophthoromycosis is a rare, invasive fungal infection common in tropics. Potential sources of infection could be contaminated soil, leaf litter, insects and water. High index of suspicion is needed as entomophthoromycosis mimics the common sinonasal disease in its nascent stage. Concurrent medical and surgical management is the most effective treatment.

A rare case of nasal septal schwannoma: Case report and literature review

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Schwannoma is a benign nerve sheath tumor that can arise from any myelinated nerve fiber.

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Nasal septal schwannoma is rare, and only 32 cases have been reported in the literature.

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The diagnosis of the nasal septal schwannoma primarily depends on histopathological examination.

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Endoscopic endonasal excision of the mass is considered the ideal treatment for such pathology, with rare postoperative recurrence.

Introduction: Sinonasal schwannoma accounts for only 4% of head and neck nerve sheath tumors. Schwannoma of the nasal septum is still the rarest, with only few cases previously reported.

Case presentation: This study presents the case of a 64-year-old Saudi female of the Eastern Province who presented a several-month history of unilateral progressive nasal obstruction and recurrent episodes of epistaxis. The diagnosis of nasal septal schwannoma was made on the basis of a histopathological examination. The case was managed successfully by endoscopic endonasal excision with no postoperative recurrence.

Discussion: Nasal septal schwannoma is rare and has only 32 reported cases. Diagnosis primarily depends on histopathological examination. Endoscopic endonasal excision of the mass is considered the ideal treatment for such pathology.

Conclusion: Schwannoma of the nasal septum is rare. However, it should be included as a differential diagnosis in a patient presenting with a unilateral nasal mass.

Corpus callosal lipoma extending as nasal encephalocoel/cranial lipomeningocoel

A hitherto unreported case is presented wherein a 2year old child had a 'cranial lipomeningocoel' or a 'nasal lipo-encephalocoel'. The child presented with a growing mass in the base of the nose. Investigations revealed that the nasal mass was a lipoma that was an extension of intracranial lipoma. The intracranial component extended up to corpus callosum. Resection of the extracranial extension and basal reconstruction resulted in cosmetic recovery.

Nasal septal lipoma in a child: Pai syndrome or not?

Lipoma is the most common soft tissue mass in adults but it is uncommon in children. Nasal septal lipoma is an even more rare entity. In this report, a 12-year-old girl was presented with congenital nasal septal lipoma. She had permanent partial nasal obstruction on her right side and disfigurement of her right upper lip. CT scan revealed a lipoma-like mass in the septum plus an additional incidental finding of an intracranial lipoma. Further workup with MRI demonstrated corpus callosum agenesis with interhemispheric lipoma. To remove the mass, septoplasty, nasal lipoma excision and nasal vestibule V-Y advancement flap were performed. To close the lip a rotational advancement flap was required. Our case seemed to be a variety of Pai syndrome. We recommend imaging of the central nervous system in newborns with congenital lipomas located in the craniofacial midline to rule out the Pai syndrome.