|Year : 2020 | Volume
| Issue : 3 | Page : 246-250
Spectrum of pediatric malignancies in a referral hospital of the eastern region of India
Senjuti Dasgupta1, Sudipta Chakrabarti2, Asit Ranjan Deb3
1 Department of Pathology, Medical College, Kolkata, West Bengal, India
2 Department of Pathology, ESI PGIMSR, Manicktala, Kolkata, West Bengal, India
3 Department of Radiotherapy, Medical College, Kolkata, West Bengal, India
|Date of Submission||18-Mar-2020|
|Date of Acceptance||02-May-2020|
|Date of Web Publication||12-Sep-2020|
Dr. Sudipta Chakrabarti
Department of Pathology, ESI PGIMSR, Manicktala, 54, Bagmari Road, Kolkata - 700 054, West Bengal
Source of Support: None, Conflict of Interest: None
Background: Pediatric malignancies are one of the most common causes of childhood morbidity and mortality. The prevalence of different malignancies in the pediatric age group varies from one place to another. The present study was done to find out the occurrence of childhood malignancies in the southern region of West Bengal to compare the patterns of different malignancies with other established epidemiological studies and to search for the specific causes for apparently increased occurrence of childhood malignancies. Methods: A prospective study was conducted for 7 years in which patients with pediatric malignancies were included in the study. The clinicopathological features of each case were analyzed. Results: A total number of 247 cases were included in the study among which 162 were males (65.59%). Children below the age of 5 years accounted for 90 cases (36.58%). Hematological malignancies were found in 122 cases (49.39%), and the rest constituted nonhematological malignancies (125, 50.61%). The most common malignant disorder noted was acute leukemia, constituting about 33.37% of cases (82 cases). The highest occurrence (37.9%) of malignancies was encountered in 5–10 years of age, and the next common (31.7%) was between the age group of 2 and 5 years. The most common malignancies noted in these age groups were acute leukemia, retinoblastoma, Wilm's tumor, and neuroblastoma. Conclusion: Lympho-hematogeneous malignancies were the most common followed by embryonal tumors. Although the occurrence of hematological malignancies was comparable to the similar studies of the developed countries, the corresponding figures of central nervous system tumors were considerably less.
Keywords: Clinicopathologic features, embryonal tumors, lymphohematogenous tumors, pediatric malignancies
|How to cite this article:|
Dasgupta S, Chakrabarti S, Deb AR. Spectrum of pediatric malignancies in a referral hospital of the eastern region of India. Biomed Biotechnol Res J 2020;4:246-50
|How to cite this URL:|
Dasgupta S, Chakrabarti S, Deb AR. Spectrum of pediatric malignancies in a referral hospital of the eastern region of India. Biomed Biotechnol Res J [serial online] 2020 [cited 2020 Sep 25];4:246-50. Available from: http://www.bmbtrj.org/text.asp?2020/4/3/246/294854
| Introduction|| |
Malignant neoplasms are not a rare entity among children. The overall cancer in birth to 14 year olds of the world increased from 124.0 per million person-years in the 1980s to 140.6 per million person-years in 2001–2010. Cancer is the 9th most common cause of death among children aged between the age group of 5 and 14 years in India. In the developing countries, a lot of effort has been devoted to reduce the child mortality from nonmalignant conditions such as malnutrition, diarrhea, respiratory diseases, and many other infective causes. Childhood malignancies also require urgent attention so that early diagnoses can be done and therapeutic interventions may be undertaken. One of the important steps in this regard is conducting epidemiological studies to determine the incidence of pediatric malignancies in different regions of the country. This will help the health professionals of a particular region to look out for the more common malignancies in that part. At the same time, the importance of reporting rare malignancies from a region cannot be overemphasized. Provision of better health care is the ultimate goal of such epidemiological studies.
A study from West Bengal reported a lower prevalence of neuroblastoma and a higher prevalence of soft-tissue sarcoma and retinoblastoma in comparison to the southern parts of India and the Western countries. A study from Chennai reported that the incidence of cancer among children who are boys is comparable with that of developed countries, whereas the incidence among the girls is much less. While the study mentioned the possibility that the girls may have been underdiagnosed due to their lesser access to health care in comparison to boys, it was impossible to rule out other factors as well. This was mostly due to the fact that a similar kind of differential sex ratio was found among the Singapore Indians, where accessibility to health care among both the sexes was not an issue.
The aims of the study were to have an account of occurrence of childhood malignancy in the southern region of West Bengal, to compare the pattern of different malignancies with other established epidemiological studies and to search for the specific causes for apparently increased occurrence of childhood malignancies in the region of the present study.
| Materials and Methods|| |
The present study was conducted at a tertiary care center, prospectively over a period of 7 years. All the children with histopathologically diagnosed or bone marrow-proven malignant diseases between the ages 0–14 years were included in the study. The present study also included a few cases of surgically inoperable retinoblastoma and brain tumors where histopathological studies could not be performed. No benign neoplasm except a few cases of histiocytosis X was included. The reports of referral cases, where the diagnoses were obtained from other laboratories were reviewed from the department of pathology.
Cases where the diagnosis of malignancy could not be established pathologically, children above the age of 14 years were excluded from the study. Patients refusing to provide consent for the study were also excluded.
After a thorough clinical examination, the results of routine investigations including radiological findings were recorded. Peripheral blood smear was studied in details. Bone marrow aspiration and biopsy were done whenever required. Fine-needle aspiration cytology was performed in appropriate cases. Biopsy was also done, and the final diagnosis recorded. Sometimes, categorization of the malignant disease required the use of immunohistochemical analysis.
All the cases were analyzed critically in respect of epidemiological point of view. Appropriate statistical methods were employed.
| Results|| |
At the onset, 263 patients with suspected pediatric malignancies were included in the study. On detailed analysis of reports, seven patients were found to be older than 14 years. Further, it was not possible to establish a confirmed diagnosis of malignancy in nine cases. Hence, these 16 cases were excluded from the study.
The total number of cases included in the present study was 247. These children accounted for 7.3% of cases of neoplastic diseases recorded in this center during the study period. Overall, the malignancies were more common in males (162 cases, 65.59%). Children below the age of 5 years accounted for 36.58% of all cases (90 cases). Majority (179 cases, 72.3%) of the patients were the residents of rural areas, whereas urban dwellers accounted for 27.5% (68 cases) of cases.
Hematological malignancies were found in 122 cases (49.39%). The rest constituted non– hematological malignancies (125, 50.61%) [Table 1]. The most common malignant disorder noted in the children was acute leukemia, constituting about 33.37% of all cases (82 cases). Among this group, acute lymphoblastic leukemia (ALL) was the most common type of leukemia (25.08%, 62 cases), whereas acute myeloblastic leukemia (AML) was detected in 8.29% (20) cases. The ratio of ALL and AML was 3.03:1. Lymphomas were the second most common cause (16.35%, 40 cases) which was almost equally shared by Hodgkin's (8.5%, 21 cases) and non-Hodgkin's (7.7%, 19 cases).
|Table 1: Incidence of various childhood malignancies in the present study|
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Retinoblastoma comprised a good proportion of cases, constituting about 10.62% (26 cases) of all patients. Central nervous system (CNS) tumors occurred in 9.3% (23 cases) of cases, majority of which were medulloblastoma and craniopharyngioma (69.6%, 16 cases) of all CNS tumors. Ewing's sarcoma and osteosarcoma were the two common forms of bone tumors of which Ewing's was more common (4.49%, 11 cases and 3.15%, 8 cases, respectively).
According to the age group distribution, it was noted that the highest occurrence (37.9%) of malignancies was encountered in 5–10 years of age, and the next common (31.7%) was between the age group of 2 and 5 years. The most common malignancies noted in these age groups were acute leukemia, retinoblastoma, Wilm's tumor, and neuroblastoma [Table 2]. Lymphomas and bone tumors were more frequent in 5–14 years of age which is comparable to other studies. Male children were seen more commonly (162; 65.59%) suffering from malignancies than female (85; 34.4%). Genetic differences in immune function might be responsible for the increased incidence in male children embryonal tumors such as retinoblastoma, Wilm's tumor, and neuroblastoma were more common in children between 0 and 5 years of age (79%; 195 cases).
|Table 2: Age wise distribution of pediatric malignancies in the present study|
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Rhabdomyosarcoma was the most common histological subtype (78%; 5 cases) seen among the soft-tissue sarcomas. The majority of germinal malignancies were testicular and ovarian in origin. Only a few cases of nasopharyngeal, basal cell, and urinary bladder carcinomas were found along with a single case of primary hepatocellular carcinoma of the liver.
One case of embryonal rhabdomyosarcoma (ERMS) was found in the leg of a patient. This case was significant since extremities are a rare location for ERMS. Among the CNS tumors, one case was diagnosed with pleomorphic xanthoastrocytoma. The patient deserves special mention since the incidence of this tumor in the pediatric population is very low. Another rare tumor diagnosed in the study was rhabdoid tumor in the kidney of a 3-year-old child. Rhabdoid tumors are rare, and 80% of them occur in children below 2 years of age. The only nonmalignant condition, histiocytosis X comprised about 2.91%, (7 cases) of all cases in the present study.
| Discussion|| |
Childhood malignancies are highly specific and unlike the adults, epithelial tumors are rare. Most of the tumors originate from lymphoreticular system, CNS, and the connective tissues. The relative frequencies of pediatric cancers in the present study resemble to some extent the pattern of malignancy reported in different data of some developed countries [Table 3]. The occurrence of acute leukemia was the highest (33.37%) in the study group, akin to the developed countries. However, higher occurrence of lymphomas (both Hodgkin's and non-Hodgkin's) (16.35%) and retinoblastoma (10.62%) was noted in the present study – unlike the studies of the developed countries. In comparison, CNS tumors were more common in the UK and US children (16.6 and 19.1%, respectively). Brain tumors were found to be significantly less (9.3%) in the present study but comparable to similar Indian studies (6.97%).,
|Table 3: Comparison of incidence of pediatric malignancies in the present study with that in developed countries|
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Majority (179; 72.3%) of the patients were rural children, and only 68 (27.5%) were urban residents. The reasons for the increased occurrence of malignancy in the rural population in this locality were probably low socioeconomic status and poor hygienic conditions.
It has been estimated that nearly 45000 children are diagnosed with cancer every year in India. According to Indian cancer registries, pediatric malignancies range from 0.8% to 5.8% in boys and 0.5% to 3.4% in girls. The present study demonstrated a higher occurrence (7.3%) of pediatric cancers. The different types of pediatric tumors reported in various Indian studies are shown in [Table 4]. This incidence of pediatric malignancies in the present study is higher than that reported in developed countries as well., This might be due to the increased population of children in this region. Linabery and Ross reported that between 1992 and 2004, there was a modest, nonsignificant increase in the average annual incidence rate for all pediatric malignancies in the United States.
|Table 4: Comparison of incidence of pediatric malignancies in the present study with that found in other Indian studies|
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Xie et al. reported a significant increase in the incidence of leukemias, thyroid carcinomas, ependymomas, melanomas, and hepatoblastoma among children in Canada between the years 1992 and 2010. Samaila reported the five most common childhood malignancies in Africa to be rhabdomyosarcoma, Burkitt lymphoma, retinoblastoma, non-Hodgkin's lymphoma, and nephroblastoma.
In the present study, leukemia was found to be the most common childhood malignancy. Similar results have been found by Jan et al., Chauhan et al., and Pattnaik et al.,, However, in some Indian studies, lymphoma has been reported to be the most common pediatric malignancy., Bone tumors constituted 7.64% of all childhood malignancies in the present study. A higher incidence (11.8%) of malignant bone tumors was reported by Chauhan et al. They also observed a higher incidence of leukemia, lymphoma, brain and bone tumors in children >5 years of age, whereas neuroblastoma and retinoblastoma are the most common in the younger age group (<5 years). This observation was found to be in accordance with the results of the present study.
Due to the lack of population-based statistical data, it was not possible to assess the actual magnitude of cancer burden in the Southern districts of West Bengal and adjoining regions. A committed pediatric cancer registry will be helpful for generating data for epidemiological research work.
| Conclusion|| |
The pediatric cases accounted for 7.3% of total cases of malignancies in the present study. Lymphohematogeneous malignancies were the most common followed by tumors arising from the embryonal cells. The age group of 5–10 years was the most common group of occurrence of these tumors. Although the occurrence of hematological malignancies was comparable to similar studies of the developed countries, the corresponding figures of CNS tumors were considerably less. In contrast, retinoblastoma and bone tumors occurred more commonly in the study group.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Steliarova-Foucher E, Colombet M, Ries LA, Moreno F, Dolya A, Bray F, et al
. International incidence of childhood cancer, 2001-10: A population-based registry study. Lancet Oncol 2017;18:719-31.
Chaudhuri K, Sinha A, Hati GC, Karmakar R, Banerjee A. Childhood malignancies at BS Medical College: A ten year study. Indian J Pathol Microbiol 2003;46:194-6.
Swaminathan R, Rama R, Shanta V. Childhood cancers in Chennai, India, 1990–2001: Incidence and survival. Int J Cancer 2008;122:2607-11.
Xie L, Onysko J, Morrison H. Childhood cancer incidence in Canada: Demographic and geographic variation of temporal trends (1992-2010). Health Promot Chronic Dis Prev Can 2018;38:79-115.
Dénes FT, Duarte RJ, Cristófani LM, Lopes RI. Pediatric genitourinary oncology. Front Pediatr 2013;1:48.
Bhalodia JN, Patel MM. Profile of pediatric malignancy: A three year study. Nat J Comm Med 2011;2:24–27.
Baade PD, Youlden DR, Valery PC, Hassall T, Ward L, Green AC, et al
. Trends in incidence of childhood cancer in Australia, 1983-2006. Br J Cancer 2010;102:620-6.
Arora RS, Eden TO, Kapoor G. Epidemiology of childhood cancer in India. Indian J Cancer 2009;46:264-73.
] [Full text]
Three-Year Report of the Population Based Cancer Registries of India: 2009-2011. Report of PBCRs; National Cancer Registry Programme. Bangalore: ICMR; 2013.
Devi S. Pattern of Pediatric Malignancy- 8 year experience. Int J Med App Sci 2014;3:208-18.
Linabery AM, Ross JA. Trends in childhood cancer incidence in the U.S. (1992-2004). Cancer 2008;112:416-32.
Samaila MO. Malignant tumours of childhood in Zaria. Afr J Paediatr Surg 2009;6:19-23.
] [Full text]
Jan M, Ahmad S, Rashid I, Quyoom S, Rashid T. Pattern and clinical profile of childhood malignancies in Kashmir, India. JK Practitioner 2015;20:12-6.
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. Natl J Lab Med 2017;6:PO23-7.
Pattnaik N, Khan MA, Rao ES, Rao BM. Pediatric malignancies. J Clin Diagn Res 2012;6:674-77.
Mangal N, Miglani N. The pattern of pediatric malignancies in Rajasthan. Indian Pediatrics 1991;28:1517-8.
[Table 1], [Table 2], [Table 3], [Table 4]