Braz J Oral Sci. July-September 2006 - Vol. 5 - Number 18
Oral cysticercosis Hercílio Martelli Júnior1,2 Mario Rodrigues Melo Filho1 Luis Antônio Nogueira dos Santos1 1
Stomatology Clinic, Dental School, University of Montes Claros, UNIMONTES, Brazil. 2 Oral Pathology, Faculty of Odontology of Alfenas-Unifenas, Alfenas-MG, Brazil.
Abstract Cysticercosis rarely involves the oral region in humans, although is a common disease in developing countries. In this report we document a case of oral cysticercosis in a 7-year-old boy who sought treatment for an asymptomatic nodule of the right buccal mucosa. Histopathologic findings of the excised cyst are diagnostic of the lesion. Key Words: cysticercosis, differential diagnosis and oral lesion
Received for publication: August 01, 2005 Accepted: May 01, 2006
Correspondence to: Hercílio Martelli Júnior Clínica de Estomatologia, Sub-Área de Diagnóstico Oral Curso de Odontologia – Universidade Estadual de Montes Claros – Unimontes Campus Universitário “Darcy Ribeiro” – Caixa Postal 126 - CEP 39401-089 Montes Claros - MG - Brasil. Phone: + 55 38 32298181 E-mail: [email protected]
Braz J Oral Sci. 5(18):1109 - 1111
Introduction Cysticercosis is a condition in which a human acts as the intermediate host of Taenia solium, a pork tapeworm. The larvae infestation sites frequently include cerebral tissue, ocular organs, and muscles1. The life cycle of Taenia solium is characterized by different stages of development, requiring various kinds of hosts that can appropriately harbour the eggs (proglottids), the oncospheres, the larvae, and the adults 1-2. The term taeniasis is used when these larvae complete their life cycle developing into adult worms in the definitive host3. In the endemic areas which are Mexico, South America, Eastern Europe, India, and the northern part of Asia, cysticercosis in pigs is caused by contamination of swine food by human faeces1. Cysticercosis in human is common in cerebral tissue, subcutaneous tissue, muscle, and the eye. The pathological conditions manifested are usually the functional disturbance of the infected tissue such as seizure and visual impairment4. Cysticercosis in the oral tissue such as the tongue, labial mucosa, buccal mucosa, and floor of the mouth have also been reported5-6. However, the incidence is very rare and a correct and precise clinical diagnosis is infrequently established. Usually the disease is confused with other benign swellings2. We report here a case of oral cysticercosis that emphasizes the importance of routine microscopic examination and diagnosis of even apparently innocuous lesions of the oral cavity. Clinical Case A 7-year-old boy patient presented with a chief complaint of painless swelling localized of the right buccal mucosa (Fig.1). The lesion was well-circumscribed and hard to palpation and provisionally diagnosed as benign nodule. No discharge or redness was detected. The patient’s physical status was good and his medical history investigation was non-contributory. He had not taken any medication. The differential diagnosis includes mucocele, fibroma, lipoma, and pleomorphic adenoma. The lesion was enucleated under local anesthesia and submitted to histophatologic examination. The microscopic examination showed a thin to thick fibrous capsule. The capsule surrounded a membrane or bladder enclosing the cyst containing the larval stage of Taenia solium (Cysticercus cellulosae) (Fig.2). The cerebral examination with computed tomography revealed no abnormal density lesion (Fig.3). This case presented the typical invaginated segments with papillary projections of the larval body. With the final diagnosis of cysticercosis established, the patient was referred for medical evaluation. Clinical information about of case, as no signs or symptoms of disseminated cysticercosis were detected, additional therapy was not performed. Clinical follow-up was available. The patient remained free of clinical signs of cysticercosis for 12 years.
Fig. 1 – Clinical photograph of buccal mucosa showing smooth nodule.
Fig. 2 – Histological section showing the cyst of Cysticercus cellulosae (H&E, x100).
Fig. 3 – Cerebral examination with computed tomography revealed no abnormal density lesion.
Discussion Cysticercosis, a helminthic disease commonly seen India, Latin America, Eastern Europe and Southern Africa, results from extraintestinal encystations of the larval form of Taenia solium. Cysticercosis presents with multiorgan infestations, giving rise to varied symptoms7. Oral cysticercosis is a rare event that, when encountered, usually elicits a clinical diagnosis of mucocele. The most common locations for oral
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cysticercosis are the lips, buccal mucosa, and tongue2. In a large series of 450 cases, Dixon and Lipscomb8 detected oral involvement in only 8 cases (1,8%). Some of these 8 cases showed subcuticular nodules. Similar findings of multiple foci have been mentioned by other authors9-10. Assocation of oral cysticercosis and post kala azar dermal leishmaniases have been reported11. The present case had buccal mucosa involvement, manifested with asymptomatic nodule. The male-to-female ratio also indicates that there is no gender preference for oral cysticercosis. The clinical presentation suggested the presence of mucocele 2 . The differential diagnosis of oral cysticercosis depends on the location of the lesion. Nodules on the lips and cheeks may be considered as fibroma, lipoma, mucocele, pyogenic granuloma or pleomorphic adenoma. Nodules on the tongue may be considered as fibroma, pyogenic granuloma, granular cell myoblastoma or rhabdomyoma 12 . Laboratory tests and radiologic imaging can be used to confirm cysticercosis, but the definitive diagnosis can only be confirmed by the histological examination13. Risk factors for human cysticercosis include frequent consumption of pork, poor personal and household hygiene, as well as a history of passing tapeworm proglotids in feces. Once a person becomes the intermediate host, cysticercosis can develop in various organs and tissues. In order of frequency, the tissue affected by cysticercosis are subcutaneous layers, brain, muscles, heart, liver, lungs, and peritoneum. The intensity of the signs and symptoms produced by cerebral cysticerci (headaches, acute obstructive hydrocephalus, and epileptic seizures) depend on the number of invasive oncospheres present and their anatomic location. In some occasions, the symptoms may even suggest the presence of a cerebral neoplasm. Iridocyclitis, secondary glaucoma, and cardiac arrhythmias may also occur2. The treatment of oral cysticercus is surgical excision and the biopsy specimen will allow confirmation of the tentative diagnosis12. The treatment in other locations is dependent on the symptomatology and the accessibility of the lesion to surgical intervention12. In the present case since the patient had not developed related symptoms, no medical treatment except periodic follow-up was prescribed. Had the patient been symptomatic, medication would have been indicated1. In summary, we showed the clinical and histopathological findings in a boy with oral cysticercosis, emphasizes the need to consider cysticercosis along with other causes of cystic lesions, particularly in areas with a high incidence of this condition. References 1. 2.
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