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


 
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CASE REPORT  
Year : 2023  |  Volume : 27  |  Issue : 5  |  Page : 95-97
 

Lower lip cysticercosis: An unusual case report


1 Department of Pathology, King George Medical University, Lucknow, Uttar Pradesh, India
2 Department of Microbiology, King George Medical University, Lucknow, Uttar Pradesh, India

Date of Submission03-Aug-2022
Date of Acceptance08-Sep-2022
Date of Web Publication04-Feb-2023

Correspondence Address:
Anurag Singh
Department of Pathology, King George's Medical University, Lucknow - 226 003, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomfp.jomfp_329_22

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   Abstract 


Cysticercosis is a disease that occurs when humans are infected with Taenia solium larvae. The parasitic illness cysticercosis, which is common in impoverished nations, hardly ever affects the mouth. Oral cysticercosis is rare that might be challenging to diagnose clinically. This rare case report documents an oral cysticercosis case in a 38-year-old male patient who had an asymptomatic lesion in the buccal mucosa of his lower lip. A T. solium larva was identified on histopathological examination in a cystic cavity after an excisional biopsy.


Keywords: Cysticercosis, lower lip, mouth, Taenia solium


How to cite this article:
Sagar M, Rawat S, Singh A, Anuragini. Lower lip cysticercosis: An unusual case report. J Oral Maxillofac Pathol 2023;27, Suppl S1:95-7

How to cite this URL:
Sagar M, Rawat S, Singh A, Anuragini. Lower lip cysticercosis: An unusual case report. J Oral Maxillofac Pathol [serial online] 2023 [cited 2023 Mar 21];27, Suppl S1:95-7. Available from: https://www.jomfp.in/text.asp?2023/27/5/95/369176





   Introduction Top


Infection with cysticercus cellulosae, larval cysts of the pig tapeworm Taenia solium, is carried on by consuming raw pork, contaminated food, or after contact with an infected person.[1] Humans and pigs, respectively, are the definitive and intermediate hosts. T. solium eggs mature into oncospheres that enter the blood and lymphatic vessels, pass through the gut wall, and then infiltrate different tissues and organs where they mature into cysticerci. Striated muscles of the neck, tongue, trunk, subcutaneous tissue, brain, liver, lungs, orbit, meninges, and other structures are frequently affected.[2] It is especially prevalent in poor nations in Latin America, Asia, and Africa.[3] The intense muscular activity of oral tissues in human prevents cysticerci from developing and lodging in the oral cavity, which makes it a rare site for them. The lips, cheeks, and tongue are among the preferred intraoral locations for cysticercus formation.[4] We report this unusual case of lower lip cysticercosis with clinical, histomorphological, and management discussion.


   Case Presentation Top


A 38-year-old man presented with a small, painless swelling on the inner aspect of the lower lip that had been growing slowly for the past 4 months. Trauma, fever, dysphagia, or excessive salivation were not present in the past. Previous medical history was not significant. A nodule on the lower lip's buccal mucosa was found during an oral examination of the patient. Initially, it was a very tiny, well-defined elevation over the buccal mucosa of the lower lip that became slightly larger over 4 months duration. There was no discomfort or other unusual feeling, and it was about 0.8 cm × 0.5 cm in size [Figure 1]a. It had a partly ulcerated overlying mucosa and could be palpated as being firm. There were no palpable lymph nodes in the neck area.
Figure 1: (a) Clinical photograph showing smooth, nodular swelling in the buccal mucosa of the lower lip. (b) Photomicrograph showing cysticercus cellulosae larva of Taenia solium displaying irregular membrane infolding (*) (H&E ×10). (c) Photomicrograph displaying an inner aspect of the cyst showing duct-like invaginations lined by a double layer of the eosinophilic membrane (H&E ×20). (d) Photomicrograph showing a closer view of the scolex composed of refractile hooklets (*) and suckers (H&E ×40)

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Based on clinical presentation and examination findings, a differential diagnosis of mucocele, dermoid cyst, and hemangioma was made. An excisional biopsy was carried out under local anaesthesia and submitted for histopathological evaluation. On microscopic examination of a hematoxylin and eosin (H&E)-stained biopsy tissue section, a cystic cavity containing the T. solium larval form of cysticercus cellulosae was shown to be enclosed by a capsule of fibrous connective tissue. The capsule had a moderate inflammatory infiltrate, comprising plasma cells and lymphocytes. The larva was composed of a scolex with suckers and a caudal end that displayed duct-like inavaginations. A uniform eosinophilic membrane coated the cystic structure and the larva [Figure 1]b, [Figure 1]c, [Figure 1]d. In the biopsy tissue section, there were no regions of dystrophic calcification. On the basis of histomorphological findings, a diagnosis of cysticercosis was rendered.

Following the histopathological diagnosis, the patient was advised for a complete blood count, stool examination to look for eggs or cysts, and computerised tomography of the head to rule out cysticercosis elsewhere. The patient received 400 mg of albendazole every day for 15 days. The patient is routinely followed up and monitored for any neurological or ophthalmic manifestations.


   Discussion Top


The zoonotic illness cysticercosis is caused by T. solium larvae. Cysticercosis can develop in the subcutaneous muscles, eyes, central nervous system (CNS), spinal cord, and heart after consumption of food contaminated with T. solium eggs shed in the stool of a human tapeworm carrier. Embryos are released by the action of bile and gastric enzymes; then, they invade the bowel wall and spread hematogeneously to the striated muscles, liver, brain, and/or other tissues. Oral cysticercosis is an uncommon condition that can be difficult to diagnose and has less documentation in the literature. The tongue is the organ of the oral cavity that is most frequently affected, followed by the lips and mouth floor.[5]

Cysticercosis is diagnosed by histopathological examination when the cysticercus cellulosae-containing cyst is identified. The scolex bears two crowns of rostellar hooklets and four suckers. The caudal end is made up of a duct-like invaginated segment that is bordered by a homogeneous eosinophilic membrane. The eosinophilic membrane that lines the capsule is composed of two layers, one that is acellular on the outside and sparsely cellular on the inside.[6] A series of inflammatory reactions, including the infiltration of neutrophils and eosinophils, lymphocytes, plasma cells, and occasionally giant cells, may be triggered by the developing larva in cysticercosis. These reactions are followed by the capsule's fibrosis and necrosis, and the larva may eventually caseate or calcify.[7]

Due to its relatively uncommon prevalence, oral cysticercosis may be clinically confused for a number of benign lesions. The location of the oral lesion affects the differential diagnosis. The differential diagnosis in this case would include mucocele, vascular neoplasm, vascular leiomyoma, fibroma, and granular cell myoblastoma.[8]

The preferred course of therapy is surgical excision, with histological examination used to confirm the diagnosis. The appropriate cooking of pork meat, good personal hygiene, proper faecal disposal, and efficient treatment of human intestinal infections can all help to prevent this infestation. Strong antihelminthic medications like praziquantel and albendazole are used to treat cysticercosis. There were no symptoms of disseminated cysticercosis in the index case; just routine follow-ups were recommended.


   Conclusion Top


The primary treatment for oral cysticercosis is simple surgical excision with antihelminthic medication; however, it is critical to conduct a thorough medical assessment on every patient to rule out the presence of the parasite in other locations. The patient has to be monitored for ophthalmologic, neurologic, and otolaryngologic signs and symptoms.

Declaration of patient consent

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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Symeonidou I, Arsenopoulos K, Tzilves D, Soba B, Gabriël S, Papadopoulos E. Human taeniasis/cysticercosis: A potentially emerging parasitic disease in Europe. Ann Gastroenterol 2018;31:406-12.  Back to cited text no. 1
    
2.
Elhence P, Bansal R, Sharma S, Bharat V. Case Report-Cysticercosis presenting as cervical lymphadenopathy: A rare presentation in two cases with review of literature. Niger J Clin Pract 2012;15:361-3.  Back to cited text no. 2
  [Full text]  
3.
Ito A, Yanagida T, Nakao M. Recent advances and perspectives in molecular epidemiology of Taenia solium cysticercosis. Infect Genet Evol 2016;40:357-67.  Back to cited text no. 3
    
4.
Joshi J, Sharanesha MB, Jatwa R, Khetrapal S. Oral cysticercosis: A diagnostic difficulty. J Clin Diagn Res 2014;8:ZD24.  Back to cited text no. 4
    
5.
Lee KH, Cepeda L, Miller M, Siegel DM. Mucoceles not–Oral cysticercosis and minor salivary gland adenocarcinoma: Two case reports. Dermatol Online J 2009;15:8.  Back to cited text no. 5
    
6.
Elias FM, Martins MT, Foronda R, Jorge WA, Araújo NS. Oral cysticercosis: Case report and review of the literature. Rev Inst Med Trop São Paulo 2005;47:95-8.  Back to cited text no. 6
    
7.
Singh S, Chhabra S, Aggarwal G, Kalra R, Duhan A, Sen R. Oral cysticercosis–a rare presentation. Asian Pac J Trop Med 2011;4:587-8.  Back to cited text no. 7
    
8.
Deshmukh A, Avadhani A, Tupkari JV, Sardar M. Cysticercosis of the upper lip. J Oral Maxillofac Pathol 2011;15:219-22.  Back to cited text no. 8
  [Full text]  


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    Abstract
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   Discussion
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