Brain Pathology Case of the Month - December 2017

Contributed by Zhe Bao Wu, Yi Jun Cheng, Wei Guo Zhao
Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China


A 55-year-old male patient presented with a half-month history of intermittent headache; no nausea, weakness, convulsion, fever, or any other symptoms were accompanied. His physical examination was normal. The neurologic examination did not reveal any abnormalities. Laboratory findings were unremarkable. The results of chest radiograph and abdominal ultrasonography were normal. Axial T1-weighted MRI of brain showed heterogeneous enhancement signal in the deep sites of left temporal and insula lobe (Figure 1A). FLAIR sequence showed the lesion was slightly hyperintensity signal surrounded by obvious edema (Figure 1B). Then, a glioma was highly suspected and an operation of subtotal resection was performed under neuronavigation.


The "tumor" tissue was processed with standard pathology technique. Histologic examination showed schistosomal granulomas in tissue slice (Figure 1C); there were heavy infiltration of eosinophilics, epithelioid cells and necrotic tissue round Schistosoma japonicum ova (Figures 1C, 1D). In addition, a test for serum schistosome antibody was positive. What is your diagnosis?


International Society of Neuropathology