56545463535
Páginas: 9 (2140 palabras)
Publicado: 16 de noviembre de 2014
Cysticercosis of masseter
Cysticercosis is an infestation caused by the larval stage of the tapeworm, Taenia solium, a cestode measuring about 2.5-3.0 m.[1] Human beings serve as either a definitive or an intermediate host of the adult tapeworm. T. solium has a complex life cycle requiring two mammalian hosts: A definitive host, in which the worm reaches sexual maturity, and anintermediate host.Humans are the only definitive hosts for the adult T. solium.
Consumption of inadequately cooked pork is the primary cause because pigs serve as normal intermediate hosts. Cysticercosis is endemic to developing countries (mainly India, Indonesia, China, Africa, Peru and Mexico) but may also occur in non-endemic areas.Oral cysticercosis is very rare in spite of the abundance of musculartissue in the oral and maxillofacial region and is usually asymptomatic. According to the literature reports, he prevalence of oral cysticercosis is 4.1%.The most likely involved intraoral sites include buccal mucosa, tongue and lips.Here, we report an isolated lesion of cysticercosis involving the masseter muscle.
CASE REPORT
An 18-year-old female patient reported with a complaint of swelling inher right cheek. She gave a history of intermittent increase in the size of swelling accompanied by pain since the past 1 year. Her past medical history was noncontributory.On extraoral examination, the face appeared symmetrical and the overlying facial skin appeared normal. I Intraoral examination revealed a mild swelling of the right cheek. Bimanual palpation of right masseter muscle revealed awell defined, nontender, mobile nodule of approximately 1.5 cm in diameter, which became less prominent on clenching of teeth.No limitation in mandibular movement was noted.
Neither any palpable lymph node was present in the head and neck nor any neurological deficit was seen. The oral mucosa appeared normal with minimal inflammatory changes. The salivary flow from the right Stensen’s ductappeared normal.
Ultrasonography (USG) of the right cheek revealed a 1.2 × 0.8 cm, well-defined cystic lesion with a central echogenic area within it. Absence of vascularity was noted. The USG gave the impression of cysticercosis in the masseter muscle, following which USG-guided fine needle aspiration cytology (FNAC) was performed. The aspirate obtained was clear. The smear showed mixed inflammatorycell infiltrate and histiocytic clusters with an occasional fragment of muscle fiber. There was no evidence of any parasite in that aspirate. A magnetic resonance image (MRI) was done which showed an irregularly marginated, well-encapsulated, low attenuation, peripherally enhancing cyst of approximately 10 mm in diameter within the right masseter. It showed an eccentrically located focus ofdifferent signal characteristics.
The patient was scheduled for excisional biopsy under general anesthesia. A well-encapsulated cystic lesion, milky white in color was identified which was not attached to the masseter muscle. The lesion was removed in toto. The postoperative course was uneventful.
Histopathologic examination
The gross specimen revealed a whitish cyst measuring 0.6 × 0.4 × 0.3 cm,yielding a milky white fluid on the cut surface.On microscopic examination, the H and E stained sections revealed the presence of a fibrous pseudocapsule infiltrated by chronic inflammatory cells. The encysted larva showed a degenerated scolex covered by a wavy, refractile, eosinophilic cuticle. Aggregates of subcuticular cells were also seen along with bundles of smooth muscle fibers in thedeeper layers. Areas of calcification were also noted. This confirmed the diagnosis of cysticercosis.
DISCUSSION
The ingestion of T. solium eggs happens by consumption of fecally contaminated vegetables, food or water, as well as well as self contamination by reflux from the intestine into the stomach or by contaminated hands. When a man ingests the eggs, he becomes the intermediate host, a role...
Cysticercosis is an infestation caused by the larval stage of the tapeworm, Taenia solium, a cestode measuring about 2.5-3.0 m.[1] Human beings serve as either a definitive or an intermediate host of the adult tapeworm. T. solium has a complex life cycle requiring two mammalian hosts: A definitive host, in which the worm reaches sexual maturity, and anintermediate host.Humans are the only definitive hosts for the adult T. solium.
Consumption of inadequately cooked pork is the primary cause because pigs serve as normal intermediate hosts. Cysticercosis is endemic to developing countries (mainly India, Indonesia, China, Africa, Peru and Mexico) but may also occur in non-endemic areas.Oral cysticercosis is very rare in spite of the abundance of musculartissue in the oral and maxillofacial region and is usually asymptomatic. According to the literature reports, he prevalence of oral cysticercosis is 4.1%.The most likely involved intraoral sites include buccal mucosa, tongue and lips.Here, we report an isolated lesion of cysticercosis involving the masseter muscle.
CASE REPORT
An 18-year-old female patient reported with a complaint of swelling inher right cheek. She gave a history of intermittent increase in the size of swelling accompanied by pain since the past 1 year. Her past medical history was noncontributory.On extraoral examination, the face appeared symmetrical and the overlying facial skin appeared normal. I Intraoral examination revealed a mild swelling of the right cheek. Bimanual palpation of right masseter muscle revealed awell defined, nontender, mobile nodule of approximately 1.5 cm in diameter, which became less prominent on clenching of teeth.No limitation in mandibular movement was noted.
Neither any palpable lymph node was present in the head and neck nor any neurological deficit was seen. The oral mucosa appeared normal with minimal inflammatory changes. The salivary flow from the right Stensen’s ductappeared normal.
Ultrasonography (USG) of the right cheek revealed a 1.2 × 0.8 cm, well-defined cystic lesion with a central echogenic area within it. Absence of vascularity was noted. The USG gave the impression of cysticercosis in the masseter muscle, following which USG-guided fine needle aspiration cytology (FNAC) was performed. The aspirate obtained was clear. The smear showed mixed inflammatorycell infiltrate and histiocytic clusters with an occasional fragment of muscle fiber. There was no evidence of any parasite in that aspirate. A magnetic resonance image (MRI) was done which showed an irregularly marginated, well-encapsulated, low attenuation, peripherally enhancing cyst of approximately 10 mm in diameter within the right masseter. It showed an eccentrically located focus ofdifferent signal characteristics.
The patient was scheduled for excisional biopsy under general anesthesia. A well-encapsulated cystic lesion, milky white in color was identified which was not attached to the masseter muscle. The lesion was removed in toto. The postoperative course was uneventful.
Histopathologic examination
The gross specimen revealed a whitish cyst measuring 0.6 × 0.4 × 0.3 cm,yielding a milky white fluid on the cut surface.On microscopic examination, the H and E stained sections revealed the presence of a fibrous pseudocapsule infiltrated by chronic inflammatory cells. The encysted larva showed a degenerated scolex covered by a wavy, refractile, eosinophilic cuticle. Aggregates of subcuticular cells were also seen along with bundles of smooth muscle fibers in thedeeper layers. Areas of calcification were also noted. This confirmed the diagnosis of cysticercosis.
DISCUSSION
The ingestion of T. solium eggs happens by consumption of fecally contaminated vegetables, food or water, as well as well as self contamination by reflux from the intestine into the stomach or by contaminated hands. When a man ingests the eggs, he becomes the intermediate host, a role...
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