Neoplas c Solid Lesions of Pediatric age group- A hospital based study

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1 Original Research Paper IJRRMS 0;() Neoplas c Solid Lesions of Pediatric age group- A hospital based study Kediya AS, Likhar KS, Girji DD, Likhar SK ABSTRACT Background: Cancer is essen ally a disease of adults, yet it is one of the common killers in childhood. In western countries, cancer is next only to trauma as a cause of mortality in children under years of age. Only % of all the malignant tumors occur in infancy and childhood. Aim: To observe frequency, age and sex wise distribu on and to correlate histopathological findings of tumors of pediatric age group. Method: A prospec ve cross sec onal study conducted during Jan '00 to Nov '00 in the department of Pathology of S.R.T.R.Medical College & Hospital, Ambajogai. 9 cases of pediatric solid tumor diagnosed clinically and histopathologically were included. Result: Pediatric tumors accounts for.8% with a female predominance (M:F ra o 0.8:). 6.89% were benign and 3.% were malignant with B: M ra o of.8:. Maximum cases were observed in the age group 0- year i.e. 7 cases (0%) followed by cases (6.6%) in 0- year of age group and cases (3.%) in -0 year of age group. Conclusion: Most common benign tumor was hemangioma. Re noblastomas and lymphomas were the most common malignant tumors. Key Words: neoplas c lesion, pediatric tumour, benign, malignant INTRODUCTION Cancer is essen ally a disease of adults, yet it is one of the common killers in childhood. In western countries, cancer is next only to trauma as a cause of mortality in children under years of age. In India, although infec ons and malnutri on are the major factors contribu ng to morbidity and mortality, malignancies are coming into greater focus because of preven ve measures being taken for the former. Most benign tumors are of li le concern but some mes they can cause serious problems due to their loca on or rapid increase in size. Child is not a miniature adult the features of malignancies in children differ biologically and 3 histologically from those of adults. The main differences are; incidence and type of tumor, prevalence of underlying familial or gene c aberra on, tendency of fetal and neonatal malignancies to regress spontaneously or cytodifferen ate and close rela onship b e t w e e n a b n o r m a l d e v e l o p m e n t ( teratogenesis) a n d t u m o u r i n d u c o n (oncogenesis). But for brain tumors, tumors in the children are invariably classified by histological type rather than their anatomic site, as their prognosis depends on the former. Histologically, these tumors are o en characterized by sheets of cells with small round nuclei and frequently show features of organogenesis specific to the site of tumor origin so designated by suffix Blastoma and collec vely referred to as small round blue cell tumors. Acute leukaemia, brain cancers, lymphomas a n d s a r c o m a s o f s o s s u e a n d b o n e predominate in children and adolescents. In adults, in contrast, epithelial tumors of organs like lung, colon, breast, and prostate are most common. Unlike incidence pa erns in adults where cancer rates tend to rapidly increase with IJRRMS VOL- No. APR - JUN 0

2 IJRRMS 0;() increasing age, rela vely wide age variability exists during development, with two peaks, one in early childhood and another in adolescence. During the st year of life, embryonal tumors such as Neuroblastoma, Wilms' Tumor ( N e p h r o b l a s t o m a ), R e n o b l a s t o m a, Rhabdomyosarcoma and Medulloblastoma are most common. These tumors, which are likely congenital, occur far less o en among older children, whose developmental processes and cell differen a on have slowed considerably and are extremely unusual in adults. Embryonal tumors together with acute leukemias, Non-Hodgkin lymphomas and gliomas, peak in incidence from years of age. As children age, especially a er they pass puberty, bone malignancies, Hodgkin disease, gonadal germ cell malignancies (tes cular and ovarian carcinomas) and various carcinomas s u c h a s t hy ro i d c a n c e r a n d m a l i g n a n t melanoma increase in incidence. It appears that adolescence is a transi onal period b etween t h e common e a r l y c h i l d h o o d malignancies and characteris c carcinomas of adulthood. Accurate diagnosis and staging of disease is impera ve, especially for children, whose cure rates are so high. Accuracy also is essen al, not only because the natures of therapy depends strongly on the type of cancer but also because be er and worse prognos c subgroups, based on stage of disease, have been established for m o s t c a n c e r s t h a t o c c u r i n c h i l d r e n. Accordingly, children with a be er prognosis are treated with less intensive therapy thus avoiding the occurrence of excessive acute adverse effects and long-term complica ons of therapy. Because of major advances in diagnosis and mul modality therapy over 60% of childhood cancers are now curable. The present study is undertaken to observe frequency, age/sex wise distribu on, to classify benign and malignant paediatric tumor in a period from Jan 00 to Nov 00 with the exclusion of leukemias. MATERIAL AND METHODS A prospec ve cross sec onal study conducted d u r i n g J a n ' 0 0 t o N o v ' 0 0 i n t h e department of Pathology of S.R.T.R.Medical College & Hospital, Ambajogai, to know the frequency of pediatric tumor. Study Popula on: 9 cases of pediatric solid t u m o r d i a g n o s e d c l i n i c a l l y a n d histopathologically. Inclusion Criteria: Only those cases which a er clinical examina on had been subjected to biopsy or surgery and subsequently to histopathological examina on. Exclusion Criteria: Pa ents who were treated conserva vely, either biopsy or surgery was not performed or referred to other hospitals were excluded from the study. While selec ng the age, sex and clinical p re s e n t a o n o f t h e p a e n t fo r m e d a n important part. All recruited pa ents were examined thoroughly. Local examina on included site, size, surface, consistency and movement of the swelling. Only those cases were selected for study which had been subjected for histopathological examina on. IJRRMS VOL- No. APR - JUN 0

3 IJRRMS 0;() RESULTS A total of 98 cases were received by the department during the study tenure; out of which pediatric tumors were 9 (.8%). Out of total malignant tumour 3, pediatric tumours were 33 (.9%) Out of 9 cases 3 were male and were female with 0.8: M:F ra o. Out of 9 cases of pediatric tumors, 6 (6.89%) were benign and 33 (3.%) were malignant with B: M ra o of.8:. Maximum cases were observed in the age group 0- year i.e. 7 cases (0%) followed by cases (6.6%) in 0- year of age group and cases (3.%) in -0 year of age group. Table.. Frequency of Paediatric Tumours according to Age distribu on Age groups Malignant Benign No.(33) % No.(6 ) % 0- year 33.33% 3.3% -9 year 9 7.8% 9.67% 0- year % % Total 33 cases of malignant pediatric tumors consisted o f 7 cases (. % ) e a c h o f re noblastomas and lymphomas, 6 cases (8.8%) of Wilms' tumors, cases (6.06%) each of Ewing's sarcoma, mesenchymal c h o n d r o s a r c o m a, o s t e o s a r c o m a, rhabdomyosarcoma and teratoma and case (3.03%) each of germ cell tumor, squamous cell carcinoma and secondary in lymph nodes. Thus lymphomas and Re noblastomas are the most common malignant tumors followed by kidney, bone and so ssue tumors. In malignant pediatric tumors, maximum cases were observed in the age group of 0- year i.e. cases (36.36%) followed by 0- year i.e. cases (33.33%) and -0 year i.e. 0 cases (30.3%) with a M:F ra o of.7:. All the 7 cases of re noblastoma were below year of age with M:F ra o of 0.7: and the most common presenta on was white pupillary reflex. One case (.9%) had bilateral involvement and posi ve family history. Out of 7 cases of lymphoma, were NHL and 3 were HL with most common age group affected was 0 year ( cases) followed by 0 year ( cases). All 7 cases of lymphoma were male and presented with lymph node disease. All the 6 cases of Wilms' tumor presented with kidney involvement and the most common age group affected was 0 year ( cases) followed by 0 year ( cases) with M:F ra o of :. Both the cases of Ewing's sarcoma were female aged and year and both the cases of osteosarcoma were male aged 3 and year. All the cases of so ssue tumor presented with swelling. cases of malignant teratomas were studied, one in ovary and second in sacrococcygeal region. Tes s, anal canal and inguinal lymph node were the site involved respec vely in cases of germ cell tumor, squamous cell carcinoma and secondaries. Out of 6 cases of benign tumors, 36 (9.0%) were so ssue tumors, 8 (9.0%) were fibro adenomas, 3 cases (.9%) were nerve sheath tumors, (3.7%) were bone tumors i.e. osteochondroma and (3.7%) were mature cys c teratoma of ovary. In benign pediatric tumors, maximum cases were observed in the age group of 0- year i.e. 36 cases (9.0%) followed by 0- year i.e. 3 cases (.3%) and -0 year i.e. cases (9.67%) with a M: F ra o of 0.6:. Among nerve sheath tumors, cases were of s c h w a n n o m a s ( 3. 8 % ) a n d c a s e o f IJRRMS VOL- No. APR - JUN 0 3

4 IJRRMS 0;() neurofibroma (.6%). Out of total 36 cases of s o s s u e t u m o r s, 3 c a s e s w e r e o f hemangiomas (37.7%), cases were of l i p o m a s ( % ) a n d c a s e s w a s o f hemangioendothelioma (.6%). Table.. Distribu on of Various Malignant Paediatric Tumours according to site Tumor Type Organ Site No. of cases Lymphoma Lymph nodes *C **A ***I ****G NHL 0 HL 0 Secondary Lymph node Retinoblastoma Eye 7 Squamous cell carcinoma Anal canal Wilms tumor Kidney 6 Teratoma Mixed Germ cell tumor Osteosarcoma Ewing s Sarcoma Rhabdomyosarcoma Mesenchymal Chondrosarcoma Ovary Sacrococcygeal Testis Bone Soft Tissue Proximal end of tibia Proximal Humerous Distal Femur Lower Limb Head, Neck, Face Upper Limb *Cervical **Axillary ***Inguinal ****Generalised DISCUSSION Incidence of total pediatric tumor reported in 6 the studies of Singh et al (988) and Akhiwu et 7 al (009) was.% and.83% respec vely which is in accordance with the present study (.8%). Banerjee et al (986) and Sharma et al (00) recorded the ra o of benign to malignant paediatric tumor in the range of.3: to.06: which is comparable with the present study (.8:). Incidence of paediatric malignant tumor was.9% in present study which is low as compared to the studies of 8 9 Jamal et al (006) and Jabeen et al (00) who recorded the incidences as.3% and.% respec vely. In present study, most common age group affected for malignant tumor was 0- year 8 (39.39%) followed by 0- year (33.33%) and -9 year (7.8%) which is in accordance with the 9 study of Jabeen et al (00). The Male to female ra o of malignant pediatric tumors in present study is in concordance with 0 the studies done by Jussawalla et al (988), 7 9 Akhiwu et al (009) and Jabeen et al (00). In our study, most common malignant tumor were re noblastoma and lymphoma followed by Wilms' tumor. In studies of Sharma et al 7 (00) and Akhiwu et al (009) most common tumor reported was lymphomas followed by Wilms' tumor and re noblastoma while Jabeen 9 et al (00) reported lymphomas as the most common tumor followed by re noblastoma and Wilms' tumor. In our study, most common benign tumor was hemangioma followed by fibroadenoma and lipoma which is similar to the findings of study done by Sharma et al (00). Limita ons: Major limita on is exclusion of leukemias in this study which is most common malignancy in p a e d i atric a ge. A l s o, Pa e nts t re ated conserva vely; on which biopsy or surgery was not performed & referred to other hospitals were also excluded from study thus reducing the incidence of paediatric tumours. CONCLUSION Neoplas c solid lesions in paediatric age group in Marathwada region of Maharashtra is similar to that observed in rest of the country. IJRRMS VOL- No. APR - JUN 0

5 IJRRMS 0;() AUTHOR NOTE Anupkumar S Kediya, Assistant Professor, Pathology, PCMS & RC, Bhopal Komal Singh Likhar, Professor, Pathology, RKDFMCH & RC Bhopal (Corresponding Author): dr.komallikhar@yahoo.com D D Girji, Professor, Pathology, V K Pa ll Medical Founda on, Ahmednagar, PCMS & RC, Bhopal S K Likhar, Community Medicine, RKDFMCH & RC Bhopal REFERENCES. Banerjee CK, Walia BN, Pathak IC. Pa ern of neoplasms in children. Indian J Pediatr. 986 Jan-Feb;3(): Maitra A. Diseases of Infancy and Childhood. In: Kumar V, Abbas A,Fausto N, Aster J., editors. Robbins and Cotran Pathologic Basis of Disease. 8th ed. Saunders, Elsevier; Kurkure PA. Malignancies in Children: Pediatric Oncology. In: Menon PSN, Agarwal RK, Choudhury P, Thacker NC, Ugra D, editors. IAP Textbook of Pediatrics. th ed. Jaypee Brothers Medical Publisher (P) Ltd.; Sharma S, Mishra K, Agarwal S, Khanna G. Solid tumors of childhood. Indian J Pediatr. 00 Jun;7(6):0-.. Cancer and Benign Tumors. In: Kleigman, Behrman, Jenson, Stanton, editors. Nelson Textbook of Pediatrics. 8th ed. Volume. Saunders Elsevier; Singh S, Sambandam S, Sharma PD, Jaiprakash MP, Gidwani CH. Pa ern of Childhood Malignancies seen at Malignant Diseases Treatment Centre, Command Hospital, Pune. Medical Journal Armed Forces India. Apr 988;(): Akhiwu WO, Igbe AP, Aligbe JU, Eze GI, Akang EE. Malignant childhood solid tumours in Benin City, Nigeria. West Afr J Med. 009 Jul-Aug;8(): Jamal S, Mamoon N, Mushtaq S, Luqman M. Pa ern of childhood malignancies: study of 9 cases at Armed Forces Ins tute of Pathology (AFIP), Rawalpindi, Pakistan. Asian Pac J Cancer Prev. 006 Jul-Sep;7(3): Jabeen S, Haque M, Islam MJ, Talukder MH. Profile of Paediatric Malignancies: A Five Year Study. J Dhaka Med Coll. April 00;9 (): Jussawalla DJ, Yeole BB. Childhood cancers in greater Bombay (973-98). Indian J Cance. 988 Dec;(): IJRRMS VOL- No. APR - JUN 0