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Skin nontumor

Infectious disorders

Cysticercosis

Authors: Abha Soni, D.O., M.P.H., Jaya Ruth Asirvatham, M.D., Julie M. Jorns, M.D.

Last author update: 1 January 2016

Last staff update: 6 September 2022

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PubMed Search: Cysticercosis [title] skin

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Table of Contents

Cite this page: Soni A, Slominski A. Cysticercosis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skinnontumorcysticercosis.html. Accessed April 20th, 2024.

Definition / general

Tissue infection caused by ingestion of larval cysts of the cestode Taenia solium (cysticercus cellulose) (CDC: Cysticercosis [Accessed 27 August 2018])
Acquired by swallowing food, water or feces contaminated by T. solium eggs
In cystecicercosis, the human represents an intermediate host and the parasite develops cysticerci in various organs
Taeniasis: infection caused by the adult tapeworm in the human intestine, which occurs from ingestion of larvae in undercooked pork
Cysticerci: larval forms of tapeworms found within a fluid filled cyst

Epidemiology

50 - 100 million people infected worldwide (eMedicine: Cysticercosis [Accessed 27 August 2018])
Endemic areas include: Central and South America, India, China Southeast Asia, Africa and Eastern Europe
In the United States, infection is most common in rural areas and among Latin American immigrants

Sites

Cysticerci develop in the nervous system, heart, skeletal muscle, eyes and subcutaneous tissue
Cases in breast are rare; 8 cases were identified by FNAC over a 15 year period in India (Acta Cytol 1996;40:653)

Diagrams / tables

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Life cycle

Cysticercus

Etiology

Accidental ingestion of eggs or gravid proglottids of Taenia solium by human host via infected food, water or feces

Clinical features

Cysticercosis of the skin is rare
It presents as a palpable, subcutaneous nodule
In the breast, may present as a freely mobile cystic mass

Diagnosis

Thorough history, skin biopsy, serology (serum or CSF) and imaging can aid in the proper diagnosis

Radiology description

CT scan can reveal hyperdense lesions in subcutaneous tissue with or without calcification
Ultrasound can reveal cystic lesions

Radiology images

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Computed tomography

Cysts

Mammogram, tubular structure

Case reports

14 year old boy presented with an arm swelling for 2 months (Case #458)
15 year old girl with solitary breast cysticercosis (Med Trop (Mars) 2007;67:179)
19 year old woman with disseminated cutaneous cysticercosis and neurocysticercosis (Indian Dermatol Online J 2012;3:135)
19 year old woman with subcutaneous cysticercosis (Rev Chilena Infectol 2013;30:323)
31 year old man with disseminated cysticercosis and taeniasis (Am J Trop Med Hyg 2013;89:58)
32 year old woman with cysticercus of the breast which mimicked a fibroadenoma (J Clin Diagn Res 2012;6:1555)
35 year old woman with an incidental case associated with fibroadenoma (Indian J Pathol Microbiol 2001;44:59)
38 year old woman with cystic lesion in left breast containing larval fragment of cysticercus (Trop Parasitol 2013;3:148)
45 year old patient with subcutaneous and cerebral cysticercosis (J Am Acad Dermatol 2004;50:S14)
56 year old woman with gigantic solitary cysticercosis pseudotumour of the neck (J Surg Case Rep 2010;2010:5)
63 year old woman with calcifications detected by mammography caused by cysticercus (Am J Trop Med Hyg 2008;79:864)

Treatment

Praziquantel and albendazole are effective
Surgery is appropriate for large, solitary lesions which would otherwise require prolonged antiparasitic therapy

Clinical images

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Gigantic cysticercosis pseudo tumour

Swelling over neck

Swellings over back

Gross description

Circumscribed, white to tan, cystic nodules containing a clear fluid
- Viable cysts are translucent, through which a single scolex may be visible (2 - 3 mm nodule)
- As the cyst begins to degenerate, the fluid becomes dense and opaque
- In the later stages, only a calcified nodule may be present
Cyst sizes vary; commonly 1 mm - 2 cm
Larval forms identified within the cyst cavity

Gross images

AFIP images

Breast cyst

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Cysticercosis pseudotumor

Well circumscribed nodule

Specimen from trunk

Breast: tubular, worm-like structure

Microscopic (histologic) description

Cystic cavity contains the the larval form: scolex with hooklets and 2 pairs of suckers
- The larval form, composed of duct-like invaginations, is lined by a double layered, eosinophilic membrane
- Scolex is single and invaginated; contains a rostellum, 4 suckers and 22 - 23 bifrefringent hooklets (may persist for a long time)
- Body wall exhibits a myxoid matrix and calcareous bodies (calcified concretions)
Cysticerci may remain viable for years
Colloidal stage: first stage of involution of cysticerci; transparent vesicular fluid is replaced by a turbid, viscous fluid and the scolex shows signs of hyaline degeneration
Granular stage: cysticercus is no longer viable; cyst wall thickens and the scolex is transformed into coarse mineralized granules
Host inflammatory reaction is usually not present if the larva is viable
Finally, a granulomatous reaction develops characterized by histiocytes, epitheloid cells and foreign body giant cells, leading to fibrosis of the supporting stroma and calcification of the parasitic debris

Microscopic (histologic) images

Contributed by Thiriveni Balajji, M.D., M. Kavitha, M.D., Case #458 and Case #115

Subcutaneous cysticercosis with neurocysticercosis

CNS

Eyelid

Cytology description

Fibrillary stroma with interspersed nuclei and a honeycomb pattern
Parts of parasite may be identifiable (Acta Cytol 1996;40:653)
Background usually consists of a mixed inflammatory infiltrate (Acta Cytol 1989;33:659)
Granulomas may be seen

Cytology images

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