Question
A 51 year old male patient presented with a reddish mass in his right nasal cavity, with frequent bleeding episodes, for the past five months.Histopathological examination shows the following picture.
What can be the most possible diagnosis?
A. Inverted Papilloma
B. Rhinoscleroma
C. Rhinosporidiosis
D. Angiofibroma
Show Answer
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Correct Answer » B Explanation |
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Ans:B. Rhinoscleroma.
Image shows:
Marked Cellular infiltrates consisting of plasma cells and lymphocytes.There are many macrophages with clear to foamy cytoplasm(Mikulicz Cells) .Plasma Cells with eccentric nucleus and deep eosin staining cytoplasm(Russel Bodies).
RHINOSCLEROMA
- Rhinoscleroma is a progressive granulomatous disease of the upper respiratory tract.
- It is caused by the gram-negative coccobacillus K rhinoscleromatis or Frish Bacillus.
- The disease probably begins in areas of epithelial transition such as the vestibule of the nose, the subglottic area of the larynx, or the area between the nasopharynx and oropharynx.
- It is a chronic infection of the nose characterised by sclerosis and stenosis of the nasal passage.
- Rhinoscleroma may be found in all age groups, but typically young adults 20–30 years old are most frequently affected.
- Both sexes are equally affected.
- The disease is endemic in several parts of world.
- In India, it is seen more often in northern than in the southern parts.
- Airborne transmission combined with poor hygiene, crowded living conditions, and poor nutrition contributes to its spread.
PATHOLOGY OF RHINOSLEROMA
- The disease is characterized by presence of granulations which infiltrate the submucosa ,with scattered Mikulicz cells(large vacuolated foamy cells containing a central nucleus and acid fast Frisch bacilli),Rusell bodies(resmbling plasma cells with an eccentric nucleus and deep eosin staining cytoplasm) and lymphocytes in dense fibrous tissue.
CLINICAL FEATURES IN A CASE OF RHINOSCLEROMA
- SYMPTOMS
- Blocking of the nose,Nasal Discharge,Headache,Epistaxis
- SIGNS
External nose is firm and woody to touch.
- Anterior Rhinoscopy:
3 stages:
- Atrophic Stage:is present initially,with crusting ,roomy cavity and atrophic dry nasal mucosa.
- Nodular stage:Bluish red non-ulcerative polypoidal masses of rubbery consistency are formed.
- Fibrotic stage of stenosis:of the nasal passages varying from partial obstruction to total atresia .
- Throat:may show extension of the sclerosing process downwards from the nose to the oropharynx,larynx.
TREATMENT IN A CASE OF RHINOSCLEROMA
- In rhinoscleromatosis, organism may be difficult to eradicate, despite aggressive therapy.Relapses may occur.
- A combination of conservative surgical debridement and long-term antibiotic coverage is the mainstay of therapy for rhinoscleroma.
- Tetracycline has been shown to be effective .
- Fluoroquinolones may be used as an alternative, given their excellent gram-negative activity and convenient dosing regimen