Abstract
Background: Recent studies, including a comprehensive study by National Cancer Institute, have shown that a significant increase in the incidence of childhood brain tumours makes them the most common paediatric tumour. The objectives of this study were to determine the frequency of central nervous system tumours in paediatric age group (0–12 years), and to segregate various morphologic types according to WHO classification. Methods: The study included consecutive cases of central nervous system tumours diagnosed in children in the histopathology department at Federal Government Polyclinic, PGMI, Islamabad, during a period of 4.8 years (Jan 2009–Aug 2013). The initial histopathological evaluation of these lesions was performed on H&E stained sections of paraffin embedded tissues. Special stains and immunohistochemistry were performed whenever indicated. Results: Out of 75 cases, 34 (45.3%) were astrocytic tumours, including 16(47.1%) Pilocytic astrocytomas (WHO Grade-I), 1 (2.9%) diffuse fibrillary astrocytoma (WHO Grade-II), 1 (2.9%) anaplastic astrocytoma (WHO Grade-III) and 16(47.1%) glioblastoma multiforme (WHO Grade-IV); 18 (24%) were embryonal tumours including 17 (94.4%) medulloblastoma (WHO Grade-IV) and 1 (5.6%) neuroblastoma (WHO Grade IV); 10 (13.3%) were craniopharyngiomas (WHO Grade-I) and 5 (6.7%) were ependymal tumours including 1 (20%) myxopapillary ependymoma (WHO Grade-I) and 4 (80%) ependymomas (WHO Grade-II). Miscellaneous entities included 3 (4%) choroid plexus tumours; 1 (2%) anaplastic oligodendroglioma (WHO Grade-III); 1 (2%) atypical meningioma (WHO Grade-II); 1 (2%) schwannoma (WHO Grade-I); 1 (2%) neurofibroma (WHO Grade-I) and 1 (2%) lipoma (WHO Grade-I). Conclusion: Astrocytic tumours are the most common central nervous system tumours in paediatric age group and high grade lesions (WHO Grade-IV) constitute the largest category (45.3%). Keywords: Paediatric, Central nervous system, Astrocytoma, Medulloblastoma,Pilocytic, astrocytomas, craniopharyngiomasJ Ayub Med Coll Abbottabad 2016;28(1):44–6INTRODUCTIONFor several decades,paediatric brain tumours were reported to be the most common type of cancer in children,second only to leukaemia.But recent studies,including a comprehensive study by National Cancer Institute, have shown that an increasingincidence of childhood brain tumours makes them the most common malignancy in paediatric age group.1In United States,brain and CNS tumours in children younger than 15 years occurred at an annual rate of 3.45 per 100,000 person years in 19942,which increased to a corresponding value of 4.92 per 100,000 person years in 2004-20083.This is partly attributed to the use of more sophisticated diagnostic methods including CT scan and MRI.4However environmental and genetic factors cannot be completely ruled out.5In developing countries the prevalence rate has been reported from 4.38–12.6%,while in developed countries it is only 2%.6Part of this may be due to the fact that children make up a large proportion of our population (Approximately 39%).7Morbidity and mortality caused by these tumours is a serious issue which needs to be addressed.Overall 5 year survival rate for brain and central nervous system tumours according to Central Brain Tumour Registry of United States was estimated to be 71.9%,with a wide range between low and high grade tumour types.For example,estimated 5 year survival rates for pilocytic astrocytoma(WHO grade I),medulloblastoma(WHO grade IV) and glioblastoma(WHO grade IV) were 97.1%,61.5% and 20.5% respectively.3Although hospital based studies cannot give exact incidence rates,however,the information may be useful in giving patterns of these tumours in our region.8Keeping in view these facts and figures,the aim of this study was to provide a comprehensive data regarding the prevalence of central nervous system tumours in children in our vicinity by using an updated WHO classification,so that better management of these tumours can be planned in future.MATERIAL AND METHODSThe study was conducted in the histopathology department of Federal Government Polyclinic, PGMI Islamabad. Most of the cases were received from Neurosurgery department,Pakistan Institute of Medical Sciences(PIMS) hospital, Islamabad,while a few cases were from private hospitals.The time span was 4.8
Mohammad Tahir, , Samina Khaleeq, Mohammad Tahi, Khaleeq-uz-Zamaan. (2016) MORPHOLOGICAL PATTERN AND FREQUENCY OF CENTRAL NERVOUS SYSTEM TUMOURS IN CHILDREN, JOURNAL OF AYUB MEDICAL COLLEGE ABBOTTABAD, Volume 28, Issue 1.
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