Objective: This study was conducted to formulate locationwise radiologic diagnostic algorithms and assess their concordance with the final histopathological diagnosis of intracranial mass lesions to evaluate their utility in a rural setting where only basic facilities are available.
In present study seventy two cases were analyzed.Histopathological evaluation was done from biopsy sample sent in formalin, tissue processing was done by standard procedure, tissue sections were routinely stained by H&E, immunohistochemical examination was performed in case of histopathological discrepancies. Radiological findings were correlated with histopathological diagnosis and concordances were calculated.
Statistical Analysis: Frequencies and crosstabs were used for calculation.
Result: This was a study of seventy-two patients with age ranging from 9months to 65 years. In these entire 72 cases, male patients were 42(58%), female patients were 30(42%). M: F was 1.38:1. Most of patient presented with headache, and frontal lobe was the most common location. In all these lesions, 88.8% cases were neoplastic lesions. Among all neoplastic lesions, 52.7% were malignant tumors and 34.7% were benign tumors. Among all malignant tumors, Astrocytoma was the most common malignant tumor.Meningioma was the second most commonly encountered lesion. In the present study radiological and histopathological correlation was present in84.7% of cases. IHC was performed wherever needed, to support diagnosis.
Radiological investigations are reliable diagnostic tools for space occupying central nervous system lesions, but histopathology is still the gold standard. So multidisciplinary approach is the ideal approach for space occupying lesions of central nervous system.
An Intra cranial space-occupying lesion (ICSOL) is defined as a mass lesion in the cranial cavity with a diverse etiology like benign or malignant neoplasm, inflammatory or parasitic lesion, haematoma, or arterio-venous malformation.Central nervous system neoplasms represent a unique heterogenous population of neoplasms. Annual incidence of intracranial tumors is10 to17per/100000 person. 1 A broad spectrum of non -neoplastic conditions can mimic a braintumor, both clinically and radiologically and these patients undergo biopsy. In such cases, the pathological examination can readily differentiate between neoplastic and nonneoplastic lesions. Space occupying lesions of brain is one of the importantcauses of neurological morbidity and mortality 2 . These lesions may follow serious clinical course even or when they are inflammatory lesions or benign neoplasm.Any CNS neoplasm without intervention, regardless of histological grade or classification, may have lethal consequences if situated in critical brain region.Early diagnosis is necessary to plan appropriate management.
The aim of this study to correlate clinical, radiological and histopathological findings of intracranial space occupying lesions in a tertiary care center in rural India.
The present study was conducted in the department of pathology, in a tertiary level teaching institute in central India. The study includes prospective cases sent to Department of Pathology from 1stMarch, 2017 to 31stAugust, 2018 (18 months) from Neurosurgery Department of same institute. The material consisted of the biopsy specimens from intracranial mass lesions removed. Tissue sample received in 10% formalin were allowed to fix for 24 hours. Gross examination was done and sections were given. Paraffin embedded sections were routinely stained by H&E. Radiological diagnosis (CT scan or MRI) was compared with that of histopathology. Available clinical details, radiological and laboratory investigation data were documented. For histological examination labeling of sample with unique identification number, fixation, dehydration, clearing, impregnation, embedding, section cutting, staining and mounting was done as per standard departmental protocols followed. In case of histopathological-clinical discrepancy the blocks were sent for immunohistochemistry (IHC) to National institute of mental health and neurosciences (NIMHANS) Bangalore. RESULT:-Over the period of 18 months, post-operative histopathological examination was performed in the patients operated for ICSOL. In our study total 72 cases were studied. In present study we observed that maximum number of cases belong to age group of 36-45 years(26.4%).In present study total male patients were 58% and females were 42%. It shows males are more affected than females. Male to female ratio (M: F) was 1.38:1.Headache was the most common presenting complaints of patients (31.9%) followed by vomiting. Frontal lobe was the most common site for lesions. Among all lesions neoplastic lesions were most common. Among all neoplastic lesions Astrocytomas were the most common lesions contributing 30.6% of all lesions, followed by meningioma (22.2%), which included various types like meningotheliomatous and transitional meningioma, psammomatousmeningioma etc. Pituitary adenoma, oligodendroglioma, ependymoma, schwannoma, Craniopharyngioma, glioblastoma multiforme,choroid plexus papilloma,subependymoma,hemangioblastoma,medulloblastoma, metastatic adenocarcinoma from thyroid also contributed.Non-neoplastic lesions were 11.1%, which include neurocysticercosis,hydatid cyst, tuberculoma, epidermoid cyst and brain abscess. In present study the correlation of radiological and histopathological diagnosis of ICSOL is 84.7%. Intracranial space occupying lesions comprise of a diverse group of lesions. With the introduction of CT and MRI scanning, imaging of lesions has acquired a new dimension whereby excellent anatomical detail in axial, sagittal and coronal planes as well as lesion characterization has become possible. These modalities have helped in the early diagnosis and localization of the ICSOL and in complement with advanced neurosurgical techniques, have improved the prognosis of patients of mass lesions. It may be considered as an important supportive and complimentary tool to histopathological diagnosis.Radiological similarity of the lesions and presence of interfering factors are important contributory factors for misdiagnosis. So histopathological diagnosis remains gold standard and superior to radiological diagnosis in the context of space occupying lesions of brain. Hence by this study it is concluded that a multidisciplinary approach is the ideal for space occupying lesions of the central nervous system. The neurosurgeon, neuroradiologist and neuropathologist form a triad that is essential for diagnosis, management and follow up of these cases. Out of 72 cases, 11 cases (15.7%) were misdiagnosed on radiology. Misdiagnosis of cases is probably due to radiological similarity of the lesion. In our study tumour presenting as illdefined nodular lesion with mass effect near fourth ventricle was misdiagnosed as medulloblastoma, which on histopathological examination diagnosed as anaplastic glioma, craniopharyngioma was misdiagnosed as Rathke's cyst due to cystic nature and similar location. Anaplastic glioma was misdiagnosed as medulloblastomas because of areas of haemorrhage and infiltrative growth pattern. In present study various limiting factors were haemorrhage, necrosis andedema.
Sunila et al
Radiological investigation is a reliable diagnostic tool for space occupying central nervous system lesions. It may be considered as an important supportive and complimentary tool to histopathological diagnosis. Radiological similarity of the lesions and presence of interfering factors are important contributory factors for diagnostic pitfalls. Radiological investigation has high sensitivity and is highly efficacious for the diagnosis of neoplastic CNS lesions. However, in view of low specificity, multimodality approach may be beneficial for management of the patient.