APLICACIÓN DE NORMAS Y REGLAMENTOS
CENTRO RURAL
TABLE 10- DEMOGRAPHIC FEATURES OF EPENDYMOMAS IN THE CURRENT STUDY
DEMOGRAPHIC FEATURES
TABLE 11 HISTOLOGICAL DIAGNOSES, GENDER AND OCCURRENCE IN CHILDREN AND ADULTS OF METASTATIC NEOPLASMS
SOURCE OF METASTASIS
GENDER ADULT &
CHILDREN
TENTORIAL
RELATIONSHIP TOTAL PERCENTAGE Male Female Adult Children Infratentorial Supratentorial
Choriocarcinoma 0 2 2 0 0 2 2 6.5
Retinoblastoma 1 0 1 0 0 1 1 3.2
Burkitt’s lymphoma 3 0 2 1 0 3 3 9.7
Rhabdomyosarcoma 4 1 1 4 0 5 5 16.1
Endometrial
carcinoma 0 1 1 0 0 1 1 3.2
Breast carcinoma 0 1 1 0 0 1 1 3.2
Oesophageal
carcinoma 1 0 1 0 0 1 1 3.2
Soft tissue sarcoma 2 0 2 0 0 2 2 6.5
Malignant melanoma 2 0 2 0 0 2 2 6.5
Thyroid carcinoma 0 2 2 0 0 2 2 6.5
Renal cell carcinoma 1 0 1 0 0 1 1 3.2
Osteogenic sarcoma 1 0 1 0 0 1 1 3.2
Squamous cell
carcinoma 1 1 2 0 1 1 2 6.5
Acute lymphoblastic
leukaemia 2 0 1 1 1 1 2 6.5
Prostatic carcinoma 2 0 2 0 0 2 2 6.5
Carcinosarcoma 0 1 1 0 0 1 1 3.2
Chronic myeloid
leukaemia 1 0 1 0 0 1 1 3.2
Neuroblastoma 0 1 0 1 0 1 1 3.2
TOTAL 21 10 24 7 2 29 31 100.0
Figure 1
Figure 2
Figure 3- Gender distribution among the tumour groups
Figure 4- Photomicrographs showing pilocytic astrocytoma. The photograph on the left (a) displays the characteristic biphasic pattern with loose (green arrow) and compact areas (red arrow) (Haematoxylin and eosin, X40). The photograph on the right (b) shows numerous Rosenthal fibres (blue arrow) (Haematoxylin and eosin, X100).
Figure 5- Photomicrographs showing glioblastoma multiforme. The photograph on the left (a) displays extensive areas of geographic necrosis (red arrow) (Haematoxylin and eosin, X40). The photograph on the upper right (b) shows marked cytonuclear pleomorphism (Haematoxylin and eosin, X100). The photograph on the lower right (c) shows florid endothelial proliferation with glomeruloid body formation (green arrow) (Haematoxylin and eosin, X40).
Figure 6- Photomicrograph showing anaplastic astrocytoma (Haematoxylin and eosin, X100).
Figure 7- Photomicrograph showing gemistocytic astrocytoma (Haematoxylin and eosin, X400).
FIGURE 8
Figure 9- Photomicrograph showing medulloblastoma composed of sheets of small round blue cells. There are numerous Homer Wright rosettes (Haematoxylin and eosin, X100).
Figure 10- Photomicrograph showing oligodendroglioma composed of clusters of small uniform cells interspersed by a meshwork of capillary channels (Haematoxylin and eosin, X100).
Figure 11- Photomicrograph showing transitional meningioma composed of whorls of syncytial meningothelial cells interspersed by fibroblast-like cells (Haematoxylin and eosin, X100).
Figure 12- Photomicrograph showing fibroblastic meningioma composed of whorls of fibroblast-like cells (Haematoxylin and eosin, X100).
Figure 13- Photomicrograph showing secretory meningioma composed of meningothelial cells interspersed by numerous round hyaline globules (Haematoxylin and eosin, X100)
Figure 14- Photomicrograph showing angiomatous meningioma composed of meningothelial cells interspersed by numerous capillary channels (Haematoxylin and eosin, X100).
Figure 15-
Figure 16- Photomicrograph showing haemangiopericytoma composed of spindle cells interspersed by dilated thin walled vascular channels (Haematoxylin and eosin, X100).
Figure 17- Photomicrograph showing pituitary adenoma composed of uniform round to polygonal epithelial cells arranged in a sinusoidal pattern (Haematoxylin and eosin, X100).
FIGURE 18- AGE DISTRIBUTION OF PATIENTS WITH SELLAR REGION NEOPLASMS
Figure 19- Photomicrograph showing craniopharyngioma composed of epithelial cells rimmed by peripheral layer of columnar cells with central stellate reticulum (Haematoxylin and eosin, X100).
CHAPTER SIX DISCUSSION
The Neurosurgical Unit of the University College Hospital, Ibadan serves most of the western states of Nigeria, which collectively have a population of over twelve million people.57 The University College Hospital, Ibadan is the largest teaching hospital in the south western geopolitical zone of Nigeria and the hospital provides a major part of the adult and paediatric neurology, neurosurgery and neuropathology services in this area. A meaningful pattern of occurrence of CNS neoplasms appears to have emerged in Ibadan, with the gradual expansion of available neurological, neurosurgical and pathology services in the teaching hospital14,15,25,55. This analysis of 356 intracranial neoplasms represents the largest and most recent compilation of data that has emerged from Ibadan, Nigeria.
The present study has revealed that there has been an overall gradual increase in the annual occurrence of CNS neoplasms in Ibadan. This agrees with the earlier observation by Olasode et al that with improvement in neurosurgical facilities, more cases of intracranial neoplasms are being diagnosed in Ibadan.14,15
Considering the anatomical distributions,The majority of intracranial neoplasms in the present study were supratentorial, with supratentorial to infratentorial tumour ratios of 3.6:1 overall, 6.5:1 in adults and 1.2:1 in children. The last ratio is similar to that of 1.125:1 reported in the childhood series of Aghadiuno et al from Ibadan.55 Our findings also agree with those of the earlier study of Idowu et al from Ibadan.48 Huang et al reported a relatively lower ratio of 2.44:1 among Chinese patients.49
Neuroepithelial neoplasms consisted 32.8% of all the central nervous system neoplasms and showed a male preponderance with high frequency within the first two decades of life. These findings are similar to the findings by Olasode et al. who observed that 33.3% of all intracranial neoplasms were neuroepithelial neoplasms, and which also accounted for 57% of all childhood intracranial neoplasms.14,15
In this study, astrocytic neoplasms (61.5%), embryonal neoplasms (17.5%), and ependymal neoplasms (7.7%) were the three most common neuroepithelial neoplasms. These findings are in contrast to the findings by Olasode et al. in an earlier study from Ibadan, where the three most common neuroepithelial neoplasms were astrocytic neoplasms (75.7%), oligodendrogliomas (11.4%) and embryonal neoplasms (11.4%).14,15 This suggests that the relative frequency of oligodendrogliomas has declined, whereas that of ependymoma has increased. The reason for this difference is not clear.
There was a single case of subependymal giant cell astrocytoma in the right lateral and third ventricles of an 8 year old male. This patient presented with clinical features of tuberous sclerosis. This case has been exhaustively documented in a recent case report.51
There was an overall bimodal age distribution which peaked in the first and sixth decades of life. By contrast, analysis of the data of Olasode et al reveals a peak during the third decade of life. The age distribution of astrocytic neoplasms in our present study displayed an initial peak in the 1st decade (agreeing with the findings of Olasode et al).14,15 Aghadiuno et al noted that astrocytoma was the most common primary intracranial neoplasm in children.55 In contrast to this finding, Izuora et al reported that craniopharyngioma was the most common childhood tumour in Enugu.54
Astrocytic neoplasms displayed 2 subsequent peaks in the fourth and sixth decades, due to glioblastoma multiforme, anaplastic astrocytoma and gemistocytic astrocytoma. In the study
of Olasode et al, astrocytic neoplasms were rare in patients aged above 49 years of age, which is in contrast to our findings.14 15
Ependymal and embryonal neoplasms both had a unimodal peak frequency in the 1st decade of life. This agrees with findings of Aghadiuno from Ibadan, Nigeria. Izuora et al from Enugu, Nigeria noted that in their childhood series, medulloblastoma was confined to the first 5 years of life.54
Meningeal neoplasms accounted for 28.4% of all intracranial neoplasms in the present study, with Ninety-four (94%) being meningiomas, four (4%) mesenchymal neoplasms and three (3%) haemangioblastomas. By contrast to our findings, meningiomas only accounted for 11.4% of all intracranial neoplasms in the study of Olasode et al14,15. In the study of Idowu et al also from Ibadan, meningiomas accounted for 23% of primary intracranial neoplasms48. These results indicate that there has been an increase in the relative frequency of meningiomas in Ibadan since the period covered by the study of Olasode et al14,15.
Our findings of female preponderance of the meningiomas were similar to the findings by of Sorour in Egypt25 and that of Idowu48 it however differs from the findings of Olasode14, 15 and Odeku10,12 in which a male predominance was reported. These findings might be due to increasing presentation of females with meningiomas for orthodox medical treatment.
The finding in this study that transitional meningiomas were the most frequent type is similar to finding of previous studies from Ibadan10,24.
In this study, craniopharyngiomas accounted for 7.9% of all intracranial neoplasms and 35.9% of sellar region neoplasms, and were most frequent in the second decade of life.
Olasode et al from Ibadan reported that craniopharyngiomas comprised 9.1% of intracranial neoplasms, which agrees fairly well with the present study, while Idowu et al reported that 15.9% of all primary intracranial neoplasms were craniopharyngiomas14,15,48. The present study and that of Olasode et al included both primary and secondary neoplasms, whereas that
of Idowu et al concentrated only on symptomatic primary neoplasms, which accounts for this discrepancy. Our study and both previous studies also reported a preponderance of these neoplasms in children, as had earlier been reported by Adeloye et al, also from Ibadan.14,15,48,55 These findings are similar to that of Izuora in Enugu about 2 decades ago where he noted the preponderance of craniopharyngiomas among childhood neoplasms from Enugu, Nigeria54.
Pituitary adenomas comprised 14% of all intracranial neoplasms and 68.1% of the sellar region neoplasms, with a male to female ratio of 1.4:1. This is comparable to the findings of Olasode et al and Idowu et al, in which pituitary adenomas accounted for 17.1% and 16.8%
of all intracranial neoplasms respectively, with a male to female ratio of 1.25:1 and 1.4:1, respectively.14,15,48 In contrast to these findings, Odeku et al reported a female preponderance for pituitary adenomas in Ibadan10,12.
The peak occurrence of pituitary adenomas was in the fifth decade of life, similar to the finding of Olasode et al, but differing slightly from Odeku’s finding of a peak incidence in the fourth decade.11,14,15 In Caucasian series, the peak occurrence of pituitary adenomas is between 30 and 50 years, which agrees with our findings, but there is a female predominance, unlike what has been observed in the present study.56
Metastatic neoplasms accounted for 8.7% of all CNS neoplasms and occurred most frequently in the fifth and sixth decades of life. By contrast, 23% of all CNS neoplasms in the study of Olasode et al were metastatic neoplasms.14,15 This difference may partly be accounted for by the decline in the rate of post-mortem examinations in our centre. There has been a progressive decline in the autopsy rate in Ibadan from 19% in 1984 to 3.6% in 2003.58 This decline in autopsy rates will result in reduced detection of metastatic CNS neoplasms.
Twenty-four cases (77.4%) occurred in adults while seven cases (22.6%) occurred in children. In the study of Olasode et al, the corresponding figures were 72.9% for adult and 27.1% for children, which agrees closely with the present study.14,15
The male to female gender ratio of adults with metastatic neoplasms (2:1) in the present study was significantly different from the male to female ratio of 0.3:1 reported by Olasode et al.14,15 The major reason for this difference is the predominance of metastatic choriocarcinoma in the series of Olasode et al.14,15
This study found only one case each of immature teratoma, schwannoma and lymphoblastic lymphoma. In the study of Olasode et al, there was only germ cell tumour (germinoma) and no cases of schwannoma or primary CNS lymphoma were observed. This attests to the rarity of these neoplasms in the indigenous population.14,15.
CONCLUSION
The pattern of intracranial neoplasms displayed in this study reveals several interesting observations, which includes similarities with previous published studies in West Africa and other parts of the world. The major difference between our findings with those of other previous studies were in the metastatic group of neoplasms which in our studies accounted for 8.1% as against 23% in one of the largest previous series 14, 15. However a direct comparison between our result and Idowu’s study is not possible because the study concentrated on only symptomatic primary intracranial neoplasms 48. However, the finding of high frequency of astrocytoma and meningiomas are quite similar.
REFERENCES
1. Kumar V, Abbas AK, Fausto N (eds.). Robbins and Cotran’s pathologic basis of disease, 7th edition. Elsevier Saunders, Philadelphia, 2005, pp. 269-270.
2. DeAngelis LM. Brain tumors. N Engl J Med 2001; 344(2): 114-23.
3. Levin VA, Leibel SA, Gutin PH. Neoplasms of the central nervous system. In:
Devita VT JR, Hellman S, Rosenberg SA, eds. Cancer: principles and practice of oncology. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2001, pp 2100-60.
4. Moss AR. Occupational exposure and brain neoplasms. J Toxicol Environ Health 1985; 16 (5): 703-11.
5. Hochberg FH, Miller G, Schooley RT, et al. Central-nervous-system lymphoma related to Epstein-Barr virus. N Engl J Med 1983; 309 (13): 745-8.
6. Schabet M. Epidemiology of primary CNS lymphoma. J Neurooncol 1999; 43 (3):
199-201.
7. Behin A, Hoang-xuan K, Carpentier AF, et al. Primary brain neoplasms in adults.
Lancet 2003; 361 (9354): 323-31.
8. Louis DN, Ohgaki H, Westler OD, et al. (eds) the 2007 WHO classification of neoplasms of the central nervous system; familial tumour syndromes; IARC;
Lyon: pp. 215-240.
9. Odeku EL. Beginning of neurosurgery at the University of Ibadan. West Afr Med J. (1965); 14: 85-95.
10. Odeku EL., Janota I. Intracranial masses in Ibadan. West Afr. Med J 1967; 16:31-42.
11. Odeku EL., Osunkoya BO, Adeloye A. And William's AO. Neoplasms of the sella turcica region in Ibadan, Nigeria. Afr J Med. Sci. 1973; 4: 127-136.
12. Odeku EL., Adeloye A., Osuntokun BO, Williams AO. Intracranial tumour patterns in Ibadan, Nigeria. Afr. J Med. Sci. 1973; 4: 137-141.
13. Adeloye A., Odeku EL., Williams AO. Metastatic neoplasms of the brain and its enveloping structures in Ibadan. Afr. J. med. Sci. 1976; 5: 181-184.
14. Olasode BJ, Shokunbi MT, Aghadiuno PU. Intracranial neoplasms in Ibadan, Nigeria. East Afr Med J 2000; 77[1]:4-8.
15. Olasode BJ. A pathological review of intracranial neoplasms seen at the University College Hospital, Ibadan between 1980 and 1990. Niger Postgrad Med J 2002; 9[1]:23-28.
16. Ohaegbulam SC, Saddeqi N, Ikerionwu S. Intracranial neoplasms in Enugu, Nigeria. Cancer; 1980; 46[10]:2322-4
17. Igun GO. Diagnosis and management of brain neoplasms. East Afr Med J. 2001;
78[3];148-51.
18. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK. 2007 WHO classification of neoplasms of the central nervous system. Acta Neuropathol 2007;114. 97-109.
19. Parkin DM, Bray F, Ferlay J, et al.: Estimating the world cancer burden:
Globocan 2000. Int J Cancer 2001; 94 (2): 153-6.
20. Stewart BW, Kleihues P [eds]. World cancer report. IARC Press, Lyon, France, 2003; pp. 259-269
21. National cancer institute, treatment statement for health professionals. Adult brain neoplasms. http://www.meb.uni-bonn.de/cancer.gov/cdr 0000062900.htm/
22. Jackson JG, Okubadejo DA. A review of intracranial neoplasms seen at necropsies at University College Hospital, Ibadan between 1957-1961. West Afr.
Med. J 1967; 12:251-263
23. Leestma EJ. Brain neoplasms. Am J. Pathol 1980; 100:243-317.
24. Odebode TO, Akang EE. Shokunbi MT, Malomo AO, Ogunseyinde AO. Factors influencing visual and clinical outcome in Nigerian patients with cranial meningioma. J Clin Neurosci 2006; 13[6]:649-54.
25. Adeloye A. Neoplasms of Brain in the African. Surg Neurol 1979;11:247- 256 26. Abu-Salih HS, Abdul-Rahmam AM. Neoplasms of the brain in the Sudan. Surg
Neurol 1988;29:194-6
27. Moore KL Persaud TVN (eds). The developing human: clinically oriented anatomy 6th edition, Saunders, Philadelphia, 1998: pp 451-490.
28. Cushing H. Intracranial neoplasms. Notes upon a series of two thousand verified cases with surgical mortality, percentages pertaining thereto. Springfield Illinois, Charles C. Thomas. 1932: pp. 1-150.
29. Rubinstein LJ. Neoplasms of the central nervous system. 2nd series, Fascicle 6.
Armed Forces Institute of Pathology, Bethesda., 1972: pp. 7-332.
30. Zulch KJ. Histologic typing of neoplasms of the central nervous system.
International histologic classification of neoplasms, no 21. World Health Organization; Geneva, 1979.
31. Tatter SB. The new classification of neoplasms affecting CNS.
Http://www.brainlife.org/fulltext/1996/tatter_96000.htm
32. Cloughesy T, Seleh MT, Liau L (eds). Brain. Cancer treatment. Philadelphia; WB Saunders co. 2001; pp. 1106-42
33. Ricci PE. Imaging of adult brain neoplasms. Neuroimaging Clin N Am 1999;
9:651-69.
34. Kleihues P, Louis DN, Wiestler OD. Astrocytic neoplasms. In Louis DN, Ohgaki H, Wiestler OD, Cavenee KW (eds). The 2007 WHO classification of neoplasms of the central nervous system; IARC; Lyon: pp. 13-52.
35. Reifenberger G, Kros JM, Louis DN, Collins VP. Oligodendroglial neoplasms and mixed gliomas. In Louis DN, Ohgaki H, Wiestler OD, Cavenee KW (eds). The 2007 WHO classification of neoplasms of the central nervous system; IARC;
Lyon: pp. 53-68
36. Mclendon RE, Schiffer D, Rosenblum MK, Wiestler OD. Ependymal neoplasms.
In Louis DN, Ohgaki H, Wiestler OD, Cavenee KW (eds). The 2007 WHO classification of neoplasms of the central nervous system; IARC; Lyon: pp. 69-80 37. Aldape KD, Rosenblum MK. Neuroepithelial neoplasms of uncertain origin. In Louis DN, Ohgaki H, Wiestler OD, Cavenee KW (eds). The 2007 WHO classification of neoplasms of the central nervous system; IARC; Lyon: pp. 87-94 38. Giangaspero F, Eberhart CG, Haapasalo H, Pietsch T, Wiestler OD, Ellison DW.
Embryonal neoplasms. In Louis DN, Ohgaki H, Wiestler OD, Cavenee KW (eds).
The 2007 WHO classification of neoplasms of the central nervous system; IARC;
Lyon: pp. 131-150
39. Brat DJ, Vandenberg SG, Figarella-Branger D, Taratuto AL. Neuronal and mixed neuronal-glial neoplasms. In Louis DN, Ohgaki H, Wiestler OD, Cavenee KW (eds). The 2007 WHO classification of neoplasms of the central nervous system;
IARC; Lyon: pp. 95-120
40. Paulus W, Brandner S. Choroid plexus neoplasms. In Louis DN, Ohgaki H, Wiestler OD, Cavenee KW (eds). The 2007 WHO classification of neoplasms of the central nervous system; IARC; Lyon: pp. 81-86
41. Nakazato Y, Jouvet A, Scheithauer BW. Neoplasms of the pineal region. In Louis DN, Ohgaki H, Wiestler OD, Cavenee KW (eds). The 2007 WHO classification of neoplasms of the central nervous system; IARC; Lyon: pp. 121-130
42. Perry A, Louis DN, Scheithauer BW, Budka H, Von Deimling A. Meningeal neoplasms. In Louis DN, Ohgaki H, Wiestler OD, Cavenee KW (eds). The 2007 WHO classification of neoplasms of the central nervous system; IARC; Lyon: pp.
163-186
43. Rosenblum MK, Nakazato Y, Matsutani M. Germ cell neoplasms. In Louis DN, Ohgaki H, Wiestler OD, Cavenee KW (eds). The 2007 WHO classification of neoplasms of the central nervous system; IARC; Lyon: pp. 197-204
44. Rushing EJ, Giangaspero F, Paulus W, Burger PC. Neoplasms of the sellar region. In Louis DN, Ohgaki H, Wiestler OD, Cavenee KW (eds). The 2007 WHO classification of neoplasms of the central nervous system; IARC; Lyon: pp.
237-246
45. Plate KH, Vortneryer AO, Zagzag D, Neumann HPH. Familial tumour syndromes In Louis DN, Ohgaki H, Wiestler OD, Cavenee KW (eds). The 2007 WHO classification of neoplasms of the central nervous system; IARC; Lyon: pp. 215-217
46. Scheithauer BW, Louis DN, Hunter S, Woodruff JM, Antonescu CR. Neoplasms of cranial and paraspinal nerves. In Louis DN, Ohgaki H, Wiestler OD, Cavenee KW (eds). The 2007 WHO classification of neoplasms of the central nervous system; IARC; Lyon: pp. 151-162
47. Wesseling P, Von Deimling A, Aldape KD. Metastatic neoplasms of the CNS. In Louis DN, Ohgaki H, Wiestler OD, Cavenee KW (eds). The 2007 WHO classification of neoplasms of the central nervous system; IARC; Lyon: pp. 247-252.
48. Idowu O, Akang EEU, Malomo A. Symptomatic primary intracranial neoplasms in Nigeria, West Africa; J Neurol Sci (Turkish) 2007, 24:212 -218.
49. Huang WQ, Zheng SJ, Tian QS, et al. Statistical analysis of Central Nervous System neoplasms in China. J Neurosurg 1982; 56: 555-6.
50. Heshmat MY, Kovi J, Simpson C, et al. Neoplasms of the Central Nervous System. Incidence and population selectivity in the Washington DC Metropolitan area. Cancer 1976; 38: 2135-42.
51. Lagunju IA, Okolo CA, Ebruke BE, et al. Severe neurological involvement in tuberous sclerosis: a report of two cases and a review of the African literature. Afr J Neurol Sci 2007; 26:[2]. 103-8
52. Billinghurst JR. Intracranial space occupying lesions in African patients at Mulago Hospital, Kampala. East Afr Med J 1966; 43:385-393.
53. Odeku EL, Osuntokun BO, Adeloye A, William AO. Neoplasms of the brain and its coverings, an African series. Int Surg 1972; 57:798-801.
54. Izuora GI, Ikerionwu S, Saddeqi N, Iloeje SO. Childhood intracranial neoplasm Enugu, Nigeria. West Afr J Med. 1989; 8[3]:171-4
55. Aghadiuno PU, Adeloye A, Olumide AA, Nottidge VA. Intracranial neoplasms in children in Ibadan. Child’s Nerv. System 1985;1:39-34.
56. Rorke LB. The cerebellar medulloblastoma and its relationship to primitive neuroectodermal tissues. J Neuropathol Exp Neurol 1983;42:1-15.
57. Bailey CC, Spooner D. Brain neoplasms in children. In Peckham M, Pinedo H, Veronesi U (eds.). Oxford textbook of Oncology, vol. 2. Oxford University Press, New York, 1995: pp. 2056.
58. National Bureau of Statistics. Federal Republic of Nigeria. 2006 Population Census. http://www.nigerianstat.gov.ng/Connections/Pop2006.pdf.
59. Oluwasola AO, Fawole OI, Otegbayo JA, et al. Trends in clinical autopsy rate in a Nigerian tertiary hospital. Afr J Med Med Sci 2007; 36:267-272.