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Introduction
Central nervous system (CNS) tumors comprise 2% to 5%
of all tumors. 80% involve the brain and 20% involve the
spinal cord. Brain tumors cause approximately 2% of all
cancer deaths. 60% to 80% of brains tumors are primary
and rest 20% to 40% are metastatic.1 Tumors of the CNS
account for as many as 20% of all cancers of childhood
and are second only to leukaemia as a cause of death from
malignancy. In childhood 70% of primary brain tumors are
infratenorial and involve cerebellum, midbrain, pons and
medulla. 2

Benign tumors of the brain tend to grow slowly and some
of them may be cured by surgery with or without radiation
therapy. The malignant tumors grow more rapidly and are
associated with a shorter survival. Some of those highly
lethal tumors, such as medulloblastoma and
ependymoblastoma have a tendency to disseminate
throughout the CNS.

There are increasing data documenting a genetic basis or
at least a genetic association with some brain tumours. An
association of brain tumours with certain chemical/drugs,
Epstein-Barr virus and irradiation has been reported. 3,4 In
our country, there is no epidemiological and statistical
data regarding various features of brain tumors. Although,

Clinical and Pathological Characteristics of Brain Tumor
Naziruddin Mollah1, Abdul Baki2, Nur Afzal3, Akram Hossen4
1Resident. Department of Oncology, BSMMU. 2Senior Medical Officer, BIRDEM Hospital. 3Medical Officer, Police Hospital.  4 Professor,
Department of Oncology, BSMMU

Abstract
Background: CNS tumors comprise 2% to 5% of all tumors. There was no epidemiological and statistical data regarding
various features of brain tumors in this country. 80% involve the brain and 20% involve the spinal cord. Brain tumors
cause approximately 2% of all cancer deaths. Objectives: to evaluate the clinical and pathological characteristics of brain
tumors. Methods: This prospective study was done at Oncology department and Neurosurgery department of
Bangabandhu Shiekh Mujib Medical University from July 2006 to June 2007. Total 50 patient age 2-60 years attending
the oncology department with the diagnosis of primary brain tumor were included in this study. Clinical symptoms and
sign in relation to brain tumor were recorded. X ray skull and CT scan reports of all cases were evaluated. To find out the
histopathological pattern of the brain tumors all histopathological reports were also evaluated. Results: Most common
symptoms of brain tumor were headache (76%), mental change (64%), vomiting (52%), visual defect (46%), difficulty in
movement (42%) and convulsion (36%). Astrocytoma was found in 40% patients and 30% brain tumor was associated
with hydrocephalus Conclusion:This study represent the brain tumor and gives some idea about the clinicopathological
aspects of the disease in our country. It will help to do further studies to evaluate the clinical, epidemiological and
pathological characteristics of brain tumor.

[BSMMU J 2010; 3(2): 68-71]

the incidence of brain tumours has not been determined in
our country, overall clinical experiences indicate that its
incidence is not low. This study was done to evaluate the
clinical and pathological characteristics of primary brain
tumors.

Methods:
This retrospective study was done at Oncology
department and Neurosurgery department of
Bangabandhu Shiekh Mujib Medical University from July
2006 to June 2007. Total 50 patients age 2-60 years attending
the oncology department with diagnosis of primary brain
tumor were included in this study. Primary brain tumor
was diagnosed by neurosurgery department of BSMMU.

Study Procedure:
All patients with primary brain tumor fulfilling inclusion
criteria were included in the present study. A predesigned
data collection sheet was used for each subject and
informations regarding history, clinical examination and
investigations were recorded. After inclusion of the cases,
data were collected from surgeon’s clinical notes. History
of the patients was taken in details with special emphasis
given on the following points: age, sex, religion,
occupation, socioeconomic condition, educational status,
residence, history of radiation exposure, family history,
personal history and past history of illness with a view to

Address for Correspondence: Dr. Naziruddin Mollah, Resident.
Department of Oncology, BSMMU, Dhaka



find out any relationship with the brain tumor. Clinical
symptoms and sign in relation to brain tumor were recorded.
X ray skull and CT scan reports of all cases were evaluated.
To find out the histopathological pattern of the brain
tumors all histopathological reports were also evaluated.

Collected data was analyzed by using Statistical Package
for Social Science (SPSS version 12.0).

Results:
Among the 50 patient 66% were male and male female ratio
was 1.9:1. Mean (+SD) age of the patients were 46±11
years. Seventy percent patients came from rural area and
92% patients were Muslim. Forty eight percent patients
from middle socioeconomic background and rest from
higher or lower socioeconomic status. There was no
difference in socioeconomic status.

Most common symptoms of brain tumors were headache
(76%), mental change (46%), Vomiting (52%), visual defect
(46%), difficulty in movement (42%) and convulsion (36%).
Others symptoms were complete blindness (20%),
dementia (14%), unconsciousness (14%), fever (06%),
weight gain (06%), anorexia (04%), vertigo (04%), sensory
loss (04%) and loss of libido (02%). In most of the cases
more than one symptom were present (Table-I).

Table-I
Distribution of patient according to presenting

symptom (n=50)

Symptoms No. of cases Percentage
Headache 38 76.0
Vomiting 26 52.0
Vertigo 02 04.0
Convulsion 18 36.0
Anorexia 02 04.0
Fever 03 06.0
Mental change 32 64.0
Dementia(past/recent memory) 07 14.0
Difficulty in movement 21 42.0
Sensory loss 02 04.0
Visual defect 23 46.0
Complete blindness 10 20.0
Disturbance of consciousness 03 06.0
Unconsciousness 07 14.0
Weight gain 03 06.0
Loss of libido 01 02.0

Large number of patients had signs of increased intracranial
pressure (58%), focal presentation (46%), visual defects
(50%), and oculomotor and abducens nerve defects (12%),
other signs (less frequent) includes sensory level defects
(12), facial palsy (08%), incoordination (06%), endocrine
abnormalities (06%), Parinaud’s Syndrome (02%). In most
of the cases more than one signs were present (Table-II)

Table-II
Distribution of patient according to presenting sign (n=50)
Signs No. of Percentage

Cases
Focal presentation related to 23 46.0
tumor location (hemiplegia, hemi
paresis,  monoplagia, aphasia)
Sensory level defect 06 12.0
Increased  intracranial pressure 29 58.0
 (papilloedema)
Visual defects 25 50.0
Oculomotor and abducens nerve 16 32.0
defects  (squint/diplopia/pupillary
abnormality)
Facial palsy 04 08.0
In coordination 03 06.0
Endocrine abnormalities 03 06.0
(Hypopituitarism/Hyperpituitarism)
Parinaud’s Syndrome 01 02.0

X ray skull was done in all patients. More than 50% of
case there were no radiological findings, 32% cases showed
bony lesion and 14% cases showed calcification (Fig 1).
CT was done in all patients and hydrocephalus was
detected in 30% patients (Fig 2)

Fig.-1:  Radiological finding of skull in brain tumor
(n=50)

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Histological examination was done in all patients. 40%
patients had astrocytomas. Pituitary tumors and
Meningiomas were 16% and 14% respectively. Other tumor
types include, Craniopharyngioma (06%), Pineal tumour
(08%), Ependymoma (04%), Medulloblastma (04%),
Oligodendroglioma (02%), Brain stem tumor (02%),
Thalamic tumor (02%) (Table-III).

Table-III
Histological  finding of brain tumor (n=50)

Type No. of cases Percentage
Astrocytoma 20 40.0

Grade-I 06 12.0
Grade-II 09 18.0
Grade-III 02 04.0
Grade-IV 03 06.0

Meningioma 07 14.0
Pituitary tumour 08 16.0
Craniopharyngioma 03 06.0
Pineal tumour 04 08.0
Ependymoma 02 04.0
Medulloblastma 02 04.0
Oligodendroglioma 01 02.0
Brain stem tumour (radiologically) 01 02.0
Brain tumour 01 02.0
(Thalamic radiologically)

Discussion:
The present study is a clinicopathological study of brain
tumor. Clinical presentation may very according the site
and type of brain tumor, although there are some common
symptoms, namely, headache, seizure, mental change and
sensorimotor defects and any of which can eventually be
found in more than 50% of the patient population. Ocular

change (e.g. visual defect) is associated with the tumors,
like, pituitary adenoma craniopharyngioma optic nerve
glioma and pineal growth. Most of the tumors present
focal presentation related to tumors location.5 In this
series, 76% of case present headache, 64% mental changes,
52% vomiting, 46% visual defect, 36% convulsion, 20%
completely blind.

Physical findings can be variable according to tumor type
and location. Common signs are focal presentation related
to location of tumor, and increased intracranial pressure
(ICP) and abducence and oculomotor nerve defects,.
Ocular changes are accompaniment of optic glioma
pituitary adenoma and pineal growth. Endocrine
abnormalities may be found in case of pituitary adenoma
and pineal tumor. 5 In the present series, 58% cases had
ICP, 50% visual defects, 46%focal presentation related to
tumor location and 32% cases abducence and oculomotor
nerve defects.

In this study skull radiography and CT scan were done in
all patients. Skull radiography is poor in detecting brain
tumour.  Intracranial space occupying lesion (ICSOL) was
found in all patients. Some degree of hydrocephalus  was
associated with 30% patients. Biopsy and histopathology
were also performed in all patients. In this study
astrocytomas were found in 40% of cases, among them
22% are grade II, 10% grade I, 6% grade III and 4% grade IV
(glioblastoma multiforme). Pituitary tumors were 16% pineal
tumor 6% ependymoma, 4% medulloblastoma 4%,
oligodendroglioma 2% and brain stem tumor 2%. Allen and
Chutorian found gliomas 50% of all primary brain tumors
and glioblastomas comprise over 50% of all glioma,
meningioma constitutes 15% of primary intracranial
neoplasm. Pituitary adenomas comprise 12% to 18% of
intracranial neoplasm, the majority of which are chromo
phobic; they are almost never malignant.3,6 Walker MD
found medulloblastoma represents 4% to 8% of all primary
brain tumor and ependymomas account for 1% to 8%.4
Percentage of gliomas was correlates with the study done
by Allen and Chutorian but the grading of the tumor markedly
varies and almost reverse. In the previous study  it was
found that more than 50% of gliomas are in advanced grade,3
but in this study maximum glioma cases are found in grade
I. & II Percentage of pituitary adenoma, meningioma and
other tumors well correlate with the previous study.

In conclusion in this study most common manifestation
of brain tumor was vomiting, convulsion, headache, visual
defect, papilloedema, focal neurological sign, oculomotor
and abducens nerve defects. One third of the patient had
associated hydrocephalus. Astrocytoma was the common
tumor of brain followed by Meningioma and Pineal tumour.

Fig.-2:  CT finding of skull in brain tumor (n=50)

Clinical and Pathological Characteristics of Brain Tumor Naziruddin Mollah et al

70



Diagnostic yield of x-ray skull is poor. MRI or CT scan
should be done in any suspected case of Brain tumour.

References:
1 . Rubin P, Mc Donald S, Qazi R. Clinical oncology, 7th edition.

Philadelphia: WE saunders ; 1993.

2 . Burger PC, Scheithauer BW, Vogel FS. Surgical pathology of
nervous system and its covering, 3rd edition. New York :
Churehill Livingstone; 1991.

3 . Allen JC. Childhood brain tumors: Current status of clinical
trials in newly diagnosed and recurrent disease. Clin N Am.
1996l 32: 633-51.

4 . Walker MD. Brain and peripheral nervous system tumors. In:
Holland JF, Feri E (eds). Cancer medicine. Philadelphia : Lea
& Febiger; 1993, pp 1385-1417.

5 . Kornbilth PL. Increased intracranial pressure. In: Devita VT,
Hellmann S, Rosenberg SA (eds): Cancer: principles and practice
of oncology.  Philadelphia : JB Lippincott; 1992, p. 1586-
1588.

6 . Chutorian AM, Grati SR: Diagnosis of intracranial tumors in
infants and children. In: Chang CH, Houspian EM (eds):
Tumors of the Central Nervous system: Modern Radiotherapy
in Multidisciplinary Management  New York, Masson
publishing 1992, pp 83-125.

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