PATHOLOGY OF BRAIN
TUMOURS - THE SUBREGIONAL
EXPERIENCE
E.E.U. AKANG, MBBS

Professor of Pathology, University of Ibadan, ...
E k’abo! Welcome to Ibadan!
Introduction 1
• Central nervous system (CNS) tumours
are a diverse group of neoplasms
• Each neoplasm has distinctive bio...
Introduction 2
•Cancer is the leading cause of
nd
death in developed and the 2
most common cause in developing
nations
•Ag...
Historical background
•CNS tumours were believed to be rare in
native Africans up until half a century ago
•Expanding gene...
144 million population
35,000 medical doctors
<500 pathologists
Per capita (p.c.) income $300
Health budget $50 p.c.
307 m...
Early studies in Africa
•Necropsy-based studies were the 1st
reports of CNS tumours in tropical Africa
•Strachan, 1934- So...
Meningioma

WAMJ 1963; 12:251-263

3 meningiomas
2 astrocytomas
2 pituitary adenomas
1 pinealoma
WAMJ 1963; 12:251-263
Case reported as medulloblastoma

3 cases of medulloblastoma14 yr F- frontal lobe;
30 yr M- Lt thala...
WAMJ 1963; 12:251-263
Case reported as ependymoma
15 year old
male with
fibrosarcoma
of thigh with
lung
metastases
and dur...
Later studies

Odeku & Janota 19673 yrs after establishment of Neurosurgery at UCH,
Ibadan- “not so rare”
48 intracranial ...
Other early African studies

• Kasili et al 1971- Kenya
97 intracranial tumours; gliomas 45%, meningiomas
28%
• Collomb et...
Ibadan- 1980-1997

East Afr Med J 2000; 77:1-5
Olasode et al 20002nd and 3rd generations of Ibadan neurosurgeons
210 histo...
Ibadan- 1991-2007
Sahabi 20083rd generation of Ibadan neurosurgeons
Progressive increase in CNS tumour rates
356 histologi...
Sahabi, 2008
Gender distribution among tumour groups
Pilocytic astrocytoma
Sahabi, 2008
Gemistocytic astrocytoma
Sahabi, 2008
Anaplastic astrocytoma
Sahabi, 2008
Oligodendroglioma
Sahabi, 2008
MeningiomasSahabi, 2008

HISTOLOGICAL HISTOLOGICAL
TYPES
SUBTYPES

Meningioma

Mesenchymal
tumours
Other

WHO GRADE
TOTAL
...
Odebode et al, 2002
Unpublished observations

Morphological
variants

Nigeria
(1972)
N=38

Nigeria
(2002)
N=60

Turkey S’A...
Meningioma- secretory
Sahabi, 2008
Meningioma- transitional
Sahabi, 2008
Craniopharyngioma
Sahabi, 2008
Metastatic CNS neoplasms
Sahabi, 2008
Metastatic choriocarcinoma
Sahabi, 2008
Lagos University Teaching Hospital
LAGOS- 2001-2011
Awelimobor 20111st and 2nd generation of Lagos neurosurgeons
Progressive increase in CNS tumour rates
110...
Craniopharyngioma
Awelimobor, 2011
PAEDIATRIC CNS NEOPLASMS 1
• Age standardised incidence rates for
childhood CNS neoplasms is 25-40
per 106 in developed co...
PAEDIATRIC CNS NEOPLASMS 2
IBADAN
•Aghadiuno et al- 89 CNS neoplasms (1960-1982)Astrocytoma, medulloblastoma, ependymoma a...
PAEDIATRIC CNS NEOPLASMS 3
• Karkouri et al reviewed 542 CNS
neoplasms in Morrocco
• Astrocytoma and medulloblastoma
were ...
INTRAOPERATIVE CONSULTATION
A primary role of pathologist in patient
management
-Gross examination
-Frozen section
-Cytolo...
Glioblastoma- cytology, Frozen section and
permanent section
Awelimobor, 2011
Pituitary adenoma- cytology and frozen section
Awelimobor, 2011
Meningioma- cytology, Frozen section and
permanent section
Awelimobor, 2011
COMPARISON OF SELECTED AFRICAN SERIES

TUMOUR
TYPES

Ibadan
1957-1969
N = 116*

Ibadan
1980-1990
N = 210

Ibadan
1991-2007...
CONCLUDING REMARKS

•Pathologists in the sub region faces enormous
challenges in terms of diagnostic facilities
•Biologic ...
LIST OF REFERENCES
Thanks for listening!
Have a safe trip home!
O d’abo!
Pathology of brain tumors   the subregional experience
Upcoming SlideShare
Loading in …5
×

Pathology of brain tumors the subregional experience

895 views

Published on

Published in: Education, Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
895
On SlideShare
0
From Embeds
0
Number of Embeds
4
Actions
Shares
0
Downloads
23
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Pathology of brain tumors the subregional experience

  1. 1. PATHOLOGY OF BRAIN TUMOURS - THE SUBREGIONAL EXPERIENCE E.E.U. AKANG, MBBS Professor of Pathology, University of Ibadan, Nigeria Consultant Pathologist, Department of Pathology, University College Hospital, Ibadan, Nigeria CLINICAL NEUROSCIENCE REVIEW CONFERENCE AUGUST 8 - 10, 2011 IBADAN, NIGERIA
  2. 2. E k’abo! Welcome to Ibadan!
  3. 3. Introduction 1 • Central nervous system (CNS) tumours are a diverse group of neoplasms • Each neoplasm has distinctive biology, treatment and prognosis • High-grade CNS neoplasms are among the most aggressive and intractable types of cancer
  4. 4. Introduction 2 •Cancer is the leading cause of nd death in developed and the 2 most common cause in developing nations •Age-standardised mortality rates for CNS tumours is 3.6 in developed and 2.9 per 100,000 in developing nations
  5. 5. Historical background •CNS tumours were believed to be rare in native Africans up until half a century ago •Expanding general/specialist medical services have led to increasing recognition of CNS tumours •Most of the early reports from the sub region have been clinical neurosurgery series
  6. 6. 144 million population 35,000 medical doctors <500 pathologists Per capita (p.c.) income $300 Health budget $50 p.c. 307 million population 814,000 medical doctors* *How many of these are Nigerians? 20,000 pathologists* Per capita (p.c.) income $39,000 Health budget $2,250 p.c. 6
  7. 7. Early studies in Africa •Necropsy-based studies were the 1st reports of CNS tumours in tropical Africa •Strachan, 1934- South Africa- less common in Bantus than other races •Davies, 1957- 6 gliomas among 2162 PMs- not uncommon •Jackson & Okubadejo, 1963- wellillustrated report of 13 CNS tumours among 3489 PMs- uncommon
  8. 8. Meningioma WAMJ 1963; 12:251-263 3 meningiomas 2 astrocytomas 2 pituitary adenomas 1 pinealoma
  9. 9. WAMJ 1963; 12:251-263 Case reported as medulloblastoma 3 cases of medulloblastoma14 yr F- frontal lobe; 30 yr M- Lt thalamus, cerebellum and midbrain; 4 yr F- basal ganglia and optic n. 14 yr Fleft frontal lobe mass Could this be a PNET or an anaplastic astrocytoma?
  10. 10. WAMJ 1963; 12:251-263 Case reported as ependymoma 15 year old male with fibrosarcoma of thigh with lung metastases and dura based intracranial tumour
  11. 11. Later studies Odeku & Janota 19673 yrs after establishment of Neurosurgery at UCH, Ibadan- “not so rare” 48 intracranial masses 44 neoplasms; neurogenous neoplasms (47.7%), meningiomas (22.9%), sellar region (15.9%) Ohaegbulam et al 198043 intracranial neoplasms from Enugu Gliomas (23.2%), sellar region (20.9%), meningioma (18.6%)
  12. 12. Other early African studies • Kasili et al 1971- Kenya 97 intracranial tumours; gliomas 45%, meningiomas 28% • Collomb et al 1973- Senegal 187 intracranial neoplasms and 33 inflammatory masses Gliomas, meningiomas, sellar region tumours • Sorour et al 1973- Egypt Two series 291 clinical and 377 autopsy Gliomas, meningiomas- high incidence
  13. 13. Ibadan- 1980-1997 East Afr Med J 2000; 77:1-5 Olasode et al 20002nd and 3rd generations of Ibadan neurosurgeons 210 histologically confirmed CNS neoplasms- 135 (64.3%) adults & 75 (35.7%) children Gliomas most common, followed by metastases (choriocarcinoma and Burkitt’s lymphoma) Sellar region tumours predominate in children
  14. 14. Ibadan- 1991-2007 Sahabi 20083rd generation of Ibadan neurosurgeons Progressive increase in CNS tumour rates 356 histologically confirmed CNS neoplasms264 (74.2%) adults & 92 (25.8%) children Gliomas most common, followed by meningiomas. Female predominance in meningiomas; Reduced metastases, with decline in choriocarcinoma
  15. 15. Sahabi, 2008
  16. 16. Gender distribution among tumour groups
  17. 17. Pilocytic astrocytoma Sahabi, 2008
  18. 18. Gemistocytic astrocytoma Sahabi, 2008
  19. 19. Anaplastic astrocytoma Sahabi, 2008
  20. 20. Oligodendroglioma Sahabi, 2008
  21. 21. MeningiomasSahabi, 2008 HISTOLOGICAL HISTOLOGICAL TYPES SUBTYPES Meningioma Mesenchymal tumours Other WHO GRADE TOTAL I II III Secretory Anaplastic Atypical Angiomatous Psammomatous Meningothelial Fibroblastic Transitional 3 0 0 2 5 21 8 45 0 0 3 0 0 0 0 0 0 7 0 0 0 0 0 0 3 7 3 2 5 21 8 45 Haemangiopericytoma 0 3 1 4 Haemangioblastoma 3 0 0 3
  22. 22. Odebode et al, 2002 Unpublished observations Morphological variants Nigeria (1972) N=38 Nigeria (2002) N=60 Turkey S’Arabi Canada (1997) a (1996) (1983) N=203 N=131 N=114 USA (1982) N=51 Norway (1974) N=256 Transitional Meningothelial 44.7 55 26.6 19 30.5 23 34 42.1 34.2 37.3 35.3 6 52 Psammomatous Fibrous Angiomatous 23.7 7.9 5.3 1.7 1.7 1.7 7 26 3.5 3 23 5 20.2 0.9 9.8 7.8 - 14 5 Mixed patterns 18.4 - - - - - 23 Sclerosing - - - 10.7 - - - Chordoid - - - 0.8 - - - Hemangiopericytoma - 8.3 - - - - - Papillary - - - - - 9.8 - Anaplastic - 5.0 13 - 2.6 - - Atypical - - 1 - - - -
  23. 23. Meningioma- secretory Sahabi, 2008
  24. 24. Meningioma- transitional Sahabi, 2008
  25. 25. Craniopharyngioma Sahabi, 2008
  26. 26. Metastatic CNS neoplasms Sahabi, 2008
  27. 27. Metastatic choriocarcinoma Sahabi, 2008
  28. 28. Lagos University Teaching Hospital
  29. 29. LAGOS- 2001-2011 Awelimobor 20111st and 2nd generation of Lagos neurosurgeons Progressive increase in CNS tumour rates 110 CNS neoplasms- 76.4% adults & 23.6% children Meningioma (30.9%), pituitary adenoma (20%) and astrocytic tumours (19%). Metastases in 3.5%.
  30. 30. Craniopharyngioma Awelimobor, 2011
  31. 31. PAEDIATRIC CNS NEOPLASMS 1 • Age standardised incidence rates for childhood CNS neoplasms is 25-40 per 106 in developed countries and <15 per 106 in developing nations • Due partly to under ascertainment and partly to racial factors
  32. 32. PAEDIATRIC CNS NEOPLASMS 2 IBADAN •Aghadiuno et al- 89 CNS neoplasms (1960-1982)Astrocytoma, medulloblastoma, ependymoma and oligodendroglioma •Olasode- astrocytoma, craniopharyngioma and medulloblastoma •Overall increase with fewer Burkitt’s cases ENUGU- Izuora et al Craniopharyngioma (38%), astrocytoma and medulloblastoma (14% each)
  33. 33. PAEDIATRIC CNS NEOPLASMS 3 • Karkouri et al reviewed 542 CNS neoplasms in Morrocco • Astrocytoma and medulloblastoma were most common • Emphasised the need for population based registry to assess true burden of these neoplasms
  34. 34. INTRAOPERATIVE CONSULTATION A primary role of pathologist in patient management -Gross examination -Frozen section -Cytology Awelimobor 2011100% concordance rate between cytological and frozen section diagnosis, as well as between frozen section and routine paraffin embedded tissue diagnosis
  35. 35. Glioblastoma- cytology, Frozen section and permanent section Awelimobor, 2011
  36. 36. Pituitary adenoma- cytology and frozen section Awelimobor, 2011
  37. 37. Meningioma- cytology, Frozen section and permanent section Awelimobor, 2011
  38. 38. COMPARISON OF SELECTED AFRICAN SERIES TUMOUR TYPES Ibadan 1957-1969 N = 116* Ibadan 1980-1990 N = 210 Ibadan 1991-2007 N = 356 Lagos 2001-2010 N = 110 Senegal 1960-1971 N = 187 Kenya 1968-1971 N = 97 Egypt 1956-1962 N = 315* 53 (25.3%) 88 (24.7%) 21 (19.1%) 64 (34.2%) 33 (34%) 99 (31.4%) Astro 15 (12.9) Oligo 1 (0.9) 8 (3.8) 8 (2.2) 1 (0.9) 0 (0) 0 (0) 5 (1.6) Ependymal 6 (5.2) 1 (0.5) 11 (3.1) 3 (2.7) 6 (3.2) 5 (5.2) 28 (8.9) Choroid 0 (0) 0 (0) 1 (0.3) 2 (1.8) 3 (1.6) 1 (1) 3 (9.5) Neuronal/ Glial 0 (0) 0 (0) 8 (2.2) 0 (0) 0 (0) 0 (0) 0 (0) Pineal 5 (4.3) 0 (0) 2 (0.6) 1 (0.9) 0 (0) 1 (1) 13 (4.1) Embryonal 6 (5.2) 8 (3.8) 25 (7) 5 (4.5) 5 (2.7) 4 (4.1) 15 (4.8) Cranial nerve 1 (0.9) 0 (0) 1 (0.3) 1 (0.9) 4 (2.1) 3 (3.1) 27 (8.6) Meningeal 19 (16.4) 24 (11.4) 104 (29.2) 37 (33.6) 35 (15.9) 24 (24.7) 75 (23.8) Lymphoma 0 (0) 0 (0) 1 (0.3) 0 (0) 0 (0) 0 (0) 0 (0) 2 (1.7) 3 (1.4) 1 (0.3) 0 (0) 0 (0) 0 (0) 0 (0) Sellar region 24 (20.7) 55 (26.1) 78 (21.9) 31 (28.2) 14 (7.5) 13 (13.4) 28 (8.9) Metastatic 21 (18.1) 48 (23) 31 (8.7) 5 (4.5) 26 (13.9) 10 (10.3) 14 (4.4) Germ cell
  39. 39. CONCLUDING REMARKS •Pathologists in the sub region faces enormous challenges in terms of diagnostic facilities •Biologic characteristics of CNS neoplasms in developing countries have been discussed •Expansion of adult/pediatric neurologic/neurosurgical facilities requires increased sophistication of routine laboratory diagnostic methods •This can be facilitated by training and research linkages between centers in developing and developed countries.
  40. 40. LIST OF REFERENCES
  41. 41. Thanks for listening! Have a safe trip home! O d’abo!

×