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of the images were also studied in addition to screening cavity to maintain the lacrimal flow. The medial canthus
ultrasonography (USG). A well‑defined soft tissue lesion was repaired and the wound closed in layers. The tissue
measuring 20 mm × 15 mm in size was noted in the was sent for histopathology [Figures 3‑5].
subcutaneous plane at the medial canthus of the left eye Pathological sections showed fragments of polypoidal
at the level of the nasolacrimal sac. The lesion extended
into the upper part of the nasolacrimal duct. The lesion tissue lined by hyperplastic squamous and respiratory
was hyperdense with a mean CT attenuation of 48 mucosa. The underlying stroma showed variable sized
Hounsfield units (HU) [Figures 1 and 2]. round fungal sporangia lined by a thickened wall
and many small intraluminal spores. The surrounding
Screening USG showed multiple abnormal vessels with tissue showed granuloma formation and infiltration with
a highly vascular hyperechoic lesion. All the paranasal lymphocytes, plasma cells and eosinophils. The diagnosis
sinuses were normal. A provisional diagnosis of vascular was rhinosporidiosis of lacrimal sac [Figures 6 and 7].
malformation was made and excision under general anesthesia
was planned. The patient was treated with diaminodiphenyl sulfone
(Dapsone) 100 mg/day postoperatively for one month.
Two percent xylocaine with adrenaline was infiltrated There was no recurrence and the incision healed well with
in the region of the medial canthus of the left eye. An minimal scarring [Figure 8].
elliptical incision was made over the medial canthus of
the left eye and extended to the infra‑orbital region. The DISCUSSION
mass was dissected out within the subcutaneous plane
and was noted to arise from the lacrimal sac. The mass Rhinosporidiosis was first described in 1900 by Guillermo
was soft in consistency, highly vascular and irregular Seeber who treated a 19‑year‑old farm worker in Argentina
in appearance. The sac could not be preserved during whose breathing was impaired by a nasal mass. Ashworth
dissection. The lacrimal bone was drilled and silastic described the life cycle of the organism in 1923, observing
tubes were placed from the lacrimal punctum to the nasal
its similarity to the fungal life cycle and renaming it

Figure 1: Coronal section of CT scan PNS showing diffuse swelling over
left medial canthus and floor of orbit (indicated by arrow). CT: computed Figure 2: Axial section of CT scan PNS showing diffuse swelling over left
tomography, PNS: nose and paranasal sinuses medial canthus and floor of orbit (indicated by arrow). CT: computed
tomography, PNS: nose and paranasal sinuses

Figure 4: Intraoperative photograph showing complete excision and
Figure 3: Preoperative photograph showing medial canthus swelling external DCR with silicon tubes in situ. DCR: dacryocystorhinostomy
354 Plast Aesthet Res || Vol 2 || Issue 6 || Nov 12, 2015