Histopathological Analysis of Brain Tumours- A Seven Year Study from a Tertiary Care Centre in South India

The Spectrum of Central Nervous System Tumors at a Tertiary Care Center Primarily Serving a Rural Population

Background Central nervous system (CNS) tumors cause significant mortality and morbidity in all age groups. There was no data about the histological spectrum of all CNS tumors in the tertiary care center serving primarily the rural population of Uttar Pradesh. Aims and objectives The present study aimed to describe the histopathological spectrum of all CNS tumors reported in a rural tertiary care center at Saifai, Uttar Pradesh. It also aimed to provide an overview of the descriptive epidemiology of CNS tumors. Material and methods This was a retrospective, cross-sectional study. The study duration was three years. A total of 115 cases of CNS tumors were studied during that period. Cases were classified according to their histological types, and results were analyzed. Results The most common histological group was neuroepithelial tumors, with 53 cases (46.08%). This group had 36 cases of astrocytic tumors (31.3%), three cases of oligodendroglial tumors (2.6%), five cases of oligoastrocytic tumors (4.34%), five cases of ependymal tumors (4.34%), and four cases of embryonal tumors (3.47%). The second most common tumor was meningeal tumors, with 32 cases (27.82%). The male/female ratio (M/F) ratio was 0.7. Females were found to be more affected by almost all histologic categories. Most meningiomas (89.6%) were of World Health Organization (WHO) grade I (26 cases out of 29). Astrocytic tumors showed WHO grade I, II, III, and IV tumors in two cases (5.5%), twelve cases (33.3%), four cases (11.1%), and eighteen cases (50%), respectively. In the younger age group (0-20 years), ependymoma and medulloblastoma were most common, followed by pilocytic astrocytoma and schwannoma. Conclusion In this region, neuroepithelial tumors were seen more commonly than meningioma. Females were found to be more affected by CNS tumors. This study has provided relevant data, which can be used for research and better patient management. Further studies with the incorporation of advanced radiological investigation and immunohistochemistry have been recommended.

Demographic and Diagnostic Spectrum of Neurosurgical Biopsies: Initial Experience From a Re-established Neurosurgical Unit in a Tertiary Hospital in North Central Nigeria

Introduction Neurosurgical biopsies are obtained from lesions of the central nervous system, comprising the skull, brain, spine, spinal cord, and nerves. Neurosurgery practice is a highly specialized field with wide disparities related to access to care, especially in developing countries where there are few specialists and poor support care for patients. After over 20 years of redundancy, the neurosurgical unit in Jos University Teaching Hospital (JUTH), Jos, Plateau State, Nigeria, was re-established to meet the needs of patients in the area of neurosurgery. The aim of the study is to document the demographic and diagnostic spectrum of neurosurgical biopsies obtained in JUTH in the first five years of the re-establishment of its neurosurgical unit, highlighting the need for inclusion of neurosurgical services in health planning and resource allocation; and to compare these findings to similar studies elsewhere. Materials and methods This was a retrospective, descriptive, hospital-based study of neurosurgical lesions diagnosed in the Department of Histopathology at JUTH between January 2011 and December 2015. One hundred and forty-five lesions met the inclusion criteria out of 151 in the records and were studied. Archival slides of these neurosurgical biopsies were retrieved, and fresh sections were re-cut and stained with hematoxylin and eosin (H&E) where necessary. The diagnoses of some of the neoplastic lesions were confirmed by immunohistochemistry. The data obtained was analyzed, and the results are presented as tables, bar charts, ratios, and percentages. Results Thirty-one different lesions were diagnosed. The lesions most commonly diagnosed were traumatic/degenerative intervertebral disc, 54/145 (37.2%); neoplastic, 48/145 (33.1%); and congenital, 31/145 (21.4%), while inflammatory/infectious, 9/145 (6.2%); and vascular, 3 (2.0%) lesions were the least. Bimodal peak frequencies involving the 0-14 years and 30-44 years age ranges were noted for the neoplastic lesions, occurring 37.5% (18/48) in the 0-14 years and 25% (12/48) in the 30-44 years, respectively. The 31 congenital anomalies diagnosed were all neural tube defects, and of these, occipital encephalocele, 10/31 (32.3%) and myelomeningocele, 9/31 (29.0%) were diagnosed most frequently. Of the neoplastic lesions, 66.7% (32/48) were benign and low-grade, and 33.3% (16) were malignant. Meningioma, 14/32 (43.8%), was the most common benign and low-grade neoplasm and accounted for 29.1% (14/48) of all neoplastic lesions. Astrocytoma (WHO grades I, II), 25% (8/32), was the next most common benign and low-grade neoplasm and accounted for 16.7% (8/48) overall. Astrocytoma (WHO grades III, IV), 8/16 (50%), was the most common malignant neoplasm and accounted for 16.7% (8/48) overall. Overall, neuroepithelial tumors, both benign and low-grade, and malignant, 43.8% (21/48), were the commonest neoplastic lesions. Most neoplastic lesions occurred in the brain, 75% (32/48), followed by the spine, 10.4% (5/48), and skull, 8.3% (4/48); while the least common was the spinal cord, 2.1% (1/48). The sex distribution of the neoplastic lesions showed almost equal frequency between males and females, 23/48 (47.9%) and 25/48 (52.1%). Conclusion The spectrum of neurological lesions highlighted in this study demonstrates that neurosurgical lesions abound in our environment with a similar prevalence to other regions of the world, and therefore speaks to the need for neurosurgical services.

The Use of Photodynamic Therapy in the Treatment of Brain Tumors-A Review of the Literature

The treatment of neoplastic disease of the brain is still a challenge for modern medicine. Therefore, advanced methodologies are needed that can rationally and successfully contribute to the early diagnosis of primary and metastatic tumors growing within the brain. Photodynamic therapy (PDT) seems to be a valuable method of treatment for precancerous and cancerous lesions including brain tumors. The main advantage of PDT is its high efficiency, minimal invasiveness and no serious side effects, compared with chemotherapy and radiotherapy. This review was conducted through a comprehensive search of articles, scientific information databases and the websites of organizations dealing with cancer treatment. Key points from clinical trials conducted by other researchers are also discussed. The common databases such as PubMed, Google Scholar, EBSCO, Scopus, and Elsevier were used. Articles in the English language of reliable credibility were mainly analyzed. The type of publications considered included clinical and preclinical studies, systematic reviews, and case reports. Based on these collected materials, we see that scientists have already demonstrated the potential of PDT application in the field of brain tumors. Therefore, in this review, the treatment of neoplasm of the Central Nervous System (CNS) and the most common tumor, glioblastoma multiforme (GBM), have been explored. In addition, an overview of the general principles of PDT, as well as the mechanism of action of the therapy as a therapeutic platform for brain tumors, is described. The research was carried out in June 2022.

Trends in clinico-epidemiology profile of surgically operated glioma patients in a tertiary care center over 12 years—through the looking glass!

Background

Hospital-based cancer registries can provide information on the magnitude and distribution of cancers in a given hospital. Hospital-based brain tumor registry data, focusing on glioma, from a tertiary care rural neurological center is lacking in the scientific literature. This data can be useful in understanding the need for research and funding required for these specific brain tumors.

Data of patients operated for glioma, at our institute, was collected between January 2004 and December 2015. Patients’ clinical details and histopathological diagnosis were recorded. Data were analyzed and compared with that of previously published literature, and inferences were drawn on patterns of reporting and epidemiology.

Results

A total of 1450 cases of glioma, with a mean age of 39.3 (± 17.36 SD) years with males (66.6%) comprising more population as compared to females. Majority of patients 70.8% (n = 1027) belong to the economically active age group of country (18–60 years). Majority of cases (41.4%) were glioblastoma with the next common tumor (22.8%) being diffuse astrocytoma (n = 331) followed by pilocytic astrocytoma (6.2%) and oligodendroglioma (4.5%) in that order. While our data followed similar trends with other Indian data the average age of glioma was a decade younger to what is quoted earlier in Indian and international studies.

Conclusion

This data for glioma gives a glimpse of the prevalence of this tumor in a primarily rural population and highlights the need for a National Brain Tumor Registry with the need for the development of evidence-based policymaking and enhanced research into this particular ailment.

Gliomas - An experience based on molecular markers

Background

Gliomas account for 45% of all intracranial tumors. Newer technologies have allowed deeper genetic and epigenetic analysis leading to the discovery of IDH (Isocitrate dehydrogenase) mutations and their association with ATRX (alpha-thalassemia/mental retardation syndrome X-linked) and p53, for better diagnosis and prognosis. In this study, we analysed their expression and correlated with various clinicopathological parameters. A follow up to prognosticate gliomas based on the molecular findings is also attempted.

Materials and Method

During last 5 years both retrospective and prospective cases were included in the study. Immunohistochemistry for IDH1, ATRX, and p53 was done and reported based on intensity and percentage of tumor cells expressing the markers.

Results

A total of 53 cases of gliomas were included, excluding primary glioblastomas and ependymomas. The patient's age ranged from 10 to 53 years. The male to female ratio was 1.3:1. IDH1 positivity was seen in 88% of diffuse astrocytoma, 80% of anaplastic astrocytoma, 90% of oligodendroglioma, 60% of anaplastic oligodendroglioma, and 54% of glioblastoma. A significant association was seen between positive IDH1 expression and low-grade gliomas (p = 0.028). A combined analysis of expression of IDH1 and ATRX versus IDH1, ATRX, and p53 with WHO grade showed a statistically significant association. A follow-up of 32 patients was available. Out of 24 IDH1+ (positive) cases, 22 patients had a median survival of 21.5 months (92%). Out of 8 IDH1- (negative) cases, 5 had a median survival of 15.8 months (62%).

Conclusion

Gliomas expressing IDH1 mutation show improved survival of patients. Combined analysis of IDH1, ATRX, and p53 has diagnostic and prognostic significance. For routine cases of gliomas, a combination of IDH1 and ATRX are sufficient; however, the use of p53 is recommended for further prognostication and for possible targeted therapy in the future.

The Analysis of Human Serum N-Glycosylation in Patients with Primary and Metastatic Brain Tumors

The identification of patients with different brain tumors is solely built on imaging diagnostics, indicating the need for novel methods to facilitate disease recognition. Glycosylation is a chemical modification of proteins, reportedly altered in several inflammatory and malignant diseases, providing a potential alternative route for disease detection. In this paper, we report the quantitative analysis of serum N-glycosylation of patients diagnosed with primary and metastatic brain tumors. PNGase-F-digested and procainamide-labeled serum glycans were purified by magnetic nanoparticles, followed by quantitative liquid chromatographic analysis. The glycan structures were identified by the combination of single quad mass spectrometric detection and exoglycosidase digestions. Linear discriminant analysis provided a clear separation of different disease groups and healthy controls based on their N-glycome pattern. Altered distribution of biantennary neutral, sialylated but nonfucosylated, and sialylated-fucosylated structures were found to be the most significant changes. Our results demonstrate that serum glycosylation monitoring could improve the detection of malignancy.