Histopathological Spectrum of Central Nervous System Tumors: A Single Centre Study of 100 Cases

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130International Journal of Scientifi c Study | September 2015 | Vol 3 | Issue 6
Histopathological Spectrum of Central Nervous
System Tumors: A Single Centre Study of 100 Cases
Sarita Nibhoria1, Kanwardeep Kaur Tiwana1, Richa Phutela2, Akanksha Bajaj2, Sahil Chhabra2,
Saloni Bansal2
1Associate Professor, Department of Pathology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India, 2Post-graduate
Student, Department of Pathology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
(males:3.0/100,000; females:2.1/100,000).2 In 2008, the
rates had risen to 3.8/100,000 in males and 3.1/100,000
in females, although the incidence rates in developed
countries (males:5.8/100,000; females:4.4/100,000) still
remained higher than those in developing countries (males:
3.2/100,000; females: 2.8/100,000).
In developing countries like India, due to lack of complete
registration of newly diagnosed cases with local cancer
registries, the exact tumor burden of such disease
goes unnoticed and is underestimated. Hospital-based
prevalence data, therefore, forms the basis for estimating
the disease load. With increased availability of diagnostic
facilities and better healthcare, the incidence of CNS
tumors seems to be on the rise in developing countries.3
All the CNS tumors were divided into seven categories:
Tumors of neuroepithelial tissue; tumors of the cranial and
paraspinal nerves; tumors of the meninges; lymphomas
INTRODUCTION
Though central nervous system (CNS) tumors are not
as frequent as tumors of many other sites,1 they showed
a varied histopathologic spectrum. It has been revealed
by International Agency for Research on Cancer that the
worldwide incidence rate of CNS tumors in 2002 was
3.7/100,000 population among males and 2.6/100,000
population among females. The incidence rates were
higher in developed countries (males:5.8/100,000;
females:4.1/100,000) than in developing countries
Original Article
Abstract
Introduction: Central nervous system (CNS) tumors are not frequent tumors with primary malignant brain tumors accounting
for 2% of all cancers in the U.S adults. The incidence rates are lower in developing countries like compared to the developed
countries while increased rates have been observed in both.
Purpose: The aim of the present study is to study the histopathological spectrum of CNS tumors irrespective of age in single
tertiary care center.
Material and Methods: The present 5 years study from a single tertiary care center, patient clinically diagnosed with CNS
tumors and registered between 2009 and 2014 in pathology department were included and classifi ed according to WHO 2007
classifi cation along with grading of the tumor.
Results: A wide range of histopathological spectrum of CNS tumors was observed and was classifi ed according to the recent
WHO classifi cation system. The primary CNS tumors were graded from Grade 1 to Grade 1V. Overall tumors of neuroepithelial
tissue (51.7%) was the most common entity followed by the tumors of meninges (34.8%), metastatic tumors (5.6%), tumors of
peripheral nerves (4.5%), tumors of the sellar region (2.3%), and lymphomas and hematopoietic neoplasm (1.1%).
Conclusion: Rising global trends in the incidence of CNS tumors, irrespective of age have been observed. The present study
highlights the histological diversity in CNS tumors in both, adult as well as pediatric age groups.
Key words: Astrocytoma, Central nervous system, Meningioma, Tumors
Access this article online
www.ijss-sn.com
Month of Submission : 07-2015
Month of Peer Review : 08-2015
Month of Acceptance : 08-2015
Month of Publishing : 09-2015
Corresponding Author: Richa Phutela, House Number BV, 1283, Street Number 1, Chowk Number 4, Jain Nagar, Abohar, Punjab, India.
Phone: +91-9988442680. E-mail: drricha31@gmail.com
DOI: 10.17354/ijss/2015/408

Nibhoria, et al.: Histopathological Spectrum of Central Nervous System Tumors
131 International Journal of Scientifi c Study | September 2015 | Vol 3 | Issue 6
and hematopoietic neoplasms; germ cell tumors; tumors
of the sellar region; and metastatic tumors. The WHO
classifi cation offers a crude histological grading system,
in which each CNS tumor is classifi ed as Grades I-1V
according to its degree of malignancy. This system can
provide an estimate for the prognosis of a patient. In this
study, age, sex and the histological tumor type and grade
were systematically recorded.
The spectra of the malignant tumors were different in the
pediatric and adult groups. For the adults, astrocytic tumors,
tumors of meninges, and metastatic tumors occupied the
top three places while astrocytic tumors took the lead in
pediatric cases.
MATERIALS AND METHODS
The present 5 years study from a single tertiary care center,
the patient diagnosed with CNS tumors and registered
between 2009 and 2014 in the pathology department
were consecutively screened. The H and E stained
histopathological slides of biopsy received were evaluated.
The cases were diagnosed and characterized where
necessary using immunohistochemistry and categorized
according to the WHO 2007 classifi cation. The inclusion
criteria were cases of CNS tumors of all age groups. The
tumors of peripheral nervous system and non-neoplastic
conditions of the CNS were excluded. With these criteria,
a total of 100 cases of CNS tumors were studied, and their
histological typing and grading was done.
RESULTS
The present study was conducted during 2009-2014 in
which 100 cases of clinically diagnosed CNS tumors
received in the department of pathology were studied.
Out of the 100 clinically diagnosed CNS tumors, neoplasm
was seen in 89% of the cases and 07% showed reactive
gliosis while biopsy was inadequate or inconclusive in 04%.
Among the CNS tumors, the majority (95.5%) presented
as space occupying lesion in the brain and only 4.5% were
intra-spinal tumors. The CNS tumors showed a slight male
predominance (Male: Female = 1.2:1) and a broad range
was found, i.e. 0-70 years with the mean age of 40. The
pediatric tumors contributed 12.3% of all CNS tumors
(Table 1).
A wide range of histopathological spectrum of CNS
tumors was observed and was classifi ed according to the
recent WHO classifi cation system. The primary CNS
tumors were graded from I to IV. Overall tumors of
neuroepithelial tissue (51.7%) was the most common entity
followed by the tumors of meninges (34.8%), metastatic
tumors (5.6%), tumors of peripheral nerves (4.5%), tumors
of the seller region (2.3%), and hemolymphoid neoplasm
(1.1%)(Figure 1) respectively (Table 2).
The tumors of neuroepithelial tissue comprised mainly of
astrocytic tumors (39.32%) followed by oligodendroglial
tumors (4.50%), (Figure 2) mixed gliomas (2.25%),
ependymal tumors (2.25%), choroid plexus tumors (2.25%),
and embryonal tumors (1.12%). Male predominance was
seen in the ratio of 1.8:1.0 and the mean age was found
to be 36.4 years. Among the astrocytic tumors, anaplastic
Table 1: Depicting the age, sex, histological
subtypes and WHO grading of meningiomas
Age Sex Histologic subtypes WHO grade
45 Female Transitional I
55 Male Transitional I
31 Female Fibroblastic I
50 Female Meningotheliomatous I
50 Female Transitional I
48 Male Meningotheliomatous I
50 Female Transitional I
35 Female Transitional I
49 Female Transitional I
35 Female Meningotheliomatous I
70 Male Fibroblastic I
21 Female Transitional I
45 Female Meningotheliomatous I
42 Female Meningotheliomatous I
55 Female Fibroblastic I
60 Female Transitional I
19 Female Fibroblastic I
71 Male Meningotheliomatous I
65 Female Meningotheliomatous I
24 Female Atypical meningioma II
28 Male Atypical meningioma II
32 Female Atypical meningioma II
58 Male Meningotheliomatous I
30 Male Meningotheliomatous I
62 Female Meningotheliomatous I
49 Female Transitional I
50 Male Meningotheliomatous I
Figure 1: Plasmacytoma (H&E X400)

Nibhoria, et al.: Histopathological Spectrum of Central Nervous System Tumors
132International Journal of Scientifi c Study | September 2015 | Vol 3 | Issue 6
Meningiomas (Figure 3) dominated the tumors of
meninges contributing 30.3% of the total 34.8% followed
by mesenchymal, not meningeal tumors (3.4%) and
occasional tumors of uncertain histogenesis (1.1%).
The mean age in meningiomas was found to be 45.5 years,
and family preponderance was seen in the ratio of 1:1.2.
Atypical meningiomas constituted 3.34% of the total
meningiomas and occurred in the younger age group with a
mean age of 28 years. A wide range of histologic subtypes
was observed in meningiomas, and WHO grading system
was applied to them (Table 3).
This was followed by metastatic tumors (Figure 4) that
constituted 5.6% of the total tumors with a mean age of
61 years and slight male preponderance (3:2).
The pediatric tumors were peculiar by their histologic
diversity with astrocytic tumors (25% of pediatric tumors)
taking a lead. The median age in pediatric tumors was
found to be 9.4 years with equal male to female ratio (1:1).
(Table 4)
DISCUSSION
The incidence of CNS tumors is quite low in adults
while they form the second most common childhood
tumors after leukemia.4 Adult CNS tumors differ
Table 2: Percentage breakup of CNS tumors with
histologic subtypes and WHO grading
Tumor types WHO
grading
Percentage
Tumor of neuroepithelial tissue 39.3
Astrocytic tumors
Diffuse astrocytoma Grade II
Anaplastic astrocytoma Grade III
Glioblastoma multiforme Grade IV
Oligodendroglial tumors 4.5
Oligodendroglioma Grade II
Anaplastic oligodendroglioma Grade III
Mixed gliomas 2.3
Oligoastrocytoma Grade II
Anaplastic oligoastrocytoma Grade III
Ependymal tumors 2.3
Ependymoma Grade II
Choroid plexus tumors 2.3
Choroid plexus papilloma Grade I
Choroid plexus carcinoma Grade IV
Embryonal tumors 1.1
Medulloblastoma Grade IV
Tumors of peripheral nerves 4.5
Neurofi broma Grade I
Tumors of meninges
Meningiomas 34.8
Meningiomas Grade I
Atypical meningiomas Grade II
Mesenchymal, non-meningothelial tumors 3.4
Lipoma Grade I
Haemangioma Grade I
Tumors of uncertain histogenesis 1.1
Hemangioblastoma Grade I
Lymphomas and haemopoietic neoplasm 1.1
Plasmacytoma Grade IV
Tumors of the sellar region 2.3
Craniopharyngioma Grade I
Metastatic tumors 5.6
CNS: Central nervous system, WHO: World Health Organization
Table 3: Percentage split of astrocytic tumors
Type of astrocytic
tumor
WHO
grade
Percentage
Diffuse astrocytoma Grade II 34.3
Anaplastic astrocytoma Grade III 45.7
Glioblastoma multiforme Grade IV 20
WHO: World Health Organization
Figure 2: Oligodendroglioma (H&E X100)
astrocytomas Grade III (45.7%) was the commonest type
followed be diffuse astrocytoma Grade II (34.3%) and
glioblastoma multiforme Grade IV (20.0%).
Figure 3: Meningioma (H&E X100)

Nibhoria, et al.: Histopathological Spectrum of Central Nervous System Tumors
133 International Journal of Scientifi c Study | September 2015 | Vol 3 | Issue 6
signifi cantly from childhood brain tumors in relation
to their sites of origin, clinical presentation, tendency
to disseminate, histological features and their biological
behavior. Whereas in adults the predominant CNS tumor
types are metastases, glial neoplasms, and meningiomas,
in children, besides gliomas, other major tumor types
including primitive embryonal neoplasms are also
common. In recent times, an enhanced understanding
of these biological differences between adult and
childhood CNS tumors has led to investigations in
distinct molecular and genetic pathways and therapeutic
approaches for each tumor type.
It has been observed worldwide that the incidence of CNS
tumors is on a rise. Moreover due to the high mortality seen
in CNS tumors, they form the most challenging group of
tumors for neurooncologists.
In the present study comprising of 100 CNS tumors
irrespective of age, from a single center, have been
categorized according to the recent WHO classifi cation.5
In our study, the most common CNS tumors in the
descending order are tumors of neuroepithelial tissue
(51.7%) followed by tumors of meninges (34.8%) and
metastatic tumors (5.6%). This was in concordance with
the nationwide database in France which revealed the
proportion of tumors of neuroepithelial tissue and the
Figure 5: Anaplastic Astrocytoma exhibiting vascular
proliferation. (H&E X400)
Figure 6: Glioblastoma Multiforme (H&E X400)
Figure 4: Metastatic carcinomatous deposits (H&E X100)
Table 4: Distribution of CNS tumors with histologic subtypes among children and teenagers
(age 0-19 years)
Age Sex Histologic subtype WHO grade Percentage
18 years Female Cavernous hemagioma Grade 1 8.3
10 months Male Choroid plexus carcinoma Grade IV 8.3
8 years Male Medulloblastoma Grade IV 8.3
17 years Female Craniopharyngioma Grade I 8.3
5 years Male Choroid plexus papilloma Grade I 8.3
10 years Male PNST-neurofi broma Grade I 8.3
15 years Male Diffuse fi brillary astrocytoma Grade II 8.3
6 months Male Inadequate biopsy 8.3
14 years Female Anaplastic oligodendroglioma Grade III 8.3
19 years Female Meningioma-fi broblastic Grade I 8.3
11 years Female Glioblastoma multiforme Grade IV 8.3
5 years Female Anaplastic astrocytoma Grade III 8.3
CNS: Central nervous system, PNST: Peripheral nerve sheath tumors, WHO: World Health Organization

Nibhoria, et al.: Histopathological Spectrum of Central Nervous System Tumors
134International Journal of Scientifi c Study | September 2015 | Vol 3 | Issue 6
meninges were 53.9% and 28.8%, respectively, from 2004
to 2008.6 Another population-based report from Central
Brain Tumor Registry of the United States (CBTRUS)
recorded rates of 33.7% and 35.5%, respectively, from 2004
to 2007.7 The reason for this variation remains unknown
and requires further investigation.8 For the tumors of the
meninges, increasing trends were observed around the
world,9-15 and improvements in the diagnostic technologies
are still considered to be the major causal factor. Worldwide
studies have also demonstrated an apparently increased
incidence of metastatic tumors,16 supporting their third
position in our study.
The tumor spectra varied from adults to children and
teenagers as well as from males to females. In our study,
astrocytic tumors (45.7%) were the major tumor entity
with anaplastic astrocytoma (Figure 5) topping the list
followed by diffuse astrocytoma (34.3%). This was contrary
to CBTRUS data, in which glioblastoma (Figrue 6) and
anaplastic astrocytoma were the most common malignant
tumors in adults.
The CNS tumors in children and teenagers showed a great
histologic diversity. The most common CNS tumor in our
study was astrocytic tumors comprising 25% of all tumors
in this age group. This was in concordance with the study
did by Chen et al. who found astrocytomas to be leading
tumors (29.2%) in this age group in their 60 years review
of cases.8 While in a multi-institutional study did by Jain
et al. fi nd a slight higher proportion of astrocytoma (34.7%)
as compared to our study.3
The incidence of various CNS tumors in the current study
falls well within the range seen in the international studies
for every tumor category.
CONCLUSION
Rising global trends in the incidence of CNS tumors,
irrespective of age have been observed. The present study
highlights the histologic diversity in CNS tumors in both,
adult as well as pediatric age groups.
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How to cite this article: Nibhoria S, Tiwana KK, Phutela R, Bajaj A, Chhabra S, Bansal S. Histopathological Spectrum of Central Nervous
System Tumors: A Single Centre Study of 100 Cases. Int J Sci Stud 2015;3(6):130-134.
Source of Support: Nil, Confl ict of Interest: None declared.