|Year : 2018 | Volume
| Issue : 1 | Page : 30-33
Retrospective analysis of incidence of central nervous system tumors in a tertiary care centre: A 3-year study
Neha Yadav, Sant Prakash Kataria, Jyoti Sharma, Sunita Singh, Nisha Marwah, Sanjay Kumar, Gajender Singh
Department of Pathology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
|Date of Web Publication||10-Sep-2018|
Dr. Sant Prakash Kataria
Department of Pathology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana
Source of Support: None, Conflict of Interest: None
Introduction: Tumors of the central nervous system (CNS) are rare neoplasm constituting <2% of all malignancies. In India, CNS tumors constitute about 1.9% of all tumors. The objective of this study is to have an insight into the pattern of CNS lesions over a period of 3 years in a tertiary care hospital retrospectively. Materials and Methods: A retrospective study was conducted at the Department of Pathology, Pandit Bhagwat Dayal Sharma, Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, a tertiary care hospital, over a period of 3 years. Two hundred and thirty-nine cases of CNS lesions reported during this period comprised the patients of the study. All data and information were archived from the case records maintained in the histopathological division of the Department of Pathology. Results: The age of the patients ranged from 2 to 65 years, with the mean age of 43.28 years. Majority of the cases were seen in the age group of 28–58 years (70%). Overall, males slightly outnumbered females; however, meningioma is an exception with higher rates in females. Majority of tumors were intracranial (96.2%) and remaining (3.76%) were spinal. Of the intracranial cases, frontal lobe was the most common site (25.5%) followed by temporoparietal lobe (13.2%). Astrocytomas comprising 84 (35.2%) cases constituted the largest group of the present study, followed by meningioma constituting 22.2% of all CNS tumors and glioblastoma forming the largest subtype of astrocytic tumor (35.7%). Among 16 pediatric cases, astrocytomas (6 cases) were more common as compared to medulloblastoma (4 cases). Conclusion: The most frequent type of CNS tumor in the present study was astrocytoma, followed by meningioma. The ratio of male: female for all CNS tumors was 1.06:1. Females outnumbered males in meningioma (2.8:1).
Keywords: Astrocytoma, central nervous system tumors, retrospective analysis
|How to cite this article:|
Yadav N, Kataria SP, Sharma J, Singh S, Marwah N, Kumar S, Singh G. Retrospective analysis of incidence of central nervous system tumors in a tertiary care centre: A 3-year study. J Datta Meghe Inst Med Sci Univ 2018;13:30-3
|How to cite this URL:|
Yadav N, Kataria SP, Sharma J, Singh S, Marwah N, Kumar S, Singh G. Retrospective analysis of incidence of central nervous system tumors in a tertiary care centre: A 3-year study. J Datta Meghe Inst Med Sci Univ [serial online] 2018 [cited 2020 Jul 9];13:30-3. Available from: http://www.journaldmims.com/text.asp?2018/13/1/30/240897
| Introduction|| |
Central nervous system (CNS) neoplasms represent a unique, heterogeneous population of neoplasms and include both benign and malignant tumors. In most developed countries, brain tumors are the 12th most frequent cause of cancer-related mortality in men. Geographical variation in incidence is less than that for most other human neoplasms. CNS tumors are reported to be <2% of all malignancies. In India, they constitute about 1.9% of all tumors. However, the incidence rate tends to be higher in more developed countries. The age distribution of brain tumors is said to be bimodal, with one peak seen in children and a second large peak in adults aged 45–70 years. CNS tumors that predominate in adults differ from those seen in children. Most pediatric neoplasms occur in the posterior fossa; however, in adults, majority of CNS tumors arise in anterior fossa. Heritable syndromes and ionizing radiations are the only two established causes of primary CNS neoplasms. The World Health Organization (WHO) classification offers a crude histological grading system, in which each CNS tumor is classified as Grade I–IV according to its degree of malignancy. During the past decade, the incidence of glioblastomas in the elderly has increased by 1%–2%/year due to some extent; this may be due to the introduction of high-resolution neuroimaging. The brain is also a frequent site of metastases, with carcinoma of the breast and lung being most frequent primary tumors. The main aim of the study was to determine the relative frequency of CNS tumors in our region according to the WHO classification.
| Materials and Methods|| |
A retrospective study was conducted at the Department of Pathology, PGIMS, Rohtak, Haryana, a tertiary care hospital, over a period of 3 years. A total of 239 cases of CNS neoplasms were diagnosed during this period. The diagnosis in all the cases was made on hematoxylin and eosin-stained slides of the biopsy received. Special stains such as reticulin, periodic acid–Schiff, and immunohistochemistry were applied wherever necessary. The histological categorization and grading of CNS tumors were done according to the WHO 2007 classification.
| Results|| |
During this study, a total of 239 cases of CNS tumors were found. Of 239 cases, 218 cases were of malignant, 21 cases were of benign, and 6 cases were excluded due to inadequate biopsy. The age of the patients ranged from 2 to 65 years, with the mean age of 43.28 years. Majority (70%) of the cases were seen in the age group of 28–58 years. Overall, males (n = 123, 51.5%) slightly outnumbered females (n = 116, 48.5%), ratio being 1.06:1. However, meningioma is an exception with higher rates in females (ratio 1:2.8).
Majority (230 cases, 96.2%) of the tumors were intracranial, whereas the remaining 9 (3.76%) cases were spinal. Of the intracranial cases, frontal lobe was the most common site involved (25.5%) followed by temporoparietal lobe (13.2%). Headache was the most common symptom seen in intracranial tumors followed by seizures.
Among intracranial tumors, astrocytomas constituted the largest group (35.2%) of the present study, mostly seen after the third decade of life. Glioblastoma forms the largest subtype of astrocytic tumor (35.7%), mostly seen in the fifth or sixth decade of life [Figure 1]. Meningioma was the second most common group of tumors involving CNS constituting 22.2% of all tumors, followed by pituitary adenoma (10.9%) [Figure 2]. Meningioma was the most common spinal tumor [Table 1].
|Figure 1: Photomicrograph showing (a) Pilocytic astrocytoma (H and E, ×200). (b) Diffuse astrocytoma (H and E, ×200). (c) Anaplastic astrocytoma (H and E, ×200). (d) Glioblastoma multiforme (H and E, ×200)|
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|Figure 2: Photomicrograph showing (a) Meningioma (H and E, ×200). (b) Schwannoma (H and E, ×200). (c) Oligodendroglioma (H and E, ×200). (d) Ependymoma (H and E, ×200)|
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|Table 1: Histopathological types of various central nervous system neoplasms|
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The study showed that overall malignant lesions (218 cases) were more commonly encountered than benign lesions (21 cases). Among malignant lesions, most of were primary malignant brain tumors (89%), whereas secondary of brain tumors constituted 2.3%.
Increased incidence of malignant neoplasms was observed in the third and fourth decades as compared to fifth and sixth decades which showed lower incidence [Table 2].
Among 14 pediatric cases, astrocytomas (6 cases) were more common as compared to medulloblastoma (4 cases) [Table 3] and [Figure 3].
|Table 3: Histopathological types of central nervous system neoplasms in children|
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|Figure 3: Photomicrograph showing (a) Medulloblastoma (H and E, ×200). (b) Pituitary adenoma (H and E, ×200). (c) Lymphoma (H and E, ×200). (d) Metastatic carcinoma (H and E, ×200)|
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The study revealed that Grade I tumors were more commonly observed, constituting 60.3% of all CNS neoplasms [Table 4]. However, among astrocytic tumors, Grade IV tumors (35.7%) were commonly seen as compared to Grade I (15.8%) as per the WHO classification.
|Table 4: Frequency of various central nervous system tumors according to the WHO grading|
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Majority of the CNS tumors (60.3%) belonged to Grade I, followed by 12.1% of Grade II, 8.4% of Grade III, and 19.2% of Grade IV.
| Discussion|| |
CNS tumors are rare neoplasms reported to <2% of all malignancies. In India, CNS tumors constitute about 1.9% of all tumors. In our study, a bimodal peak of age distribution was observed: one peak is seen in children and other seen in around 40–65 years of age group. Overall males are slightly more affected than females (1.06:1), meningiomas being an exception with higher frequency in females (1:2.8), as observed in other studies also.,, In our study, intracranial tumors were more common (96.2%) as compared to spinal tumors (3.76%). Frontal lobe (25.5%) was the most common site involved followed by temporoparietal lobe (13.2%) in our study. Torres et al., Andrews et al., and Jamal et al. also mentioned the frontal lobe as common site followed by temporoparietal lobe. In the present study, astrocytomas were the most common tumors (84 cases), constituting 35.2% of all CNS neoplasms. Ahmed et al., Ghosh et al., Jalali and Datta, and Patty  also reported astrocytomas to be the most common tumors in their studies. Glioblastoma forms the largest subtype of astrocytic tumors and mainly affects adults. These tumors are surgically incurable and largely resistant to radiation and chemotherapy, having fatal outcomes; only 3% of patients survived >3 years. Meningiomas were the second most common tumors (54 cases), constituting 22.2% of all CNS neoplasms followed by pituitary adenoma (10.9%). Similar incidence was reported by Iyengar and Chandra, Ahmed et al., and Patty.
Embryonal tumors including cerebellar medulloblastomas, retinoblastomas, and peripheral neuroblastomas predominantly affect children, ranked second after leukemia as the most common type of pediatric cancer. Among 14 pediatric cases, astrocytomas (6 cases, 2.8%) were commonly seen as compared to medulloblastoma, which consists of 4 (1.8%) cases.
CNS lymphoma constituted 0.8%–1.5% and in some series even up to 6.6% were reported. In our study, we found CNS lymphoma to be 1.89% of all tumors. Among metastatic deposits, most of them were from poorly differentiated carcinoma.
Overall, the WHO Grade I lesions were more common in our region constituting 60.3% of all CNS neoplasm. However, among astrocytic tumors, the WHO Grade IV lesion was more common in comparison to Grade I lesions, indicating the need for imaging and neurology consultation at primary grass root level.
| Conclusion|| |
In this study, overall, malignant tumors were more commonly encountered than benign lesions. The most frequent type of CNS tumors seen was astrocytoma, glioblastoma being the most common subtype. The second most common tumor was meningioma followed by pituitary adenoma. Males were slightly more affected than females. This study may provide the representative incidence and highlights the histological diversity of various types of CNS tumors in both adults and pediatric age groups in our area.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Ferlay J, Bray F, Parkin DM, Pisani P. Cancer Incidence and Mortality Worldwide (IARC Cancer Bases No. 5). Lyon: IARC Press, Globocan; 2000.
Stewart BW, Kleihues P. Tumors of the nervous system. In: World Cancer Report. Lyon, France: IARC Press; 2003.
Iyengar B, Chandra K. The pattern of distribution of tumours in the brain and spinal cord. Indian J Cancer 1974;11:134-8.
Lantos PL, Louis DN, Rosenblum MK, Kleihues P. Tumors of the nervous system. In: Graham Dl, Lantos PL editors, Greenfield's Neuropathology. 7th
ed. London: Arnold; 2002.
Preston-Martin S. Epidemiology of primary CNS neoplasms. Neurol Clin 1996;14:273-90.
Rohringer M, Sutherland GR, Louw DF, Sima AA. Incidence and clinicopathological features of meningioma. J Neurosurg 1989;71:665-72.
Das A, Chapman CA, Yap WM. Histological subtypes of symptomatic central nervous system tumours in Singapore. J Neurol Neurosurg Psychiatry 2000;68:372-4.
Hadidy AM, Nadi MM, Ahmad TM, Al-Hussaini MA, Al-Abaddi AA, Musharbash AF, et al.
Descriptive epidemiological analysis, MRI signals intensity and histopathological correlations of meningiomas. Neurosciences (Riyadh) 2010;15:11-4.
Torres LF, Almeida R, Avila S, Alessi S, Freitas R. Brain tumours in South Brazil: A retrospective study of 438 cases. Arq Neuropsiquiatr 1990;48:279-85.
Andrews NB, Ramesh R, Odjidja T. A preliminary survey of central nervous system tumors in Tema, Ghana. West Afr J Med 2003;22:167-72.
Jamal S, Moghal S, Mamoon N, Mushtaq S, Luqman M, Anwar M. Pattern of central nervous system tumors: A study of 430 cases. Pak J Pathol 2005;16:106-9.
Ahmed Z, Muzaffar S, Kayani N, Pervez S, Husainy AS, Hasan SH, et al.
Histological pattern of central nervous system neoplasms. J Pak Med Assoc 2001;51:154-7.
Ghosh A, Sarkar S, Begum Z, Dutta S, Mukherjee J, Bhattacharjee M, et al.
The first cross sectional survey on intracranial malignancy in Kolkata, India: Reflection of the state of the art in Southern West Bengal. Asian Pac J Cancer Prev 2004;5:259-67.
Jalali R, Datta D. Prospective analysis of incidence of central nervous tumors presenting in a tertiary cancer hospital from India. J Neurooncol 2008;87:111-4.
Patty IS. Central nervous system tumors: A clinicopathological study. J Dohuk Univ 2008;11:173-9.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]