Clinical and Pathological Characteristics of Brain Tumor

Background: CNS tumors comprise 2% to 5% of all tumors. There was no epidemiological and statistical data regarding various features of brain tumors in this country. 80% involve the brain and 20% involve the spinal cord. Brain tumors cause approximately 2% of all cancer deaths. Objectives: to evaluate the clinical and pathological characteristics of brain tumors. Methods: This prospective study was done at Oncology department and Neurosurgery department of Bangabandhu Shiekh Mujib Medical University from July 2006 to June 2007. Total 50 patient age 2-60 years attending the oncology department with the diagnosis of primary brain tumor were included in this study. Clinical symptoms and sign in relation to brain tumor were recorded. X ray skull and CT scan reports of all cases were evaluated. To find out the histopathological pattern of the brain tumors all histopathological reports were also evaluated. Results: Most common symptoms of brain tumor were headache (76%), mental change (64%), vomiting (52%), visual defect (46%), difficulty in movement (42%) and convulsion (36%). Astrocytoma was found in 40% patients and 30% brain tumor was associated with hydrocephalus Conclusion:This study represent the brain tumor and gives some idea about the clinicopathological aspects of the disease in our country. It will help to do further studies to evaluate the clinical, epidemiological and pathological characteristics of brain tumor. [BSMMU J 2010; 3(2): 68-71] the incidence of brain tumours has not been determined in our country, overall clinical experiences indicate that its incidence is not low. This study was done to evaluate the clinical and pathological characteristics of primary brain tumors. Methods: This retrospective study was done at Oncology department and Neurosurgery department of Bangabandhu Shiekh Mujib Medical University from July 2006 to June 2007. Total 50 patients age 2-60 years attending the oncology department with diagnosis of primary brain tumor were included in this study. Primary brain tumor was diagnosed by neurosurgery department of BSMMU. Study Procedure: All patients with primary brain tumor fulfilling inclusion criteria were included in the present study. A predesigned data collection sheet was used for each subject and informations regarding history, clinical examination and investigations were recorded. After inclusion of the cases, data were collected from surgeon’s clinical notes. History of the patients was taken in details with special emphasis given on the following points: age, sex, religion, occupation, socioeconomic condition, educational status, residence, history of radiation exposure, family history, personal history and past history of illness with a view to Address for Correspondence: Dr. Naziruddin Mollah, Resident. Department of Oncology, BSMMU, Dhaka find out any relationship with the brain tumor. Clinical symptoms and sign in relation to brain tumor were recorded. X ray skull and CT scan reports of all cases were evaluated. To find out the histopathological pattern of the brain tumors all histopathological reports were also evaluated. Collected data was analyzed by using Statistical Package for Social Science (SPSS version 12.0). Results: Among the 50 patient 66% were male and male female ratio was 1.9:1. Mean (+SD) age of the patients were 46±11 years. Seventy percent patients came from rural area and 92% patients were Muslim. Forty eight percent patients from middle socioeconomic background and rest from higher or lower socioeconomic status. There was no difference in socioeconomic status. Most common symptoms of brain tumors were headache (76%), mental change (46%), Vomiting (52%), visual defect (46%), difficulty in movement (42%) and convulsion (36%). Others symptoms were complete blindness (20%), dementia (14%), unconsciousness (14%), fever (06%), weight gain (06%), anorexia (04%), vertigo (04%), sensory loss (04%) and loss of libido (02%). In most of the cases more than one symptom were present (Table-I). Table-I Distribution of patient according to presenting symptom (n=50) Symptoms No. of cases Percentage Headache 38 76.0 Vomiting 26 52.0 Vertigo 02 04.0 Convulsion 18 36.0 Anorexia 02 04.0 Fever 03 06.0 Mental change 32 64.0 Dementia(past/recent memory) 07 14.0 Difficulty in movement 21 42.0 Sensory loss 02 04.0 Visual defect 23 46.0 Complete blindness 10 20.0 Disturbance of consciousness 03 06.0 Unconsciousness 07 14.0 Weight gain 03 06.0 Loss of libido 01 02.0 Large number of patients had signs of increased intracranial pressure (58%), focal presentation (46%), visual defects (50%), and oculomotor and abducens nerve defects (12%), other signs (less frequent) includes sensory level defects (12), facial palsy (08%), incoordination (06%), endocrine abnormalities (06%), Parinaud’s Syndrome (02%). In most of the cases more than one signs were present (Table-II) Table-II Distribution of patient according to presenting sign (n=50) Signs No. of Percentage Cases Focal presentation related to 23 46.0 tumor location (hemiplegia, hemi paresis, monoplagia, aphasia) Sensory level defect 06 12.0 Increased intracranial pressure 29 58.0 (papilloedema) Visual defects 25 50.0 Oculomotor and abducens nerve 16 32.0 defects (squint/diplopia/pupillary abnormality) Facial palsy 04 08.0 In coordination 03 06.0 Endocrine abnormalities 03 06.0 (Hypopituitarism/Hyperpituitarism) Parinaud’s Syndrome 01 02.0 X ray skull was done in all patients. More than 50% of case there were no radiological findings, 32% cases showed bony lesion and 14% cases showed calcification (Fig 1). CT was done in all patients and hydrocephalus was detected in 30% patients (Fig 2) Fig.-1: Radiological finding of skull in brain tumor (n=50) BSMMU J Vol. 3, Issue 2, July 2010

find out any relationship with the brain tumor. Clinical symptoms and sign in relation to brain tumor were recorded. X ray skull and CT scan reports of all cases were evaluated. To find out the histopathological pattern of the brain tumors all histopathological reports were also evaluated.
Collected data was analyzed by using Statistical Package for Social Science (SPSS version 12.0).

Results:
Among the 50 patient 66% were male and male female ratio was 1.9:1. Mean (+SD) age of the patients were 46±11 years. Seventy percent patients came from rural area and 92% patients were Muslim. Forty eight percent patients from middle socioeconomic background and rest from higher or lower socioeconomic status. There was no difference in socioeconomic status.

Discussion:
The present study is a clinicopathological study of brain tumor. Clinical presentation may very according the site and type of brain tumor, although there are some common symptoms, namely, headache, seizure, mental change and sensorimotor defects and any of which can eventually be found in more than 50% of the patient population. Ocular change (e.g. visual defect) is associated with the tumors, like, pituitary adenoma craniopharyngioma optic nerve glioma and pineal growth. Most of the tumors present focal presentation related to tumors location. 5 In this series, 76% of case present headache, 64% mental changes, 52% vomiting, 46% visual defect, 36% convulsion, 20% completely blind.
Physical findings can be variable according to tumor type and location. Common signs are focal presentation related to location of tumor, and increased intracranial pressure (ICP) and abducence and oculomotor nerve defects,. Ocular changes are accompaniment of optic glioma pituitary adenoma and pineal growth. Endocrine abnormalities may be found in case of pituitary adenoma and pineal tumor. 5 In the present series, 58% cases had ICP, 50% visual defects, 46%focal presentation related to tumor location and 32% cases abducence and oculomotor nerve defects.
In this study skull radiography and CT scan were done in all patients. Skull radiography is poor in detecting brain tumour. Intracranial space occupying lesion (ICSOL) was found in all patients. Some degree of hydrocephalus was associated with 30% patients. Biopsy and histopathology were also performed in all patients. In this study astrocytomas were found in 40% of cases, among them 22% are grade II, 10% grade I, 6% grade III and 4% grade IV (glioblastoma multiforme). Pituitary tumors were 16% pineal tumor 6% ependymoma, 4% medulloblastoma 4%, oligodendroglioma 2% and brain stem tumor 2%. Allen and Chutorian found gliomas 50% of all primary brain tumors and glioblastomas comprise over 50% of all glioma, meningioma constitutes 15% of primary intracranial neoplasm. Pituitary adenomas comprise 12% to 18% of intracranial neoplasm, the majority of which are chromo phobic; they are almost never malignant. 3,6 Walker MD found medulloblastoma represents 4% to 8% of all primary brain tumor and ependymomas account for 1% to 8%. 4 Percentage of gliomas was correlates with the study done by Allen and Chutorian but the grading of the tumor markedly varies and almost reverse. In the previous study it was found that more than 50% of gliomas are in advanced grade, 3 but in this study maximum glioma cases are found in grade I. & II Percentage of pituitary adenoma, meningioma and other tumors well correlate with the previous study.
In conclusion in this study most common manifestation of brain tumor was vomiting, convulsion, headache, visual defect, papilloedema, focal neurological sign, oculomotor and abducens nerve defects. One third of the patient had associated hydrocephalus. Astrocytoma was the common tumor of brain followed by Meningioma and Pineal tumour. Diagnostic yield of x-ray skull is poor. MRI or CT scan should be done in any suspected case of Brain tumour.