Abstract
Histological reports on tumour specimens recorded at a teaching hospital in Accra, Ghana from 1989 to 2008 were reviewed to determine the incidence of head and neck tumours in children less than 16 years old. There were 4546 reports of head and neck tumours (2041 malignant, 2505 benign). Of these 613 met the study age selection criteria. 186(30.3%) were malignant and 427(69.7%) benign. The male to female ratio for malignant tumours was 1.86:1, benign 0.73:1 and for all tumours 1:1.04. Lymphoma (54.8%), nasopharyngeal carcinoma (19.9%) and rhabdomyosarcoma (14%), together constituted over 88% of malignant neoplasms. The commonest benign neoplasm was squamous papilloma (76/427) 17.8%, and then haemangioma (60/427) 14.05%. The incidence increased with age, peaking in those aged 12–16 years. The commonest site for benign tumours was the larynx and for malignant tumours the neck (cervical lymph nodes). Relative to all head and neck malignancies, the incidence of childhood head and neck malignancies was 11% (186/2041). This study reveals that malignant head and neck tumours are not rare in Ghana compared to benign tumours and the incidence of rhabdomyosarcoma is higher in females.
Most head and neck swellings in children tend to be inflammatory in nature. The differential diagnosis of these swellings includes cysts, vascular malformations and tumours, which may be benign or malignant . The latter is rare but can have serious consequences for the child. In the USA, malignant neoplasms consist of 5% of all childhood malignancies and the percentage is said to be rising. The overall annual incidence of cancer in children under 15 years of age rose from 11.22 cases/100,000 person-years in the period 1973–1975, to 14.03 cases/100,000 person-years in 1994–1996, an increase of 25%. This study found an even larger increase in the incidence of paediatric head and neck malignancies. The incidence rate increased from 1.10 to 1.49 cases/100,000 person-years in the same timeframe, an increase of 35%.
Data on the incidence of these pathologies worldwide is limited, and that from Africa is restricted mainly to Nigeria. To the best of the authors’ knowledge, no such study has been carried out in Ghana.
To enable early diagnosis and successful management, a comprehensive knowledge of these tumours, including their frequency, common sites and histological type, is crucial to all surgeons and physicians who manage these pathologies in the head and neck region. A retrospective study based on pathology charts was carried out. The aim of this study is to investigate the incidence, age distribution, localization, and gender preferences of head and neck tumours in a paediatric population in Ghana. It is hoped that findings from this study will contribute to, and further elucidate, this subject.
Materials and methods
Data recorded from specimens received at the pathology department of a tertiary care teaching hospital over a 20-year period (1989–2008) were inspected. There were 4546 reports of head and neck tumours (2041 malignant; 2505 benign). 613 of the 4546 reports, which met the selection criteria of occurring in patients aged less than 16 years, were studied in detail. Inflammatory swellings mimicking neoplasms, and reactive cervical lymphadenitis, the commonest cause of neck swellings in children, were not included in this study. Also excluded from this study were primary intracranial tumours, intra-orbital tumours (retinoblastoma) and obvious metastasis to the head and neck areas. Benign tumours and non-neoplastic swellings presenting as tumour-like conditions were included in the study for the purpose of comparison only, and will be analyzed separately in a different study. The age, sex, site of pathology, the date the sample was received and the histological diagnosis were noted and recorded. All the data related to patients who had been seen at this hospital, having been referred from various parts of Ghana.
Patients were seen initially at the ENT department, maxillofacial or paediatric unit. The decision to biopsy any presenting pathology was made by the senior clinician at the time of presentation. The specimens were sent to the pathology department, where they were prepared for the pathologist. Copies of all records were kept at the department and necessary information or diagnosis passed on to the referring physician or surgeon. The data were scrutinized, cleaned, and analyzed using Microsoft Excel spread sheets.
Results
4546 reports of head and neck tumours (2041 malignant; 2505 benign) were recorded over the period of study. From these, 613 (27.55%) reports satisfying the age criteria for the study were studied. Of these 613, there were 186 (30.34%) malignant tumours and 427 (69.66%) benign tumours, giving a ratio of 1:2.3, in favour of benign tumours ( Table 1 ). The incidence of childhood head and neck malignancies, relative to all head and neck malignancies, was 9.11% (186/2041), and relative to all head and neck tumours over the period of study was 4.09% (186/4546).
| Tumour | Number | Percentage |
|---|---|---|
| Benign | 427 | 69.66 |
| Malignant | 186 | 30.34 |
| Total | 613 | 100 |
For all tumours, 301 reports were of boys and 312 were of girls giving an overall male to female ratio of 1:1.04. The incidence of benign tumours was higher in females (180 boys and 247 girls), with a male to female ratio of 0.73:1, but the reverse was the case with regard to malignant tumours (121 boys and 65 girls) with a male to female ratio of 1.86:1 ( Fig. 1 and Table 2 ).
| Sex | Benign | Malignant | All tumours |
|---|---|---|---|
| Boys | 180 | 121 | 301 |
| Girls | 247 | 65 | 312 |
| Both sexes | 427 | 186 | 613 |
| Ratio of boys to girls | 0.73 | 1.862 | 1.04 |
The incidence of tumour occurrence in the different age groups is shown in Table 3 . The frequency of benign, malignant or both tumours, increased with age peaking in the oldest age group (12–16 years) ( Fig. 2 ). Regarding malignant tumours, 45.7% occurred in those aged 12–16 years, and 76.34% occurred in those over 8 years of age.
| Age (years) | Benign | Malignant | All tumours |
|---|---|---|---|
| 0 to <1 | 37 | 4 | 41 |
| 1 to <4 | 51 | 6 | 57 |
| 4 to <8 | 95 | 34 | 129 |
| 8 to <12 | 114 | 57 | 171 |
| 12 to <16 | 130 | 85 | 215 |
| 0 to <16 | 427 | 186 | 613 |
Table 4 shows the histological diagnosis of malignant tumours in the study. The commonest malignant neoplasm was lymphoma ( N = 102) constituting 54.8%, of all malignant tumours, of which non-Hodgkin’s lymphoma ( N = 46), constituting 24.73% of all malignant tumours, was most predominant. This was followed by nasopharyngeal carcinoma ( N = 37) 19.89% and rhabdomyosarcoma ( N = 26) 13.90%, of which the embryonal form ( N = 17) 9.13% was predominant. With respect to rhabdomyosarcoma overall, the female incidence was higher than the male (16 girls and 10 boys) and after the age of 9 years there were no male patients with rhabdomyosarcoma, all the patients were female ( N = 10). Up to the age of 9 years, the male to female ratio favoured the boys (10:6). Some lesions were seen once, demonstrating rarity. The commonest benign neoplasm was squamous papilloma ( N = 76), constituting 17.79% of all benign tumours, and then haemangioma (60/427) 14.05%.
| No. | Tumour | % |
|---|---|---|
| 46 | Non-Hodgkin’s lymphoma | 24.73118 |
| 37 | Nasopharyngeal carcinoma | 19.89247 |
| 34 | Hodgkin’s lymphoma | 18.27957 |
| 22 | Burkitt’s lymphoma | 11.82796 |
| 17 | Embryonal rhabdomyosacoma | 9.139785 |
| 9 | Rhabdomyosarcoma | 4.83871 |
| 3 | Sqamouscell carcinoma | 1.612903 |
| 2 | Neuroblastoma | 1.075269 |
| 2 | Neuroectodermal tumour | 1.075269 |
| 2 | Papillary carcinoma | 1.075269 |
| 1 | Adenoid cystic carcinoma | 0.537634 |
| 1 | Ewing’s sarcoma | 0.537634 |
| 1 | Fibrosarcoma | 0.537634 |
| 1 | Follicular carcinoma | 0.537634 |
| 1 | Haemangioendothelioma | 0.537634 |
| 1 | Leiomyosarcoma | 0.537634 |
| 1 | Malignant teratoma | 0.537634 |
| 1 | Medullary carcinoma | 0.537634 |
| 1 | Malignant fibrous histiocytoma | 0.537634 |
| 1 | Mucoepidermoid carcinoma | 0.537634 |
| 1 | Neuroepidermal tumour | 0.537634 |
| 1 | Carcinoma in situ | 0.537634 |
| 186 | 100 |
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