Background: Brain tumors are associated with marked disability and mortality Understanding the patterns and epidemiological characteristics associated with brain tumors can be crucial to their treatment
Objective: To explore the magnitude and epidemiological features of primary brain tumors among patients admitted to Aseer Central Hospital (ACH), Abha City, Saudi Arabia, and to identify different decisions for their management Methodology: All hospital records of brain tumor patients admitted to ACH from 2015-2017 were reviewed Collected data included patients' demographic characteristics, clinical findings, histopathological diagnosis, and management
Results: During the aforementioned period, a total of 100 patients with primary brain tumors were admitted to ACH The most commonly presenting symptoms were headache (72%), vomiting, dizziness, and focal motor deficits (25% for all) Tumor location was mostly at the frontal or parietal lobes Among those who underwent surgery, meningioma grade I was the most frequently diagnosed (417%) The mean surgical time was 42 ± 16 h Most patients who underwent surgery at ACH stayed in the intensive care unit anywhere from 1 d or 2-4 d (34% and 40%, respectively) The Glasgow outcome scale scores of most patients (917%) indicated that the patients had a good recovery However, one patient died (17%), one was in a persistent vegetative state (17%), and three sustained moderate disability (5%)
Conclusion: Most patients with brain tumors admitted to ACH undergo surgery Meningioma grade I is the most commonly encountered brain tumor, and this finding may reflect different epidemiological findings from the internationally accepted concept that glioblastoma multiforme is the most common brain tumor The most common locations for brain tumors are the frontal and parietal lobes

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Does brain tumor epidemiology differ from place to another? Saudi single tertiary care center experience

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. 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. 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.

/pdf/trends-in-clinico-epidemiology-profile-of-surgically-3mphvzlofw.pdf

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

Background: Descriptive epidemiology of intracranial central nervous system (CNS) tumours is a significant part of tumour studies which provides information on magnitude and distribution of the lesions. The objective of this study is to provide an overview of frequency of intracranial CNS tumours with comparison with national and international data. Methods: In this retrospective study 101 intracranial CNS tumours diagnosed over a period of 4 years were included. Histological diagnosis of tumours was confirmed and they were classified according to revised WHO classification of CNS tumours 2016. Frequencies of tumours in accordance to age, gender, location, laterality and grades were evaluated. Results: Total 101 cases including 59 (58.42%) males and 42 (41.58%) females were studied. Paediatric and adult cases accounted for 17 (16.83%) and 84 (83.17%), respectively. Most tumours were noted in the 6th decade. Out of total cases, 91 (90.1%) were primary intracranial CNS tumours and 10 (9.9%) were metastatic tumours. Most common tumours were astrocytoma followed by meningioma. Among children, astrocytoma (41.18%), medulloblastomas (41.18%), ependymomas (11.76%) and meningiomas (5.88%) were the reported lesions. In adults, astrocytoma (39.29%), meningiomas (23.81%), metastatic tumours (11.90%), ependymomas (8.33%), hemangioblastomas (5.95%) and schwannomas (4.76%) were common. Glioblastomas were the commonest astrocytoma. WHO grade I tumours were commonest followed by grade IV. Conclusions:  The study gives a glimpse of prevalence of intracranial central nervous system tumours forming a baseline profile based primarily on the histopathological diagnosis at rural tertiary care hospital.

Analysis of histopathological spectrum of intracranial central nervous system tumours in a tertiary care hospital

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.

Gliomas - An experience based on molecular markers.

Dear Editor, I read this article with great interest entitled, “Role of image‐guided fine needle aspiration cytology of lung lesions in diagnosis and primary care of patients: Experience in a Government Medical College of Eastern India” by Chakrabarti et al.[1] and congratulate the author for well written manuscript. But there are few queries considering very frequently performed procedure and common condition. First title should be CT guided unless you have used more than one radiological modality like CT and Ultrasound both for procedure. This is full length article in which ethical approval was taken and author must had submitted their research proposal. But it was not clear, what was the inclusion and exclusion criteria. Whether author included all non‐resolving radiological lesion for fine needle aspiration cytology (FNAC) or all suspected malignancy case are only included in study.

Role of image-guided fine needle aspiration cytology of lung lesions in diagnosis and primary care of patients: Experience in a Government Medical College of Eastern India.

Background: Brain tumors are heterogeneous group of neoplasms, affecting different age groups. Although some studies have been published regarding pathological pattern of brain tumors from different countries of the world and also from India, comprehensive clinicopathological studies from Eastern India is lacking. Aims: The aim of this study was to observe recent incidence of different brain tumors and to study clinical and histopathological spectrum of brain tumors in Eastern India. Materials and Methods: The present study was a cross-sectional observational study involving 130 cases of brain tumors which were diagnosed during the 3-year study period (January 2010–December 2012). Data regarding clinical presentation and radiological features of all cases were collected from all patients. Histopathological diagnosis was correlated with clinical and radiological diagnosis. Results: We found 130 cases of brain tumor with a male preponderance. The cases were distributed in a wide age range from 4 years to 78 years with the mean age of 42.38 years. Most common tumor type in our study was neuroepithelial tumor (92 cases, 70.76%). Among the neuroepithelial tumors, most frequent subtype was astrocytic tumor (54 cases, 41.5%). The second most frequent brain tumor was meningioma (20 cases, 15.3%). We found higher incidence of oligodendroglial tumor (8.46%) and medulloblastoma (7.69%) in our series. Conclusion: Males are more predispose to brain tumors in comparison to females. Astrocytic tumors are most common subtype in Eastern India. However, the WHO Grade I neoplasms are more frequent brain tumors.

Clinicopathological pattern of brain tumors: A 3-year study in a tertiary care hospital in India

Lymphatic leishmaniasis is a rare parasitic disease even in endemic region. It is usually associated with visceral and post-kala-azar dermal leishmaniasis. Leishmaniasis is being increasingly recognized in association with immunodeficient patients (HIV/AIDS). However, leishmanial lymphadenitis has been rarely diagnosed by fine-needle aspiration cytology (FNAC) of epitrochlear lymph node in an HIV patient. Cytological features of leishmanial lymphadenitis in an HIV-reactive patient have been rarely addressed in previous literature. We present the FNAC of a case of leishmanial lymphadenitis in epitrochlear lymph node in the case of an HIV-reactive patient with visceral leishmaniasis.

Fine-needle aspiration cytology of leishmanial lymphadenitis in an HIV-reactive patient: Report of a rare case

Introduction: Fine-needle aspiration cytology (FNAC) is a simple, safe, and effective tool for cytological diagnosis of different neoplastic lesions. Computed tomography (CT)-guided core biopsy is also essential for tissue diagnosis. Aims and Objectives: The aim of this study is to assess the diagnostic value and limitations of fine-needle aspiration and core biopsy in diagnosis of intrathoracic lesions; we have done this retrospective study. Materials and Methods: In all 54 cases with mean age of 57.37 years, CT-guided FNAC and core biopsy were performed on same sittings. 20–22 G Chiba needle was used for FNAC, and core biopsy was performed by 18–20 G coaxial automated cutting needle. The cytological and histological evaluations were done in our cytology and histopathology laboratory. Complications were managed by pulmonologists. Results: On the evaluation of FNAC smears, diagnosis was done in 44 cases and 10 cases were inconclusive. In core biopsy, five cases were inconclusive. Most of the tumors were of epithelial origin (43 cases, 87.75%) and 95.59% cases were malignant in our series. Sensitivity and diagnostic accuracy of core biopsy (90.38% and 90.74, respectively) were higher than FNAC (84.62% and 85.18%, respectively). Conclusion: CT-guided core biopsy was more effective and accurate in diagnosis and tumor classification than FNAC in spite of higher complication rate.

Computed tomography-guided fine-needle aspiration and concurrent core biopsy in diagnosis of intrathoracic mass: An evaluation of 54 cases in a tertiary care hospital

Leishmaniasis is a parasitic disease caused by protozoa called “Leishmania species” and it is transmitted by “Sandfly.[1]” It is an endemic disease in several parts of India.[2] Leishmaniasis is categorized under several manifestations – visceral, cutaneous, and mucosal.[1] The parasite affects the macrophages of mononuclear phagocyte system and increased incidence seen in malnutrition, immunosuppression, and HIV infection.[1,2] Leishmaniasis is an emerging opportunistic coinfection in HIV‐positive patients in endemic areas.[3] Diagnosis of the cases often delayed due to lack of awareness and uncommon presentation.[3] Demonstration of Leishman–Donovan (LD) bodies in lymph node by fine‐needle aspiration cytology (FNAC) has rarely been reported in visceral leishmaniasis.[4] We describe a rare case of cytology of leishmanial lymphadenitis involving epitrochlear lymph node in a case of HIV reactive visceral leishmaniasis.

Fine-needle aspiration cytology of leishmanial lymphadenitis in a HIV reactive patient

Primary mucinous eccrine carcinoma is a rare malignant adnexal tumor of older patients. The histopathological features of this tumor are well-established but the cytomorphology of this neoplasm has only been documented in a few cases. The cytology and histology of this tumor may mimic metastatic mucinous carcinoma and may cause a diagnostic dilemma, especially when the tumor is located at axilla. A correct diagnosis is important because the prognosis is better than that of a metastatic mucinous carcinoma. Here we report the cytological and histological features of a case of primary cutaneous mucinous carcinoma of axilla in an elderly male patient.

Fine needle aspiration cytology of primary cutaneous mucinous carcinoma of axilla-report of a rare case

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