|Year : 2016 | Volume
| Issue : 2 | Page : 124-125
Cysticercosis: Presenting as a swelling of sternocleidomastoid muscle
Komal Sawaimul, Banyameen Mohamad Iqbal, Tushar Kambale
Department of Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra, India
|Date of Web Publication||24-May-2016|
Banyameen Mohamad Iqbal
Department of Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune - 411 018, Maharashtra
Source of Support: None, Conflict of Interest: None
Cysticercosis presenting as neck swelling is an uncommon disease caused by Cysticercus cellulosae which is the larval form of the tapeworm Taenia solium. Human beings are the only definitive host. They harbor the adult tapeworm. Both humans and pigs can act as intermediate hosts and contain the larvae or cysticerci. We report a case of a 40-year-old female patient who presented to our hospital with a solitary swelling in the anterior triangle of the neck for the last 6 years. On excision and hist opathologic examination, it revealed a multilayered, lamellated cyst wall with a single invaginated scolex containing rostellum and hooklets giving a diagnosis of cysticercosis.
Keywords: Cysticercosis, Lamellated membranes, Parasitic neck swellings
|How to cite this article:|
Sawaimul K, Iqbal BM, Kambale T. Cysticercosis: Presenting as a swelling of sternocleidomastoid muscle. J Med Soc 2016;30:124-5
| Introduction|| |
Cysticercosis is an uncommon disease caused by Cysticercus cellulosae which is the larval form of the tapeworm Taenia solium (T. solium). T. solium has a complex life cycle consisting of two hosts. Human beings are the only definitive host and harbor the adult tapeworm (taeniasis). Both humans and pigs can act as intermediate hosts. They can harbor the larvae or cysticerci. T. solium exists worldwide and is most prevalent in Latin America, China, India, sub-Saharan Africa, and Southeast Asia.  In literature, head and neck manifestation of cysticercosis is reported as soft tissue swellings at the submental area, cheek, as well-astongue.  This paper reports a case of cysticercosis with a neck mass, describes the histology and documents the chosen management for this condition.
| Case report|| |
We are presenting a case of a 40-year-old female patient who presented to our hospital with a solitary swelling in the anterior triangle of the neck for the last 6 years. On examination, the swelling was firm, mobile, and nontender measuring 2 cm × 2 cm [Figure 1]. There was no rise of temperature or any other skin abnormality overlying the swelling. The swelling has progressively increased in size over the years. The patient did not give any positive history regarding diabetes mellitus, hypertension, or any infective process. Baseline investigation like hemogram revealed hemoglobin 10.2 g, total erythrocyte count 7500, different leccyte count: Polymorphs 65, lymphocytes 30, eosinophils 4, and monocytes 01. Serology examination was done and was negative for hepatitis B surface antigen, HIV, tuberculosis, syphilis. The patient was subsequently advised to perform fine needle aspiration cytology which came out to be inconclusive and subsequently an excisional biopsy was advised. Histopathological examination of slides revealed multilayered, lamellated cyst wall with a single invaginated scolex containing rostellum and hook lets [Figure 2].
|Figure 2 : Photomicrograph showing lamellated, multilayered cyst wall with a single invaginated scolex containing hooklets|
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| Discussion|| |
T. solium the pork tapeworm causes two distinct forms of infection. The form of disease that develops depends on whether humans are infected with larval forms in the tissues known as cysticercosis or with adult tapeworms in the intestine. Encysted larvae of T. solium which is endemic in many countries of Africa, Asia as well as in some parts of Europe is responsible for cysticercosis of soft tissues.  Autoinfections may occur after ingestion of eggs derived from its own feces or if eggs pass by reflex from the intestine into the stomach. Ingestion of encysted pork may cause an intestinal infestation of the adult tapeworm and a carrier state for T. solium eggs.  Humans being only definitive hosts for T. solium, whereas pigs are the usual intermediate hosts, although dogs, cats, and sheep may also harbor the larval forms. The adult tapeworm generally resides in the upper jejunum. 
Brown et al. reported a case of "cysticercosis involving only the sternocleidomastoid muscle of an otherwise healthy pregnant woman in whom enzyme-linked immunoelectrotransfer blot assay for cysticercosis was nonreactive."  He reported that the results of serological tests may not always be positive, and histopathology remains the only reliable method for confirming the diagnosis of cysticercosis. Cysticercosis larvae evoke a cellular reaction with infiltration of neutrophils, lymphocytes, eosinophils, plasma cells, and giant cells. This is followed by fibrosis and death of larva with eventual calcification.  Cysticercosis, which presents as a subcutaneous nodule is diagnosed by microscopic examination in which T. solium larvae is found. Over time, these larvae may calcify, and the calcified cyst reveals the presence of Cysticercus.  If seen in muscles and accessible areas, excision of the cyst is the best line of treatment. Medically, the cyst is treated by using praziquantel, niclosamide, and metrifonate.  In our patient, the cyst was excised into and send for histopathological examination, which revealed cysticercosis.
| Conclusion|| |
Cysticercosis of the soft tissues should be kept in mind as a differential diagnosis in case of soft tissue swellings especially in T. solium endemic areas where pork is frequently consumed.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]