Case presentation
We are presenting a seven (7) year old male boy who presented at our outpatient otorhinolaryngology clinic at Benjamin Mkapa Hospital which is a zonal referral hospital in Central Tanzania 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 by the patient.
On physical examination, he had no external nose deformity but rather a friable left-sided obstructive nasal mass. He was not pale and had no any palpable peripheral lymph nodes. Laboratory results showed hemoglobin 11g/dl and elevated erythrocyte sedimentation rate (35mm/hour). A provisional diagnosis of pyogenic granuloma was made and consequently endoscopic surgical excision of the nasal mass under general anaesthesia was done. The surgically excised specimen was sent for histopathology.
Histopathological analysis revealed thick-walled sporangium containing numerous endospores (daughter spores) (Figure 1) and with further sections showing thick walled sporangium with endospores in different stages of development accompanied by mixed inflammatory cells mainly plasma cells (Figure 2). Another cross-section showed a papilla with delicate fibrovascular core admixed with thick walled sporangium, lined by stratified squamous epithelium with minimal surface keratinization (Figure 3). On the other hand, low power micrographs showed papillary arrangement with delicate fibrovascular core admixed with thick-walled sporangium and the papillae are lined by stratified squamous epithelium with no surface keratinization (Figure 4)
Figure 1: Intermediate power view of thick-walled sporangium containing numerous endospores (daughter spores)