Racemose cysticercosis presenting as cystic neck swelling
A 60-year-old tribal female patient presented with a 3 month history of right supraclavicular neck swelling. She denied any history of trauma, pain, fever, or constitutional symptoms. She belonged to lower socio-economic stratum and consumed mixed diet. There was no history of consuming pork.\nExamination revealed a soft swelling in the right supraclavicular region of approximately 6 cm×7 cm in size, mobile and non-tender. There were no other palpable swellings in any other part of the body. Rest of the ear, nose, throat (ENT) examination was normal. Initially, it appeared to be a lipoma. Ultrasonography (USG) of neck revealed an ill-defined cystic mass of approximately 11×5 cm in the right supraclavicular region with internal septations and small cysts in it which was not markedly differentiable from underlying muscle and connective tissue [Figures and ]. FNAC revealed non-specific inflammation. Blood investigations showed eosinophilia with a raised absolute eosinophil count of 1152/cu3 and differential leukocyte count (DLC) with eosinophils of 35%. Other investigations were normal. Stool examination showed no ova or cysts.\nThe patient was taken for an excisional biopsy. The operative findings revealed an approximately 10 cm, cystic mass, adherent to underlying musculature deeply seated in the supraclavicular region which extended behind the clavicle but without any intrathoracic or intraspinal extension []. Grossly, the cystic mass was multiloculated and filled with clear, straw-coloured fluid. The wall of the sac was thick and contained numerous fluid-filled transparent yellow coloured vesicles within it, the largest of which measured nearly 2 cm. It was not possible to remove the entire sac as it extended deep behind the clavicle. So a part of the sac and its contents including the cysts were sent for histopathology. Microscopic examination showed complex branching of the bladder wall displaying a tegumental layer, subtegumental nuclei, and loose connective tissue. Suckers and hooklets were not seen (H and E ×100) []. Based on the above findings of gross and microscopic examination, a diagnosis of racemose cysticercosis was made. The patient was put on albendazole 400 mg for 7 days. The swelling disappeared completely.