CLINICS 2012;67(7):849-851 CASE REPORT DOI:10.6061/clinics/2012(07)24 The surgical removal of a live tapeworm with an interesting pathologic finding most likely represent- ing the migration path: a case report of cerebral sparganosis Peng Wang,I,II Xueying Su,III Qing Mao,I Yanhui LiuI I Sichuan University, West China Hospital, Department of Neurosurgery, Chengdu, China. II The Fifth People’s Hospital of Chengdu, Department of Neurosurgery, Chengdu, China. III Sichuan University, West China Hospital, Department of Pathology, Chengdu, China. Email: liuyanhui9@gmail.com Tel.: 8618980601509 INTRODUCTION Cerebral sparganosis is a rare parasitic disease of the central nervous system that is caused by sparganum. Cerebral sparganosis occurs worldwide, but it is found more frequently in China, Japan, and Southeastern Asia (1- 2). Sparganum, the second-stage larva of Spirometra mansoni, can produce chronic active inflammation through slow migration in the brain (1). They can also parasitize other sites of the human body, such as the subcutaneous tissue, body cavities and eyes, and survive for 5-20 years (3). In this paper, we report a case of cerebral sparganosis, including the magnetic resonance imaging (MRI) character- istics of local migration and the surgical finding of a live worm. A new pathological finding, a tunnel-like structure, was observed and most likely represented a sparganum migration path. CASE DESCRIPTION A fifteen-year-old girl suffered from facial and upper limb numbness on her right side one year ago. She was previously diagnosed with encephalitis at the Department of Neurology until she suffered a generalized tonic–clonic seizure six months later. MRI showed a contrast-enhanced lesion with an irregular shape located in the left frontal lobe (Figure 1 A1 and A2). The patient was advised to undergo further treatment in the Department of Neurosurgery. However, because the seizure was acutely controlled, she was noncompliant with treatment. One week before admis- sion, the seizure became uncontrollable. An MRI revealed a contrast-enhanced lesion with an irregular shape (Figure 1 B1 and B2); however, local migration of the lesion was observed. After admission, the patient’s serum was tested by ELISA, which was positive for sparganum. The patient mentioned that she had eaten inadequately cooked frog flesh. Therefore, we hypothesized that the lesion was a live tapeworm. An operation was performed, and a light yellow lesion was identified in the posterior portion of the superior temporal gyrus with a live worm inside it. The worm was milky white, approximately 12cm long and could twist its body under stimulus (Figure 2). The histology of the larval cestode showed a brush border and eosinophilic smooth muscle fibers (Figure 3A). Some portions of the parasite body contained calcareous bodies (Figure 3B). A new tunnel-like structure with infiltrating plasma cells and eosinophils was identified in the tissue (Figure 3C). Under higher power, calcareous bodies were also observed within the tunnel (Figure 3D). Based on the pathological findings, the patient history and serum test results, a final diagnosis of cerebral sparganosis was made. During a follow-up period of more than two years, the patient’s symptoms disappeared. No enhanced lesion was found on MRI at 26 months after the operation (Figure 1 C1 and C2). Copyright 2012 CLINICS – This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. No potential conflict of interest was reported. Figure 1 - A series of pre-operational MR images demonstrates the local migration of an irregular, enhanced lesion (arrow) in the left hemisphere (A1-A2) six months before the operation; (B1-B2) three days before the operation. The lesion disappears in the post-operation MR images over the two-year follow-up period (C1-C2) 26 months after the operation. 849