Histopathologically Compatible Neurocysticercosis Mimicking an Intracranial Tumor in a Child

Abstract

Neurocysticercosis is the most common parasitic infection of the central nervous system and may mimic neoplastic, infectious, or granulomatous lesions, particularly in non-endemic settings. Diagnosis can be challenging when characteristic radiological findings are absent. An 11-year-old boy presented with persistent headache and dizziness. Brain magnetic resonance imaging (MRI) demonstrated a 6 × 8 mm right temporal lesion with ring-like peripheral enhancement and marked surrounding vasogenic edema. The lesion appeared hypointense on T1-weighted sequences and hyperintense on T2-weighted and FLAIR images. The differential diagnosis included neoplasm, bacterial abscess, granulomatous infection, and parasitic disease. Because the lesion could not be reliably characterized noninvasively and an intracranial tumor could not be excluded, neurosurgical excision was performed. Histopathological examination demonstrated parasitic structures morphologically compatible with cysticercosis, including PAS-positive tegumental components and sucker-like structures suggestive of a cestode larva. Following the pathological diagnosis, a detailed epidemiological history revealed chronic intermittent gastrointestinal complaints and a history of antiparasitic treatment among siblings. The patient received albendazole therapy, and follow-up neuroimaging demonstrated regression of both the lesion and surrounding edema. This case highlights the importance of considering histopathologically suspected neurocysticercosis in the differential diagnosis of solitary enhancing brain lesions in children, even in regions where the disease is considered uncommon. Histopathological evaluation may be required when neuroimaging findings are non-specific and malignancy cannot be excluded.