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Pediatric brain tumours at a tertiary care hospital in Karachi
Naseem Ahmed1, Yasmin Bhurgri, Saleem Sadiq
1Department of Pathology, Basic Medical Sciences Institute, Karachi.
Insights
This study analyzed childhood brain tumors in Karachi, finding a male predominance and a peak incidence in the 5-9 age group. Medulloblastoma was the most common type, unlike in developed nations.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Epidemiology
Background:
- Childhood brain tumors represent a significant health concern globally.
- Understanding the epidemiology and morphology of these tumors is crucial for diagnosis and treatment.
- Data from developing countries like Pakistan are essential for a comprehensive global perspective.
Purpose of the Study:
- To determine the epidemiology of pediatric brain tumors in Karachi.
- To define and categorize childhood brain tumors based on morphological characteristics.
- To compare findings with global trends in pediatric neuro-oncology.
Main Methods:
- Retrospective analysis of 81 pediatric brain tumor cases (ICD-10 C71) from 1989-1998 at a tertiary care hospital.
- Data collection included patient demographics, tumor site, and histological subtype.
- Statistical analysis of epidemiological and morphological data.
Main Results:
- A male predominance (2.5:1 ratio) and peak incidence in the 5-9 year age group were observed.
- Medulloblastoma (49.4%) and astrocytoma (34.6%) were the most common histological types.
- Infratentorial tumors (66.7%) were more prevalent than supratentorial tumors (33.3%).
Conclusions:
- Pediatric brain tumors in Karachi show a male predisposition and later presentation compared to developed countries.
- A predominance of medulloblastoma and a relative paucity of astrocytomas were noted.
- Population-based studies are recommended to ascertain the true cancer burden and refine morphological classifications.
Abstract:
The objectives of this study were to determine the epidemiology of brain tumors during infancy and childhood and to define and segregate childhood brain tumors vis-a-vis their morphological characteristics. The present study includes pediatric brain tumors, ICD-10 category C71 encountered during 10 years (January 1989 through December 1998) at a tertiary care hospital in Karachi. Eighty one cases were included, 58 (71.6%) in males and 23 (28.4%) in females with a male to female ratio of 2.5:1. The cases were divided into 3 age groups each covering five years of life (0-4, 5-9, 10-14 years), with the greatest number in the second age group i.e. 5-9 years followed by the third age group and the 0-4 year age group. The mean age for all cases, both genders was 8.8 years (95% CI 7.9; 9.6) with a marginal variation for cases occurring in the cerebrum and cerebellum. The malignancies occurred at a younger age in the males for each subcategory by site and morphology. The morphological distribution of cases was astrocytoma (28 cases, 34.6%), primitive neuroectodermal tumor or PNET (40 cases; 49.4%), ependymoma (8 cases, 10%), mixed glioma (4 cases; 5%) and a case of oligodendroglioma. The 81 malignancies included in this study were further categorized by site into two groups, supratentorial (27 cases; 33.3%) and infratentorial (54 cases; 66.7%). The morphological categorization of supratentorial tumors was astrocytoma (17 cases; 63%), ependymoma (5 cases; 18.5%), mixed glioma (2 cases; 7.4%). PNET with rhabdoid differentiation, oligodendroglioma and pinealoblastoma comprised 1 case (3.7%) each. The 17 supratentorial astrocytoma were sub-categorized as follows - pilocytic astrocytoma (5 cases; 29.4%), grade II astrocytoma (6 cases; 35.3%); grade III astrocytoma (2 cases; 11.8%), anaplastic astrocytoma (1 case; 5.9%) and glioblastoma multiforme (3 cases; 17.7%). The morphological categorization of infratentorial tumors was astrocytoma (11 cases; 20.4%), medulloblastoma (38 cases; 70.4%), ependymoma (3 cases; 5.6%) and mixed glioma - astroependymoma (2 cases, 3.7%). The morphological sub-categorization of infratentorial astrocytoma was pilocytic astrocytoma (7 cases, 63.6%), with gemistocytic astrocytoma, grade II, grade III and anaplastic astrocytoma comprising 1 (9.1%) case each. The morphological categorization of medulloblastoma was classical medulloblastoma (15 cases; 39.5%), desmoplastic medulloblastoma (8 cases; 21.1%), medulloblastoma with astrocytic differentiation (12 cases; 31.5%), medulloblastoma with neural differentiation (2 cases; 5.3%), and neuroblastic medulloblastoma (1 case; 2.6%). The pediatric brain tumors in Karachi reflect a developing country scenario, with a strong male predisposition and a late presentation with a peak in the 5-9 year age group. There is a predominance of medulloblastoma and a paucity of astrocytomas. The current study is a single institution study and needs cautious interpretation. 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 Karachi.
