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Cysticercosis of Temporalis Muscle: A Histological
Surprise
Corresponding Author:
Dr. Priya N Shah,
Assistant Professor, Dr. D. Y. Patil Med College, Pune, A2/702, Kumar Princetown, Near California, Undri, Pune,
411060 - India
Submitting Author:
Dr. Priya N Shah,
Assistant Professor, Dr. D. Y. Patil Med College, Pune, A2/702, Kumar Princetown, Near California, Undri, Pune,
411060 - India
Other Authors:
Dr. G. D Mahajan,
Associate Professor, Department of ENT, Padmashree Dr. D. Y. Patil Medical College and Hospital - India
Dr. Girija Ghate,Assistant Professor, Department of ENT, Padmashree Dr. D. Y. Patil Medical College and Hospital - India Dr. James Thomas,Professor and Head, Department of ENT, Padmashree Dr. D. Y. Patil Medical College and Hospital - India Article ID: WMC004313
Article Type: Case Report
Submitted on:28-Jun-2013, 09:41:54 AM GMT Published on: 28-Jun-2013, 09:53:25 AM GMT
Article URL:
Subject Categories:OTORHINOLARYNGOLOGY
Keywords:Cysticercosis, musculoskeletal swelling, tapeworm infestation, temporalis.
How to cite the article:Shah PN, Mahajan GD, Ghate G, Thomas J. Cysticercosis of Temporalis Muscle: A
Histological Surprise. WebmedCentral OTORHINOLARYNGOLOGY 2013;4(6):WMC004313
Copyright: This is an open-access article distributed under the terms of the (CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.
Source(s) of Funding:
Competing Interests:
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Downloaded from http://www.webmedcentral.com on 28-Jun-2013, 09:53:26 AM Cysticercosis of Temporalis Muscle: A Histological
Surprise
Author(s): Shah PN, Mahajan GD, Ghate G, Thomas J
palpation the swelling was measuring 2cm x 1.5cm in dimension, firm in consistency with indistinct margins and the overlying skin was mobile. The swelling was fixed on clenching the teeth. Radiographic Cysticercosis, a parasitic infection caused by the larval examination did not reveal any significant abnormality.
form of the pork tapeworm, Taenia solium.
FNAC was inconclusive showing only inflammatory Cysticercosis usually involves musculoskeletal system changes. So to know the exact extent and nature of and CNS. Here we present an isolated involvement of swelling patient was subjected to a CT scan which right sided temporalis muscle. There was no any other revealed a circular lesion measuring 1.5 cm in system involvement including CNS. So it was very diameter located in the region of the right temporalis difficult to diagnose the condition. All the investigations done were not pointing to any diagnosis.
The condition was diagnosed only after the excision of Since the swelling was painful on chewing, excision biopsy was planned. Right sided suprazygomatic vertical incision was taken in the hairline. The fibrous Keywords – Cysticercosis, musculoskeletal swelling, tissue and the temporalis fascia dissected and well encapsulated, circumscribed swelling found in the temporalis muscle tissue. There was a plane between the swelling and the muscle. The swelling could be dissected in toto out of the muscle. The incision was sutured in layers. The swelling was sent for Cysticercosis is a systemic parasitic infestation caused examination. The report was a histopathological by the pork tapeworm, Taenia solium. The occurrence surprise. It turned out to be cysticercosis. To rule out of cysts in humans in order of frequency is the central other system involvement a MRI brain and eyes was nervous system, eye, subcutaneous tissue, striated done, which did not show presence of any cysts.
tissue and rarely other tissues (1). Most muscular Sutures were removed on 7th day. The wound healed disease is associated with central nervous system nicely. Retrospectively when the patient was inquired involvement, presence of multiple muscular cysts or about his diet, he gave the history of mixed dietary both. Neurocysticercosis is the most frequent cause of habit. After a month follow-up patient did not have any adult-onset seizures in Latin America, South East Asia and Africa; it is rare in Western Europe and mainly occurs in immigrants from endemic regions (2).
Isolated muscular involvement is a rare finding (3) and because of nonspecific symptoms, isolated soft tissue cysticercosis is very difficult to diagnose (4). Till date Cysticercosis is a systemic parasitic infestation caused there are very few reported cases of isolated muscular by the pork tapeworm, Taenia solium. The symptoms cysticercosis (5). We present a 30 yrs male case of of this illness are caused by the development of isolated cysticercosis of the right temporalis muscle.
characteristic cysts (cysticerci) which most often affect the central nervous system (neurocysticercosis), skeletal muscle, eyes, and skin. Many individuals with cysticercosis never experience any symptoms (asymptomatic). The disease was also recognized by A 30 years male presented with a swelling in right Muslim physicians and is thought to be the reason for suprazygomatic region since 3 months. Patient noticed Islamic dietary prohibition of eating pork. In the 1850s, the swelling of size of a berry 3 months back. German investigators described the life cycle of T.
Gradually swelling became painful on chewing.
Tenderness was localised on the right temporalis muscle area. There was no history of any discoloration Humans are the host for Taenia solium, and they may of the skin or discharge from the swelling. On Page 2 of 5
Downloaded from http://www.webmedcentral.com on 28-Jun-2013, 09:53:26 AM carry the tapeworm in their intestine, often without investigations like FNAC or USG do not point towards symptoms. The tapeworm eggs are periodically shed in the faeces by the human reservoir, and typically pigs ingest the eggs in contaminated food or water.
The pigs subsequently become infected and develop cysticerci in their body tissue. When humans eat infected raw or undercooked pork, the life cycle of the 1. Mittal A, Das D, Iyer N. Masseter cysticercosis- a tapeworm is complete and the cycle continues. rare case diagnosed on ultrasound. Dentomaxillofacial Human cysticercosis, however, develops after humans 2. Garcia HH, Del Brutto OH: Neurocysticercosis: ingest Taenia solium eggs. The eggs are typically updated concepts about an old disease. Lancet Neurol spread via food, water, or surfaces contaminated with infected faeces. Many times the eggs may be spread 3. Zemeno-Alanis GH: A classification of human from the hands of infected food handlers who do not cysticercosis. Fissler A, Willms K, Laclette JP et al.
clean their hands or from foods fertilized/irrigated with Cysticercosis: Present state of knowledge and water containing infected human faeces. Though the perspectives. New York, Academic Press 1982; source of this faeco-oral transmission often occurs from other infected individuals, it is also possible for 4. Boris Michael Holzapfel MD, Christoph Schaeffeler individuals who carry the tapeworm to auto infect MD, Ingo Jorg Banke, Simone Waldt case report: A 37 themselves. Cysticercosis usually involve nervous year old man with a painless growing mass og the system, it is called as neurocysticercosis. Involvement thorax. Clin Orthop Relat Res 2010; 468:1193-98.
of other body tissue can occur affecting eyes, 5. Jankharia BG, Chavan GB, Krishnan P. MRI and musculoskeletal system and subcutaneous tissues. ultrasound in solitary muscular and soft tissue cysticercosis. Skeletal Radiol 2005; 34:722-26.
In conjunction with the stool examination the 6. Garcia HH, Del Brutto OH, Nash TE, White AC Jr, radiological imaging may lead to the diagnosis of Tsang VC, Gilman RH: New concepts in the diagnosis cysticercosis. Blood testing may sometimes help but is and management of neurocysticercosis (Taenia not very accurate. Rarely biopsy is needed to arrive at solium). Am J Trop Med Hyg 2005, 72:3-9.
7. Garcia HH, Pretell EJ, Gilman RH, Martinez SM, Moulton LH, Del Brutto OH, Herrera G, Evans CA, The complications that may be seen with cysticercosis Gonzalez AE: A trial of antiparasitic treatment to are seizures, stroke, vision changes, and cognitive reduce the rate of seizures due to cerebral problems. The prognosis for the majority of patients cysticercosis. N Engl J Med 2004, 350:249-258.
with cysticercosis is excellent with proper 8. Jung H, Hurtado M, Medina MT, Sanchez M, Sotelo J: Dexamethasone increases plasma levels of albendazole. J Neurol 1990, 237:279-280. Asymptomatic patients may not require any treatment.
9. Colli BO, Carlotti CG Jr, Assirati JA Jr, Machado HR, Specific anthelminthic therapy with albendazole or Valença M, Amato MC: Surgical treatment of cerebral praziquantel is recommended for patients with cysticercosis: long-term results and prognostic factors.
non-calcified, viable cystic lesions (6,7). Accompanied corticosteroids prevent increased inflammation due to cyst degeneration under anthelminthic treatment (8).
Surgical intervention can be necessary in the setting of intracranial hypertension caused by hydrocephalus or When the patient presents with a musculoskeletal swelling of uncertain aetiology especially in the endemic areas of tapeworm infestations, differential diagnosis of cysticercosis should be considered.
Excisional biopsy gives the final diagnosis when other Page 3 of 5
Downloaded from http://www.webmedcentral.com on 28-Jun-2013, 09:53:26 AM CT scan images showing circumscribed lesion in region of right temporalis muscle CT scan images showing circumscribed lesion in region of right temporalis muscle Page 4 of 5
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