I ROP\C·\\ [)()(IOR, 1990,20,95-96 Iftikhar A Malik FRCPath Khalil Ullah MPhil Tropical Doctor. April 1990 Aspergillus granuloma presenting as recurrent nasal polypi M Muzaffar MRCPalh M Luqman MPhil Ghulam Nabi FRCS Department of Pathology, Army Medical College, Rawalpindi. Pakistan and EN T Department, Ayub Medical College. Abbottabud, Pakistan A 20-year-old previously healthy male presented with bilateral recurrent nasal obstruction. Examin- ation of the nasal cavity revealed bilateral polypi. The histological examination of the resected polypi showed multiple sclerosing giant cell granulomata which on periodic acid - Schiff reaction (PAS) and Grocott's stains revealed septate hyphae of aspergillus. This relatively uncommon mode of presentation of aspergillus granuloma as nasal polypi is emphasized. It is hypothesized that in all giant cell lesions of nose and paranasal sinuses, suspicion of fungus should be entertained and confirmed by PAS and Grocott's stain by routine use. CASE REPORT A 20-year-old apparently healthy male presented to the outpatients wing of an ENT department complaining of nasal obstruction on both sides. General physical examination showed no abnor- mality. On local examination, there were polypi obstructing both the nasal cavities. The radiological examination revealed thickened mucosa and focal opacities of maxillary sinuses on both sides. Haemoglobin was 12 g/dl and the peripheral blood count was normal. Bleeding time, coagulation time and platelet count were within normal limits. Multiple polypi were removed surgically together with a thick mass arising from the nasal mucosa. The polypi and the mass were fixed in lOClJo formal- saline and sent for histopathological examination. Grossly, the tissue consisted of several irregular greyish fragments together measuring 4 x 3 x 2 ern, These were embedded in paraffin and processed in automatic tissue processor. Sections were cut at 3-4/-tm and stained with haematoxylin - eosin, periodic acid - Schiff and Grocotr's methanamine silver stain. 95 Figure I. Nasal polyp showing sclerosing giant cell reaction (H & Ex 104) Microscopically, both the specimens showed respiratory type mucosa containing several multi- nucleated giant cell granulomata, separated from one another by fibrous septa and scattered micro- abscesses (Figure I). There were refractile fungal filaments in some of the giant cells on H & E staining. PAS and Grocott's stain confirmed septate filamen- tous hyphae, lying within the giant cells and in the microabscesses. Some of these were fragmented (Figure 2). Staining for acid fast bacillus was negative. DISCUSSION Fungi which occur frequently in the nose and para- nasal sinuses include candidiasis, zygomycosis, aspergillosis and rhinosporidiosis. Figure 2. Hyphae of Aspergillus spp. as seen in the nasal granuloma. (Grocott stain x 156)