Clinical report
Oral cysticercosis in the paediatric patient: Report of six cases
Cisticercosis oral en el paciente pediátrico: informe de seis casos
Rubi López Fernándeza,
, Jorge Téllez Rodrígueza, Daniel Carrasco-Dazaa,
Autor para correspondencia
, Julio Sotelo-Moralesb, Adalberto Mosqueda-Taylorc
a Instituto Nacional de Pediatría, Cirugía Maxilofacial, departamento de Estomatología, México, DF, Mexico
b Instituto Nacional de Neurología y Neurocirugía, Servicio de Neurología, México, DF, Mexico
c Departmento de Atención a la Salud, Universidad Autónoma Metropolitana Xochimilco, México, DF Mexico
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Reporte de un caso y revisión bibliográfica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "37" "paginaFinal" => "39" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Forestier's disease as the cause of cervicomedullary compression. Case report and literature review" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 776 "Ancho" => 1300 "Tamanyo" => 126114 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Estudio radiológico: a) Signos radiológicos de hiperostosis cervical anterior de C2 a C6; b) RMN que muestra engrosamiento de partes blandas alrededor de la apófisis odontoides condicionando estenosis del canal raquídeo y voluminosos osteofitos a nivel anterior de C2-C6 que obliteran parcialmente la vía aérea.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miriam Martos-Fernández, Sergio Bordonaba-Leiva, Joan Sahuquillo-Barris, Daniel Malet-Hernández" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Miriam" "apellidos" => "Martos-Fernández" ] 1 => array:2 [ "nombre" => "Sergio" "apellidos" => "Bordonaba-Leiva" ] 2 => array:2 [ "nombre" => "Joan" "apellidos" => "Sahuquillo-Barris" ] 3 => array:2 [ "nombre" => "Daniel" "apellidos" => "Malet-Hernández" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130055815000477?idApp=UINPBA00004N" "url" => "/11300558/0000003900000001/v2_201705310036/S1130055815000477/v2_201705310036/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1130055815000702" "issn" => "11300558" "doi" => "10.1016/j.maxilo.2015.09.001" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "276" "copyright" => "SECOM" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Rev Esp Cir Oral Maxilofac. 2017;39:31-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1345 "formatos" => array:3 [ "EPUB" => 45 "HTML" => 945 "PDF" => 355 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Expansión tisular por medio de polímeros superabsorbentes como terapia coadyuvante para el aumento de reborde alveolar atrófico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "31" "paginaFinal" => "33" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Tissue expansion using super-absorbent polymers as coadjuvant treatment to increase atrophic alveolar ridges" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1333 "Ancho" => 2667 "Tamanyo" => 536396 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Imagen oclusal inicial. 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D) Adaptación de los bloques de aloinjerto en el paciente.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Acosta Behrends, Marisol Pérez Gasque Builla" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Carlos" "apellidos" => "Acosta Behrends" ] 1 => array:2 [ "nombre" => "Marisol" "apellidos" => "Pérez Gasque Builla" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130055815000702?idApp=UINPBA00004N" "url" => "/11300558/0000003900000001/v2_201705310036/S1130055815000702/v2_201705310036/es/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical report</span>" "titulo" => "Oral cysticercosis in the paediatric patient: Report of six cases" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "33" "paginaFinal" => "36" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rubi López Fernández, Jorge Téllez Rodríguez, Daniel Carrasco-Daza, Julio Sotelo-Morales, Adalberto Mosqueda-Taylor" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Rubi López" "apellidos" => "Fernández" "email" => array:1 [ 0 => "dra_rubylopez@yahoo.com.mx" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Jorge Téllez" "apellidos" => "Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Daniel" "apellidos" => "Carrasco-Daza" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "fn1" ] ] ] 3 => array:3 [ "nombre" => "Julio" "apellidos" => "Sotelo-Morales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Adalberto" "apellidos" => "Mosqueda-Taylor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Instituto Nacional de Pediatría, Cirugía Maxilofacial, departamento de Estomatología, México, DF, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto Nacional de Neurología y Neurocirugía, Servicio de Neurología, México, DF, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departmento de Atención a la Salud, Universidad Autónoma Metropolitana Xochimilco, México, DF Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cisticercosis oral en el paciente pediátrico: informe de seis casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 730 "Ancho" => 975 "Tamanyo" => 87312 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical apperance of an intraoral labial enlargement resembling a mucocele.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cysticercosis is a current public health problem related to the poor hygienic–environmental conditions. Developing countries have the highest incidence of this disease, and also countries where there are large amounts of immigrants, who are carriers of <span class="elsevierStyleItalic">Taenia solium</span>.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">1,2</span></a> In Mexico approximately 2% of autopsies performed in patients from public hospitals show evidence of cysticercosis.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">3</span></a> At present, it is estimated that at least 50 millions worldwide are carriers of cysticercosis, half of which are symptomatic, and that approximately 50–80% of them are at risk of die of this disease if they do not receive specialized attention.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Poor health conditions and a lack of measures for health control are the predisposing factors for this disease. Cysticercosis is acquired by ingesting the <span class="elsevierStyleItalic">T. solium</span> eggs through the intake of contaminated water and food. The activated embryo penetrates the intestinal wall of the host until they reach lymphatic and blood capillaries, which in turn spread them through the circulatory system to several organs and tissues. It is estimated that after 10 weeks, the egg becomes a cysticercus and may survive for several years in the tissues of the intermediary host (human or pig).<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a> In human beings, cysticerci are mainly located in the central nervous system, producing neurocysticercosis, but it may also be located in a wide variety of tissues, including the muscles, heart, eyes, and skin.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a> To the best of our knowledge, only 118 cases of oral cysticercosis have been reported up to date in the international literature.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5–10</span></a> Treatment of oral cysticercosis consists of surgical excision of the nodule. Histological examination confirms diagnosis. We present a series of 6 patients with this infection and underline the importance of searching for these parasites in other possible affected organs.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Report of cases</span><p id="par0015" class="elsevierStylePara elsevierViewall">Six cases of cysticercosis affecting the oral cavity are presented. They were diagnosed and treated in the Maxillofacial Surgery Department of the Instituto Nacional de Pediatría (Mexico City). The cases presented in this paper were treated from 1999 to 2013. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows a summary of the salient clinical features of the affected patients. There were three male and three female whose ages ranged from 1 to 8 and 5 to 14 years, respectively. All the lesions appeared as well defined, mobile and painless submucosal nodules (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Three were located in the dorsum of the tongue, 1 in the ventral surface of the tongue, 1 in the lower lip and 1 within the buccal mucosa. Diameter ranged from 0.5<span class="elsevierStyleHsp" style=""></span>cm to 2<span class="elsevierStyleHsp" style=""></span>cm. All the cases underwent surgical excision (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>). The presumptive clinical diagnoses of these lesions were salivary gland mucocele in 5 cases and lipoma in the other case.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Histologically, viable cysticerci were detected in two cases. These showed an external dense fibrous capsule that surrounded a delicate, double-layered membrane composed by an outer acellular eosinophilic layer and an inner, sparsely cellular lining. The outer part of the capsule contained a mild to moderate inflammatory cell infiltrate, in which lymphocytes, plasma cells and histiocytes predominated. On the inner aspect the inflammatory infiltrate exhibited aggregates of neutrophils and eosinophils, which were more abundant in the four cases of degenerated cysticerci. The cyst in all cases contained the larval form of <span class="elsevierStyleItalic">T. solium</span>, whose cephalic extremity (scolex) had a structure similar to that of the adult cestode, with distinct suckers and a crown of hookers (rostellum). Caudal to the scolex is the duct-like invagination segment consisting of a free duct with a digitiform coating lined by anhistic membrane. The four cases with degenerative changes exhibited colloid degeneration of their structure and abundant granular mineralization (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Oral lesions due to cysticercosis are very rare, in spite of the high prevalence of neurocysticercosis worldwide. In the largest Latin-American study of oral cysticercosis reported by Delgado et al.,<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a> the most frequently affected site was the tongue, followed by the buccal mucosa, lower lip, and the upper lip. In that study there were 16 cases retrieved from Peru, Guatemala and Mexico; of these, there were only two pediatric patients, which coincides with the rest of the literature with respect to the fact that the number of pediatric patients is lower as compared to adults affected by this disease. According to our review of the English and Spanish literature, only 31 (25%) out of 124 cases reported to date that presented complete information about age, gender and specific location (including the present series) have occurred in this age group.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5–25</span></a> Of these, 14 were males and 17 females. Age ranged from 1 to 12 years, with most cases (19) located on the tongue.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The differential diagnosis of oral cysticercosis depends on the location of the lesion. Nodules located on lips and cheeks may be misdiagnosed as mucocele, fibroma, lipoma, or a salivary gland adenoma, while the nodules located within the tongue may simulate fibroma, granular cell myoblastoma or a submucous mesenchymal tumor.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5,6,10,12,13,14,17</span></a> In most cases pediatric oral cysticercosis has been misdiagnosed clinically as mucocele, as it happened in 5 out of the 6 cases included in the present series, with the exception of a case which showed a 2<span class="elsevierStyleHsp" style=""></span>cm lesion within the cheek, which was clinically diagnosed as lipoma. Mucocele rarely exceeds 1.5<span class="elsevierStyleHsp" style=""></span>cm in larger diameter, and the clinical presentation depends on its depth and the degree of keratinization of the covering mucosa. All these characteristics are similar to those described in our patients; however, cysticercosis has a firmer consistency as compared to mucoceles and the lipomas; thus, this feature must suggest the possibility of a cysticercus. The importance of its recognition lies in that sometimes lesions clinically diagnosed as mucoceles or other apparently benign lesions are surgically excised without histopathological confirmation of the diagnosis. Although cysticercosis has to be confirmed by histopathological examination, some authors suggest that the use of other diagnostic tools such as fine needle aspiration may be also useful. This method has demonstrated the identification of some parts of the parasite in a high percentage of the cases.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">11,20,26,27,28,29</span></a> Laboratory findings in patients with cysticercosis reveal that the Enzyme-Linked Immuno-Sorbent Assay (ELISA) is positive to <span class="elsevierStyleItalic">Cysticercus cellulosae</span>.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment of oral cysticerci is based on symptoms and depends on the affected anatomical zone. Praziquantel and Albendazole are potent anthelmintic drugs used in the treatment of cysticercosis, replacing Niclosamide, which was the drug of choice for the treatment of the disease for a long period. Drugs should be used especially in cases where surgical treatment is risky or impossible, as in neurocysticercosis. Treatment may be unnecessary in asymptomatic individuals, but most cases are treated when the lesion is clearly evident, interferes with function or if it is traumatized. In the oral tissues, treatment of choice is surgical excision of the lesion as well as to perform a detailed study in each case in order to exclude the presence of the tapeworm in other sites.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5,8,20</span></a> The six pediatric patients we presented with cysticercosis in oral cavity were asymptomatic, with well defined lesions, mobile, painless and firm in consistency. Such lesions were completely removed without complications, because the surgical site was easily accessible.</p><p id="par0040" class="elsevierStylePara elsevierViewall">This infection could cause neurocysticercosis, which in turn predisposes to cancer, gliomas, astrocytomas and oligodendroglyomas.<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">30–32</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusions</span><p id="par0045" class="elsevierStylePara elsevierViewall">We can state that it is important to consider the diagnosis of cysticercosis in oral solitaire nodular lesions presenting in patients living in endemic areas, since we know that Mexico has a great deal of cases with this disease in other regions of the body. This paper emphasizes the role of the dentist in the detection of a disease that can have more serious involvement, as well as the importance of routine histological examination of every lesion excised from the oral cavity.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Ethical disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Protection of human and animal subjects</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Confidentiality of data</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Right to privacy and informed consent</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Source of funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Report of cases" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 4 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 5 => array:2 [ "identificador" => "sec0025" "titulo" => "Source of funding" ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "¿" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Fallecido</p>" "identificador" => "fn1" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 730 "Ancho" => 975 "Tamanyo" => 87312 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical apperance of an intraoral labial enlargement resembling a mucocele.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 730 "Ancho" => 975 "Tamanyo" => 109392 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Surgical excision of the lesión under local anesthesia. Safety margins were not necessary.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 518 "Ancho" => 976 "Tamanyo" => 107323 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Macroscopic view of the lesion and the capsule and surrounding tissue.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 732 "Ancho" => 976 "Tamanyo" => 120063 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Cysticercus eosinophilic lining surrounded by a thin collagenous capsule with scant lympho-histiocytic foci.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Location \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Size (cm) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical diagnosis \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right dorsum of tongue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mucocele \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left dorsum of tongue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mucocele \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lower lip mucosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mucocele \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right dorsum of tongue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mucocele \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left ventral region of the tongue \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mucocele \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right cheek \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lipoma \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Octubre | 48 | 12 | 60 |
| 2024 Septiembre | 74 | 18 | 92 |
| 2024 Agosto | 40 | 17 | 57 |
| 2024 Julio | 36 | 25 | 61 |
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| 2024 Mayo | 43 | 19 | 62 |
| 2024 Abril | 40 | 15 | 55 |
| 2024 Marzo | 81 | 16 | 97 |
| 2024 Febrero | 85 | 9 | 94 |
| 2024 Enero | 84 | 4 | 88 |
| 2023 Diciembre | 71 | 10 | 81 |
| 2023 Noviembre | 86 | 8 | 94 |
| 2023 Octubre | 123 | 9 | 132 |
| 2023 Septiembre | 69 | 5 | 74 |
| 2023 Agosto | 72 | 4 | 76 |
| 2023 Julio | 125 | 7 | 132 |
| 2023 Junio | 93 | 7 | 100 |
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| 2023 Abril | 111 | 5 | 116 |
| 2023 Marzo | 99 | 8 | 107 |
| 2023 Febrero | 68 | 7 | 75 |
| 2023 Enero | 95 | 3 | 98 |
| 2022 Diciembre | 100 | 14 | 114 |
| 2022 Noviembre | 149 | 16 | 165 |
| 2022 Octubre | 93 | 16 | 109 |
| 2022 Septiembre | 86 | 11 | 97 |
| 2022 Agosto | 70 | 12 | 82 |
| 2022 Julio | 66 | 12 | 78 |
| 2022 Junio | 56 | 7 | 63 |
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| 2022 Abril | 76 | 13 | 89 |
| 2022 Marzo | 64 | 21 | 85 |
| 2022 Febrero | 47 | 26 | 73 |
| 2022 Enero | 87 | 13 | 100 |
| 2021 Diciembre | 100 | 16 | 116 |
| 2021 Noviembre | 107 | 17 | 124 |
| 2021 Octubre | 103 | 19 | 122 |
| 2021 Septiembre | 54 | 14 | 68 |
| 2021 Agosto | 104 | 16 | 120 |
| 2021 Julio | 83 | 8 | 91 |
| 2021 Junio | 39 | 9 | 48 |
| 2021 Mayo | 58 | 15 | 73 |
| 2021 Abril | 152 | 17 | 169 |
| 2021 Marzo | 92 | 13 | 105 |
| 2021 Febrero | 91 | 10 | 101 |
| 2021 Enero | 101 | 12 | 113 |
| 2020 Diciembre | 102 | 13 | 115 |
| 2020 Noviembre | 133 | 17 | 150 |
| 2020 Octubre | 77 | 9 | 86 |
| 2020 Septiembre | 85 | 10 | 95 |
| 2020 Agosto | 120 | 5 | 125 |
| 2020 Julio | 52 | 3 | 55 |
| 2020 Junio | 64 | 11 | 75 |
| 2020 Mayo | 112 | 8 | 120 |
| 2020 Abril | 104 | 12 | 116 |
| 2020 Marzo | 98 | 9 | 107 |
| 2020 Febrero | 68 | 6 | 74 |
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| 2019 Diciembre | 57 | 9 | 66 |
| 2019 Noviembre | 72 | 16 | 88 |
| 2019 Octubre | 60 | 8 | 68 |
| 2019 Septiembre | 41 | 22 | 63 |
| 2019 Agosto | 45 | 3 | 48 |
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| 2019 Marzo | 14 | 5 | 19 |
| 2019 Febrero | 35 | 12 | 47 |
| 2019 Enero | 24 | 5 | 29 |
| 2018 Diciembre | 31 | 9 | 40 |
| 2018 Noviembre | 32 | 7 | 39 |
| 2018 Octubre | 75 | 12 | 87 |
| 2018 Septiembre | 120 | 8 | 128 |
| 2018 Agosto | 97 | 1 | 98 |
| 2018 Julio | 53 | 1 | 54 |
| 2018 Junio | 50 | 1 | 51 |
| 2018 Mayo | 82 | 3 | 85 |
| 2018 Abril | 133 | 3 | 136 |
| 2018 Marzo | 79 | 0 | 79 |
| 2018 Febrero | 25 | 1 | 26 |
| 2018 Enero | 36 | 2 | 38 |
| 2017 Diciembre | 29 | 3 | 32 |
| 2017 Noviembre | 35 | 4 | 39 |
| 2017 Octubre | 37 | 2 | 39 |
| 2017 Septiembre | 37 | 15 | 52 |
| 2017 Agosto | 12 | 15 | 27 |
| 2017 Julio | 28 | 9 | 37 |
| 2017 Junio | 34 | 16 | 50 |
| 2017 Mayo | 48 | 6 | 54 |
| 2017 Abril | 29 | 19 | 48 |
| 2017 Marzo | 46 | 65 | 111 |
| 2017 Febrero | 47 | 7 | 54 |
| 2017 Enero | 48 | 10 | 58 |
| 2016 Diciembre | 7 | 8 | 15 |
| 2016 Noviembre | 7 | 8 | 15 |
| 2016 Octubre | 5 | 12 | 17 |
| 2016 Septiembre | 5 | 6 | 11 |
| 2016 Agosto | 0 | 8 | 8 |
| 2016 Julio | 1 | 4 | 5 |
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