Brain Pathology Case of the Month - January 2004

Contributed by David Wada1, Michon Morita2, and John M Hardman1
  1Department of Pathology, and 2Department of Surgery, John A. Burns School of Medicine, University of Hawaii Honolulu, Hawaii
Published on line in January 2043


A 74-year old Filipino man with a past history of gastric carcinoma presented with new-onset partial-complex seizures. Eight months prior to this presentation he was diagnosed with gastric cancer and subsequently underwent a subtotal gastrectomy. The malignancy was classified as T1N0M0 stage IA and treated by radiation to within 2 mm of the resection margin. Two months after completing his radiation treatment, he developed confusion and rhythmic, seizure-like movements of the extremities. A head CT revealed a 2 cm right frontal lobe mass and he was admitted and placed on fosphenytoin and dexamethasone with no further recurrence of seizure activity. The patient reported no headache or weakness. There were no reports of constitutional symptoms. CT of the chest and abdomen revealed no evidence of metastatic spread or other abnormalities.

MRI revealed an irregular 2.0 x 2.5 x 3.0 cm right frontal lobe ring enhancing mass with edema (Figure 1). The lesion was believed to represent a primary or secondary tumor. A resection of the right frontal lobe lesion revealed a gliotic solid and cystic mass. The resected lesion consisted of irregular tan to pink fragments of tissue measuring 3.5 x 1.2 x 0.5 cm.


Crush prep and frozen sections were performed for intraoperative consultation. The brain tissue showed acute and chronic inflammation, gliosis, fibrosis, and many foreign body giant cells (Figure 2). Intact and necrotic larval parts were identified. These larval fragments have an integument covered by eosinophilic structureless microvilli (Figure 3). A layer of tegmental cells separated the integument from the loose spindle tissue cells in the core. The larval parts are surrounded by gliotic brain tissue containing prominent foreign body giant cells, macrophages, and lymphocytes. Eosinophils were not seen. A refractile fragment resembling a hooklet was also found in the crush preparation (Figure 4). The fragmented scolex and hooklets were identified on subsequent hematoxylin and eosin stained sections.


International Society of Neuropathology