Users Online: 941
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2015  |  Volume : 4  |  Issue : 3  |  Page : 146-148

Demographic and histopathologic profile of pediatric brain tumors: A hospital-based study

Department of Neurosurgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India

Date of Web Publication5-Jan-2016

Correspondence Address:
Bhushan P Ubhale
Department of Neurosurgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2278-330X.173165

Rights and Permissions

Background: Very few hospital-based or population-based studies are published in the context to the epidemiologic profile of pediatric brain tumors (PBTs) in India and Indian subcontinent. Aim: To study the demographic and histopathologic profile of PBTs according to World Health Organization 2007 classification in a single tertiary health care center in India. Materials and Methods: Data regarding age, gender, topography, and histopathology of 76 pediatric patients (0–19 years) with brain tumors operated over a period of 24 months (January-2012 to December-2013) was collected retrospectively and analyzed using EpiInfo 7. Chi-square test and test of proportions (Z-test) were used wherever necessary. Results: PBTs were more common in males (55.3%) as compared to females (44.7%) with male to female ratio of 1.23:1. Mean age was 10.69 years. Frequency of tumors was higher in childhood age group (65.8%) when compared to adolescent age group (34.2%). The most common anatomical site was cerebellum (39.5%), followed by hemispheres (22.4%). Supratentorial tumors (52.6%) were predominant than infratentorial tumors (47.4%). Astrocytomas (40.8%) and embryonal tumors (29.0%) were the most common histological types almost contributing more than 2/3rd of all tumors. Craniopharyngiomas (11.8%) and ependymomas (6.6%) were the third and fourth most common tumors, respectively. Conclusion: Astrocytomas and medulloblastomas are the most common tumors among children and adolescents in our region, which needs special attention from the neurosurgical department of our institute. Demographic and histopathologic profile of cohort in the present study do not differ substantially from that found in other hospital-based and population-based studies except for slight higher frequency of craniopharyngiomas.

Keywords: Astocytomas, cerebellum, epidemiologic profile, supratentorial tumors, World Health Organization

How to cite this article:
Shah HC, Ubhale BP, Shah JK. Demographic and histopathologic profile of pediatric brain tumors: A hospital-based study. South Asian J Cancer 2015;4:146-8

How to cite this URL:
Shah HC, Ubhale BP, Shah JK. Demographic and histopathologic profile of pediatric brain tumors: A hospital-based study. South Asian J Cancer [serial online] 2015 [cited 2020 Feb 23];4:146-8. Available from:

  Introduction Top

Pediatric brain tumors (PBTs) are the leading cause of cancer-related deaths in children. They account for approximately 25% of pediatric cancers. They rank second behind leukemia as the most common pediatric cancers.[1],[2],[3] Childhood tumors are a biologically different entity from tumors of adult life. They differ in topographical distribution, biological behavior, clinical presentation, histological features, prognosis and outcome from those that present in later life. In adults, metastases from extracranial malignancies, gliomas, and meningiomas are the common central nervous system (CNS) tumors, whereas in pediatric age group, astrocytomas and embryonal tumors dominate the picture.[4],[5] Due to lack of resources, in this context, the adequate epidemiologic data lacks from India. Hence, we conducted this hospital-based study as a primary step toward the subject to characterize the demographic and histopathological types of brain cancers among the pediatric patients presented to us.

  Materials and Methods Top

This is a retrospective study and is based on the data collected from Neurosurgery Department of one of the major tertiary health care centers in India. The case summaries, histopathological records and discharge reports of all the children up to 19 years of age, were reviewed who were operated for brain tumors during the period from January 2012 to December 2013. Only patients with the proven histopathological diagnosis were included in the study. In addition to the location and histological types of the tumor, patient demographics including age and sex were also recorded. Patients with metastatic tumor, tumor-like cystic lesion (arachnoid cysts, epidermoid cysts and colloid cysts), the secondary tumor, space occupying lesion of infectious etiology and vascular malformation were excluded from the study. Furthermore, patients who were diagnosed as a case of PBT clinically and on imaging (e.g., brain stem gliomas) but not biopsied and treated by chemoradiation were also excluded from the study. All histopathological diagnoses were made according to the 2007 World Health Organization classification system.[6] Thus, with all above considerations we had a cohort of 76 pediatric patients with histopathologically proven brain tumors. We analyzed the data using EpiInfo 7 (version 3.5, CDC website, Chi-square test and test of proportions (Z-test) were used wherever necessary to test for statistical significance.[7]

  Results Top

During the study period, 744 patients of childhood and adolescence age group (0–19 years) underwent neurosurgical procedures at Neurosurgical Department of our institute. Out of these total cases, 10.21% (76/744) patients were operated for primary PBTs. Furthermore, PBTs accounted for 16.52% (76/460) of total intracranial tumors operated.

Age-wise and gender-wise distribution

Among these 76 cases, 42 (55.3%) were males and 34 (44.7%) were females. Male:female ratio was 1.23:1 suggesting that, PBTs were more common in males when compared to females. Their ages varied from 3 months to 19 years. Children (0–14 years) accounted for 50 cases (65.8%) with 25 (50%) males and 25 (50%) females. On the other hand, adolescents (15–19 years) accounted for 26 cases (34.2%) with 17 (65.4%) males and nine (34.6%) females. This clears that the frequency of PBTs is higher in childhood age group when compared to adolescent age group. The mean age of patients was 10.69 ± 5.67 years (95% confidence interval [CI]).

Location wise distribution

In the present study, the most common anatomical site for PBT was cerebellum (39.5%) followed by cerebral hemispheres (22.4%), ventricles and sellar region (13.2% each). Diencephalic region constituting optic apparatus, hypothalamus and thalamus was involved in 7.8% of patients. The distribution of PBTs according to anatomical location in the present series is shown in [Figure 1].
Figure 1: Distribution of pediatric brain tumors according to anatomical location

Click here to view

Out of 76 PBTs, 52.6% (40/76) were supratentorial, and 47.4% (36/76) were infratentorial tumors. In children, 52% (26/50) cases had tumors in the infratentorial region, whereas 48% (24/50) had in the supratentorial region. On the other hand, in adolescents, 61.5% (16/26) tumors were supratentorial and 38.5% (10/26) were infratentorial in location. Mean age for supratentorial tumors was 11.48 ± 5.60 years (95% CI) and the mean age for infratentorial tumors was 9.67 ± 5.68 years (95% CI).

Histopathological distribution

The most common histological entities encountered were medulloblastomas accounting for 22.4% of all PBTs, and then Grade-I astrocytomas (18.4%), Grade-II astrocytomas (14.5%), craniopharyngiomas (11.8%), ependymomas (6.6%), high-grade astrocytomas and primary neuroectodermal tumors (5.3% each). Grade-I astrocytomas included pilocytic astrocytomas (17.1%) and subependymal giant cell astrocytomas (1.3%). Grade-II astrocytomas included pleomorphic xanthoastrocytomas (2.6%), pilomyxoid astrocytomas (1.3%) and diffuse fibrillary astrocytomas (10.5%). Less common entities included anaplastic astrocytomas, nerve sheath tumors, oligodendrogliomas and choroid plexus tumors (2.6% each), whereas, meningiomas, gangliogliomas, pituitary adenomas and atypical teratoid/rhabdoid tumors (AT/RT) constituted rare histological entities (1.3% each). Thus, astrocytomas (40.8%) and embryonal tumors (29.0%) were the most common histological types almost contributing more than 2/3rd of all PBTs as shown in [Figure 2]. We did not find any case of germ cell tumor and pineal region tumor in this cohort.
Figure 2: Distribution of major histological types of pediatric brain tumors

Click here to view

The frequencies of various PBTs except few at our institute were well in a range of national and international data. Data of this study was comparable to the data of various hospital-based and population-based studies quantifying PBTs, which were carried out in different developed and developing nations.

  Discussion Top

Pediatric neuro-oncology has emerged as one of the fastest developing subspecialty under Neurosurgery. Now-a-days most of the neurosurgeons are taking keen interest in the management of PBTs due to their high incidence, challenging aspects of surgery and high mortality. This was the hospital-based study hence the incidence rate of PBTs could not be estimated, however, the frequency of PBTs in total pediatric neurosurgical cases was 10.2%. Most of the published literature from India is hospital-based because of inconsistent maintenance of regional cancer registries. Hence, the hospital-based data forms the basis to study the demographics, clinical and histologic profile and the outcome of PBTs. With the tremendous development in the field of radiodiagnosis and histopathology and easy availability of these services at major regional tertiary centers has possibly up-surged the incidence of brain tumors both in adults and pediatric patients in recent times.

In the present study, we retrospectively analyzed the data regarding demographics and histological profile of 76 pediatric patients operated for brain tumors at one of the major tertiary health care centers in India over a period of 24 months.

Age and gender

Consistent with the findings of other international hospital and population-based studies on PBTs, we found the slightly higher proportion of brain tumors in males as compared to in females with male to female ratio of 1.23:1. The male to female ratio in pediatric patients varies from as low as 1.03 to as high as 2.52, with Pakistan reporting the highest ratio.[8],[9],[10],[11],[12],[13],[14] Mean age at diagnosis in our study was 10.69 years, which was bit higher than the mean age reported from Nigeria [7] (9.75 years), Morocco [8] (9.3 years), Pakistan [14] (8.8 years) and Iran [15] (8.8 years), but lower than that reported in Chinese study [12] (12.68 years). This could be attributed to the delayed presentation of cases to our referral center or to the genetic and environmental differences of the study cohort. In our study, males and females with PBT were evenly distributed among different age groups and observed differences were not statistically significant (X2 = 5.21, df = 3, P = 0.15), which was in line with the findings of other studies.[8],[16],[17] The frequencies of PBTs in children and adolescents were comparable to the frequencies observed in other studies, which were higher among childhood age group when compared to the adolescent age group.[17],[18] Statistically, no significant gender difference was found in the distribution of cases between childhood and adolescent age groups (Z = 1.30, P > 0.05).

Anatomical location

Topographically, the cerebellum was found to be the most common site for PBTs followed by cerebral hemispheres and ventricles. Medulloblastomas and most of the pilocytic astrocytomas, which comprise the major histological entities of PBTs were frequently found involving the cerebellum. These findings were in line with the results of other published data.[9],[17],[19] In this study, supratentorial and infratentorial tumors were evenly distributed among different age groups without a statistical significant difference (X2 = 1.5, df = 3, P = 0.67). Overall, supratentorial locations predominated slightly in the present series which complemented the data in the literature.[12],[18],[19] When we considered childhood age group, infratentorial tumors were bit predominant whereas, in adolescent age group, supratentorial tumors were more common, which was consistent with the findings of other studies.[5],[7],[17],[18] However, statistically, we could not find any significant difference in the distribution of supratentorial and infratentorial tumors among children and adolescents (Z = 1.13, P > 0.05). However, the actual frequency of infratentorial tumors may be slightly higher than shown in the present study because the majority of the brain stem tumors were not biopsied.


In the present study, medulloblastoma was the single most common histological entity, followed by pilocytic astrocytomas (Grade-I) and Grade-II astrocytomas. However, overall, astrocytomas were the most common tumors followed by embryonal tumors including medulloblastomas, supratentorial PNETs, and AT/RT. Astrocytomas and embryonal tumors almost constituted more than 2/3rd of all PBTs in the study population. Craniopharyngiomas appeared to be the third most common tumor in our series which contradicted the results of major international studies,[8], 9, [16],[17],[18] but was in line with the multi-institutional study carried out in India.[4] Ependymomas followed next to craniopharyngiomas accounting for the fourth most common histological type in the study complementing the findings from Indian,[4] Brazilian [19] and Korean studies.[20] In most of the published literature, ependymomas were third most common tumors.[8],[9],[19] Both observations suggest intra-regional differences in the epidemiology of PBTs. Some studies with an upper age limit of 14 years had reported a preponderance of medulloblastoma in their series [5],[14] whereas studies, which reported astrocytomas as the most common tumors mostly had upper age limit up to 20 years. In our series, we too had a predominance of astrocytomas, which was in line with the published studies with a similar age limit.[8],[17],[18],[19] In the present study, we did not find a single case of germ cell tumor, but it constituted a major histological entity from other Asian countries suggesting the environmental factors and genetic differences to play a role in the cause of PBTs.[10],[12],[20] We could find very few cases of intracranial nerve sheath tumors and meningiomas, which form the predominant entities in adulthood.

Though this was a hospital-based study with small cohort and data collection was restricted to short duration, results were comparable to those observed in other mentioned hospital-based and population-based studies. The current study is a single tertiary care center study and needs cautious interpretation. The population-based studies are required to study the demographics and determine the burden of CNS malignancies among the pediatric patients in India. This is only possible if regional cancer registries are maintained meticulously, which is quite difficult in developing countries like India where doctors in such major referral institutes are overworked. Hence, such hospital-based studies have a major role to play in estimating the disease load in a particular geographical region and subsequent planning of healthcare infrastructure toward the disease.

  Conclusion Top

From the present series, we conclude that, the frequencies of major histologic types of PBTs found in the study do not differ substantially from that found in other developed and developing countries except for slight higher frequency of craniopharyngiomas. Medulloblastomas and astrocytomas, which form the major histologic types in pediatric patients need special attention. Epidemiological surveillance of various histological types of PBTs is of great importance from public health perspective. It helps in planning the distribution of infrastructure and resources toward the disease management and preventive programs. In countries like India where there is a scarcity of data because of inadequacies in tumor registration, such hospital-based studies have a major role to play in such planning.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Fleming AJ, Chi SN. Brain tumors in children. Curr Probl Pediatr Adolesc Health Care 2012;42:80-103.  Back to cited text no. 1
Wilne SH, Ferris RC, Nathwani A, Kennedy CR. The presenting features of brain tumours: A review of 200 cases. Arch Dis Child 2006;91:502-6.  Back to cited text no. 2
Baldwin RT, Preston-Martin S. Epidemiology of brain tumors in childhood – A review. Toxicol Appl Pharmacol 2004;199:118-31.  Back to cited text no. 3
Jain A, Sharma MC, Suri V, Kale SS, Mahapatra AK, Tatke M, et al. Spectrum of pediatric brain tumors in India: A multi-institutional study. Neurol India 2011;59:208-11.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
Nasir S, Jamila B, Khaleeq S. A retrospective study of primary brain tumors in children under 14 years of age at PIMS, Islamabad. Asian Pac J Cancer Prev 2010;11:1225-7.  Back to cited text no. 5
Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, editors. World Health Organization Classification of Tumors of the Central Nervous System. Lyon: IARC; 2007.  Back to cited text no. 6
Uche EO, Shokunbi MT, Malomo AO, Akang EE, Lagunju I, Amanor-Boadu SD. Pediatric brain tumors in Nigeria: Clinical profile, management strategies, and outcome. Childs Nerv Syst 2013.  Back to cited text no. 7
Karkouri M, Zafad S, Khattab M, Benjaafar N, El Kacemi H, Sefiani S, et al. Epidemiologic profile of pediatric brain tumors in Morocco. Childs Nerv Syst 2010;26:1021-7.  Back to cited text no. 8
Kaatsch P, Rickert CH, Kühl J, Schüz J, Michaelis J. Population-based epidemiologic data on brain tumors in German children. Cancer 2001;92:3155-64.  Back to cited text no. 9
Makino K, Nakamura H, Yano S, Kuratsu J, Kumamoto Brain Tumor Group. Population-based epidemiological study of primary intracranial tumors in childhood. Childs Nerv Syst 2010;26:1029-34.  Back to cited text no. 10
Zhou D, Zhang Y, Liu H, Luo S, Luo L, Dai K. Epidemiology of nervous system tumors in children: A survey of 1,485 cases in Beijing Tiantan Hospital from 2001 to 2005. Pediatr Neurosurg 2008;44:97-103.  Back to cited text no. 11
Zhang R, Shen WQ, Zhou LF. Primary pediatric central nervous system tumors statistic: Study of 763 cases in a single institution. Zhonghua Yi Xue Za Zhi 2007;87:442-7.  Back to cited text no. 12
Neervoort FW, Van Ouwerkerk WJ, Folkersma H, Kaspers GJ, Vandertop WP. Surgical morbidity and mortality of pediatric brain tumors: A single center audit. Childs Nerv Syst 2010;26:1583-92.  Back to cited text no. 13
Ahmed N, Bhurgri Y, Sadiq S, Shakoor KA. Pediatric brain tumours at a tertiary care hospital in Karachi. Asian Pac J Cancer Prev 2007;8:399-404.  Back to cited text no. 14
Mehrazin M, Rahmat H, Yavari P. Epidemiology of primary intracranial tumors in Iran, 1978-2003. Asian Pac J Cancer Prev 2006;7:283-8.  Back to cited text no. 15
Kaderali Z, Lamberti-Pasculli M, Rutka JT. The changing epidemiology of paediatric brain tumours: A review from the Hospital for Sick Children. Childs Nerv Syst 2009;25:787-93.  Back to cited text no. 16
Katchy KC, Alexander S, Al-Nashmi NM, Al-Ramadan A. Epidemiology of primary brain tumors in childhood and adolescence in Kuwait. Springerplus 2013;2:58.  Back to cited text no. 17
Rickert CH, Paulus W. Epidemiology of central nervous system tumors in childhood and adolescence based on the new WHO classification. Childs Nerv Syst 2001;17:503-11.  Back to cited text no. 18
Rosemberg S, Fujiwara D. Epidemiology of pediatric tumors of the nervous system according to the WHO 2000 classification: A report of 1,195 cases from a single institution. Childs Nerv Syst 2005;21:940-4.  Back to cited text no. 19
Suh YL, Koo H, Kim TS, Chi JG, Park SH, Khang SK, et al. Tumors of the central nervous system in Korea: A multicenter study of 3221 cases. J Neurooncol 2002;56:251-9.  Back to cited text no. 20


  [Figure 1], [Figure 2]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Materials and Me...
Article Figures

 Article Access Statistics
    PDF Downloaded216    
    Comments [Add]    

Recommend this journal