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)