|Year : 2022 | Volume
| Issue : 2 | Page : 118-125
Unique tumors come in small packages: A single centre experience of histopathological spectrum of solid pediatric tumors in North West India
Shikha Narang1, Pavneet Selhi2, Ruchita Tyagi2, Harshi Dhingra1, Neena Sood2, Sumit Dhuria3
1 Department of Pathology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
2 Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
3 Department of General Surgery, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
|Date of Submission||12-Jan-2022|
|Date of Decision||07-Feb-2022|
|Date of Acceptance||21-Feb-2022|
|Date of Web Publication||3-Aug-2022|
Dr. Harshi Dhingra
Department of Pathology, Adesh Institute of Medical Sciences and Research, Bathinda - 151001, Punjab
Source of Support: None, Conflict of Interest: None
Introduction: Nonhematologic tumors in children differ biologically and histologically from adults in terms of incidence, type of tumor, and tendency to regress spontaneously. The study was aimed to evaluate the pattern, frequency, and histopathological spectrum of solid tumors and to correlate histopathological findings with immunohistochemistry (IHC) wherever feasible.
Materials and Methods: This observational study was a retrospective analysis of all solid tumors of children less than 18 years, conducted over a period of 5 years. The specimens were analyzed grossly and microscopically with IHC wherever feasible. All leukemias and myeloproliferative neoplasms/myeloproliferative disorders were excluded from the study.
Results: A total of 261 solid tumors were seen in the age of 2 days to 17 years with the median age being 10.41 years. The M: F ratio was 1.6:1. Benign tumors were more common (59.39%), with soft tissue tumors being more frequent. Lymphomas and reticuloendothelial cell tumors constituted the majority (27%) of malignant tumors.
Conclusion: This institution-based study depicted the pattern of childhood tumors. As most of the studies have focused on malignant tumors, data on the prevalence of benign pediatric tumors is scarce. Pediatric tumors need to have a dedicated pediatric cancer registry for assessing the magnitude of the problem. This study provides useful insight into the pattern of benign and malignant pediatric tumors in the northwest region of India, which can be utilized in planning health policies. The present study also proves the importance of IHC in making the final diagnosis.
Keywords: Benign, cancer, malignant
|How to cite this article:|
Narang S, Selhi P, Tyagi R, Dhingra H, Sood N, Dhuria S. Unique tumors come in small packages: A single centre experience of histopathological spectrum of solid pediatric tumors in North West India. J NTR Univ Health Sci 2022;11:118-25
|How to cite this URL:|
Narang S, Selhi P, Tyagi R, Dhingra H, Sood N, Dhuria S. Unique tumors come in small packages: A single centre experience of histopathological spectrum of solid pediatric tumors in North West India. J NTR Univ Health Sci [serial online] 2022 [cited 2022 Dec 10];11:118-25. Available from: https://www.jdrntruhs.org/text.asp?2022/11/2/118/353218
| Introduction|| |
Tumors of children are equally diverse as those in adults and are quite challenging for pathologists. Virtually, any tumor may be encountered in children but hematolymphoid malignancies, that is, leukemias and lymphomas, are more common in children, while carcinomas are more common in adults. Most of the nonhematologic tumors of childhood arise from embryonal cells, respond to treatment rapidly, and the survival has improved dramatically over the last two decades due to aggressive combined modality management. Malignancies in children differ with respect to incidence, type of tumor, underlying familial or genetic aberration, and tendency to regress spontaneously or to differentiate.
Accurate histopathological reporting of both benign and malignant tumors is important by morphology in conjugation with ancillary methods as this allows the pediatric medical and surgical oncologist to weigh the risks and benefits of treatment for each patient and helps to maximize survival, minimize morbidity, and improve the quality of life.
The environmental and genetic differences play an important role as seen by variability in regional distribution and the spectrum of malignancies. An increased risk of childhood cancers has been described to be associated with certain genetic conditions or syndromes such as chromosomal abnormalities, DNA repair disorders, congenital anomalies, hereditary immune deficiency states, and other hereditary syndromes.,
We studied the spectrum of childhood tumors diagnosed histopathologically to better understand the epidemiology of pediatric tumors in our tertiary care center in North India. The aim of the study was to evaluate the pattern and frequency of solid organ neoplasms of children and to correlate histopathological findings with immunohistochemical markers wherever available. Due to the lack of registration of newly diagnosed pediatric tumors with local registries, the exact tumor burden of pediatric tumors can only be estimated through such hospital-based data, which can be utilized in disease management.
| Material and Methods|| |
A retrospective analysis was conducted over a five-year period. The data of all solid organ tumors (benign and malignant) of patients less than 18 years of age were retrieved from the records of the histopathology laboratory. Gross features, including size, site, color, capsule, cut section, consistency, areas of hemorrhage, necrosis, and calcification, were noted from the requisition forms. The slides were reviewed by two pathologists independently to note the presence or absence of capsule, cellularity, architecture and arrangement, morphology of cells and its nuclear and cytoplasmic features, prominence of nucleoli, number of mitosis per 10 high power field (hpf), presence or absence of necrosis and other changes (such as myxoid change, hyaline change, and cystic change), calcification, hemorrhage, inflammatory infiltrate, etc.Immunohistochemistry (IHC) was applied wherever required. Exclusion criterion - All leukemias were excluded from the study. Ethical approval for this study (Ethical Committee DMCH/ETH/2014/589) was provided by the Ethical Committee of Dayanand medical college and hospital, Ludhiana, on 25 February 2014.
| Results|| |
The total number of pediatric tumors studied was 261. The age ranged from 2 days to 17 years, with a median age of 10.41 years. The majority of patients (34.87%) were in the age group of 10–15 years. The least patients (13.79%) were in the age group of 5–10 years. The overall male: female ratio was 1.6:1.
Benign tumors were more common, comprising 59.39% as compared to malignant tumors, which comprised 38.31% of total patients; the remaining were categorized as intermediate. The incidence of benign tumors was maximum in the 10–15 years age group (59 cases, 22.61%), while the incidence of malignant tumors was maximum in the 15–<18 years age group (36 cases, 36%).
The soft tissue tumors were the most common morphological type overall (n = 91, 34.87%) and also in the benign (70 cases, 45.16% of all benign) and intermediate category (four cases, 66.67% of all intermediate tumors). Among the malignant tumors, lymphomas and reticuloendothelial cell tumors were the most frequent (27%) [Table 1].
|Table 1: Histopathology of cases according to the cell of origin (n=261)|
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The majority of soft tissue tumors were benign, with vascular tumors comprising the largest subgroup with 70 cases (76.92%). Among malignant soft tissue tumors, skeletal muscle tumors were the most common, constituting nine cases (50%) of all malignant tumors. Bone tumors were the second most common tumors, with osteochondromas being the most common benign tumors (n = 11,45. 83%), while Ewing sarcomas were the most common malignant tumors (n = 8, 57.14%). Males were more commonly involved than females. Lymphomas and reticuloendothelial tumors were the third most common tumors with an equal incidence of non-Hodgkin lymphoma and Hodgkin lymphoma. Central nervous system (CNS) tumors were the fourth most frequent tumors, among which astrocytic tumors were the most common, followed by craniopharyngiomas, and male preponderance was noted. Among germ cell tumors, benign tumors (mature teratoma) were more common, constituting 75% as compared to malignant germ cell tumors constituting 25% (two cases of dysgerminoma and one case of nonseminomatous mixed germ cell tumor). The germ cell and gonadal tumors had female preponderance and were the most common in the age group of 15–<18 years, constituting 43.75% (seven cases). Melanocytic tumors were the most common skin and adnexal tumors, comprising eight cases (50%) with the majority being benign and having female preponderance. Among head and neck tumors, pleomorphic adenoma was the most common salivary gland tumor, constituting 66.67% of all salivary gland tumors. Among the breast tumors, all the cases were benign with fibroadenomas being the most common. The tumors of the adrenal gland were the most frequent endocrine tumors, constituting four cases (57.14%), which included three cases of benign pheochromocytoma and one case of malignant pheochromocytoma. Among the gastro-intestinal tract (GIT) tumors, the rectum was the most common site of involvement, constituting three cases (42.86%). All the five renal tumors were malignant with morphological diagnosis of nephroblastoma and all were seen below 10 years of age. We came across only one case of retinoblastoma, which was involving the right eye of a 1-year-old female child [Table 2] [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6].
|Figure 1: Photomicrograph of neuroblastoma showing sheets of small round cells and perivascular rosettes. (H&E, ×100).|
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|Figure 2: Photomicrograph of monophasic synovial sarcoma showing spindle cells arranged in alternating hypocellular and cellular areas with hemangiopericytic focus. (H&E, ×400)|
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|Figure 3: Photomicrograph of cavernous hemangioma showing large blood-filled vascular channels. (H&E, ×400)|
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|Figure 4: Photomicrograph of Hodgkins lymphoma showing classical binucleate Reed–Sternberg cell with prominent eosinophilic nucleoli. (H&E, ×1000)|
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|Figure 5: Photomicrograph of pilocytic astrocytoma on the upper left showing the biphasic pattern and normal brain parenchyma on the lower right. (H&E, ×400)|
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|Figure 6: Photomicrograph of pheochromocytoma showing Zellballen morphology. (H&E, ×100)|
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|Table 2: Age-Wise and gender-wise distribution of various tumors and histopathological spectrum of tumor (n=261)|
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| Discussion|| |
The maximum number of pediatric tumors were seen in the age group of 10–<15 years (34.87%), which is also corroborated by many studies.,,,, The least number of pediatric tumors were seen in the 5–<10 years age group, constituting 13.79% of total childhood tumors, as also reported by others such as Chauhan et al. and Yeole et al.,,,, However, Wani et al. and Bhalodia et al. reported maximum incidence in 0–4 years., We found male preponderance in our study, as also observed by many authors.,,,,,, Gender bias in seeking healthcare, including treatment of cancer, is one possible explanation for this observation.
Benign tumors were more common, comprising 59.39%, which was in agreement with the findings of other authors.,, Soft tissue tumors were the most common benign tumors, which is in concordance with many other studies.,,, Benign bone tumors were the second most common benign pediatric tumors, as also reported by Punia et al., Rajyalakshmi et al., and Ali et al.,, However, Monga et al. found bone tumors as the least common tumor in their study. Skin and adnexal tumors constituted 9.68%, which closely resembles the results of Punia et al. and Monga et al., Breast tumors in our study constituted 6.45%, as also reported by some authors., Similar to the study by Rajyalakshmi et al., we also found fibroadenoma as the most common breast tumor.
Among the malignant tumors, lymphomas/reticuloendothelial cell tumors were the most common (27%). Similar results have been seen in many studies.,,,,,,, Sarcomas were the second most common malignant tumors, constituting 17%, which corresponded with the study by Punia et al. However, Bhalodia et al. and Ali et al. reported much lower results of 3.6% and 2.32%, respectively., The higher incidence of soft tissue sarcoma in our study may be attributed to the increased use of IHC to make the definitive diagnosis. The diagnosis of both cases of Ewing sarcoma/PNET which also had round cell morphology was made with the help of IHC. The CNS tumors follow soft tissue sarcomas closely in our study, comprising 16%. These results are similar to Rajyalakshmi et al. and Ali et al., However, studies by Punia et al., Jabeen S et al., and Bhalodia et al. quoted variable results.,, The reason behind the increased incidence of CNS tumors may be increased exposure to an unidentified risk factor, or that our study is conducted in a well-equipped tertiary care hospital that caters to more patients of CNS tumors. The bone tumors in our study constituted 14%, which is consistent with results obtained by a few studies., However, Punia et al. found an increased incidence of bone tumors. The low incidence of germ cell and gonadal tumors in our study (3%) was also comparable to studies by Punia et al. and Ali et al., However, Chauhan et al. reported a higher incidence of germ cell tumors. We found only one case of retinoblastoma; however, other studies quoted much higher results.,, We have reported five cases of Wilm's tumor. Bhalodia et al., Malik et al., Soyemi et al., and Anoop et al. found Wilm's tumor as the most common nonhematologic malignancy,,, [Table 3].
|Table 3: Comparative analysis of pediatric malignant tumors in the present study with other similar studies|
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Histopathological diagnosis was confirmed with IHC in 65 cases, which underlined the importance of advanced diagnostic methods such as IHC and cytogenetic studies to reach the final diagnosis.
The limitation of this study is that this is a single institute-based retrospective analysis of solid pediatric tumors, which cannot serve as a touchstone for the epidemiology of pediatric tumors.
| Conclusion|| |
This institution-based study depicted the pattern of childhood tumors. In the absence of a dedicated national cancer registry for pediatric tumors, data from such hospital-based studies can serve to provide some insight on the prevalence of pediatric tumors. Most studies have focused mainly on malignant tumors, which leaves a dearth of data on benign pediatric tumors. This study compiles a spectrum of benign and malignant nonhematologic solid pediatric tumors and provides useful information about their patterns, which can be utilized in planning health policies. The present study also proves the importance of IHC in making the final diagnosis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sharma S, Mishra K, Agarwal S, Khanna G. Solid tumors of childhood. Indian J Pediatr 2004;71:501-4.
Fajardo-Gutiérrez A, Juárez-Ocaña S, González-Miranda G, Palma-Padilla V, Carreón-Cruz R, Ortega-Alvárez MC, et al
. Incidence of cancer in children residing in ten jurisdictions of the Mexican Republic: Importance of the Cancer registry (a population-based study). BMC Cancer 2007;7:1-15.
Kusumakumari P. Childhood malignancies. Ind J Med Pediatr Oncol 1996;17:168-77.
Nagaraja CT, Patil RB, Ugrappa G, Krishnamurthy R. Solid malignant tumors of infancy and childhood: A histopathological study. Sch J App Med Sci 2015;3:167-74.
Mamatha HS, Kumari BA, Appaji L, Attili SV, Padma D, Vidya J. Profile of infantile malignancies at tertiary cancer center-A study from south India. J Clin Oncol 2007;25:20026.
Stiller CA. Epidemiology and genetics of childhood cancer. Oncogene 2004;23:6429-44.
Pinkerton CR, Cushing P, Sepion B. Epidemiology and aetiology of childhood cancer. In: Childhood Cancer Management: A Practical Handbook. London (UK): Arnold; 1994. p. 28-41.
Punia RS, Mundi I, Kundu R, Jindal G, Dalal U, Mohan H. Spectrum of nonhematological pediatrictumors: A clinicopathologic study of 385 cases. Ind J Med Pediatr Oncol 2014;35:170-4.
Monga T, Kuka AS, Singh N. Histopathological profile of solid tumours of childhood and infancy in northwest Punjab, India. Indian J Pathol Oncol 2017;4:166-73
Jabeen S, Haque M, Islam MJ, Talukder MH. Profile of paediatric malignancies: A five year study. J Dhaka Med Coll 2010;19:33-8.
Rajyalakshmi R, Lakshmi CV, Kishore Kumar CH. Pediatric solid tumors: A Pathologic study of 152 cases. Global J Res Analysis 2016;5:95-7.
Chauhan R, Tyagi A, Verma N, Tyagi M, Singh P, Singh A. Spectrum of pediatric malignancies at a tertiary care centre in western Uttar Pradesh. National J Lab Med 2017;6:PO23-7.
Yeole BB, Advani SH, Sunny L. Epidemiological features of childhood cancers in greater Mumbai. Indian J Pediatr 2001;38:1270-7.
Wani LA, Farooq S, Beigh A, Khuroo M, Abass F. Histopathological pattern of solid malignant pediatric tumors in Kashmir, India. Int J ContempPediatr 2018;5:1087-91.
Bhalodia JN, Patel MM. Profile of pediatric malignancy: A three year study. National J Community Med 2011;2:24-7.
Elhassan MMA, Mohamedani AA, Yousif NO, Elhaj NM, Qaddoumi I, Abuidres DO. Epidemiological review of childhood cancers in central Sudan. S Afr J Oncol 2018;2:a37.
Ali EA, Talib SHS. Solid pediatric tumors. Iraqi Postgrad Med J 2009;1:62-72.
Malik FR, Tahir A, Bashir H, Akhtar P. Spectrum of Pediatric malignancies. J Rawalpindi Med Coll 2012;16:37-9.
Soyemi SS, Osuoji RI, Obafunwa JO, Oyewole OO, Sanni AA, Emiogum FE. The spectrum of solid childhood malignant tumours in a tertiary health care institution. World J Epidemiol Cancer Prev 2014;3:6.
Anoop C, Appaji L, Padma M, Arunakumari BS, Avinash T, Madhumati DS. Profile of malignancies in children under 2 years of age – Study from a tertiary care cancer centre in south India. BMH Med J 2018;5:37-42.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3]