Abstract Background and Objectives Central nervous system (CNS) tumor under three years of age is particularly challenging due to the developing brain and limited resources. This study aimed to describe the demographic profile, clinical characteristics, treatment patterns, and survival outcomes of children under three years diagnosed with CNS tumors at a largest public-sector referral center in Pakistan. Methods This prospective, observational cohort study included all newly diagnosed CNS tumors in children from birth to three years presenting between January 1, 2023, and December 31, 2025. Data were recorded prospectively and summarized using descriptive statistics. Results A total of 115 patients were included, with a mean age of 1.92 ± 0.90 years and a male-to-female ratio of 1.4:1. Twenty-four percent traveled over 600 km for care, and the median monthly household income was USD 90 (range, USD 20–1000). The median diagnostic delay was 2.0 months (IQR 1.0–4.0), attributed to healthcare-related delay in 21% and patient-related delay in 36%, while 43% presented within one month. Common presenting symptoms included vomiting (24%), focal neurological deficits (21%), and motor regression or delay (12%). Consanguinity was present in 36%, family history of cancer in 11%, and neurocutaneous stigmata in 10%. Tumors were Infratentorial in 49%, Supratentorial in 46%, and Spinal in 5%, with the cerebellum being the most common primary site (42%). Surgical excision was performed in 30% of patients. Among histologically confirmed cases, low-grade glioma was most frequent (26%), followed by embryonal tumors (21%) and Ependymoma (19%). The median time to surgery or treatment initiation was 0.9 months (IQR 0.5–2.0). At data cutoff, 40% were lost to follow-up, 39% had died, and only 8% were on post-treatment follow-up. Median event-free survival was 1.5 months (IQR 0.0–5.0), with an overall survival rate of 21%. Survivors demonstrated good functional outcomes, with a median Lansky performance score of 100 (IQR 80–100). Conclusion In children under three years with CNS tumors, access to definitive treatment remains limited, with high attrition contributing to poor survival. Survivors who complete therapy demonstrate excellent performance status. Strategies addressing diagnostic delay, capacity-building, treatment abandonment, and possible cancer predisposition are urgently needed in resource-limited settings.

Background: Chemotherapy-induced Febrile neutropenia (FN) is a potentially catastrophic complication in childhood cancer, requiring urgent management and hospitalization, with a heightened risk of mortality. Granulocyte-colony stimulating factors (G-CSFs) are used both prophylactically to decrease FN episodes and therapeutically during febrile neutropenia. However, evidence supporting their role in resource-limited settings remains scarce. Objectives: To evaluate the effect of granulocyte colony-stimulating factor on hospital stay duration, treatment cost, and mortality among children suffering from febrile neutropenia. Methodology: This prospective cohort study enrolled 250 children with chemotherapy-induced FN at the Children’s Hospital Lahore (CHL) from September 2018 to December 2018. Patients received G-CSF (filgrastim, 10 mcg/kg/day for five days or until ANC >1000 for two consecutive days), primarily in the solid malignancy group. Clinical characteristics, neutrophil counts, hospital stay, treatment costs, and outcomes were recorded. Data were analyzed using SPSS 23. Results: G-CSF significantly decreased hospital stay (p = 0.048) and was administered more frequently in instances of severe neutropenia (ANC < 100x10³/µL in 82% of cases, p = 0.000). Mortality in the G-CSF group was 3%, though not statistically significant (p = 0.147). In clinical settings, G-CSF improved hematological recovery in solid malignancies and was cost-effective (p = 0.027). Conclusion: G-CSF demonstrated superior clinical efficacy compared to intravenous antibiotics alone by reducing hospitalization and neutropenia severity, without imposing a substantial cost burden. These findings support G-CSF as a desirable FN management strategy, even in low-resource pediatric oncology centers.

Primary extraosseous central nervous system Ewing Sarcoma (CNS-EES) in children is a rare disorder, and this study aimed to document the experience of dealing with these rare pathologies of CNS in our center. This ambidirectional descriptive case series included all consecutive cases of CNS-EES in children under the age of 16 years presenting to the The Children's Hospital Lahore, Pakistan, from January 2023 to December 2024. During the 24-month study period, 4 out of 139 incident CNS tumor cases at our center were diagnosed as primary CNS-EES, corresponding to a proportional incidence of 2.9% (95% CI: 1.1-7.2%). The median age of presentation was 8.5 years, with equal gender distribution. Pain was the first presenting symptom, with a median symptom duration of 5.75 weeks. Half of the cases presented with a cerebral hemispheric mass and half with a spinal mass. The median event-free survival was 4.5 weeks with a survival rate of 25%. All cases were diagnosed based on a round blue cell morphology with a positive NKX2.2. Primary CNS-EES is not very infrequent in our population, with possible parietal lobe predilection and association with cancer predisposition syndrome. In resource-limited settings, NKX2.2 might serve as a fair substitute to diagnose CNS-EES.

Background: Febrile neutropenia in children on intensive chemotherapy is very frequent requiring urgent evaluation and management, imposing a significant strain on the already available limited resources in low-middle-income countries (LMIC) Objectives: To evaluate the need of cost-effectiveness in managing in-hospital FN and explore the mechanisms to implement in public sector LMIC to pave the way for cost-minimization Methodology: Prospective extraction of patient level costs from hospital records to evaluate the costing of injectable antimicrobial and inotropes provided by the hospital management free of cost as part of the comprehensive childhood cancer care Results: A total of 250 FN episodes were analyzed, all of them managed in the inpatient unit, complete cost data were extracted for these FN episodes. The analysis revealed that despite subsidized purchase of antimicrobials and supportive care materials FN has a huge burden on the public sector hospital resources whereas length of hospital stays, blood products, laboratory tests and staff consultations were excluded. Majority of these patients were of acute leukemia, having the last session of chemotherapy in a week time in 87% and majority on intensive chemotherapy and suffered from respiratory tract infections and mucositis. More than half had severe derangements of Laboratory parameters and gram-negative septicemia among positive cultures. The mean estimated cost per FN episode was around 15,000 PKR. Conclusion: Febrile neutropenia exerts a huge burden on childhood cancer care services emphasizing the need to explore the cost-effectiveness in FN management by different mechanisms including parents’ health literacy to promote early seeking behavior, emergency management, shared care therapy and social support and standardized de-escalation of therapy to minimize the costs.

Background: Hepatoblastoma is one of the most common malignant childhood tumors with diverse histologic patterns. Recent advances in imaging, pathologic evaluation ,risk stratification, neo-adjuvant treatment and surgical interventions have remarkably improved the survival status of these patients in the developed world. In developing countries like Pakistan successful outcome with limited resources is still challenging for the clinicians and pathologists. Histopathology plays an important role in timely correct diagnosis leading to prompt clinical management and survival. Materials &Methods: 34 cases of hepatoblastoma of both genders were recorded. Clinical presentation,radiology,serum AFP level , histopathologic diagnosis and outcome data were collected and analyzed. Results: Out of 34 cases,24 were male and 10 were female with median age of diagnosis was 3 years. Most children were presented with abdominal distension 19 cases and right sided hepatic lesion 21 cases. The most common histopathologic type was mixed mesenchymal and epithelial 35% followed by fetal type(20%),epithelial type (17%),embryonal and small cell types(6%),macro trabecular type (11%) and pleomorphic type(2%). Elevated AFP level was observed in more than 90% of cases. Conclusion: The most common histopathologic type was mixed epithelial and mesenchymal with male predominance was observed. Key words: hepatoblastoma, fetal, histomorphology

Purpose:To assess histopathology and outcomes after primary enucleation of eyes with retinoblastoma presenting with neovascular glaucoma (NVG). Methods:This was an international multicenter case series study across five continents. A retrospective review of patient charts was performed for all patients undergoing primary enucleation for retinoblastoma (n = 1,420) using a standardized data-collection spreadsheet. Clinical features, pathologic grade, and outcomes were compared between NVG patients and those with an American Joint Commission on Cancer eighth edition clinical stage of cT2. High-risk histopathology was defined as American Joint Commission on Cancer eighth edition pathologic stage >= pT2b. Results:Neovascular glaucoma was seen in 224/1,420 (16%) patients. The mean age at presentation of those with NVG was 30 months (median 25, range 0-120 months), and 131 (58%) patients had high-risk histopathology. The univariate logistic regression odds ratio for NVG predicting high-risk histopathology was 1.73 (95% confidence interval: 1.3-2.31) and from multivariate logistic regression was 1.77 (95% confidence interval: 1.23-2.56). Patients with a longer duration of symptoms (P = 0.03), buphthalmos (P = 0.02), and ectropion uveae (P < 0.01) were more likely to have high-risk histopathology. Patients with NVG were more likely to develop metastasis than cT2 patients (P = 0.04). Conclusion:There is a significant association between NVG at presentation, high-risk histopathology, and metastatic risk.

Background and Objective: Evaluation of intraoperative frozen section (FS) in central nervous system (CNS) lesions is an invaluable tool to ensure adequacy of tissue obtained to establish the diagnosis and is consistently practiced for rapid assessment and ancillary studies. The objective of this study was to determine the diagnostic concordance between frozen section for the pediatric CNS lesions considering Histopathology as a gold standard in the local pediatric population with respect to age and gender. Methods: This cross-sectional study was conducted at the Department of Histopathology, University of Child Health Sciences & The Children’s Hospital, Lahore, Pakistan. The biopsy specimens from 35 pediatric patients with CNS tumors were sent fresh frozen and in formalin, both, for analysis of the diagnostic accuracy of FS while taking formalin fixed paraffin embedded (FFPE) tissues as gold standard. The data was analyzed by using statistical tests of significance. Results: Comparing FS with FFPE tissues, 77.1 % cases showed complete concordance, 17% were partially concordant while only 5.7% cases were discordant. Male patients demonstrated higher (10.5%) discordance as compared to females (0%) (p= 0.251). Across age groups, concordance rates vary with no statistically significant differences. Conclusion: The diagnostic concordance of frozen sections is quite higher in CNS lesions in comparison to formalin fixed paraffin embedded tissues with certain limitations occurring in different tumors. Histopathological review and clinical correlation is mandatory for reaching a conclusive diagnosis in challenging cases.

center dot PURPOSE: To compare the clinical outcomes of children with unilateral retinoblastoma (Rb) and high-risk histopathology features (HRHF) following upfront enucleation with/without adjuvant chemotherapy, and investigate cases locally considered non-HRHF but converted to a standardized HRHF definition. center dot DESIGN: Retrospective multinational clinical cohort study. center dot METHODS: Children with Rb who presented to 21 centers from 12 countries between 2011-2020, and underwent primary enucleation were recruited. Centers retrieved clinical data and were asked to report detailed histopathology findings, as well as indicate cases defined locally as high-risk. For analysis, only unilateral cases with standardized HRHF, defined as retrolaminar optic nerve invasion, massive choroidal invasion, scleral invasion, anterior-segment involvement, and/or combined nonmassive choroidal and prelaminar/laminar optic nerve invasion, were included. Main outcome measures included orbital tumor recurrence, systemic metastasis, survival and number, and outcome of cases converted to standardized HRHF. center dot RESULTS: A total of 600 children presenting to 14 centers in 9 countries were included. Of these, 505 (84.2%) were considered locally as HRHF and received adjuvant chemotherapy. After a median follow-up period of 39.2 +/- 1.6 months (range: 0.8-60.0 months), 36 (6.0%) had orbital tumor recurrence, 49 (8.2%) metastasis, and 72 (12.0%) children died. Children not receiving adjuvant chemotherapy were at significantly increased risk of orbital tumor recurrence, metastasis, and death ( P <= .002). Of the study children, 63/600 (10.5%) were considered locally non-HRHF, but converted to standardized HRHF and included in the analysis. Of these, 6/63 (9.5%) had orbital tumor recurrence, 5/63 (7.9%) metastasis, and 6/63 (9.5%) children died. Isolated minor choroidal invasion with prelaminar/laminar optic nerve invasion was reported in 114 (19.0%) children, but considered locally as HRHF only in 68/114 (59.6%). Of these, 6/114 (5.3%) children developed metastasis and subsequently died, yielding a number needed to treat of 15. center dot CONCLUSION: Based on this multinational cohort of children with Rb, we recommend the use of adjuvant chemotherapy following upfront enucleation and diagnosis of HRHF. Variation exists worldwide among centers when defining HRHF, resulting in adverse patient outcomes, warranting standardization. (Am J Ophthalmol 2024;268: 399-408. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Purpose: To evaluate high-risk histopathological features following primary enucleation of eyes with retinoblastoma and assess the patient outcomes across continents. Methods: A retrospective study of 1,426 primarily enucleated retinoblastoma eyes from five continents. Results: Of all, 923 (65%) were from Asia (AS), 27 (2%) from Australia (AUS), 120 (8%) from Europe (EUR), 162 (11%) from North America (NA), and 194 (14%) from South America (SA). Based on the continent (AS vs. AUS vs. EUR vs. NA vs. SA), the histopathological features included massive choroidal invasion (31% vs. 7% vs. 13% vs. 19% vs. 27%, P = 0.001), postlaminar optic nerve invasion (27% vs. 0% vs. 16% vs. 21% vs. 19%, P = 0.0006), scleral infiltration (5% vs. 0% vs. 4% vs. 2% vs. 7%, P = 0.13), and microscopic extrascleral infiltration (4% vs. 0% vs. <1% vs. <1% vs. 4%, P = 0.68). Adjuvant chemotherapy with/without orbital radiotherapy was given to 761 (53%) patients. Based on Kaplan-Meier estimates in different continents (AS vs. AUS vs. EUR vs. NA vs. SA), the 6-year risk of orbital tumor recurrence was 5% versus 2% versus 0% versus 0% versus 12% (P < 0.001), systemic metastasis was reported in 8% versus 5% versus 2% versus 0% versus 13% (P = 0.001), and death in 10% versus 3% versus 2% versus 0% versus 11% (P < 0.001) patients. Conclusion: There is a wide variation in the infiltrative histopathological features of retinoblastoma across continents, resulting in variable outcomes. SA and AS had a higher risk of orbital tumor recurrence, systemic metastasis, and death compared to AUS, EUR, and NA.

Introduction: Squamous cell carcinoma of the esophagus is more common than adenocarcinoma. It is most common in Asian countries and more prevalent in black population as compared to white population. Its incidence has a decreasing trend, recent years. This disease is very rarely seen in children and adolescents. Case Report: A 12-year-old boy with moderately differentiated adenocarcinoma of lower esophagus is reported because it is a very rare disease in children. Patient presented with vomiting and dysphagia. Surgery was not possible due to widespread disease. Chemotherapy followed by radiotherapy was given. Patient started taking semisolids after two courses of chemotherapy. Discussion: Esophageal carcinoma is disease of old age and most prevalent in Asian countries. Most patients with this disease are male and have age more than 50 years. This disease is very rarely found in children, the youngest patient presented with the disease was eight years old. It frequently metastasizes to lungs, liver and mediastinal lymph nodes.

Introduction: Wilms tumor is the most common pediatric renal neoplasm. Following preoperative therapy, various histological subtypes, risks and clinical stages are determined as per following SIOP 2001 protocol. To determine the clinicopathological features of different histopathological subtypes and stages of Wilms tumor after completing course of preoperative as well as postoperative chemotherapy following SIOP 2001 protocol. Methodology: This is a retrospective cross-sectional study and sample size calculated by non-probability technique. Ninety-three patients with abdominal masses in the Hematology/Oncology Department were included. After radiological and histopathological diagnosis, four weeks of preoperative chemotherapy, given to patients, followed by partial and radical nephrectomies by surgical team. Specimens received in Histopathology Department grossed and microscopically examined for different post chemotherapy histological subtypes. Further risk categorization and clinicopathological staging in accordance with SIOP 2001, done after completion of treatment. Patients called for yearly follow up for the next five years. Categorical variables are presented as frequencies and percentages. Results: Mean age of ninety-three children was 44.4 months + 30.92with predominance of males (55.9%) and more common in right sided kidney (55.9%). Majority patients completed the entire course of treatment (77.4%). Majority were intermediate risk tumors (76.3%) and most common histological subtype was Mixed Tumor subtype (23.4%). In our study majority, tumors were stage III (48.3%) and patients died due to febrile neutropenia (9.6%) Conclusion: In our study the majority of patients completed the entire course of treatment and relapse was fairly less. Patients lost to follow up after nephrectomy and deaths at home caused by febrile neutropenia were our major challenges.

Aim: To analyze clinical manifestations, course and outcome of Langerhans Cell Histiocytosis in children in resource limited settings lacking salvage therapy. Study design: Observational retrospective study Place and duration of study: Department of Haematology/Oncology, The Children’s Hospital, Lahore Pakistan from 1st January 2011 to 31st December 2018. Methodology: Sixty-five patients with age range from<1 to 8 years included analysing their age, gender, clinical classification, course of therapy and outcome. The major treatment was composed of either prednisolone and vinblastine or cytarabine pulses. Results: There were 59% males and 41% females. Forty-seven (72%) patients presented with multi system-LCH with 49% Risk Organ involvement. Most of them 42 (65%) had bone lesions while 15patients (23%) presented with central nervous system involvement. Forty patients (61%) have completed treatment, 11(17%) left against medical advice and 12(18%)patients expired due to progressive disease and worsening infection. Only 2 patients were put on palliation with progressive brain parenchyma disease. 22 patients (34%) had reactivations of disease requiring therapy for more than one-year (p-value=0.06), while 15 (23%) patients received two cycles of initiation therapy before continuation therapy started. The treatment initiated >6 months after the onset of symptoms in 48 (74%) patients. Conclusion: Early diagnosis and timely initiation of therapy are of utmost importance to reduce mortality and morbidity. There is a dire need of social support to reduce treatment abandonment in low-middle-income countries LMIC. Keywords: Paediatric Langerhans cell histiocytosis, Resource-limited settings, Delayed diagnosis, Abandonment

Background: Each year, it is estimated that over 200 000 children and adolescents are diagnosed with cancer, and 80% of these reside in low-middle-income countries, with 90% mortality. There are enormous psychosocial needs of these patients, families, and care-givers, which are primarily affected by the communities' social, economic, cultural, and religious factors. Aim: To elucidate the significant psychosocial and socio-economic issues faced by the caregivers of children suffering from different types of cancer at the Children's Hospital Lahore. Study design: Prospective cohort study Place and duration of study: Department of Paediatric Hematology and Oncology, Children's Hospital Lahore Pakistan from 1st January 2018 to 30th June 2018 Methodology: Two hundred family members/caregivers of the patients were enrolled with ages ranging from <1 to 15 years (43% <5 years and 57% >5years old). Results: Male to female ratio was 1.2:1. 52% belonged to hematological malignancies and 48% from solid tumor groups. Most of these children had malnutrition with anemia (81% with Hb <10g%) and small weight forage in 63% cases at presentation. 80% of families had more than three children, with the youngest child being less than five years in 75%. 95% of families relied on public transport, with 65% of them traveling 100-500Km with 2-10 hours duration to reach the primary treatment center. 80% had a monthly income of less than USD150. 68% of these families had to borrow money for trip to hospital (p-Value=0.003), and 58% took a loan for treatment course. Conclusion: The significant socio-economic challenges faced by these families and caregivers included large family size with low incomes increasing their financial difficulties, logistic burden like traveling long distances to access health care, and parental employment and family dynamics disruptions.

Introduction: Pediatric renal tumors constitute 7 to 8% of pediatric solid malignancies and most common is Wilms tumor. It usually presents as unilateral mass with sporadic and familial associations. It is currently treated by NWTS and SIOP protocols worldwide. In our hospital setup we follow SIOP 2001 protocol to subcategorize different histological subtypes and staging of Wilms tumor after completing four cycles of chemotherapy. Aims & Objectives: To determine the frequency of histological subtypes of Wilms tumor (WT) in post chemotherapy nephrectomy specimens Place and duration of study: Histopathology Section of Pathology Department, Children’s Hospital and Institute of Child Health Lahore from January 2015 to June 2018. Material & Methods: Ninety-three radical nephrectomy specimens of different histological subtypes i.e. Wilms Tumor (WT) consisting of blastemal predominant (BP), epithelial predominant (EP), stromal (ST), mixed (MT), regressive (RP), completely necrotic (CN) and diffuse anaplastic (DA) were analyzed. Risk categorization and staging proposed by SIOP 2001 was appraised. Data analysis was done using SPSS version 23. Results: A total of 93 cases were included in the present study. Mean age of children recorded was 42 months with male predominance. Mean tumor size after chemotherapy was 7.25 cm. Majority cases were observed on the right side. Regarding the histological subtype there was a predominant group of MT while least observed was DA. Based on subtypes and necrosis, majority of WT were of intermediate risk (IR) and stage I tumors. Conclusion: Majority of pretreated cases (n=80, 85.1%) were stage 1 tumors. Commonest histological subtype is MT followed by RP, CN, EP, BP, ST and DA.

Craniopharyngioma (CP) is a rare tumor accounting for <1% of all primary central nervous system (CNS) tumors. We herein report a case of a 2.5 years old male child diagnosed with supra-sellar tumor on prenatal ultrasound. Histologically, the tumor had tooth enamel like structures, one of the rarest finding in the literature. This case from Pakistan is hereby reported as a seventh such case world-wide. Our patient is a rare presentation of an antenatal diagnosis of CP with World Health Organization (WHO) grade I.

Background Alimentary tract duplications are rare anomalies and any delay in the diagnosis may develop various complications. Infection, hemorrhage, or perforation of the duplication cyst may lead to an acute presentation. Occasionally, it may lead to a diagnostic and management dilemma. Herein, we report an unusual complication of gastric duplication cyst. Case presentation A 2.5-year-old girl presented with recurrent abdominal distension, fever, and abdominal pain. The imaging workup revealed a huge intraperitoneal collection. Intraoperatively, a huge pseudocyst was encountered communicating with the gastric duplication cyst. The gastric duplication cyst was sharing a common wall with the greater curvature of the stomach but was not communicating with the gastric lumen. Pseudocyst along with gastric duplication cyst was completely excised. The resultant seromuscular defect of the stomach was also closed. The postoperative period was uneventful. Conclusion Perforation of the gastric duplication cyst should be kept in differentials of intraperitoneal collection not amenable to multiple aspirations. Huge intraperitoneal collection secondary to perforation of gastric duplication is exceedingly rare and scarcely reported in the literature.

Background: Neuroblastoma (NBL) is the commonest extra-cranial neoplasm in the pediatric population. Clinically it can present as an abdominal mass, but is usually metastatic at the time of diagnosis so the clinical features can vary. Nephroblastoma, also more commonly known as Wilms tumor (WT), presents as abdominal mass. The early diagnosis and treatment of these tumours is necessary to have a better prognosis. Aim: To determine the frequency of positivity of Wilms tumor 1 gene (WT1) and neuron specific enolase (NSE) in WT and NBL in order to differentiate between them in the core needle biopsies of paediatric population. Methods: It was a Cross sectional study and was completed at Histopathology Section, Pathology Department, Children's Hospital & Institute of Child Health, Lahore. Using non-probability consecutive technique, 100 biopsy specimens fulfilling the inclusion criteria were taken. The requisition forms sent from the Oncology, Surgery, Urology and Nephrology departments were collected along with other relevant investigations. The clinical parameters like age, gender and provisional diagnosis made by the clinicians were recorded. Results: The mean age of children was 3.15 +/- 2.14 years with 56% male and 44% female patients. After the confirmation of the diagnosis by immunomarkers, 55% was diagnosed as WT, whereas 45% of the population was labelled as NBL. Conclusion: In this study 55% children were diagnosed as WT on WT1 and rests of 45% children were diagnosed as NBL on NSE. So in future we can rely on these immunohistochemical markers on core biopsies for undifferentiated abdominal tumors for the definitive diagnosis and early treatment for better prognosis and higher survival rate of these patients.

There is a difference in geographical distribution, clinical aspects, effect of therapy and prognosis in brain tumors occurring in infancy and childhood as compared to brain tumors of adults. This study is based on histologic spectrum of tumorsof brain under 14 years of age. A total of 155 brain tumors were diagnosed during the study period of eight years from Jan 2010 to 31(st) Dec 2017. Out of which 52 (33.54%) were Supratentorialand 103 (66.45%) were Infratentorial in location. Medulloblastoma was the most common in this age group seen in 62 patients (40%). The second most common tumor was Pilocytic astrocytoma diagnosed in 37 patients (23.87%) followed by choroid plexus papilloma 14 cases (9.03%), Ependymoma 13 cases (8.38%), Craniopharyngioma 08 cases (5.16%), and Glioblastoma 6(3.87%). Other tumors include high grade gliomasNOS, Hemangioblastoma and Oligodendroglioma with 2 cases each(1.29%), while a single case (0.64%) of Meningioma, Hemangioma, Subependymalgiant cell tumor, Astroblastoma, Pleomorphic Xanthoastrocytoma, Choroid plexus carcinoma, Immature teratoma, Langerhans cell histiocytosis and Non-Hodgkin lymphoma was diagnosed in this period. On conclusion, the commonest tumor was medulloblastoma and infratentorial tumors were more common than supratentorial among pediatric age group.