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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
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Year : 2019  |  Volume : 23  |  Issue : 2  |  Page : 289-291
 

Oral cysticercosis in a vegetarian female: A diagnostic dilemma


1 Department of Oral and Maxillofacial Pathology and Oral Microbiology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
2 Department of Oral and Maxillofacial Pathology and Oral Microbiology, IDST Dental College, Ghaziabad, Uttar Pradesh, India
3 Department of Oral Medicine and Radiology, Saraswati Dental College, Lucknow, Uttar Pradesh, India

Date of Submission24-Nov-2018
Date of Acceptance08-May-2019
Date of Web Publication20-Aug-2019

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomfp.JOMFP_291_18

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How to cite this article:
Sah K, Grover N, Chandra S, Gulia S. Oral cysticercosis in a vegetarian female: A diagnostic dilemma. J Oral Maxillofac Pathol 2019;23:289-91

How to cite this URL:
Sah K, Grover N, Chandra S, Gulia S. Oral cysticercosis in a vegetarian female: A diagnostic dilemma. J Oral Maxillofac Pathol [serial online] 2019 [cited 2019 Sep 22];23:289-91. Available from: http://www.jomfp.in/text.asp?2019/23/2/289/264825





   Case Report Top


A 37-year-old vegetarian female reported with the chief complaint of a swelling on the ventral surface of the tongue since 1 year, which had gradually increased to the present size measuring approximately 1 cm × 1 cm in diameter. The overlying mucosa was intact and slightly pale in appearance. A clinical differential diagnosis of fibroma, mucocele, ranula and leiomyoma was made. Occlusal radiograph showed a small radiopacity of around 0.3 cm in diameter. On clinicoradiographic correlation, a differential diagnosis of calcinosis circumscripta and sialolithiasis was made. Excisional biopsy was preformed, and on gross examination, the specimen was roughly oval in shape, creamy white in color, soft to cystic in consistency and measured approximately 1 cm × 0.5 cm in diameter.


   Microscopic Findings Top


  • On microscopic examination, the hematoxylin and eosin-stained section was lined by a thick fibrous cystic capsule surrounding the cystic cavity having many invaginations [Figure 1]
  • The cystic lumen was lined by a delicate double-layered membrane containing an outer acellular hyaline eosinophilic and an inner sparsely cellular layer, indicating the presence of larval stage of Taenia solium (cysticercus cellulosae). The larva showed the presence of suckers and caudal to it duct-like invagination segment lined by a homogenous membrane [Figure 2]
  • Areas of dystrophic calcifications were also seen with granuloma formation [Figure 3].
Figure 1: Photomicrograph showing a thick fibrous cystic capsule surrounding the cystic cavity having many invaginations (H&E, ×40)

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Figure 2: Photomicrograph showing delicate double-layered membrane containing an outer acellular hyaline eosinophilic and an inner sparsely cellular layer (H&E, ×40)

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Figure 3: Photomicrograph showing areas of dystrophic calcifications with granuloma formation (H&E, ×40)

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   Discussion Top


T. solium passes its life cycle in two hosts. The definitive host is human who harbors the adult worm, and the intermediate host is pig which harbors the larval stage. Human beings are infected through eating undercooked contaminated pork or infected vegetables, where it develops into the adult tapeworm in the intestine, thus completing the cycle.[1],[2]

The prevalence of oral cysticercosis is 3.5% out of 769 cases of cysticercosis in other sites of the human body. The most frequently involved site for oral cysticercosis in humans is the tongue (51.85%), as it is highly muscular and vascular than any other part of the oral cavity. Lesions may be asymptomatic when involving the oral cavity. It was found that the lesion on the tongue could interfere with movement, causing discomfort during speaking and eating.[3]

Oral cysticercosis may be clinically mistaken for a variety of benign lesions because of their relatively rare occurrence. Differential diagnosis of oral lesion depends on the site involved. In case of a solitary nodule on the tongue, lined by normal mucosa, the differential diagnosis would be benign neoplasm i.e. fibroma, lipoma, neurofibroma, benign schwannoma, granular cell myoblastoma, vascular neoplasm and minor salivary gland tumor.[3]

Although oral cysticercosis indicates disseminated infestation, systemic complications are not demonstrated in most of the patients with oral lesions. This may be due to the fact that generally disseminated larvae are located in deep tissues, where it may remain alive throughout the life of the host without giving clinical manifestations. Still, it is mandatory that patients with oral cysticercosis must be referred for thorough medical evaluation.[4]

For the present case, the patient was referred for medical evaluation. Routine blood examination, urine and stool tests were insignificant. To eliminate the possibility of neurocysticercosis, a computed tomography of the head was performed, and no parasitosis focus was established.


   Differential Diagnosis Top


Fibroma

It is the most common benign connective tissue neoplasm of the oral cavity. The most common location is buccal mucosa, though it can also occur on the gingiva, tongue, lip and palate. Clinically, it appears as an elevated nodule with a smooth surface (normal oral mucosa) with sessile or pedunculated base. Histopathologically, it consists of interlacing bundles of collagen fibers with varying number of fibroblasts or fibrocytes. Although we had clinically considered it in the differential diagnosis, it was excluded based on histological features.[5],[6]

Mucocele

Mucocele can be of mucous retention (RT) or extravasated type (ET). It is most frequently seen involving the lower lip, but may also occur on the palate, cheek and tongue (glands of Blandin–Nuhn) and clinically appears as a raised, circumscribed swelling of few millimeters in diameter. Microscopically, ET consists of a well-circumscribed cystic cavity surrounded by the compressed connective tissue stroma which most often shows infiltration of neutrophils, lymphocytes, macrophages, plasma cells and mucous acini. The cystic lumen contains eosinophilic coagulum which also contains variable number of inflammatory cells. RT shows almost the same histological features as mentioned above, with the cystic lumen lined by epithelial lining. Clinically, it was considered in the differential diagnosis but was excluded histopathologically, as it lacks the presence of larva inside the cystic cavity.[5],[6]

Ranula

Clinically, ranula is also a form of mucocele which clinically manifests as a slowly enlarging painless mass on one side on the floor of the mouth. If the lesion is superficial, the mucosa has a translucent bluish color, whereas, in deep-seated lesion, the mucosa appears normal. Histopathologically, it appears similar to mucocele, most commonly RT. It was excluded based on the clinical features (size and location) and histopathological features (presence of larva inside the cystic cavity).[5],[6]

Leiomyoma

Oral leiomyoma is an asymptomatic, slow-growing lesion and is often pedunculated. They are uncommon in the oral cavity but can occur in the posterior tongue, palate, cheek, gingiva, etc. Microscopically, it is composed of interlacing bundles of smooth muscles interspersed with fibrous connective tissue fibers with spindle-to-blunt-end fibroblasts. Exclusion of the lesion was done based on the clinical and histopathological features.


   Proposed Criteria For Diagnosis Top


  • Positive epidemiological factors
  • Fine-needle aspiration aspirate showing white pearly material
  • Histopathological demonstration of the parasite (Gold Standard).



   Precautionary and Preventive Measures Top


  • Maintaining good personal hygiene and effective fecal disposal
  • Adequate cleaning of consumable uncooked food
  • For any innocuous intraoral nodule, histopathological evaluation is a must
  • Adequate cooking of pork and vegetables.



   Final Diagnosis Top


The histopathological picture was characteristic of cysticercus (larval form of T. solium), and a final diagnosis of cysticercus cellulosae of the tongue was established.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Bueno EC, Vaz AJ, Machado LD, Livramento JA, Mielle SR. Specific Taenia crassiceps and Taenia solium antigenic peptides for neurocysticercosis immunodiagnosis using serum samples. J Clin Microbiol 2000;38:146-51.  Back to cited text no. 1
    
2.
de Souza PE, Barreto DC, Fonseca LM, de Paula AM, Silva EC, Gomez RS, et al. Cysticercosis of the oral cavity: Report of seven cases. Oral Dis 2000;6:253-5.  Back to cited text no. 2
    
3.
Gadbail AR, Korde S, Wadhwan V, Chaudhary M, Patil S. Oral cysticercosis: report of two cases with review of literature. Oral Surg 2010;3:51-6.  Back to cited text no. 3
    
4.
Mahajan S, Agrawal P, Datarkar A, Borle R. Oral cysticercosis: A case report. J Maxillofac Oral Surg 2009;8:85-7.  Back to cited text no. 4
    
5.
Rajendran R, Sivapathasundharam B, editors. Shafer's Textbook of Oral Pathology. 6th ed. New Delhi, India: Elsevier; 2009.  Back to cited text no. 5
    
6.
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology. 3rd ed. St. Louis: Saunders; 2009.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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