组织病理学确诊的青少年男性鼻部鼻孢子菌病表现为长期右侧鼻塞和鼻出血：一例病例报告。

文献信息

中文摘要

引言： 鼻孢子菌病是由西伯鼻孢子菌引起的慢性肉芽肿性黏膜感染，最常累及鼻腔和鼻咽部。通常表现为易碎的息肉样病变，伴有鼻塞和反复鼻出血。组织病理学检查对于明确诊断至关重要。
病例介绍： 一名17岁男性，有五年进行性右侧鼻塞和反复鼻出血病史。鼻部肿块逐渐增大，最终从右侧鼻孔突出。患者报告在症状出现前曾反复在附近池塘游泳和玩耍。基线实验室检查显示血红蛋白水平为13.9 g/dL，白细胞计数为6.63 × 10^9/L，血小板计数为345 × 10^9/L。平均红细胞体积降低至76.2 fL。计算机断层扫描显示一个边界清晰的软组织病变占据右侧鼻腔，无明显骨质破坏性侵蚀。通过经鼻入路切除病变，随后对其基底部进行烧灼。组织病理学检查显示慢性炎症的黏膜下间质中含有大量厚壁孢子囊，囊内充满内生孢子，确诊为鼻孢子菌病。孢子囊存在于切除边缘，表明组织学上未完全清除。术后，在确认葡萄糖-6-磷酸脱氢酶状态正常后，开始口服氨苯砜100 mg每日一次，计划疗程为六个月。三个月随访时，复查计算机断层扫描显示无复发的影像学证据。
结论： 对于有长期单侧鼻塞、反复鼻出血和池塘水接触史的患者，应考虑鼻孢子菌病。完整的手术切除加烧灼以及术后持续监测非常重要，尤其是在组织学边缘受累时。

英文摘要

INTRODUCTION: Rhinosporidiosis is a chronic granulomatous mucosal infection caused by Rhinosporidium seeberi, most commonly affecting the nasal cavity and nasopharynx. It typically presents as a friable polypoidal lesion associated with nasal obstruction and recurrent epistaxis. Histopathological examination is essential for definitive diagnosis.
CASE PRESENTATION: A 17-year-old male presented with a five-year history of progressive right-sided nasal obstruction and recurrent epistaxis. The nasal mass gradually enlarged and eventually protruded through the right nostril. He reported repeated swimming and playing in a nearby pond before symptom onset. Baseline laboratory investigations showed a hemoglobin level of 13.9 g/dL, white blood cell count of 6.63 × 109/L, and platelet count of 345 × 109/L. Mean corpuscular volume was reduced at 76.2 fL. Computed tomography demonstrated a well-defined soft-tissue lesion occupying the right nasal cavity without obvious destructive bony erosion. The lesion was excised through a transnasal approach, followed by cauterization of its base. Histopathological examination demonstrated chronically inflamed subepithelial stroma containing numerous thick-walled sporangia filled with endospores, confirming nasal rhinosporidiosis. Sporangia were present at the resection margin, indicating incomplete histological clearance. Postoperatively, oral dapsone 100 mg once daily was commenced for a planned six-month course after confirmation of normal glucose-6-phosphate dehydrogenase status. At three-month follow-up, repeat computed tomography showed no radiological evidence of recurrence.
CONCLUSION: Nasal rhinosporidiosis should be considered in patients with long-standing unilateral nasal obstruction, recurrent epistaxis, and pond-water exposure. Complete surgical excision with cauterization and continued postoperative surveillance are important, particularly when histological margins are involved.