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: Page 1 of 5
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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
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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
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CT scan images showing circumscribed lesion in region of right temporalis muscle
CT scan images showing circumscribed lesion in region of right temporalis muscle
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6. See the discussion in S. Brownlee, “Doctors without Borders,”13. D. Healy, letter to Peter J. Pitts, Associate Commissioner for Ex- Washington Monthly, April 2004. ternal Relations at the Food and Drug Administration, February 19,7. See J.M. Drazen and G.D. Curfman, “Financial Associations ofAuthors,” NEJM 346 (2002): 1901-1902. 14. “Depressing Research,” Lancet 363 (2004