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Case of the Week 55

Here’s a challenge for all of you: Nasal polyp removed from a 50 year old Indian man with complaints of chronic nasal obstruction. Histologic exam reveals the following:

Hematoxylin and Eosin, 40x final magnification

Hematoxylin and Eosin, 100x final magnification

Hematoxylin and Eosin, 200x final magnification

Hematoxylin and Eosin, 600x final magnification

Hematoxylin and Eosin, 600x final magnification

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S/s polypoid structure lined with pseudostratified columnar reparatory epithelium the submucosa show multiple sherules lined with refractile shell and studded with endospores, the stroma is heavily infiltrated with chronic inflammatory cells feature consistent with Cocciidoides immitis

Rhinosporidiosis.

I say rhinosporidiosis too…but I don’t have anything else on my differential!

Rhinosporidiosis (Rhinosporidium seeberi)

rhinosporidiosis…spherules too big to be cocci. Also commont to be associated with polypoid proliferations of the mucous membranes.