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What Percentage Of Brain Tumors Are Benign
Cite this article as: El Hage S, Kawtharani M, Nabha S, et al. (13 September 2021) Distribution of primary brain tumor subtypes in Lebanon: An eleven-year study of 695 patients. 13(9): e17918. doi:10.7759/.17918
Pituitary Tumors/adenomas: Symptoms, Causes, & Treatments
Brain tumors are associated with high mortality and morbidity compared to low rates. Little is known about brain tumors in Lebanon and in the Arab world. This study aims to analyze the epidemiology of brain tumors in the entire Lebanese population.
Data from pathology reports of patients diagnosed with malignant and benign brain tumors were collected retrospectively over eleven years (2007-2017) from four medical centers in Lebanon. A total of 695 cases of primary brain tumors (61% malignant and 39% non-malignant) were collected from various regions throughout the country.
Meningioma was the most common histology in this sample (29.6%), followed by glioblastoma (25.5%) and oligodendroglioma (5.9%). Pituitary tumors only account for 3.5% of brain tumors. In addition, the most common anatomical locations of malignant and benign tumors were the meninges of the brain (29.6%), the “other brain” category (21.3%), and the frontal lobe (11.2%). In children and adolescents, embryonal tumors (21%) were the most common histology, whereas glioblastomas and meningiomas accounted for 14.8% and 13.6%, respectively.
Lebanon shows a low incidence of pituitary tumors and an unusually high percentage of malignant tumors, as well as childhood glioblastomas and meningiomas. This should be a serious concern for policy makers to find out the possible root causes.
What Is Glioblastoma And Why Is It So Deadly?
According to the World Cancer Research Fund, tumors of the brain and other central nervous system (CNS) are ranked as the 17th most common cancer in the world and account for 1.7% of all cancers, excluding non-melanoma skin cancer [1]. Patel et al. reported a 17.3% increase in cancers of the nervous system between 1990 and 2016. Along with this explosion in case incidence and although they are rare, CNS tumors are a very high source of morbidity and mortality worldwide [2, 3]. These tumors pose a huge burden to society and health care because of their high malignancy potential and the complex treatment costs required, ranging from chemotherapy, radiotherapy and neurosurgery. However, its incidence varies widely between studies, possibly due to a lack of standardized methods to measure outcomes [4]. Brain tumors are the most common solid tumors in the pediatric population. Compared to adults, childhood brain tumors have a different histological distribution and are often located in the infraetorial region [5, 6].
Brain tumors cover more than 100 different histologies, which are divided into more than 20 main histological groups [7, 8]. Until now the causes of brain tumors are unclear, only a small proportion are caused by radiation, autoimmunity which causes lymphoma in the brain, and genetic syndromes such as neurofibromatosis, Li-Fraumeni syndrome and Turcot syndrome [9]. There is also speculation that some subtypes of brain tumors share certain risk factors. For example, meningioma is strongly associated with previous radiation exposure and is more common in women [9].
In the Middle East region, only a limited number of studies address the problem of brain tumors. Most of the articles describing the tumor epidemic are from Saudi Arabia, Egypt and Kuwait [10-13]. For example, a study conducted in Western Saudi Arabia found that the most common brain tumor was an astrocytoma and the results were similar to international regions [11]. Another study conducted in Egypt showed that glioma followed by meningioma was the most common histology [13]. In addition, in Lebanon, a small country in the Middle East region with a population of around 6.8 million, 238 cases of brain cancer were reported in 2016 by the Ministry of Public Health (MOPH) [14]. To date, no studies have been conducted to explain the outbreak of various types of brain tumors among the population. This article describes the distribution of these tumors, across four Lebanese medical centers, in terms of age, sex, behavior, histology, and anatomical location. Our aim is to show the most common histology in our sample and provide a detailed report on the different malignant and non-malignant tumors. We also compare our results with available data from other countries in the region and around the world.
This is a descriptive retrospective epidemiological study in which data were collected from pathology reports from 695 patients diagnosed with primary brain tumors between January 2007 and July 2017. Secondary (metastatic) brain tumors that primarily grow outside the CNS and tumors originating in the spinal cord were excluded. in this research. Only primary brain tumors of all ages were included. Data were obtained from four medical centers across Lebanon: the Institut National de Pathologie (INP) in Hadath; Hammoud Hospital University Medical Center (HHUMC) in South Lebanon; Al Zahraa Hospital University Medical Center (ZHUMC) in Beirut; and the Sahel General Hospital (SGH) in Beirut. The INP is a pathology referral center for more than 30 institutions and hospitals across Lebanon, including Abou Jaoude Hospital, Bekaa Hospital, Ain Wazein Hospital and others (Saad et al.) [15]. This study was approved by the Institutional Review Boards (IRB) of the four hospitals previously mentioned, as well as the IRB of the Lebanese University.
Childhood Brain Stem Glioma Treatment (pdq®)–patient Version
The variables collected were gender, age at diagnosis, histopathological type of tumor, anatomical location (frontal lobe, occipital lobe, temporal, meninges, etc.) and behavior (malignant vs non-malignant). Histology, behavior, and anatomical location were coded according to the International Classification of Diseases of Oncology, manual third edition (ICD-O-3), and according to the manual coding guidelines for topography and morphology, and the 2007 WHO classification for CNS, which is primarily used for code of conduct [7, 8].
In addition, Ostrom et al. used a set of sites based on the WHO ICD-O-3 oncology classification [7, 8]. This classification is used in this report to classify the anatomic and histological sites of this tumor. Geographical locations and codes used in this report can be seen in the appendix (Table 1). All assigned history and histology ICD-O-3 codes and behaviors reported in this study are also shown in the appendix (Table 2).
Although pilocytic astrocytoma is coded as non-malignant by the WHO code, it is considered malignant in population-based cancer registries in the United States [8]. Therefore, to obtain comparable data, we coded a pilocytic astrocytoma as malignant (Appendix, Table 2). In addition, several tumors in our report were labeled as “low-grade gliomas” and coded 9380/1, which is interpreted as gliomas of uncertain or malignant prognosis. The use of this code is also supported by Percy et al. [16].
Descriptive statistics were performed using statistical analysis software SPSS (Statistical Package for the Social Sciences) version 23.0 (IBM Inc., Armonk, New York). Duplication between institutions is assessed and then removed. Basic descriptive analyzes were performed for categorical and continuous variables (bar graphs, pie charts and scatter plots). The chi-square test was used for categorical variables, and the chi-square homogeneity test was used to test whether the components of the categorical variables were the same.
World Brain Tumour Day 2022 “together We Are Stronger”, Health News, Et Healthworld
Table 3 in the appendix details the different stories found in our data set, as well as the different sexes, behaviors, and age groups. More than 40 different histologies were found in our sample. Most of the patients came from INP 70.36% (489 patients), 13.38% (93 patients) from HHUMC, 11.08% (77 patients) from ZHUMC and 5.18% (36 patients) from SGH. Interestingly, 61% of tumors were malignant, while only 39% were non-toxic. The tumors ranged from common tumors such as meningioma (29.6%) to rare histologies such as dysemboplastic neuroepithelial tumors (0.1%), atypical teratoid rhabdoid tumors (0.1%), and solitary tumors (0.1%).
Figure 1 shows the distribution of brain tumors by anatomical location. Overall, the most common sites were the meninges (29.6%); the “other brain” category, which includes overlapping brain areas and unspecified brain areas (21.3%); and frontal lobes (11.2%). Only 1.3% of brain tumors were located in the ventricles and 1.7% in the brainstem (Fig. 1A).
Among non-malignant brain tumors, the most common location was the meninges of the brain with a frequency of 68.3%, followed by the pituitary and craniopharynx (10.3%) and cerebellum (7.4%) (Fig. 1B). Among the risk factors, our results showed that the “other brain” category was the most common area (31.4%), followed by the frontal lobe (17.9%) and temporal lobe (13.4%) (Fig. 1C).
Histology in our sample was assessed using the Central Brain Tumor Registry of the United States (CBTRUS) cohort, as previously mentioned. Figure 2 represents the histological distribution of brain tumors. Overall, meningioma was the most common histology in our sample with 206 cases (29.6%). Glioblastomas was the second most common histology with 177 cases (25.5%). Nerve sheath tumors and ependymal tumors were found to be rare, accounting for only 0.7% and 1% of the total cases, respectively (Fig. 2A). Among the malignancies, glioblastoma was the most frequently diagnosed (41.7%), followed by all other astrocytomas (16.5%), oligodendroglioma (14.2%), and embryonal tumors (7.3%) (Figure 2C). . Among the benign conditions, meningioma is the most common histology with a frequency of 68.3%.
Brain Tumor, Types, Causes, Symptoms, Diagnosis, Treatment & Prognosis
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