---
title: "Pediatric CNS tumor spectrum in North India classified using WHO CNS 2021"
id: "pubmed-42920018"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42920018"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42920018/"
doi: "10.1007/s00381-026-07499-z"
published_at: "2026-10-24T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Pediatric CNS tumor spectrum in North India classified using WHO CNS 2021
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42920018
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42920018/)
- **DOI:** [10.1007/s00381-026-07499-z](https://doi.org/10.1007%2Fs00381-026-07499-z)
- **Published At:** 2026-10-24T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Investigators performed a retrospective review of pediatric central nervous system (CNS) tumors diagnosed at a tertiary cancer centre in North India between January 2019 and December 2024. The study used histopathology and **immunohistochemistry** to apply the **WHO CNS 2021** classification. - The cohort comprised 92 pediatric brain/CNS tumors with a male-to-female ratio of 2.5:1. Embryonal tumors were the largest group at 38.02%, astrocytic tumors accounted for 31.52%, and ependymal tumors made up 23.91% of cases. - Among embryonal neoplasms, **medulloblastoma** predominated (88.57% of embryonal tumors). The embryonal group also included two atypical teratoid/rhabdoid tumors, one pineoblastoma, and one embryonal tumor NOS with BCOR immunopositivity. - Immunohistochemical surrogate markers allowed molecular subgrouping in seven medulloblastomas: five were non-WNT/non-SHH, one was SHH-activated TP53-wild-type, and one was SHH-activated TP53-mutant, as reported by the study team. - Ten ependymomas were classified per WHO CNS 2021: eight supratentorial tumors expressed L1CAM consistent with ZFTA fusion-positive ependymoma; two posterior fossa tumors were designated posterior fossa group A (PFA) ependymomas. - Tumor grade distribution: grade 4 tumors were most common (48%), grade 3 were 27%, grade 1 were 17%, and grade 2 were 8%. The posterior fossa was the most frequent site (51%), followed by cerebral hemispheres (37%). - Other reported entities included two germinomas and single cases of rhabdoid meningioma, atypical choroid plexus papilloma, adamantinomatous craniopharyngioma, and hemangioblastoma. - The authors noted that incorporation of immunohistochemistry enabled integrated histomolecular classification in several cases and emphasized the importance of such integrated diagnosis in pediatric neuro-oncology, especially in resource-limited settings. - The study was retrospective, single-centre, and used electronic medical records from the Department of Oncopathology; ethics approval and waiver of informed consent were granted by the institutional ethics committee, as documented in the source.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Pathology, MPMMCC, TMC Varanasi, HBNI, Varanasi, 221005, UP, India. paulparamita84@yahoo.in. * 2 Department of Pathology, MPMMCC, TMC Varanasi, HBNI, Varanasi, 221005, UP, India. * 3 Department of Radiation Oncology, MPMMCC, TMC Varanasi, HBNI, Varanasi, 221005, UP, India. * 4 Department of Pediatric Oncology, MPMMCC, TMC Varanasi, HBNI, Varanasi, 221005, UP, India. * PMID: **42920018** * DOI: [ 10.1007/s00381-026-07499-z ](https://doi.org/10.1007/s00381-026-07499-z) Item in Clipboard Observational Study # Spectrum of pediatric central nervous system tumors in North India: a histopathological and immunohistochemical study applying the WHO CNS 2021 classification Paramita Paul et al. Childs Nerv Syst. 2026. Show details Display options Display options Format Abstract PubMed PMID Childs Nerv Syst Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Childs+Nerv+Syst%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Childs+Nerv+Syst%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920018/) . 2026 Oct 24;42(1):397. doi: 10.1007/s00381-026-07499-z. ### Authors [Paramita Paul](https://pubmed.ncbi.nlm.nih.gov/?term=Paul+P&cauthor_id=42920018)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920018/#short-view-affiliation-1 "Department of Pathology, MPMMCC, TMC Varanasi, HBNI, Varanasi, 221005, UP, India. paulparamita84@yahoo.in."), [Shashikant C U Patne](https://pubmed.ncbi.nlm.nih.gov/?term=Patne+SCU&cauthor_id=42920018)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920018/#short-view-affiliation-2 "Department of Pathology, MPMMCC, TMC Varanasi, HBNI, Varanasi, 221005, UP, India."), [Zachariah Chowdhury](https://pubmed.ncbi.nlm.nih.gov/?term=Chowdhury+Z&cauthor_id=42920018)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920018/#short-view-affiliation-2 "Department of Pathology, MPMMCC, TMC Varanasi, HBNI, Varanasi, 221005, UP, India."), [Ashutosh Mukherjee](https://pubmed.ncbi.nlm.nih.gov/?term=Mukherjee+A&cauthor_id=42920018)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42920018/#short-view-affiliation-3 "Department of Radiation Oncology, MPMMCC, TMC Varanasi, HBNI, Varanasi, 221005, UP, India."), [Ninad Patil](https://pubmed.ncbi.nlm.nih.gov/?term=Patil+N&cauthor_id=42920018)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42920018/#short-view-affiliation-3 "Department of Radiation Oncology, MPMMCC, TMC Varanasi, HBNI, Varanasi, 221005, UP, India."), [Parichay Singh](https://pubmed.ncbi.nlm.nih.gov/?term=Singh+P&cauthor_id=42920018)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42920018/#short-view-affiliation-4 "Department of Pediatric Oncology, MPMMCC, TMC Varanasi, HBNI, Varanasi, 221005, UP, India.") ### Affiliations * 1 Department of Pathology, MPMMCC, TMC Varanasi, HBNI, Varanasi, 221005, UP, India. paulparamita84@yahoo.in. * 2 Department of Pathology, MPMMCC, TMC Varanasi, HBNI, Varanasi, 221005, UP, India. * 3 Department of Radiation Oncology, MPMMCC, TMC Varanasi, HBNI, Varanasi, 221005, UP, India. * 4 Department of Pediatric Oncology, MPMMCC, TMC Varanasi, HBNI, Varanasi, 221005, UP, India. * PMID: **42920018** * DOI: [ 10.1007/s00381-026-07499-z ](https://doi.org/10.1007/s00381-026-07499-z) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Introduction:** Pediatric central nervous system (CNS) tumors are the second most common childhood malignancies after leukemia and remain the leading cause of cancer-related mortality in children. Recent advances in molecular pathology have significantly refined their classification and prognostic stratification. **Aim:** To evaluate the histopathological spectrum of pediatric brain tumors at a tertiary care cancer center in North India and classify them according to the 2021 World Health Organization (WHO) Classification of Central Nervous System Tumors. **Materials and methods:** A retrospective observational study was conducted using the electronic medical records of the Department of Oncopathology, from a tertiary care cancer center in North India. Pediatric CNS tumors diagnosed between January 2019 and December 2024 were included. Demographic characteristics, tumor location, histopathological diagnosis, immunohistochemical findings, and WHO grade were analyzed. **Results:** A total of 92 pediatric brain/CNS tumors were diagnosed during the study period, with a male-to-female ratio of 2.5:1. Embryonal tumors constituted the largest group (38.02%), followed by astrocytic tumors (31.52%) and ependymal tumors (23.91%). Among embryonal tumors, medulloblastoma predominated (88.57%), followed by two atypical teratoid/rhabdoid tumors, one pineoblastoma, and one embryonal tumor, NOS with BCOR immunopositivity. Molecular subgrouping using immunohistochemical surrogate markers was performed in seven medulloblastomas, identifying five non-WNT/non-SHH tumors, one SHH-activated TP53-wild-type tumor, and one SHH-activated TP53-mutant tumor. Classification according to WHO CNS 2021 was feasible in ten ependymomas, with all eight supratentorial tumors demonstrating L1CAM positivity consistent with ZFTA fusion-positive ependymoma, while two posterior fossa tumors were classified as posterior fossa group A (PFA) ependymomas. Other tumors included two germinomas and one case each of rhabdoid meningioma, atypical choroid plexus papilloma, adamantinomatous craniopharyngioma, and hemangioblastoma. Grade 4 tumors were the most frequent (48%), followed by grade 3 (27%), grade 1 (17%), and grade 2 (8%) tumors. The posterior fossa was the most common site (51%), followed by the cerebral hemispheres (37%), spinal region (5%), sellar region (2%), pineal region (2%), and hypothalamus (1%). **Conclusion:** Embryonal tumors, particularly medulloblastoma, constituted the predominant pediatric CNS neoplasms in this cohort. Incorporation of immunohistochemistry enabled integrated classification of several tumors according to WHO CNS 2021 recommendations, including molecular subgrouping of medulloblastomas and classification of molecularly defined ependymomas. The tumor spectrum observed is comparable to contemporary Indian and Western series and highlights the increasing importance of integrated histomolecular diagnosis in pediatric neuro-oncology, particularly in resource-limited settings. **Keywords:** Astrocytoma; Ependymoma; Immunohistochemistry; Medulloblastoma; Molecular classification; Pediatric brain tumors; Pediatric neuro-oncology; WHO CNS 2021. © 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board of Institutional ethic committee Mahamana Pandit Madan Mohan Malviya Cancer Centre (IEC number 11000850), Mahamana Pandit Madan Mohan Malviya Cancer Centre and Homi Bhabha Cancer Hospital, TMC Varanasi, HBNI. The patients’ informed consent was waived by Institutional Ethic Committee Mahamana Pandit Madan Mohan Malviya Cancer Centre IEC given the retrospective nature of the study. The study adhered to the Declaration of Helsinki. Consent for publication: No identifying images or other personal or clinical details of participants are presented that compromise anonymity. Competing interests: The authors declare no competing interests. Declaration of generative AI in scientific writing: No AI tool was used during the preparation of this work. Submission declaration and verification: The work described has not been published previously that it is not under consideration for publication elsewhere, that its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright holder. ## References 1. 1. Jain A, Sharma MC, Suri V, Kale SS, Mahapatra AK, Tatke M et al (2010) Spectrum of pediatric brain tumors in India: a multi-institutional study. Neurol India 58(2):208–213 2. 1. Madhavan R, Kannabiran BP, Nithya AM, Kalyani R (2016) Spectrum of pediatric brain tumors: a single-institution experience. J Neurosci Rural Pract 7(4):545–551 3. 1. Shah HC, Patel C, Shah MJ (2015) Histopathological spectrum of pediatric brain tumors: a tertiary care center study. Indian J Pathol Microbiol 58(4):434–438 4. 1. Ward E, DeSantis C, Robbins A, Kohler B, Jemal A (2014) Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin 64(2):83–103 - [PubMed](https://pubmed.ncbi.nlm.nih.gov/24488779/) 5. 1. Ostrom QT, Coleman W, Huang W, Rubin JB, Lathia JD, Berens ME et al (2019) Sex-specific gene and pathway modeling of inherited glioma risk. Neuro Oncol 21(1):71–82 - [DOI](https://doi.org/10.1093/neuonc/noy135) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/30124908/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/6303471/) Show all 29 references ## Publication types * Observational Study Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Observational+Study%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Observational+Study) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920018/) ## MeSH terms * Adolescent Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Adolescent%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Adolescent) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920018/) * Brain Neoplasms* / classification Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Brain+Neoplasms%2Fclassification%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Brain+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920018/) * Brain Neoplasms* / pathology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Brain+Neoplasms%2Fpathology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Brain+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920018/) * Central Nervous System Neoplasms* / classification Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Central+Nervous+System+Neoplasms%2Fclassification%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Central+Nervous+System+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920018/) * Central Nervous System Neoplasms* / epidemiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Central+Nervous+System+Neoplasms%2Fepidemiology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Central+Nervous+System+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920018/) * Central Nervous System Neoplasms* / metabolism Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Central+Nervous+System+Neoplasms%2Fmetabolism%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Central+Nervous+System+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920018/) * Central Nervous System Neoplasms* / patho
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