Indian Journal of Plastic Surgery Medknow Publications on behalf of Indian Journal of Plastic Surgery ISSN: 0970-0358 EISSN: 1998-376x Vol. 38, Num. 2, 2005, pp. 160-161

Indian Journal of Plastic Surgery, Vol. 38, No. 2, July-December, 2005, pp. 160-161

Case Report

Lingual cysticercosis

S. C. Pandey, *S. D. Pandey

Dental Surgeon, Provincial Medical and Health Services of the Stateof U.P., *Professor Emeritus ; King George’s Medical University, Lucknow.

Correspondence Address: Dr. S.C. Pandey, “PANDEYS”, B-83/B; Nirala Nagar, (Opposite Ram Krishna Math), Lucknow –226020. E-mail: sharadchpandey@yahoo.co.in

Code Number: pl05034

Abstract

Keywords: Lingual, Cysticercosis, Oral, Tongue, Taenia, Cellulosae

Introduction

Case History

A forty five year male, non vegetarian, presented with a painless solitary nodular swelling near the left lateral border of his tongue of two months duration. The nodule was gradually increasing in size and had lately caused discomfort while eating and talking. Examination revealed a 1cm x 1cm well defined pink, smooth, moveable, non tender swelling at the junction of anterior one third and posterior two third of the tongue. General and systemic examination was within normal limits. Fine needle aspiration cytology was non conclusive. Under local anaesthesia excision was carried out. On excision it was a smooth well-encapsulated cystic mass, with yellowish pale fluid.

The histopathological examination revealed cysticercosis cellulosae in the tongue musculature [Figure - 1]. It was characterised by a scolex and epithelium lined tortuous body canal continuous with outer cystic layer [Figure - 2]. The cyst was enclosed by a thick fibrous capsule infiltrated with lymphocytes, plasma cells, eosinophils and giant cell granulations. The postoperative period was uneventful. The patient is being followed up regularly and is monitored for any neurological or ophthalmic signs and symptoms. He was given Albendazole 200mg TDS for thirty days.

Discussion

Taenia solium passes its life cycle in two hosts. The definitive host is human who harbours the adult worm and intermediate host is pig which harbours the larval stage. The adult worm lives in the small intestine of man. Usually one adult worm is present which lives for years. It is about three meters long with 1000 proglotids, the gravid segments with about 50,000 eggs in each gravid segment. The worm sheds gravid segments laden with eggs in the stool which infect pigs. On reaching the alimentary canal of the intermediate host these eggs rupture and oncospheres are liberated. They penetrate the gut wall and reach the systemic circulation and are lodged in the different organs and muscles of the intermediate host. Here, they develop into larvae referred to as cystecercosis cellulosae. Human beings are infected through eating undercooked contaminated pork or infected vegetables, where it develops into the adult tapeworm in the jejunum. The worms shed gravid segments laden with eggs in the stool; which reinfect pigs, thus completing the cycle. Autoinfection of man may occur by contaminated fingers or by reversal of peristaltic movement of intestine whereby the gravid segments are thrown back to the stomach, equivalent to ingestion of thousands of eggs. These are partially digested in the stomach, evolving to oncospheres and subsequently penetrating the small intestine mucosa to disseminate throughout the body via arteriovenous channels and lymphatics, frequently encysting in subcutaneous tissue; striated muscles, brain and ocular tissue.

Clinical manifestations of intestinal infection by Taenia solium could be asymptomatic or may present with epigastric pain, nausea and loose motions. In cysticersosis manifestations are different and depends on the location of cysticercosis in the body, not only this but also the number of cysticercosis at a particular site and the associated inflammatory response or scarring decides the clinical presentation. In 87% of cases cysticercosis presents as solitary lesion. Presentation as subcutaneous nodule on trunk, upper arm, eyes, neck, tongue, face and breast has been reported in this order of frequency. Neurocysticercosis is most often presented with seizures and may be associated with subcutaneous nodules comprised of extraneural cysts.

In a large series of 450 cases of cysticercosis Dixon and Lipscomb[1] detected 1.8 % suffering from lingual cysticercosis in 1961. Ortiz[2] 1963, Celissanfelix[3] 1965, Pupkin[4] 1967, Lafont[5] 1971, Sharma[6] 1986, Gupta[7] 1995, Roth[8] 2003, Nigum[9] 2003 have reported a total of 34 cases of lingual cysticercosis. Our case is one more addition to this series of rare manifestation of Cysticercosis.

Conclusion

References

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