Extraneural cysticercosis mimicking soft-tissue tumors: a case report from a low-resource setting

Extraneural cysticercosis (ECC), caused by the larval stage of Taenia solium, is a major diagnostic challenge in endemic regions such as sub-Saharan Africa. ECC frequently presents as a nonspecific, solitary soft-tissue mass, easily mimicking benign tumors and leading to delayed management. This case series highlights the varied clinical spectrum of ECC in western Uganda, following the SCARE criteria.

We report two clinically distinct cases of ECC at demographic extremes: a 6-year-old male with an acute intramuscular mass in the rectus abdominis, and a 65-year-old female with a 7-year history of a subcutaneous chest wall mass, both of which were clinically indistinguishable from benign tumors. Definitive diagnoses were established in both cases by histopathological examination of surgically excised specimens, which revealed the characteristic Cysticercus cellulosae scolex. Complete surgical excision was curative.

These cases underscore the diagnostic difficulty of ECC across disparate age groups (pediatric and elderly) and varying chronicity (2 weeks vs. 7 years). The first case highlighted the risk of systemic dissemination; the second demonstrated the fibrotic burnout stage. Both cases confirm histopathology as the gold standard for definitive diagnosis, particularly in resource-limited settings where advanced diagnostics are often inaccessible.

ECC must remain a key differential diagnosis for any unexplained soft tissue mass in endemic areas. The reliance on and proficiency in histopathology are critical for definitive diagnosis. These findings serve as a public health sentinel, demanding integrated One Health strategies to interrupt the Taenia solium transmission cycle.