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Table of Contents   
LETTER TO THE EDITOR  
Year : 2013  |  Volume : 6  |  Issue : 5  |  Page : 594-595
Unusual presentation of a common disease: Labial cysticercosis with florid granulomatous reaction; diagnosis by fine-needle aspiration cytology


Department of Pathology, MM Institute of Medical Sciences & Research, Mullana, Ambala, Haryana, India

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Date of Web Publication3-Jun-2014
 

How to cite this article:
Singh P, Garg M, Mahajan NC. Unusual presentation of a common disease: Labial cysticercosis with florid granulomatous reaction; diagnosis by fine-needle aspiration cytology. Ann Trop Med Public Health 2013;6:594-5

How to cite this URL:
Singh P, Garg M, Mahajan NC. Unusual presentation of a common disease: Labial cysticercosis with florid granulomatous reaction; diagnosis by fine-needle aspiration cytology. Ann Trop Med Public Health [serial online] 2013 [cited 2019 Jun 16];6:594-5. Available from: http://www.atmph.org/text.asp?2013/6/5/594/133774
Dear Sir,

Cysticercosis is a common disease in developing countries. Lip is the rare site of involvement in cysticercosis. [1] The objective of this article is to document the value of fine-needle aspiration cytology (FNAC) in the diagnosis of labial cysticercosis.

A 47-year-old Muslim male patient presented with a painless nodular swelling in the upper lip of 10 years duration. The swelling was slowly growing, with the sudden increase in size in the last 3 months. Clinically, it was diagnosed as a case of pleomorphic adenoma. Oral examination revealed a firm non-tender nodular mass measuring 2 cm × 2 cm on the left side of the upper lip. The overlying mucosa was bluish in color [Figure 1]a and b. FNAC of mass was performed. The aspirate consisted of purulent fluid. Microscopically the smears showed well-defined palisaded histiocytic granulomas along with lymphocytes and giant cells in a granular dirty background. Scattered in between were seen fragments resembling tegument layer of the bladder wall of cysticercus [Figure 1]c. No hooklets were identified and eosinophils were not seen. A tentative diagnosis of parasitic granuloma, most likely cysticercosis was made. Excisional biopsy was done, which on histopathological examination revealed typical cysticercus larvae with florid granulomatous reaction surrounding the fibrous capsule [Figure 1]d. The granulomas were composed of palisaded histiocytes, lymphocytes and giant cells. Follow-up imaging studies of the whole body did not reveal any other foci of cysticercosis. Final diagnosis of labial cysticercosis with florid granulomatous reaction was made.

Cysticercosis in human is caused by the larval stage of Taenia solium, where a man acts as an intermediate host instead of the definitive host. Infestation by the parasite in our case may be due to the patient hailing from a region with poor sanitation. Most frequent sites involved by cysticercosis are brain, subcutaneous tissue, muscle, heart, liver, lung and peritoneum. Although, the exact incidence is still unknown, oral cysticercosis is a rare event. [1] There were only nine cases involving the upper lip [2] and our case is unusual since it showed florid granulomatous reaction. Differential diagnosis of masses in the lip and cheek includes lipoma, mucocele, neurofibroma and pleomorphic adenoma. [1]
Figure 1: (a) Photograph showing nodular swelling on the external surface of upper lip. (b) Mucosal surface of the nodule showing bluish discoloration. (c) Photomicrograph of the fine-needle aspiration cytology smears showing palisading histiocytic granuloma with giant cells and tegument layer of the wall of cysticercus cellulosae (Giemsa stain, ×200). (d) Photomicrograph of tissue section showing cysticercus larva (H and E, ×200)

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Clinical manifestations depend upon the organ involved. In case of oral and subcutaneous forms, they are symptomless and are easily detected clinically because of their superficial location. In spite of abundance of muscular tissue in the oral and maxillofacial region, it is not a frequent site of involvement. [1] Pre-operative diagnosis of cysticercosis can be made by FNAC. The cytomorphological identification of larvae in the FNAC smears by different workers has widened the scope of FNAC as a diagnostic tool. [3],[4] Suspicion about parasitic lesion arises due to the presence of eosinophils, neutrophils, palisading histiocytes and giant cells in the smears. The diagnosis of cysticercosis is made when larval cuticle and parenchyma are identified, but the presence of scolex in aspirates is uncommon. [5] Degeneration of cysticerci sometimes evokes an exuberant granulomatous reaction raising the suspicion of some granulomatous pathology. [5] Eosinophils, however were absent in the smears as well as in the biopsy in reported case. Definitive diagnosis is confirmed by histopathological examination.

Labial cysticercosis is an important differential diagnosis in oral, cystic nodular lesions. FNAC is rapid, safe, cheaper and infallible diagnostic tool in such cases.

 
   References Top

1.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. 1
    
2.Deshmukh A, Avadhani A, Tupkari J, Sardar M. Cysticercosis of the upper lip. J Oral Maxillofac Pathol 2011;15:219-22.  Back to cited text no. 2
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3.Adhikari RC, Aryal G, Jha A, Pant AD, Sayami G. Diagnosis of subcutaneous cysticercosis in fine needle aspirates: A study of 10 cases. Nepal Med Coll J 2007;9:234-8.  Back to cited text no. 3
    
4.Saran RK, Rattan V, Rajwanshi A, Nijkawan R, Gupta SK. Cysticercosis of the oral cavity: Report of five cases and a review of literature. Int J Paediatr Dent 1998;8:273-8.  Back to cited text no. 4
    
5.Gill M, Dua S, Gill P, Gupta V, Gupta S, Sen R. Cytomorphological spectrum of subcutaneous and intramuscular cysticercosis: A study of 22 cases. J Cytol 2010;27:123-6.  Back to cited text no. 5
[PUBMED]  Medknow Journal  

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Correspondence Address:
Prem Singh
Department of Pathology, MM Institute of Medical Sciences & Research, Mullana, Ambala, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.133774

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