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Presented by Theresa Chan, M.D. and prepared by Anil Parwani, M.D.,Ph.D
Case 1: A young male with new onset seizures
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1. Question
Week 134: Case 1
A young male with new onset seizuresimages/42703case1fig1.jpg
images/42703case1fig2.jpg
images/42703case1fig3.jpgCorrect
Answer: Cysticercosis
Histology: The cyst contains structures that do not resemble any normal brain tissue. The structures are consistent with the larval form of a parasitic worm. A rim of reactive fibrous tissue with inflammation is seen in association with the parasite. Calcifications are also seen.
Discussion: Cysticercosis occurs when humans become the intermediate host of the pork tapeworm, Taenia Solium. It is acquired by consumption of the eggs, which hatch into larvae. The larvae invade through the gut to disseminate hematogenously to other organs and encyst, preferred organs include the brain, muscles, skin and heart. The cysts formed by the organism consist of a glycoprotein rich cyst wall, and does not evoke a host response when intact. However, when the cysts degenerate, calcification and scarring and inflammation are seen.
The histologic appearance of cysticercosis is quite characteristic and is not often a diagnostic challenge. Other cysts occuring in the brain can be considered in the differential diagnosis. However, these other cysts are lined by distinct epithelium, which are not seen in cysticercosis. Colloid and Rathke cleft cysts are lined by ciliated and mucinous epithelium. Arachnoid cysts show meningothelial cells.
Incorrect
Answer: Cysticercosis
Histology: The cyst contains structures that do not resemble any normal brain tissue. The structures are consistent with the larval form of a parasitic worm. A rim of reactive fibrous tissue with inflammation is seen in association with the parasite. Calcifications are also seen.
Discussion: Cysticercosis occurs when humans become the intermediate host of the pork tapeworm, Taenia Solium. It is acquired by consumption of the eggs, which hatch into larvae. The larvae invade through the gut to disseminate hematogenously to other organs and encyst, preferred organs include the brain, muscles, skin and heart. The cysts formed by the organism consist of a glycoprotein rich cyst wall, and does not evoke a host response when intact. However, when the cysts degenerate, calcification and scarring and inflammation are seen.
The histologic appearance of cysticercosis is quite characteristic and is not often a diagnostic challenge. Other cysts occuring in the brain can be considered in the differential diagnosis. However, these other cysts are lined by distinct epithelium, which are not seen in cysticercosis. Colloid and Rathke cleft cysts are lined by ciliated and mucinous epithelium. Arachnoid cysts show meningothelial cells.
