Amirthalingamia macracantha (Joyeux and Baer, 1935) larvae, a member of the Gryporhynchidae family (Cestoda: Cyclophyllidea), are commonly found in a variety of African fish species, including Nile tilapia (Oreochromis niloticus, Linnaeus, 1758). Nonetheless, little is known regarding their existence in native Egyptian fish species. Two hundred O. niloticus were examined in the current investigation, using standard parasitological techniques to detect the presence of these larvae in different fish organs. According to this study’s findings, A. macracantha larvae were found in 35% of the microscopically examined samples as red nodules, attaching to the serosa of both the anterior and posterior sections of the intestine and stomach, respectively. The mean abundance of the infection was 3.5 ± 0.05 (CI 95% 3.4–3.5), and its mean intensity was 10 ± 1.7 (CI 95% 8.2–11.7). The existence of two rows of twenty rostellar hooks of varying lengths is the main characteristic of the parasite. The upper row consisted of four large hooks and six smaller ones, while the lower row contained smaller hooks of consistent length. According to histopathological analysis, the larvae with a hook-and-spiny rostellum were affixed to the stomach serosa of O. niloticus. Additionally, there was a notable presence of degranulated mast cells and lymphocytes of varying sizes within the stomach’s lamina propria, submucosa, and blood vessels, as well as a loss of gastric epithelium, fibrosis, and enlargement of submucosal lymph vessels. This study offers a succinct description of this larval stage, representing the first reported occurrence of its presence in Egyptian O. niloticus.