31.9.27 Incidence of Brain Tumours in Children and Adults in Pakistan

Original Article

 

Brain Tumours in Children and Adults

Incidence of Brain Tumours in Children and Adults in Pakistan

Nauman Idris Butt1, Fatima Kashif2, Faisal Iqbal3, Shafiq Ur Rehman5 and Kamran Hamid4

ABSTRACT

Objective: To study the incidence of Brain Tumours in Children and Adults in Pakistan

Study Design: Retrospective Study

Place and Duration of Study: This study was conducted at the Pathology Department of Idris Teaching Hospital Sialkot and Aziz Bhatti Teaching Hospital Gujrat from January2016 to February 2020.

Materials and Methods: The histopathology records of all patients with brain tumors were reviewed which were received, diagnosed and operated for brain tumors. In addition to types and site of the tumor, patient demographics including sex and age were also recorded. To highlight the sex distribution and age frequency amongst each age group, the age of the patients was divided in two broad groups 1 (0-14 years) and 14 -82 years. The written informed was taken before collecting the data from each patient and permission of Ethical Committee was also considered before collecting the data and publishing in medical journal. The data was analyzed for results by SSPP version 10.

Results: Incidence of Benign 16 (30.76%) Small Round Blue Cell Tumor 09 (17.30%) Medulloblastoma 11 (21.15%) High grade glioma 06 (11.53%) Low grade glioma 07(13.46%) Glioblastoma multiform 03(5.76%) Total 52(100%). Incidence of GBM 27(21.95%) Meningioma 25(20.32%) Benign 25(20.32%) Low grade glioma 23(18.69%) Metastatic carcinoma 05(4.06%) High grade glioma 04(3.25%) DLBCL 02(1.62%) Mesenchymal chondrosarcoma 03(2.43%) Non diagnostic 09(7.31%). One hundred seventy-five patients with brain tumors, of ages between 2-82 years had underwent surgery during the study period. Out of these, 154(88%) were males and 21(12%) were females. Male to female ratio was 13.63:1. The mean age of patients was 6.73 (±0.21) years. A distinct overall male predominance was noted in all tumor types.

Conclusion: Population-based studies were required to determine the cancer burden due to pediatric malignancies of the brain in this population and for the morphological categorization of brain tumors in Pakistan. Conventional hematoxyl in-eosin staining is the mainstay for pathological diagnosis in most of the cases, however Immuno histochemistry (IHC) has a major role in differential diagnosis and improving diagnostic accuracy in difficult cases not only in general surgical pathology but also in neurooncologic pathology.

Key Words: Incidence, Brain Tumours, Pakistan

Citation of article: Butt NI, Kashif F, Iqbal F, Rehman S, Hamid K. Incidence of Brain Tumours in Children and Adults in Pakistan. Med Forum 2020;31(9):111-114.

 

 

INTRODUCTION

Occurrence of cerebrum tumors is identified with age, with the most noteworthy frequency in more established men and women1. In youth mind tumors are the second most normal diseases after leukemia, representing in excess of a fourth of all tumors analyzed

 

 

1. Department of Anatomy / Pathology2 / Medicine3 / Surgery4, Sialkot Medical College, Sialkot.

5. Department of Neuro Surgery, Aziz Bhatti Teaching Hospital Gujrat.

 

 

Correspondence: Nauman Idris Butt, Assistant Professor of Anatomy, Sialkot Medical College, Sialkot.

Contact No: 03008616575

Email: hrd@smcs.edu.pk

 

 

Received:    May, 2020

Accepted:    July, 2020

Printed:        September, 2020

 

 

in youngsters Although a dominant part of these tumors happen in grown-ups, some particular histological sorts which are basic in adolescence are uncommon in adults2,3. All the more significantly, there are signs that pediatric and grown-up glial tumors have contrasts in their sub-atomic science and conduct. These have significant ramifications for future research, treatment and prognosis4. In numerous pieces of the world, they are not just the most widely recognized dangerous strong tumors seen before the age of 20 years, yet in addition a biggest reason for youth malignancy mortality in the age group 0-14. Early location and improvement in remedial modalities have brought about longer endurance. It's shocking that treatments effetely affect the cerebrum tissue. Longer stabilities are regularly connected with neurological, subjective and endocrine issue and diminished nature of life5. Survivors are at an expanded danger of building up a second neoplasm later in life6.

In writing there are overall varieties in the example of cerebrum tumor as for occurrence, sexual orientation, anatomical area and recurrence of explicit histological sorts. Area and histological sorts, to an enormous degree, impact treatment choices, out-come and hazard factors. Information on these parameters are helpful for arranging of social insurance conveyance framework and future research. Generally morphological measures are useful for diagnosing the vast majority of these tumors however in situations where tumors are ineffectively separated or example gave is restricted, Immunohistochemistry and radiological assessment is extremely useful in arriving at a precise diagnosis7,8.

MATERIALS AND METHODS

For this study data of one hundred seventy five patients was collected from the Pathology department of Idris Teaching Hospital Sialkot and Aziz Bhatti Teaching Hospital Gujrat Pakistan. The histopathology records of all patients with brain tumors were reviewed which were received, diagnosed and operated for brain tumors during January2016 to February 2020. In addition to types and site of the tumor, patient demographics including sex and age were also recorded. To highlight the sex distribution and age frequency amongst each agegroup, the age of the patients was divided in two broad groups 1 (0-14 years); and 14 -82 years.

The written informed was taken before collecting the data from each patient and permission of Ethical Committee was also considered before collecting the data and publishing in medical journal. The data was analyzed for results by SSPP version 10.

Inclusion criteria: All the patients having brain tumors were included in this study.

Exclusion criteria: All the patient without brain tumor were excluded from the study.

RESULTS

Table No: 1 Childhood brain tumours distribution

Diagnosis

Number of Patients

Percentage %

Benign

16

30.76 %

Small Round Blue Cell Tumor

09

17.30 %

Medulloblastoma

11

21.15 %

High grade glioma

06

11.53 %

Low grade glioma

07

13.46 %

Glioblastoma multiform

03

5.76 %

Total

52

100 %

Incidence of Benign 16 (30.76%) Small Round Blue Cell Tumor 09 (17.30%)Medulloblastoma 11 (21.15%) High grade glioma 06 (11.53%) Low grade glioma 07(13.46%) Glioblastoma multiform 03(5.76%) Total 52(100%) as shown in table no 1.

Incidence of GBM 27(21.95%) Meningioma 25(20.32%) Benign 25(20.32%)Low grade glioma 23(18.69%) Metastatic carcinoma 05(4.06%) High grade glioma 04(3.25%) DLBCL 02(1.62%) Mesenchymal chondrosarcoma 03(2.43%) Non diagnostic 09(7.31%) as shown in table no 2

 

Table No.2: Adult brain tumours distribution

Diagnosis

Number of Patients

Percentage %

GBM

27

21.95 %

Meningioma

25

20.32 %

Benign

25

20.32 %

Low grade glioma

23

18.69 %

Metastatic carcinoma

05

4.06 %

High grade glioma

04

3.25

DLBCL

02

1.62 %

Mesenchymal chondrosarcoma

03

2.43 %

Non diagnostic

09

7.31 %

Total

123

100 %

 

Table No. 3: Age and Gender distribution

Age (Years)

Male

Female

2-14

15 (9.7%)

7 (33.33%)

15-30

25 (16.23%)

5 (23.80%)

31-45

25 (16.23%)

3 (14.28%)

46-60

30 (19.49%)

5 (23.80%)

61-76

31 (20.13%)

7 (33.33%)

77-82

30 (19.49%)

4 (19.04%)

Total

154 (100%)

21 (100%)

One hundred seventy five patients with brain tumors, of ages between 2-82 years had underwent surgery during the study period. Out of these, 154(88%) were males and 21(12%) were females. Male to female ratio was 13.63:1. The mean age of patients was 6.73 (±0.21) years. A distinct overall male predominance was noted in all tumor types.

DISCUSSION

The current investigation was intended to decide the recurrence of Brain Tumors from January 2010 to February 2014. Our examination uncovered male prevalence with by and large male to female proportion of 13.63:1, which is in accordance with past studies9-12. As it is a medical clinic based examination, it is preposterous to expect to figure tumor rate. In past investigations a moderately lower recurrence was accounted for. Grover and Hardas announced a recurrence of 8.2% in Bombay Cancer Registry13. Khan et al announced 9% recurrence of youth mind tumors14. Present examination uncovered the greater part of the patients in age bunch 6-8 which is about as per a past report done by Ahmed et al10 who revealed most cases in age bunch 5-9. Anyway Velema and Percy; and Memon et al detailed most cases in lower age group11,15. In our examination mean age for tumor occurrence was 6.73. The mean age was 6 years in a past report revealed by Farwell et al16 while Ahmed
et al10 and Mehrzin et al17 announced mean age as 8.8 and 8.7 years separately which is higher than our examination. Medulloblastoma was the most successive tumor in youngsters as indicated by our examination establishing 24% of complete cases and is equivalent to concentrate by Young et al and Ahmed et al, where it was additionally the main tumor type10,18. Some different investigations have detailed astrocytoma as the most well-known youth tumor dissimilar to our study11,19. Our investigation repudiates with contemplates done by Mehrazine et al, Rehman et al and Khan et al who revealed meningioma, neuroma and gliomas as the most ruling kinds of youth tumors12,14,19. The greater part of the studies10,11,19 indicated roughly the comparable %age of ependymoma as detailed in the current investigation (9.5%). In some studies14,17 lower rates of ependymoma is appeared. The present examination is a solitary establishment study and needs wary translation. Morphology is the way in to the conclusion and sub typing of these biopsies; in any case, this ought to be joined with clinical history, radiological connection, and proper examining. Old style morphological highlights by and large consider right finding. Challenges may emerge when tumor show irregular morphology, are, ineffectively separated or blended sort. Metastatic tumors from different locales can be of indicative difficulties. In such cases Immuno histochemistry is very useful in setting up right diagnosis20. Changes embraced with respect to analytic and treatment since mid-1970s have brought about improved endurance rates for patients analyzed as Medulloblastoma, oligodendroglioma, and astrocytoma, particularly controlling for age at determination. Glioblastoma multiform keeps on being the most obstinate essential mind tumor21. In grown-ups the astrocytomas were the commonest tumors comprising 47% and meningioma was the second most successive tumor 21%. This is similar to worldwide statistics22. Morphology alone had the option to analyze the majority of the cerebrum tumors. In kids for instances of Medulloblastoma and little round blue cell tumor Immunohistochemistry was required for the affirmation of the conclusion. In grown-ups Immunohistochemistry was required in instances of metastatic carcinomas and lymphomas. So as to get a corroborative finding a board of Immunohistochemical stains involving CK, S100, GFAP, EMA, LCA, CD20, CD56, chromogranin and synaptophysin was used23. ImranaTanvir, Rahat Malik, RizwanUllah Kh.

CONCLUSION

Population-based studies are required to determine the cancer burden due to pediatric malignancies of the brain in this population and for the morphological categorization of brain tumors in Pakistan. Conventional hematoxylin-eosin staining is the mainstay for pathological diagnosis in most of the cases, however IHC has a major role in differential diagnosis and improving diagnostic accuracy in difficult cases not only in general surgical pathology but also in neurooncologic pathology.

Author’s Contribution:

Concept & Design of Study:

Nauman Idris Butt

Drafting:

Fatima Kashif, Faisal Iqbal

Data Analysis:

Shafiq Ur Rehman, Kamran Hamid

Revisiting Critically:

Nauman Idris Butt, Fatima Kashif

Final Approval of version:

Nauman Idris Butt

Conflict of Interest: The study has no conflict of interest to declare by any author.

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