Year : 2003 | Volume
: 13 | Issue : 2 | Page : 157--158
Unusual location of cysticercus lesions in soft tissue - report of three cases
S Smiti, H Sripathi, L Naik
Mohan Dai Oswal Cancer Hospital, G.T. Road, Sherpur By Pass, Ludhiana, India
Dept of Radiodiagnosis, Manipal Teaching Hospital, P.O.Box Ni 341, Pokhare, Nepal
|How to cite this article:|
Smiti S, Sripathi H, Naik L. Unusual location of cysticercus lesions in soft tissue - report of three cases.Indian J Radiol Imaging 2003;13:157-158
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Smiti S, Sripathi H, Naik L. Unusual location of cysticercus lesions in soft tissue - report of three cases. Indian J Radiol Imaging [serial online] 2003 [cited 2020 Jan 19 ];13:157-158
Available from: http://www.ijri.org/text.asp?2003/13/2/157/30494
CASE NO. 1
A 19 year old girl presented with a history of neck swelling for last 3 months which was painless and moved with deglutition. Ultrasound showed a normal thyroid gland. An oval shaped lesion measuring 15 x 8.4 mm in size was seen in the muscle layer anterior and above the left lobe of the Thyroid. The lesion was predominantly hypoechoic and showed a central echogenic focus.
CECT sections taken through the region of interest showed a ring enhancing lesion within the Cricothyroid muscle which was suggestive of Cysticercosis.
Excision biopsy was done which showed a cystic mass in the left Cricothyroid muscle. Histopathology showed a cystic lesion with fragments of Cysticercus with a corrugated chitinous outer layer.
A 17 year old male presented with the complaint of swelling over the Right side of the chest wall for last 6 months. No tenderness was present. Ultrasound showed a hypoechoic lesion measuring 2 x 1.5 cm in size within the Pectoralis Major muscle . A calcific focus and some fluid was seen within the lesion.
Excision of the cyst was done. Histopathology was suggestive of cysticercosis.
A 20 year old Female was admitted with the complaint of hard subcutaneous nodule in the right thigh for last one year. Clinical diagnosis of Neurofibromatosis was made.
Ultrasound showed an oval hypoechoic lesion with two well defined nodules within s/o Cysticercus larva. Contrast enhanced CT sections were taken through the region of interest which showed an oval ring enhancing lesion within the subcutaneous tissue.
Excision of the cyst was done. Histopathology confirmed the findings of Cysticercosis.
Soft tissue cysticercosis is caused by encysted larvae of Tapeworm Taenia solium which is endemic in many Countries of Latin America, Africa, Asia and as well as in some parts of Europe and USSR . In many patients involvement of CNS in the form of neurocysticercosis is seen where multiple cystic ring enhancing parenchymal lesions were seen on CECT. There have been case reports of diffuse cysticercosis combined with epilepsy, myositis and confusional Syndrome . A rare case of cysticercus presenting as a muscle Cyst within the Triceps has also been reported. 
Soft tissue cysticercosis is seen in the form of a painless swelling of a long term duration. Because of its wide availability Ultrasound should be the preferred initial modality for evaluation of superficial masses . Ultrasound using high frequency probe can be used especially in localization of doubtful lesions and guided FNAC.
Cysticercus lesions are seen as well defined anechoic or hypoechoic lesions with or without calcification.
Cysticercosis presenting as subcutaneous nodules is diagnosed by microscopic examination of subcutaneous nodules in which Taenia solium larvae are found. Over a long period of time, cysticercus lesions may calcify in which case the calcified cyst reveals the presence of Cysticercus. 
Definitive diagnosis is by FNAC, by the identification of detached hooklets, scolex and fragments of Spiral wall of cysticercosis cellulosae. In some cases aspiration smears show no larval parts but contain inflammatory reaction consisting of large number of Eosinophils and pallisading histiocytes which is suggestive of a parasitic cyst. 
In necrotic lesions with eosinophils, a careful search for fragments of the invaginated portion of the larva should be made.
We are reporting these cases because of their unusual sites of presentation.
Cysticercosis should always be kept as a differential diagnosis in all kinds of Subcutaneous swellings in endemic regions like Nepal.
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