Arq Neuropsiquiatr 2007;65(1):87-91
Study performed at the General Pathology Disciplines from Federal University of Triangulo Mineiro, Uberaba MG, Brazil (UFTM)
and from Tropical Pathology and Public Health Institute from the Federal University of Goais, Goiânia GO, Brazil (IPTSP/UFG):
Pathology Doctor, Professor at the General Pathology Discipline from IPTSP/UFG;
Pathology Master, Professor at Cellular Biology
Discipline from UFTM;
Tropical Medicine Master, doctorate student from the Tropical Medicine Post-Graduation Programme from
Pathology Doctor and Professor at the General Pathology Discipline from UFTM. Financial support: Conselho Nacional
de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG),
Fundação de Ensino e Pesquisa de Uberaba (FUNEPU).
Received 20 July 2006, received in final form 3 October 2006. Accepted 26 October 2006.
Dr. Ruy de Souza Lino Junior - Universidade Federal de Goiás / Instituto de Patologia Tropical e Saúde Pública / Disciplina de Patologia
Geral - Rua 235 esquina com 1ª Avenida S/N / Setor Universitário - 74605-050 Goiânia GO - Brasil. E-mail: email@example.com
ANATOMOPATHOLOGICAL ASPECTS OF
NEUROCYSTICERCOSIS IN AUTOPSIED PATIENTS
Ruy de Souza Lino-Junior
, Ana Carolina Guimarães Faleiros
Marina Clare Vinaud
, Flávia Aparecida de Oliveira
Janaína Valadares Guimarães
, Marlene Antônia dos Reis
Vicente de Paula Antunes Teixeira
ABSTRACT - The aim of this paper was to describe the occurrence and morphology of neurocysticercosis
(NCC) in autopsies. We revised 2218 autopsies performed at the School Hospital from Federal Unversity of
Triangulo Mineiro, 1970-2003. Data referring to age, gender and color of patients were reported and NCC
was microscopically and macroscopically analyzed. We found 53 (2.4%) NCC cases. The mean age was 50
years old, 34 (64.1%) individuals were male and 36 (67.9%) white. Macroscopically, 17 cysticerci were ana-
lyzed. The most frequent location was meningocortical in 12 (70.6%) cases. Microscopically, the cysticerci
presented an ovoid shape, containing the larvae preserved in 4 (23.5%) cases or in destruction degrees in
13 (76.5%) cases. Therefore, in NCC was found several general pathologic processes (necrosis, interstitial
deposits, fibrosis, gliosis, inflammation) amongst which are highlighted beta-fibrillose in 13 (76.5%) cases
associated to inflammatory process in 16 (94.1%) cases caused by the parasite, not yet related to NCC, and
calcification present in viable and destruction parasites.
KEY WORDS: autopsy neurocysticercosis, general pathologic processes, cysticercosis, central nervous system.
Aspectos anatomopatológicos da neurocisticercose em pacientes autopsiados
RESUMO - O objetivo desse trabalho foi descrever ocorrência e morfologia da neurocisticercose (NCC) au-
tópsias. Revisou-se 2218 autópsias realizadas no Hospital Escola da Universidade Federal do Triângulo Mi-
neiro (UFTM), 1970-2003. Registrou-se idade, gênero e cor dos pacientes, analisou-se macroscopia e micros-
copia da NCC. Encontrou-se 53 (2,4%) casos de NCC. A média das idades foi 50 anos, sendo 34 (64,1%) do
sexo masculino e 36 (67,9%) brancos, não havendo diferença significante na comparação da idade, gênero
e cor dos pacientes. Analisou-se macroscopicamente 17 cisticercos. A localização mais comum foi a meningo-
cortical em 12 (70,6%) casos. Microscopicamente, os cisticercos apresentaram forma oval contendo a larva
íntegra em 4 (23,5%) casos ou em grau de destruição em 13 (76,5%) casos. Portanto, na NCC foram veri-
ficados vários processos patológicos gerais (necrose, depósitos intersticiais, fibrose, gliose, inflamação) desta-
cando-se: beta-fibrilose em 13 (76,5%) casos associada ao processo inflamatório em 16(94,1%) casos cau-
sado pelo parasito, ainda não relatada na NCC, e calcificação presente no parasito viável e em destruição.
PALAVRAS-CHAVE: autópsia, neurocisticercose, processos patológicos gerais, cisticercose, sistema nervoso
Human cysticercosis occurs due to ingestion, with
contaminated food, of eggs containing oncospheres.
In the intestinal portion the oncospheres hatch, pen-
etrate in the intestinal wall and disseminate through
blood and lymph vessels until it gets to several tis-
sues, however with great tropism to the central nerv-
ous system (CNS)
. Neurocysticercosis (NCC) is char-
acterized by presenting several clinic manifestations
The polymorphism of its clinic manifestations depends
not only on its localization but as well as on the num-
ber of parasites, on the developmental stages of cys-
ticercus (viable or in destruction) and on the organ-
ic characteristic of the patient
NCC is the most frequent from of cysticercosis.
Arq Neuropsiquiatr 2007;65(1)
The frequency of NCC in autopsies in Brazil varies
from 0.12 to 19%, in clinic manifestations varies from
0.03 to 7.5% and in serum-epidemiologic studies from
0.68 to 5.2%. The areas with high frequency reports
of this disease are: São Paulo, Rio de Janeiro, Parana,
Minas Gerais, Espirito Santo, Bahia, Rio Grande do
Norte, Paraiba and Distrito Federal. The age brack-
et prevails between 21 to 40 years old. The male gen-
der is the most common and the rural area prece-
dence prevails. The predominant clinic manifestation
is epilepsy followed by intracranial hypertension
Cysticerci may be found in an active form causing
arachnoiditis, hydrocephaly by meningeal inflamma-
tion, parenchymatous cysts and cerebral infarct; or
in an inactive form that can be constituted by pa-
renchymatous calcifications. The most common signs
and symptoms of NCC are epilepsy, cephalalgia,
papilledema, vomit and pyramidal signs
cordingly to Takayanagui and Leite
, in a review arti-
cle, the frequency of these manifestations are: epilep-
tic crisis (62%), intracranial hypertension syndrome
(38%), cysticercotic meningitis (35%), psychic distur-
bance (11%), apoplectic or endarteritic form (2.8%)
and spinal cord syndrome (0.5%). The lacunar cere-
bral infarct, which is one of the NCC cerebrovascular
complications, results from the arterial occlusion sec-
ondary to intense inflammatory reaction. The arach-
noiditis due to NCC is in many cases associated to
The aims of this study were to describe the fre-
quency and the anatomopathological aspects of NCC
in autopsied individuals.
Autopsy protocols performed at the School Hospital
from Federal University of Triangulo Mineiro (UFTM), Ube-
raba, Minas Gerais, were revised from 1970 to 2003. From
individuals with or without cysticercosis were reported:
age, color, gender and localization of the cysticerci in the
encephala. After approval of the Ethics in Research Com-
mittee from UFTM, macroscopic and microscopic analysis
were performed of the lesions associated to cysticerci in
the encephala recovered from anatomic organs archive at
the General Pathology Discpiline, UFTM. Macroscopically,
were evaluated the number of cysticerci in each organ, the
implantation site of the cysticercus and the general patho-
logic processes (GPP). To the microscopic analysis, the ence-
phalic fragments with cysticercosis were submitted to rou-
tine processing followed by cutting of 6
µm width sections.
These sections were stained by hematoxylin-eosin (HE) tech-
nique, or histochemical techniques when necessary such as
Sirius red, to fibrosis identification, periodic acid-Schiff
(PAS), to glicidic radicals deposits identification, von Kossa,
to calcium salts deposits identification, Congo red, to beta-
fibrilosis and Giemsa accordingly to established techniques
The microscopic analysis was performed aiming the iden-
tification of GPP that could occur in three distinguished
sites: at the parasite, at the host-parasite interface and at
the host tissue.
To the statistical analysis an electronic sheet was elab-
orated. Afterwards the variable were tested to verify the
normal distribution and variance through Kolmogorov-
Smirnov test. When the distribution was normal, paramet-
ric tests were used: in the comparison of two groups the
“t” Student’s test and in the comparison of three or more
groups the variance analysis for multiple groups. When the
distribution was not normal, non parametric tests were
used: in two groups comparison the Mann-Whitney test
and in the three groups comparison the Kruskal-Wallis test.
The proportions were compared by the
test followed by
the exact Fisher test. Statistically significant differences
were considered when p<0.05
2218 autopsies protocols were revised and 71
(3.2%) cysticercosis reports were found. From these
cases, 53 (74.6%) presented NCC representing 2.4%
from the total number of autopsies. The mean of age
was 50 years old, varying from 21 to 70 years old in
NCC individuals: from 21 to 30 years old, 1 NCC case;
from 31 to 40 years old, no NCC case; from 41 to 50
years old, 4 NCC cases; from 51 to 60 years old, 3 NCC
cases and from 61 to 70 years old, 2 NCC cases. The
mean of age of individuals without NCC was 48 years
old varying from 15 to 99 years old. From the NCC
individuals 34 (64.1%) were male and 36 (67.9%)
were white. There were no statistically significant
differences in the age, gender and color comparisons
between patients (p>0.05).
From the 53 patients with NCC it was possible to
recover 10 encephala and the greater number of cys-
ticerci found in one encephala was five. The macro-
scopic analysis was made in 17 cysticerci. The most
common localization was meningocortical with 12
(70.6%) cases, followed by interventricular with 2
(11.7%) cases, hypothalamic with 2 (11.7%) cases and
white matter with 1 (6%) case. In the host tissue it
was most frequently found the focal leptomeningi-
tis because the cysticerci were causing compression
and subsequent deformation of the nearby tissue.
In the microscopic analysis of the 17 cysticerci,
they usually presented an ovoid shape containing a
viable larvae in 4 (23.5%) cases or in varied degrees
of destruction in 13 (76.5%) cases. The GPP found
were necrosis, deposit of glicidic radicals (Fig 1), beta-
fibrillose (Fig 2), fibrosis (Fig 3), gliosis, calcification
and hemosiderosis (Table). The inflammation reac-
tion was identified with lymphocyte and monocyte
prevailing and, eventually, with some giant cells, even
Arq Neuropsiquiatr 2007;65(1)
so it was possible to identify eosinophils and masto-
cytes. It was also found hyperemia, specially on host
tissue vessels, in 23.5% of cases; thickening of vessel
walls exclusively on host tissue in 35.5% of cases; ede-
ma in host tissue in 100% of cases; hypotrophy in
host tissue in 5.9% of cases; cellular growth and dif-
ferentiation alterations in the host-parasite interface
in 5.9% of cases presented as increase of cellularity
of glia cells, discrete cellular pleomorphism with lit-
tle variation on the distribution and quantity of chro-
matin accompanied by mild vascular proliferation.
There was no statistically significant difference bet-
ween the GPP and the localization of the cysticerci
in the encephala.
In this study an occurrence of 2.4% of NCC was
found in autopsies, this is in accordance with values
described also in autopsy material that varies from
0.12% to 9%
. The patients mean age in this study
was 50 years old which represents a higher age brack-
et when compared to the one described in a review
Table. Distribution of general pathologic processes found in 17 cysticerci from autopsied individuals at the School Hospital of the
Federal University of Triangulo Mineiro, Uberaba (MG), in the period from 1970 to 2003, accordingly to committed site.
In destruction n(%)
Glicidid radical deposits
Observation: The sum is higher than 100% because the pathologic processes were found in more than one localization.
Fig 1. Viable cysticercus in meningocortical localization. Glicidic
radicals deposits are observed, as well as PAS positive, in the
duct area (arrow head) and membranes (arrow) of the para-
site (periodic acid-Schiff, 50X).
Fig 2. Cysticercus in destruction in meningocortical localiza-
tion. Fibrous connective tissue (arrow) neoformation is observed
in the parasite, in the host-parasite interface and in the host
tissue (Picro red, 50X).
Fig 3. Host-parasite interface nearby a cysticercus in destruc-
tion in meningocortical localization. Beta-fibrils deposits (amiloi-
dosis) (arrow) are observed (Congo red, 125X).
Arq Neuropsiquiatr 2007;65(1)
article varying from 21 to 40 years old
. Maybe this
difference can be explained because this review arti-
cle gathered clinic, serum-epidemiologic and autop-
sies data while we only considered autopsies data.
Overall the white NCC individuals prevailed in com-
parison to the non-white ones, which is compatible
to other authors’ data
. Furthermore, the male
gender was more frequent than the female one
accordingly to the reported literature
The organism reaction surrounding the cysticer-
cus may occur accordingly to its localization in sev-
eral organs as well as in the same organ the lesions
can vary accordingly to its implantation site. The
meningocortical localization of encephala cysticerci
is highlighted because it causes more severe lesions
while inside the parenchyma more discrete lesions
were observed. Differently from the data described
by Chimelli et al.
reporting the parenchymatous
localization as the most frequent in NCC.
The inflammatory infiltrate of mononuclear cells
in the cystic wall, the gliosis, the tissue edema and
the thickening of small vessels near to the cysticerci
were discrete in viable cysticerci. While the host’s
inflammatory response became more intense the par-
asite began to suffer a destruction process that result-
ed in its death. With the parasite’s disintegration the
inflammatory reaction tended to decrease although
the persistence of giant cells surrounded by the fi-
brous capsule, gliosis and edema. According to the
literature this fact indicates a continuum of the host’s
reaction against the parasite’s debris without, how-
ever, an association to the type or intensity of the
The necrosis of neurons near the cysticercus im-
plantation site is probably due to the compression
caused by the parasite or by the secretion of media-
tors from the cysticercus or by the inflammatory
response in the nearby tissue which is in accordance
to other studies
Glicidic radicals’ deposits were observed in the
parasite and in the host-parasite interface. Accordin-
gly to Thomas et al.
these deposits inside intrapar-
asitary vacuoles are connected to the parasite’s
metabolism. Therefore there is a relation to the via-
bility of the cysticercus such as the greater number
of intraparasitary vacuoles the more viable is the par-
asite. Besides these gathering indicates a probable
crossed reactivity with the embryonic tissue that com-
poses the larvae
In this study, the beta-fibrillose most frequent site
was the host-parasite interface which corresponds to
the main inflammatory site. However, in the litera-
ture there are no reports found related to beta-fib-
rillose associated to cysticercosis. Accordingly to some
authors this type of deposit in other diseases occurs
due to complications of a chronic inflammatory proc-
ess or of a process that destroys the tissue and, there-
fore, being called secondary beta-fibrillose
association of beta-fibrillose to the inflammatory
process may be due to the presence of precursor of
the serum A amyloidal substance (SAA) which have
several immunomodulatories attributions such as
chemotaxis induction and the expression of adhe-
sion molecules besides the cytokine like proprieties.
The SAA acts through some mechanisms in the lesion
sites aiming the repair of the tissue. The increase and
consequent deposit of these substance products are
the process we call beta-fibrillose
The calcification was identified more frequently
in cysticerci in destruction stage, however we also
observed calcification in viable cysticerci and with
discrete intensity. Accordingly to other studies that
describe the calcification as an important process in
, specially in more advanced evolutive stages
and representing the most important finding in com-
puterized tomography diagnosis
. Accordingly to
Vargas-Parada et al.
the calcification found in viable
cysticerci may be explained by the calcareous corpus-
cles produced by the parasite and deposited in the
lumen of protonephridial ducts.
The lesions in the growth and cellular diferenti-
ation were identified in the host-parasite interface
in one NCC case and is in accordance to the literatu-
which indicates a significant association between
NCC and gliomas.
In conclusion, in NCC were found several patho-
logic processes that differ in localization, cysticercus
viability, aggression mechanism and immunologic
response, besides its intensity is varied accordingly
to three distinguished sites: the parasite, the host-
parasite interface and the host’s tissue. Beta-fibril-
lose associated to the inflammatory process caused
by the parasite is highlighted and have not yet been
described related to cysticercosis. The calcification is
seen differently from the description of other authors
revealing the possibility of a pattern that may result
in a greater NCC diagnosis difficulty.
Aknowledgments – The authors thank Lorena Doura-
do Alves, Juliana Sayuri Sugita and Amélia Regina Semerene
Farah for the support in this study.
Arq Neuropsiquiatr 2007;65(1)
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