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CORRESPONDENCE
Year : 2014  |  Volume : 59  |  Issue : 1  |  Page : 95-96
Urethral polyp: An uncommon presentation of rhinosporidiosis


Department of Urology, IPGME and R, Kolkata, India

Date of Web Publication23-Dec-2013

Correspondence Address:
P K Pandey
Department of Urology, IPGME and R, Kolkata
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.123521

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How to cite this article:
Pandey P K, Shukla S, Kundu A K, Sarkar P. Urethral polyp: An uncommon presentation of rhinosporidiosis. Indian J Dermatol 2014;59:95-6

How to cite this URL:
Pandey P K, Shukla S, Kundu A K, Sarkar P. Urethral polyp: An uncommon presentation of rhinosporidiosis. Indian J Dermatol [serial online] 2014 [cited 2019 Dec 8];59:95-6. Available from: http://www.e-ijd.org/text.asp?2014/59/1/95/123521


Sir,

A 61-year-old sexually active male presented with complaints of recurrent passage of flakes in urine and something protruding from urethral meatus since last 8 months. He belonged to rural area and gave no history of contact, hematuria or trauma to the genital organs. His wife had no urinary complaints.

A 1 × 1 cm fleshy growth was found protruding from the urethral meatus [Figure 1]. Renal function tests, blood sugar levels, total and differential leukocyte counts were within normal limits. Urine analysis revealed 10-12 pus cells per high power fields and urine culture showed no growth.
Figure 1: Growth protruding from urethral meatus

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The growth was excised and histopathological examination of specimen confirmed the diagnosis to be rhinosporidiosis [Figure 2]. Subsequently, a cystourethroscopy was performed that revealed normal lower urinary tract. The patient has been on regular follow-up and there is no recurrence of lesion till date.
Figure 2: Microscopic picture showing typical sporangia - Rhinosporidium

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Rhinosporidium seeberi, the fungus causing rhinosporidiosis, was first analyzed and described in detailed manner by J.H. Ashworth. [1] Rhinosporidiosis is more commonly reported from Asian continent and that too predominantly from South Asia. In India, it is endemic in Tamil Nadu and Kerala. Rhinosporidiosis is not labeled as an infectious disease, since transmission between affected individuals is not reported. Mode of infection is assumed to be "a transepithelial infection" due to breach in the epithelial lining resulting from trauma. Source of infection is usually contaminated stagnant water and soil. Autoinoculation and hematogenous dissemination are described as other modes of spread. [2] Still the regional mode of spread and sexual transmission of this entity remains a controversy. [3] In our case, patient gave history of bathing in pond of his locality. So, the possible mode of infection could be contact of stagnant pond water with the traumatized urethral mucosa.

The rare urethral involvement in rhinosporidiosis was first reported in 1941 by Dhayagude. Sasidharan et al. published a series of 27 cases in 1987. [3] Another series of 5 cases was published by Pal et al., in 2008. [4] Genitourinary rhinosporidiosis cases have not been reported from western countries so far. In this subgroup, males are more frequently affected and age group commonly involved belongs to 20 to 40 years of age. [2] These cases usually present as painless polyp protruding from the meatal opening which bleeds readily.

Differential diagnosis may include mucocele, hemangioma, condylomata, transitional cell carcinoma, and adenocarcinoma of the urethra. Diagnosis is confirmed by histological examination of excised tissue showing the characteristic sporangia. [2]

Surgical removal with electrocoagulation of the underlying urothelium is proposed mode of treatment for this pathology. Electrocoagulation of the urothelium has a role to reduce the recurrence rate. Incidence of recurrence could be as high as 25% which in turn may be due to inadequate resection or reinfection.

Medical treatment has a limited effect on the course of the disease. Local infiltration with amphotericin B and dapsone after resection of lesion might reduce the recurrence rate. [2] Although, one report suggests positive outcome with the use of dapsone alone. [5]

 
   References Top

1.Ashworth JH. On Rhinosporidiumseeberi with special reference to its sporulation and affinities. Trans R SocEdin 1923;53(Pt 2): 301-42.  Back to cited text no. 1
    
2.Karunaratne WA. The pathology of rhinosporidiosis. J Path Bact 1934;17::193-202.  Back to cited text no. 2
    
3.Sasidharan K, Subramonian P, Moni VN, Aravindan KP, Chally R. Urethral rhinosporidiosis. Analysis of 27 cases. Br J Urol 1987;59:66-9.  Back to cited text no. 3
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4.Pal DK, Moulik D, Chowdhury MK. Genitourinary rhinosporidiosis. Indian J Urol 2008;24:419-21.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.Job A, Venkateswaran S, Mathan M, Krishnaswami H, Raman R. Medical therapy of rhinosporidiosis with dapsone. J Laryngol Otol 1993;107:809-12.  Back to cited text no. 5
    


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