Original articleHow do the clinical features of brain tumours in childhood progress before diagnosis?
Introduction
Brain tumours are the most common solid tumours in children. Approximately 2200 children are newly diagnosed with malignant brain tumours each year in USA [1]. Despite recent advances in neurosurgery, oncology, and radiology, the overall survival rate of affected patients has not improved.
Studies have reported that it takes several months from symptom onset to the diagnosis of a brain tumour in childhood [2], [3], [4], [5], [6], [7], [8], [9]. Many factors are associated with this delayed diagnosis, including the variety of non-specific symptoms such as headache, vomiting, and behavioural problems. Headache and vomiting are the most common symptoms of a brain tumour in children and adults. Seizures, paralysis of the extremities, and visual disturbance are other common features of brain tumours. This variety of symptoms is explained by the localisation of brain function and tumours. Previous reports have studied mainly the frequency of symptoms in patients with a particular histology or localisation of brain tumour [10], [11]. However, it is not clear how the symptoms and signs of brain tumours progress chronologically in each patient. This information is important because most affected patients are not diagnosed from the initial symptom alone, but rather as additional symptoms or signs develop. Therefore, clarification of the sequence of symptoms and signs in an individual will help clinicians to make an earlier diagnosis of brain tumour, which may lead to a better prognosis.
This study examined the progression of clinical features from onset to diagnosis in children with brain tumours.
Section snippets
Methods
Twenty-seven patients diagnosed with brain tumours between February 2004 and April 2008 at Nagoya University Hospital and 33 diagnosed between April 1995 and December 2008 at Anjo Kosei Hospital were enrolled in this study. Patients with benign tumours such as dysembryoplastic neuroepithelial tumour, ganglioglioma, gangliocytoma, and neurofibromatosis were excluded from this study. Ethical approval was obtained from the Clinical Research Ethics Committee of the Anjo Kosei Hospital and Nagoya
Results
The median age at diagnosis was 5.8 years (range, 1 day to 15 years). Thirty-five of the 60 patients were 4 years old or older. The male to female ratio was 48:52 (29 males, 31 females). The pathological diagnosis was embryonal tumours (including medulloblastoma, primitive neuroectodermal tumours, and atypical teratoid rhabdomyoma tumours) in 13; astrocytoma in 11; germ cell tumours in seven; ependymoma in four; choroid plexus papilloma in three; craniopharyngioma in three; and both
Discussion
This paper examined the progression of symptoms and signs from onset to diagnosis in children with brain tumours, and detected the presence of several clinical progression patterns according to the initial symptom or sign. These patterns of progression were strongly associated with tumour location. It is important to know the clinical course before diagnosis, because many patients with brain tumours are not diagnosed from a single symptom alone and present with non-specific symptoms at onset [2]
Conflict of interest
We have no conflict of interest in relation to this manuscript.
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