Epidemiología descriptiva y cambios en la frecuencia de tumores astrocíticos en el Instituto Nacional de Neurología y Neurocirugía de México / Descriptive epidemiology and frequency variations of astrocytic tumors in the National Institute of Neurology and Neurosurgery of Mexico

Resumen: Objetivo: Determinar distribución, localización y cambios de la frecuencia de tumores astrocíticos (TA) en un instituto mexicano de neurología. Material y métodos: Se revisaron los registros institucionales de TA de cinco décadas. Se compararon las relaciones TA/egresos quirúrgicos (EQ) y TA/total de tumores del sistema nervioso central (TSNC) de 1995 a 2014. Resultados: Se analizaron 2 287 TA (1 356 en hombres y 931 en mujeres). El glioma más común fue el glioblastoma multiforme (GBM), que estuvo presente en adultos jóvenes con una frecuencia mayor a la reportada en otros estudios. La relación TA/EQ y TA/TNSC fue similar entre 1995 y 2014. Conclusiones: En general, la frecuencia de TA atendidos en el Instituto es similar a la reportada internacionalmente. No obstante, los casos de TA en el subgrupo de adultos jóvenes con GBM son más frecuentes (40%) que las incidencias reportadas en otros estudios (menores al 5%). No se encontró variación significativa en la frecuencia de TA durante las últimas dos décadas.

Abstract: Objective: To determine distribution, localization and frequency variations of astrocytic tumors (AT) in a Mexican Institute of neurology. Materials and methods: Institutional registries of AT from five decades were analyzed. AT/Surgical discharges (SD) and AT/Central Nervous System Tumors (CNST) from 1995 to 2014 were compared. Results: Two thousand two hundred and eighty-seven AT (1 356 men and 931 women) were analyzed. The most common glioma was glioblastoma multiforme (GBM), found in young adults with a higher frequency to that reported in other studies. Relation of AT/SD, as well as, relation of AT/CNST was similar between 1995 and 2014. Conclusions: In general, the frequency of AT attended at the Institute is similar to that found worldwide, being only higher the number of GBM in younger adults. There was not significant variation in the frequency of AT during the time studied.

Caracterización clinicohistopatológica, tomográfica y por resonancia magnética de pacientes menores de 15 años con tumores cerebrales / Clinical histopathological, tomographic and by magnetic resonance characterization of patients under 15 years with brain tumors

Se realizó un estudio descriptivo y transversal de 25 pacientes menores de 15 años de edad con diagnóstico confirmado de neoplasia intracraneal, quienes fueron atendidos en el Hospital Infantil Sur de Santiago de Cuba, desde enero del 2010 hasta junio del 2013, a fin de caracterizarles según criterios clinicohistopatológico e imagenológico. En la serie predominaron el grupo etario de 1-5 años, el sexo masculino, la localización infratentorial y las neoplasias de tamaño mediano. Desde el punto de vista clínico, los tumores provocaron convulsiones, papiledema y vómitos. A través de la tomografía axial computarizada se observaron imágenes hipodensas e hiperintensas en T2 y Flair e hipointensas en T1 mediante la resonancia magnética, en casi todos los afectados. El astrocitoma fue el tipo histológico prevaleciente sobre todo en la localización infratentorial y en los niños de 1-5 años

A descriptive and cross-sectional study of 25 patients under 15 years with confirmed diagnosis of intracraneal neoplasm was carried out, who were assisted in the Southern Children Hospital in Santiago de Cuba, from January, 2010 to June, 2013, in order to characterize them according to clinical histopathological and imagenologic criteria. In the series there was a prevalence of 1-5 years age group, male sex, infratentorial localization and medium size neoplasms. From the clinical point of view, the tumors caused convulsions, papilledema and vomits. Through the CT scan, hypodense and hyperintense images were observed in T2 and Flair and through magnetic resonance, hypointense images in T1 were observed in almost all the affected patients. The astrocytoma was the histological prevalent type mainly in the infratentorial localization and in children aged 1-5

Neurotuberculosis mimicking brain tumour; A case report.

Summary: Neurotuberculosis is one of the grave complications of primary tuberculous infection. Extensive BCG vaccination of children and inadequate antituberculous drug therapy have led to the emergence of newer complex clinical pictures and diagnostic dilemma. Here we report a case of right-sided hemiparesis with features of raised intracranial tension in a sixyear- old boy. Neuroimaging revealed presence of a high grade astrocytoma. On clinical examination, right-sided cervical lymphadenopathy with discharging sinus and tenderness over right hip joint were present. On further investigation, these were proved to be of tubercular origin. All preliminary findings were in favour of disseminated tuberculosis, but the nature of CNS lesion was creating diagnostic dilemma. Etiological diagnosis of the CNS lesion was necessary, as, if it was not of tubercular origin, the management protocol would be different and with any delay we could have lost the patient. Though on routine CSF study, no AFB were present, but we confirmed the presence of mycobacterial DNA by polymerase chain reaction. Patient showed considerable improvement after being put on Anti-tubercular Treatment (ATT) and steroids. Tuberculous brain abscess is rare. Very few cases have been reported even in adults. Most reported cases are in immunocompromised patients. This case highlights the fact that tuberculous brain abscess can have atypical presentation even in immunocompetent children mimicking CNS malignancy. Careful examination and thorough investigation are required to establish the diagnosis. Timely initiation of appropriate therapy can reduce mortality and neurological sequelae.

Posterior fossa tumor in children

Primary brain tumors are the most common solid neoplasms of childhood, representing 20% of all pediatric tumors. The best current estimates place the incidence between 2.76 and 4.28/100,000 children per year. Compared with brain tumors in adults, a much higher percentage of pediatric brain tumors arise in the posterior fossa. Infratentorial tumors comprise as many as two thirds of all pediatric brain tumors in some large series. Tumor types that most often occur in the posterior fossa include medulloblastoma, ependymoma, cerebellar astrocytoma and brainstem glioma. All pediatric cases of posterior fossa tumor that were considered for surgery from 1981 to 2011 were selected and the demographic data including age, gender and tumor characteristics along with the location and pathological diagnosis were recorded. The surgical outcomes were assessed according to pathological diagnosis. Our series consisted of 84 patients [52 males, 32 females]. Cerebellar symptoms were the most common cause of presentation [80.9%] followed by headache [73.8%] and vomiting [38.1%]. The most common histology was medulloblastoma [42.8%] followed by cerebellar astrocytoma [28.6%], ependymoma [14.3%], brainstem glioma [7.2%] and miscellaneous pathologies [e.g., dermoid, and tuberculoma] [7.2%]. The diagnosis of brain tumors in the general pediatric population remains challenging. Most symptomatic children require several visits to a physician before the correct diagnosis is made. These patients are often misdiagnosed for gastrointestinal disorders. Greater understanding of the clinical presentation of these tumors and judicious use of modern neuroimaging techniques should lead to more efficacious therapies

spectrum of intradural spinal tumors

To assess the spectrum of clinical, radiological and histological features of patients with intradural spinal tumors. This descriptive study was carried out in Department of Neurosurgery Lady Reading Hospital Peshawar, from April 2003 to March 2009. Medical records of patients with spinal tumors were reviewed and patients operated for intradural spinal tumors were identified. A total of 312 patients, out of 525 cases of spinal tumors, with different intradural spinal tumors were considered in this study. Their clinical features, radiological reports, peroperative findings and histological reports were analyzed in different aspects. There were total of 312 patients with age range from 2 years to 74 years, with median age of 38 years. Out of these 187 were males and 125 were female, overall male to female ratio of 1.5: 1. Backache, leg weakness, parasthesia and poor sphincters were the main clinical features. MRI spine [274 cases] was the main diagnostic tool along with plain X-rays and X-ray myelography in limited cases [35 cases]. CT myelogram was done only in 3 cases. The common site of involvement was dorsal spine followed by lumber and cervical spines respectively in 185, 80 and 47 cases. Histological report was suggestive of Neurofibroma in 166 Meningioma in 96, Ependymoma in 20, Dermoid in 12, Astrocytoma in 7, Hemangioblastom and Tuberculoma in 3 cases each and Hydatid cyst in one case. Neurofibroma and meningioma constituted majority of cases belonging to intradural extramedulary group, while ependymoma and astrocytoma were common intramedullary tumors. Third and 5[th] decade of life was the common age group for both Intramedulary and extramedulary tumors. Intramedulary lesions were common in 3[rd] decade of life

Histological findings of posterior fossa tumors in children

To find out different histopathological types of posterior fossa tumors in children. This Descriptive study was carried out in Department of Neuro surgery Govt. Lady Reading Hospital Peshawar from June 2003 to May 2008, All patients with posterior fossa tumors under 14 years were included in the study. Patient with brainstem glioma, posterior fossa abscesses and pineal tumors were excluded. A total of 117 patients were included. There were 80 male and 37 female with sex ratio of 2.1:1 with age range from 6 months to 14 years with mean age of 8.9 years and SD + 5.4. Computerized Axial Tomography / Magnetic Resonance Imaging of the brain were done for establishing diagnosis. Different surgical procedures for tumor removal were performed and specimen was sent for histopathological study in all operative cases. Out of 117 patients Medulloblastoma was seen in 38 [32.7%], Ependymoma in 23 [19.65%] Astrocystoma in 25 [21.36%], Hemangioblastoma in 19 [16.23%] Tuberculoma in 4 [3.41%] Meningioma in 2 [1.7%] and dermoid and epidermoid cyst in 3 cases each [2.56%]. Medulloblastoma was seen commonly between 6-10 years in 22 [18.8%] patients. Astrocystoma between 6 -10 years in 12[10.25%] patients. Ependymoma is common below 5 years in 17[14.5%] patients. Hemangioblastoma between 6-10 years in 15 [12.82%] patients, tuberculoma in 3[2.56%] patients in 6 -10 years of age. Medulloblastoma and Pilocytic Astrocystoma and Hemangioblastoma are common tumors between 6-10 years of age and Ependymoma is common below 5 years. Tuberculoma is also tumor mimicking condition occurring in posterior fossa

Patterns of malignant tumors of the brain and spinal cord in Bahrain: Fifty two year period

To review malignant neoplasms of the brain and spinal cord in Bahrain, and to compare the incidence with other parts of the world. A retrospective study. All Histopathology Departments in Bahrain. Data relating to all malignant CNS neoplasms which were diagnosed histologically in Bahrain were extracted from the relevant patient medical records. All tumors were histologically diagnosed in Bahrain between 1952 and 2004. There were 103 malignant CNS tumors representing 1.4% of all malignancies histologically reported during the same period. Of the 103 patients, 77 [74.8%] were Bahraini. Of the Bahraini patients, thirty-one [40.3%] were female and the male: female ratio was 1.48:1. Sixty-two of the 77 Bahraini tumors [80.5%] were primary brain tumors, nine [11.7%] were primary spinal cord tumors, and six [7.8%] were secondary tumors. Astrocytoma and medulloblastoma were the commonest primary malignant CNS neoplasms in both adults and children. The apparent incidence of malignant brain and spinal cord neoplasms in Bahrain is very low. The small Bahraini population, inefficient registration of cancers, and the lack of routine hospital autopsies are contributory factors for the low numbers observed

Treatment outcome of Brain Astrocytoma

Astrocytoma is the most common primary brain tumor, which comprises a wide range of neoplasms with different clinical courses. This study was performed to determine some epidemiological and clinical characteristics and treatment results of patients with astrocytoma. Some presumed prognostic factors were also evaluated. In this descriptive study we evaluated 324 patients with histological proven brain Astrocytoma who were treated in Qaem and Omid hospitals, Mashhad, between April 1991 and April 2001. Information regarding individual characteristics, age. Sex, clinical presentation, type of treatment and surgry, side effects, imaging finding, histological grad and follow up were collected. WHO classification was used for the uniforming of histological reports. The collected information were analyzed using chi-square and Kaplan-Meier tests and SPSS software. 189 male and 135 female patients entered the study. There were 31 cases with grade I, 118 with grade II, 54 with grade III and 121 cases with grade IV astrocytoma. The median age for low grade and high-grade astrocytomas was 25 and 45 years respectively. The 3-year survival rate for grade I to IV was 94.7%, 74.9%, 52.7% and 6.7% respectively. In rnultivariate analysis, for low grade astrocytomas, grade II, age > 50 and biopsy only and for high grade astrocytomas, grade IV and biopsy only were associated with adverse prognosis. The survival rate for grade I astrocytomas is excellent and for grade II astrocytomas is satisfactory. But high grade astrocytomas especially gelioblastoma multiform, have dismal prognosis. For both low and high-grade astrocytomas, tumor grade and extent of surgery had significant impact on prognosis. Age over 50 was associated with adverse prognosis for low-grade astrocytomas

Astrocitomas do cerebelo na infância: experiência em 25 casos / Cerebellar astrocytomas in childhood: experience on 25 cases

E relatada a experiencia do Servico de Neurocirurgia do Hospital das Clinicas da FMUSP com o tratamento neurocirurgico de 25 criancas comastrocitoma do cerebelo no periodo de 1982 a 1994. Sao analisados incidencia, quadro clinico, localizacao, forma de apresentacao, anatomia patologica, recidivase tratamento. A serie incluiu criancas ate 10 anos com pico de incidencia (7 casos) aos 7 anos. Os sintomas iniciais mais frequentes foram: cefaleia, vomitos e disturbios da marcha. Nao houve mortalidade cirurgica. Os autores concluem quea resseccao cirurgica radical e a melhor forma de tratamento para estes tumores e que a radioterapia somente esta indicada para tumores histologicamente malignos.

Astrocitomas de bajo grado de malignidad en cerebelo: experiencia de once años en el Instituto Nacional de Enfermedades Neoplásicas / Cases of cerebellar astrocytomas degree II: 11 years experience in Neoplasic Diseases Institute

Comunicamos el resultado del seguimiento de 20 casos de astrocitoma de bajo de malignidad (grado II) en cerebelo, operados en el Instituto de Enfermedades Neoplásicas entre 1984-1985: 17 casos (80 por ciento) fueron niños menores de 15 años, la edad media global fue 12.5 años (rango 2-33 años), no hubo predominancia en el sexo. Los síntomas más frecuentes fueron cefalea y vómitos en 90 por ciento y 75 por ciento, ataxia e incoordinanción en el 80 por ciento y 75 por ciento de casos. La tomografía mostró imágenes quísticas en 15 casos (75 por ciento), sólidas en 3 pacientes y con halo-hipercaptador en dos casos; hidrocefalia en 15 casos (75 por ciento). En 13 pacientes (65 por ciento) se realizó resección total y en siete resección parcial. Un paciente falleció en el posttoperatorio. El Karnofski en el preoperatorio fue de 70-100 en el 80 por ciento de pacientes, en dos casos de 40-60 y en dos pacientes menor de 40; la mayoría mejoraron su puntuación en el postoperatorio (90 por ciento de casos en el postoperatorio con Karnoksfi de 80-100; los dos casos con Karnofski preoperatorio menor de 40 fallecieron antes de los dos meses de seguimiento. 3 pacientes sometidos a resección total no recibieron radioterapia y a la fecha no han desarrollado recuerrencdia tumoral, su Karnofski actual es de 100. 15 pacientes recibieron radioterapia (9 ingresaron a ressección total y 6 a resección parcial). Se presentó recurrencia en 4 casos (20 por ciento). Del seguimiento de 18 pacientes: 16 se encuentran libres de enfermedad y con Karnofski de 80-100. La curva de sobrevida acumulada en 20 pacientes, según el estadístico de Kaplan-Mier fue de 90 por ciento.