Intramuscular Cyst Research Articles

Distant Metastasis of Tongue Squamous Cell Carcinoma Presenting as Multiple Subdermal and Intramuscular Cysts: A Case Report.

The most common sites of distant metastasis (DM) in squamous cell carcinoma (SCC) of the tongue are the lung, bone, and liver; the early identification of metastasis to other sites is difficult. This case report discusses a 48-year-old male initially diagnosed with advanced-stage left tongue SCC, which was treated with wide excision, left radical neck dissection, and adjuvant concurrent chemoradiotherapy. Two months after completing adjuvant therapy, multiple painful nodules without local erythematous changes or warmth were found in the bilateral posterior neck and right medial thigh. Ultrasonography of these nodules revealed a cystic structure. Fine needle aspiration cytology revealed metastatic SCC. The disease progressed despite salvage chemotherapy, and the patient passed away 4months after the formation of the nodules. Subdermal and intramuscular cysts as the initial presentation of DM have rarely been reported. The identification of unusual cysts, even those outside the head and neck, should raise concern.

Giant, primary, hydatid cyst of the gluteal region

Background: Primary hydatid disease in the muscle is extremely rare, resulting in either the spread of cysts spontaneously or after operations for hydatidosis in distant regions.
 Methods: Report of an unusual case of primary hydatid cyst in the gluteus muscle, behaving as enlarging soft-tissue tumour, with a review of the literature.
 Results: Magnetic resonance imaging revealed an intramuscular cyst in the gluteus muscle; and no cyst existed in any other location. The cyst was excised totally, and the diagnosis of muscular cystic hydatidosis was confirmed by histopathologic examination. In follow-up of two years after the operation, there has been no recurrence in either patient.
 Conclusion: The involvement of the gluteus maximus muscle without the evidence of hepatic or pulmonary disease is rare, characterized by slow development, but a major local extension must be considered in the differential diagnosis of a cystic mass with well-defined margins in the extremities of individuals from endemic regions. Physical examination, serology results and radiological findings should be interpreted with care, especially in hydatid cyst endemic countries. Surgery is still the treatment of choice, with total cyst excision.

Unusual intramuscular locations as a first presentation of hydatid cyst disease in children: a report of two cases

BackgroundHydatid disease is an endemic disease in many countries of the world including the Middle East. It mainly affects the liver and lungs. Intramuscular hydatid disease is rarely reported in children. Such uncommon localization of hydatid cyst may pose difficulties in the clinical and radiological diagnosis; hence affecting patient’s management and outcome even in endemic areas.Case presentationWe herein describe intramuscular hydatid cysts in 2 different children. The first case is a 5-year-old boy who presented with a painless palpable lump over the right lumbar paraspinal region. His history was remarkable for sheep contact. His laboratory results revealed a mild increase in white blood cell (WBC) count and C-reactive protein. The lesion showed typical features of a hydatid cyst on ultrasound. Further imaging including ultrasound of the abdomen and CT of the chest, abdomen, and pelvis showed infestation of the liver and lung as well. The lesions were resected surgically without complications. The patient received Albendazole preoperatively and after surgery for 3 months. No evidence of recurrence was seen during follow-up.The second case is a 6-year-old girl who presented with an incidental palpable lump in her left thigh during her hospital admission for recurrent meningitis. Ultrasound and MRI imaging were performed demonstrating a unilocular cystic lesion in the left proximal rectus femoris muscle. A provisional diagnosis of hematoma vs. myxoma was given. Biopsy was performed and yielded blood products only. The lesion was resected surgically with a postoperative diagnosis of hydatid cyst. Blood tests performed afterward showed a positive titer for Echinococcus. The patient received Albendazole for 3 months. No evidence of recurrence was seen during follow-up.ConclusionsDespite its rarity; skeletal muscle hydatid cyst should always be considered in the differential diagnosis of cystic muscle lesions in children in endemic areas even if imaging studies did not show any of the typical signs. This will improve patient outcome by preventing unnecessary cystic puncture which might lead to serious complications, such as anaphylaxis and local dissemination.

Clinicopathological Study of Subcutaneous Heminthicnodules : Unusual Sites and Diagnostic Dilemmas

Introduction: Superficial palpable swellings with helmintic infection as an underlying etiology is usually an accidental finding in the surgically excised specimens. Somatic nematodes and cestodes are the commonly implicated organisms, and the zoonotic nematodes show an emerging trend. The present study aims to reappraise the histopathological findings of helminthic etiology in superficial swellings which were clinically suspected to be of neoplastic/non neoplastic nature. Materials and methods: Thirty six cases of palpable superficial nodules with infective etiology over a period of five years were reviewed. 19/36 were of helminthic etiology were included in the present study. Pertinent demographic and clinical data were retrieved from the medical archives. Results: Amongst the 19 cases, 8 were males and 11 females. Chest wall (4/19), and eyelids (3/19) were the most common sites involved. The size ranged from 0.8-15 cm in greatest dimension. Presence of histiocytes (13/19), granulomas (11/19), eosinophils (10/19), and giant cells (9/19) were the most consistent histological findings. 14 cases had discernible parasite morphology with diagnosis of filarial worms (7/19), Dirofilaria (3/19), cysticercosis (4/19), and hydatid cyst (1/19). Four cases had dead and calcified parasites with no discernible morphology. Conclusion: Granulomatous inflammation and tissue eosinophilia are strong indicators of a parasitic etiology. Subcutaneous and intramuscular filariasis, cysticercosis and hydatid cyst are well documented etoiologies whereas Dirofilariasis is an emerging zoonotic infection with worldwide case reports. Imaging techniques and fine needle aspiration can point towards the diagnosis; however in the absence of characteristic features, histopathology can be relied upon to diagnose a helminthicetiology.

Intramuscular hydatid cyst of thigh masquerading as a soft tissue tumour diagnosed by fine needle aspiration cytology

Abstract Introduction. Hydatid cyst, caused by Echinococcus granulosa, occurs rarely in the musculoskeletal region. Most of the time, clinically and radiologically it is diagnosed as a soft tissue tumor, benign or malignant. There are a few case reports of hydatid cyst presenting as an intramuscular thigh mass, which has been diagnosed at fine needle aspiration cytology (FNAC). Accurate pre-operative diagnosis is essential in view of specific therapeutic options for this disease. Here we report a case of hydatid cyst occurring in an unusual location (thigh) and masquerading as a soft tissue tumour, diagnosed at FNAC. Case Report. 56-year-old male patient presented with gradually increasing swelling of the left thigh since 3 years. On examination, there was a firm non-tender 25 × 20 cm swelling on the posterior aspect of left thigh extending from the gluteal region to five cm above the knee joint. An ultrasound diagnosis of a soft tissue tumor was made. At FNAC, fluid was aspirated and smears showed granulomas along with multiple hyaline acellular membrane-like fragments, few showing vague laminations. A diagnosis of hydatid cyst was made at FNAC which was corroborated at histopathology. Conclusion. Intramuscular hydatid cyst of the thigh is a very rare manifestation. The possibility of hydatid cyst should be considered while aspirating any soft tissue mass lesion, especially when fluid is obtained and microscopy shows acellular hyaline membrane-like material, even when fewer laminations are noted.

Intramuscular epidermoid cyst of flexor carpi ulnaris: A rare occurrence

Intramuscular epidermoid cyst of flexor carpi ulnaris: A rare occurrence

A Case Series of Intramuscular Orbital Choristomatous Cysts

Intramuscular choristomatous cystic lesions within the orbit are rare but may require removal due to their volume effects. The authors describe 2 such cases of intramuscular cysts in adult patients. Both patients presented with symptoms due to local mass effects with swelling, proptosis and diplopia. Imaging confirmed cystic intramuscular masses. Surgical removal involved intraoperative decompression of the cyst to aid dissection with excision of some muscle fibers. Histology confirmed a keratinized stratified squamous lined dermoid cyst within lateral rectus for case 1 and stratified squamous non-keratinized conjunctival epithelium (simple primary conjunctival cyst) within inferior oblique for case 2.

A Heavy Infection Macro-cysts of <i>Sarcocystis</i> Spp. Case in a Najdi Sheep at Buraidah Slaughter House, Qassim, Saudi Arabia

Background: Protozoal diseases caused by <i>Sarcocystis</i> species can cause serious damage in sheep and goats flocks, inducing decreased growth conversion rates and partial or complete condemnation of carcasses at the slaughter house. Sarcocystis spp. affecting sheep and goats are host specific for their intermediate hosts and family specific for their final hosts. They derive their name from the intramuscular cyst stage present in the intermediate host. Objective: Macro and micro identification of macro-cysts of <i>Sarcocystis</i> spp. affecting a Najdi sheep carcass. Method: Detection of macrosarcocystis during routine post mortem examination and identification the detected cyst by histopathological investigation. Result: The macroscopic sarcocysts were found cleared and scattered in almost all skeletal muscles including shoulder, chest and diaphragm as well as thigh. Both morphological and histopathological characteristics indicated that the detected cysts may be identified as <i>Sarcocystis gigantea</i>. Conclusion: It is a case study of macro-cysts of <i>Sarcocystis</i> spp. affecting local breed of Najdi sheep. It is considered a seldom detected case all over many years during meat inspection at Buraidah slaughter house. The possible control measures are those of simple hygiene. Farm dogs should not be housed in, or allowed access to, fodder stores nor should they be allowed to defecate in pens where livestock are housed. It is also important that they are not fed uncooked meat.

A curious case of disseminated cysticercosis in an immunocompetent adult.

Cysticercosis is an infection with the larval stage of Taenia Solium which is estimated to affect over 50 million people worldwide. We report a case of disseminated cysticercosis in an immunocompetent 68-year-old male who presented with back pain, presumed to be musculoskeletal in nature initially. Magnetic-resonance-imaging of the lumbar spine revealed intramuscular (paraspinous and psoas muscles) cysts, innumerable small cystic lesions bilaterally throughout the cerebellar and cerebral hemispheres, midbrain, and right ventricle suggestive of cysticercosis. Treatment with albendazole with dexamethasone for 3 months led to resolution of the cysts with complete resolution of symptoms. Despite its importance, current data on prevalence of this infection, disease burden and the incidence of hospitalization remains incomplete. Mandatory reporting of diagnosis would enable complete understanding of epidemiology of the disease. In this case we have emphasized the importance of early diagnosis of a systemic condition that could have caused serious implications if left untreated.

Two rare cases; primary soft tissue hydatid cyst mimicking soft tissue tumor

Hydatid cyst is a parasitic disease caused by Echinococcus granulosus, most commonly located in the liver and lung. Our country is an endemic region for this disease. While many involvement have been reported in the literature; isolated soft tissue or intramuscular involvement is rare. The liver, which acts as the first filter after the entry into the body, is the most frequently involved organ. It can reach all organs and systems with systemic circulation and lymphatics. Soft tissue and intramuscular involvement are rarely seen. Intramuscular involvement is more often seen in peripheral muscles. Soft tissue and intramuscular hydatid cysts constitute 3-5% of all cases. The recommended treatment for soft tissue hydatid cysts is extensive surgical excision. In this study, we aimed to present two cases with gluteal region and vastus lateralis muscle involvement.

Avirulence and lysozyme secretion in Paneth cells after infection of BALB/c mice with oocysts of Toxoplasma gondii strains TgCatCHn2 (ToxoDB#17) and TgCatCHn4 (ToxoDB#9)

Toxoplasma gondii has a complex life cycle and pathogenic mechanisms. Acute T. gondii infections in mice often result in death, whereas in chronic infections, the parasites may persist in the host tissues as intraneuronal or intramuscular cysts. However, the virulence of T. gondii strains in mice varies with its genetic background. The present study investigated the pathogenicity and pathological lesions of two T. gondii isolates from China: namely, TgCatCHn2 (ToxoDB#17) and TgCatCHn4 (ToxoDB#9). The virulent (ToxoDB#216) and avirulent (VEG) strains were employed as controls. Toxoplasmosis was induced by inoculating BALB/c mice with oocysts of the strains of T. gondii VEG, ToxoDB#216, TgCatCHn2 (ToxoDB#17), and TgCatCHn4 (ToxoDB#9), respectively. As a result, one oocyst of ToxoDB#216 could kill a mouse within 10 days post inoculation (DPI). The survival time of the mice for T. gondii TgCatCHn2 and TgCatCHn4 was >60 DPI for 106/mL oocysts, but this concentration (106/mL oocysts) of VEG strain could kill mice within 11 DPI. Compared with the strains of T. gondii ToxoDB#216 and VEG, the lesions in the small intestines of the strains of TgCatCHn2- and TgCatCHn4-infected mice were significantly smaller (P < 0.01). The positive area of T. gondii antigen in the ileum of mice infected with the strains of T. gondii VEG, TgCatCHn2 and TgCatCHn4 were significantly lower than that T. gondii ToxoDB#216 at 8 DPI (P < 0.01). Paneth cells (PCs) in the small intestines was eliminated by ToxoDB#216 (5–6 DPI) (P < 0.05). The strains of T. gondii TgCatCHn2-, TgCatCHn4- and VEG-infected mice, the number of PCs and granules decreased in the intestines, compared to T. gondii free mice, but the difference was not significant (8 DPI, P > 0.05). However, the granules in the PCs showed negative lysozyme expression in the intestines of mice infected with T. gondii TgCatCHn2 and TgCatCHn4. Thus, T. gondii strains of TgCatCHn2 (ToxoDB#17) and TgCatCHn4 (ToxoDB#9) were avirulent strains, they triggered an inhibition of lysozyme expression in the granules of PCs of the mouse intestine. These effects may in turn lead to intestinal dysbiosis, which may be related to further parasitic invasion of the intestines. The findings of the present study further expand the spectrum of the pathogenic features of various Chinese isolates of T. gondii.

Intramuscular Cysts at the Proximal Calf: Two Case Reports and a Systematic Review of Literature

Intramuscular cysts at the proximal calf are rare; however, their etiology is diverse, making accurate diagnosis and treatment difficult. To our knowledge, there are no previous publications in literature about intramuscular cysts at the proximal calf, arising from different origins. This article describes two rare cases with intramuscular cysts. Case 1 was diagnosed as an intramuscular ganglion cyst arising from the proximal gastrocnemius medialis muscle, and arthroscopic examination as well as open cyst excision was performed. Case 2 was another type, which has never been reported in the literature. It was diagnosed as diffuse pigmented villonodular synovitis (PVNS), with the intramuscular cyst arising from PVNS, and only arthroscopic synovectomy was performed. The diagnoses for these cases were confirmed by histopathology. In addition, we have summarized intramuscular cysts at the proximal calf by a systematic literature review and divided them into five types based on their origin. The five types are, intramuscular cysts arising from the muscular tissue, knee joint, proximal tibiofibular joint, the neurilemma and PVNS. The treatment of intramuscular cysts varies based on their origin; hence, it is important to identify the origin. J Med Cases. 2018;9(2):45-51 doi: https://doi.org/10.14740/jmc2984w

Intramuscular Cysts at the Proximal Calf: Two Case Reports and a Systematic Review of Literature

Intramuscular Cysts at the Proximal Calf: Two Case Reports and a Systematic Review of Literature

Primary Hydatid Cyst and Isolated from the Thigh: An Exceptional Localization

Muscular involvement with Echinococcusgranulosus is rare, even in endemic countries where the frequency is estimated to be less than 3%, particularly in the countries of the Mediterranean basin, North Africa and Latin America. We report the rare observation of a hydatid cyst of the internal thigh room in a 57-year-old patient of rural origin and who has no notable sickness antecedents and was hospitalized in our department for the exploration of a tumefaction of the internal surface of the left thigh appeared gradually and insidiously for 3 years. Magnetic resonance imaging (MRI) showed an oval mass evoking an intramuscular hydatid cyst and its relationship to neighboring structures. He underwent surgical excision under locoregional anesthesia. Solitary hydatid localization in muscle tissue is exceptional, but it is useful to know that its diagnosis is often delayed, its treatment is surgical, but recurrences are possible.

A Rare Primary intramuscular hydatid cyst misdiagnosed as malignant spindle cell tumor: A Case Report

Primary hydatid disease of musculoskeletal system is rare. A 46 year old man presented with soft swelling in anterior aspect of thigh of two years duration which was gradually increasing in size. He was initially diagnosed as malignant spindle cell tumor of thigh, but ultrasonography and Commuted Tomography Scan revealed to be a cystic swelling suggestive of hydatid disease. Our patient had not been operated for hydatid disease previously and investigations did not reveal any hydatid cyst in liver, lung or spleen. So our patient was diagnosed having primary hydatid disease of musculoskeletal system. Serologic test (ELISA) was negative. Patient was given albendazole preoperatively. A careful management is required to prevent systemic dissemination and anaphylactic shock. The swelling was removed en bloc without causing damage to cyst wall and advised for adjunctive albendazole chemotherapy (15 mg/kg/day) for three months.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.628-630

A Cystic Mass in the Popliteal Fossa and Its Differential Diagnosis.

A Cystic Mass in the Popliteal Fossa and Its Differential Diagnosis.

Augmentation Mammaplasty After Breast Enhancement With Hyaluronic Acid.

Macrolane is a stabilized, hyaluronic acid-based gel that has been available since 2007 as a minimally invasive, nonpermanent option for breast enhancement. However, numerous controversies pertaining to its side effects have highlighted the need for studies involving larger groups of patients. The authors sought to determine complications of Macrolane injections for breast enhancement and performed surgical evacuation of cysts comprising collections of hyaluronic acid in patients who previously received Macrolane treatment and presented for augmentation mammaplasty. The authors reviewed a case series of 20 patients who were treated elsewhere with intramammary injection of Macrolane for cosmetic purposes and who presented at the authors' medical studio with multiple intramammary and intramuscular cysts. All patients underwent surgical evacuation of the hyaluronic acid-based cysts in association with augmentation mammaplasty. Good aesthetic results were achieved in all patients. Three months after surgery, 15 of 20 (75%) patients rated themselves as very much improved; 4 patients (20%) rated themselves as moderately improved, and 1 patient (5%) rated herself as somewhat improved. The authors suggest that Macrolane cannot be considered a valid alternative for breast augmentation at this time. 4 Therapeutic.

Intramuscular Ectopic Lacrimal Gland Cyst Masquerading as Myocysticercosis

Ectopic lacrimal gland within the orbit is an extremely rare choristoma occurring due to sequestration of a portion of normal lacrimal gland at an abnormal site during embryogenesis. Most cases of orbital ectopic lacrimal gland present with progressive unilateral proptosis and often become symptomatic in the first 3 decades of life. Although diagnosis is aided by a high clinical suspicion and radiologic features, histopathologic examination is confirmatory. To the best of the knowledge, the authors report the first case of an intramuscular ectopic lacrimal gland in the inferior rectus muscle simulating myocysticercosis.

Human infections with Sarcocystis species.

Recurrent outbreaks of muscular sarcocystosis among tourists visiting islands in Malaysia have focused international attention on sarcocystosis, a disease once considered rare in humans. Sarcocystis species require two hosts, definitive and intermediate, to complete their life cycle. Humans can serve as definitive hosts, with intestinal sarcocystosis for two species acquired from eating undercooked meat: Sarcocystis hominis, from beef, and Sarcocystis suihominis, from pork. Symptoms such as nausea, stomachache, and diarrhea vary widely depending on the number of cysts ingested but appear more severe with pork than with beef. Humans serve as intermediate hosts for Sarcocystis nesbitti, a species with a reptilian definitive host, and possibly other unidentified species, acquired by ingesting sporocysts from feces-contaminated food or water and the environment; infections have an early phase of development in vascular endothelium, with illness that is difficult to diagnose; clinical signs include fever, headache, and myalgia. Subsequent development of intramuscular cysts is characterized by myositis. Presumptive diagnosis based on travel history to tropical regions, elevated serum enzyme levels, and eosinophilia is confirmed by finding sarcocysts in muscle biopsy specimens. There is no vaccine or confirmed effective antiparasitic drug for muscular sarcocystosis, but anti-inflammatory drugs may reduce symptoms. Prevention strategies are also discussed.

Unusual case presentation of intestinal Sarcocystis hominis infection in a healthy adult.

Introduction:Sarcocystosis is mainly a veterinary problem; however, humans can serve as the definitive host for at least two species (Sarcocystis hominis and Sarcocystis suihominis). Intestinal infections occur in the definitive host after ingesting the intramuscular cysts (sarcocysts) in the intermediate host, which initiate sexual stages in the intestine that terminate in oocysts excreted in the faeces.Case presentation:A 19-year-old male presented with diffuse abdominal pain, watery non-bloody diarrhoea, nausea, vomiting and intermittent low-grade fever that lasted for more than 3 weeks. Multiple stool cultures on enriched and selective media gave negative results. Microscopic examination of wet mounts of stool prepared from formalin/ethyl acetate concentrates, together with permanent staining helped in making a definitive diagnosis and ruling out other coccidian parasites. Diagnosis of the parasite as S. hominis was made based on the size and morphology of the individual sporocysts that were observed in the wet-mount preparations. This severe case of intestinal sarcocystosis in a healthy adult after eating undercooked beef shawarma meat is described.Conclusion:The unusual presentation of intestinal sarcocystis described in this case is very rare. The clinical signs and size and morphology of both oocysts and sarcocysts observed in concentrated wet mounts of stool helped in the definitive diagnosis. The food ingested prior to the appearance of symptoms was important in making the definitive diagnosis of the parasite as S. hominis, as well as the incubation period and treatment.