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Handa A, Tsujioka Y, Nishimura G, Nozaki T, Kono T, Jinzaki M, Harms T, Connolly SA, Sato TS, Sato Y. RASopathies for Radiologists. Radiographics 2024; 44:e230153. [PMID: 38602868 DOI: 10.1148/rg.230153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
RASopathies are a heterogeneous group of genetic syndromes caused by germline mutations in a group of genes that encode components or regulators of the Ras/mitogen-activated protein kinase (MAPK) signaling pathway. RASopathies include neurofibromatosis type 1, Legius syndrome, Noonan syndrome, Costello syndrome, cardiofaciocutaneous syndrome, central conducting lymphatic anomaly, and capillary malformation-arteriovenous malformation syndrome. These disorders are grouped together as RASopathies based on our current understanding of the Ras/MAPK pathway. Abnormal activation of the Ras/MAPK pathway plays a major role in development of RASopathies. The individual disorders of RASopathies are rare, but collectively they are the most common genetic condition (one in 1000 newborns). Activation or dysregulation of the common Ras/MAPK pathway gives rise to overlapping clinical features of RASopathies, involving the cardiovascular, lymphatic, musculoskeletal, cutaneous, and central nervous systems. At the same time, there is much phenotypic variability in this group of disorders. Benign and malignant tumors are associated with certain disorders. Recently, many institutions have established multidisciplinary RASopathy clinics to address unique therapeutic challenges for patients with RASopathies. Medications developed for Ras/MAPK pathway-related cancer treatment may also control the clinical symptoms due to an abnormal Ras/MAPK pathway in RASopathies. Therefore, radiologists need to be aware of the concept of RASopathies to participate in multidisciplinary care. As with the clinical manifestations, imaging features of RASopathies are overlapping and at the same time diverse. As an introduction to the concept of RASopathies, the authors present major representative RASopathies, with emphasis on their imaging similarities and differences. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Atsuhiko Handa
- From the Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.A.C.); Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.H., T.S.S., Y.S.)
| | - Yuko Tsujioka
- From the Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.A.C.); Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.H., T.S.S., Y.S.)
| | - Gen Nishimura
- From the Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.A.C.); Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.H., T.S.S., Y.S.)
| | - Taiki Nozaki
- From the Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.A.C.); Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.H., T.S.S., Y.S.)
| | - Tatsuo Kono
- From the Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.A.C.); Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.H., T.S.S., Y.S.)
| | - Masahiro Jinzaki
- From the Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.A.C.); Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.H., T.S.S., Y.S.)
| | - Taylor Harms
- From the Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.A.C.); Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.H., T.S.S., Y.S.)
| | - Susan A Connolly
- From the Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.A.C.); Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.H., T.S.S., Y.S.)
| | - Takashi Shawn Sato
- From the Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.A.C.); Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.H., T.S.S., Y.S.)
| | - Yutaka Sato
- From the Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.A.C.); Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.H., T.S.S., Y.S.)
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Wang D, Wen X, Xu LL, Chen QX, Yan TX, Xiao HT, Xu XW. Nf1 in heart development: a potential causative gene for congenital heart disease: a narrative review. Physiol Genomics 2023; 55:415-426. [PMID: 37519249 DOI: 10.1152/physiolgenomics.00024.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/26/2023] [Accepted: 07/08/2023] [Indexed: 08/01/2023] Open
Abstract
Congenital heart disease is the most frequent congenital disorder, affecting a significant number of live births. Gaining insights into its genetic etiology could lead to a deeper understanding of this condition. Although the Nf1 gene has been identified as a potential causative gene, its role in congenital heart disease has not been thoroughly clarified. We searched and summarized evidence from cohort-based and experimental studies on the issue of Nf1 and heart development in congenital heart diseases from various databases. Available evidence demonstrates a correlation between Nf1 and congenital heart diseases, mainly pulmonary valvar stenosis. The mechanism underlying this correlation may involve dysregulation of epithelial-mesenchymal transition (EMT). The Nf1 gene affects the EMT process via multiple pathways, including directly regulating the expression of EMT-related transcription factors and indirectly regulating the EMT process by regulating the MAPK pathway. This narrative review provides a comprehensive account of the Nf1 involvement in heart development and congenital cardiovascular diseases in terms of epidemiology and potential mechanisms. RAS signaling may contribute to congenital heart disease independently or in cooperation with other signaling pathways. Efficient management of both NF1 and cardiovascular disease patients would benefit from further research into these issues.
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Affiliation(s)
- Dun Wang
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Xue Wen
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Li-Li Xu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, People's Republic of China
| | - Qing-Xing Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, People's Republic of China
| | - Tian-Xing Yan
- Central Laboratory, National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Hai-Tao Xiao
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Xue-Wen Xu
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Chengdu, People's Republic of China
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Farncombe KM, Thain E, Barnett-Tapia C, Sadeghian H, Kim RH. LZTR1 molecular genetic overlap with clinical implications for Noonan syndrome and schwannomatosis. BMC Med Genomics 2022; 15:160. [PMID: 35840934 PMCID: PMC9288044 DOI: 10.1186/s12920-022-01304-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Noonan syndrome (NS) is a genetic disorder characterized by developmental delays, typical facial gestalt and cardiovascular defects. LZTR1 variants have been recently described in patients with NS and schwannomatosis, but the association, inheritance pattern and management strategy has not been fully elucidated. Here, we review the contribution of LZTR1 in NS and describe a patient with a novel, likely pathogenic variant in LZTR1. Case presentation A female patient was diagnosed with clinical NS at 8 months of age. She presented in adulthood when a brain and spine MRI identified plexiform neurofibromas; however, she did not meet the clinical criteria for Neurofibromatosis type 1. No pathogenic variants were identified through molecular genetic analysis of NF1, SPRED1 and a multigene NS panel. Whole exome sequencing at age 23 identified a novel de novo likely pathogenic heterozygous variant in the LZTR1 gene denoted as c.743G>A (p.Gly248Glu). Serial MRIs have shown stable imaging findings and the patient is being followed clinically by cardiology, neurology and medical genetics. Conclusions We identified a novel mutation in the LZTR1 gene, not previously reported in association with NS. This report provides additional evidence to support for the assessment of schwannomatosis in patients with LZTR1-NS and may have overlap with Neurofibromatosis type 1.
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Affiliation(s)
- Kirsten M Farncombe
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Emily Thain
- Bhalwani Familial Cancer Clinic, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Carolina Barnett-Tapia
- Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.,Ellen and Martin Prossermann Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Hamid Sadeghian
- Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.,Ellen and Martin Prossermann Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Raymond H Kim
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Sinai Health System, Toronto, ON, Canada. .,Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Ontario Institute for Cancer Research, Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Zhang Z, Chen X, Zhou R, Yin H, Xu J. Chinese patient with neurofibromatosis-Noonan syndrome caused by novel heterozygous NF1 exons 1-58 deletion: a case report. BMC Pediatr 2020; 20:190. [PMID: 32357851 PMCID: PMC7193357 DOI: 10.1186/s12887-020-02102-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neurofibromatosis-Noonan syndrome (NFNS) is a rare autosomal dominant hereditary disease. We present a case of NFNS due to the heterozygous deletion of exons 1-58 of the NF1 gene on chromosome 17 in a 15-month-old boy. CASE PRESENTATION A 15-month-old boy was admitted for motor and language developmental delay, numerous café-au-lait spots, hypertelorism, left blepharoptosis, pectus excavatum, cryptorchidism, secondary atrial septal defect, and UBOs (undefined bright objects) revealed by cranial MRI T2FLAIR in basal ganglia and cerebellum. Using whole exome sequencing, we identified a de novo heterozygous deletion including exons 1-58 of the NF1 gene. CONCLUSION Although genetic tests are useful tools for diagnosis of NFNS, NF1, or NS, comprehensive analysis of genetic factors and phenotypes is indispensable in the clinical practice. To the best of our knowledge, this case presents the first Chinese NFNS case due to NF1 defects, and the NF1 exons 1-58 deletion-related phenotype is unlike any other reported case.
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Affiliation(s)
- Zhen Zhang
- Department of Pediatrics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, Anhui, China
| | - Xin Chen
- Department of Pediatrics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, Anhui, China.
| | - Rui Zhou
- Department of Pediatrics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, Anhui, China
| | - Huaixiang Yin
- Department of Pediatrics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, Anhui, China
| | - Jiali Xu
- Department of Pediatrics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, Anhui, China.
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Koczkowska M, Callens T, Chen Y, Gomes A, Hicks AD, Sharp A, Johns E, Uhas KA, Armstrong L, Bosanko KA, Babovic‐Vuksanovic D, Baker L, Basel DG, Bengala M, Bennett JT, Chambers C, Clarkson LK, Clementi M, Cortés FM, Cunningham M, D'Agostino MD, Delatycki MB, Digilio MC, Dosa L, Esposito S, Fox S, Freckmann M, Fauth C, Giugliano T, Giustini S, Goetsch A, Goldberg Y, Greenwood RS, Griffis C, Gripp KW, Gupta P, Haan E, Hachen RK, Haygarth TL, Hernández‐Chico C, Hodge K, Hopkin RJ, Hudgins L, Janssens S, Keller K, Kelly‐Mancuso G, Kochhar A, Korf BR, Lewis AM, Liebelt J, Lichty A, Listernick RH, Lyons MJ, Maystadt I, Martinez Ojeda M, McDougall C, McGregor LK, Melis D, Mendelsohn N, Nowaczyk MJ, Ortenberg J, Panzer K, Pappas JG, Pierpont ME, Piluso G, Pinna V, Pivnick EK, Pond DA, Powell CM, Rogers C, Ruhrman Shahar N, Rutledge SL, Saletti V, Sandaradura SA, Santoro C, Schatz UA, Schreiber A, Scott DA, Sellars EA, Sheffer R, Siqveland E, Slopis JM, Smith R, Spalice A, Stockton DW, Streff H, Theos A, Tomlinson GE, Tran G, Trapane PL, Trevisson E, Ullrich NJ, Van den Ende J, Schrier Vergano SA, Wallace SE, Wangler MF, Weaver DD, Yohay KH, Zackai E, Zonana J, Zurcher V, Claes KBM, Eoli M, Martin Y, Wimmer K, De Luca A, Legius E, Messiaen LM. Clinical spectrum of individuals with pathogenic NF1 missense variants affecting p.Met1149, p.Arg1276, and p.Lys1423: genotype-phenotype study in neurofibromatosis type 1. Hum Mutat 2020; 41:299-315. [PMID: 31595648 PMCID: PMC6973139 DOI: 10.1002/humu.23929] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/03/2019] [Accepted: 10/02/2019] [Indexed: 12/15/2022]
Abstract
We report 281 individuals carrying a pathogenic recurrent NF1 missense variant at p.Met1149, p.Arg1276, or p.Lys1423, representing three nontruncating NF1 hotspots in the University of Alabama at Birmingham (UAB) cohort, together identified in 1.8% of unrelated NF1 individuals. About 25% (95% confidence interval: 20.5-31.2%) of individuals heterozygous for a pathogenic NF1 p.Met1149, p.Arg1276, or p.Lys1423 missense variant had a Noonan-like phenotype, which is significantly more compared with the "classic" NF1-affected cohorts (all p < .0001). Furthermore, p.Arg1276 and p.Lys1423 pathogenic missense variants were associated with a high prevalence of cardiovascular abnormalities, including pulmonic stenosis (all p < .0001), while p.Arg1276 variants had a high prevalence of symptomatic spinal neurofibromas (p < .0001) compared with "classic" NF1-affected cohorts. However, p.Met1149-positive individuals had a mild phenotype, characterized mainly by pigmentary manifestations without externally visible plexiform neurofibromas, symptomatic spinal neurofibromas or symptomatic optic pathway gliomas. As up to 0.4% of unrelated individuals in the UAB cohort carries a p.Met1149 missense variant, this finding will contribute to more accurate stratification of a significant number of NF1 individuals. Although clinically relevant genotype-phenotype correlations are rare in NF1, each affecting only a small percentage of individuals, together they impact counseling and management of a significant number of the NF1 population.
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Affiliation(s)
| | - Tom Callens
- Department of GeneticsUniversity of Alabama at BirminghamBirminghamAlbama
| | - Yunjia Chen
- Department of GeneticsUniversity of Alabama at BirminghamBirminghamAlbama
| | - Alicia Gomes
- Department of GeneticsUniversity of Alabama at BirminghamBirminghamAlbama
| | - Alesha D. Hicks
- Department of GeneticsUniversity of Alabama at BirminghamBirminghamAlbama
| | - Angela Sharp
- Department of GeneticsUniversity of Alabama at BirminghamBirminghamAlbama
| | - Eric Johns
- Department of GeneticsUniversity of Alabama at BirminghamBirminghamAlbama
| | | | - Linlea Armstrong
- Department of Medical Genetics, BC Women's HospitalUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Katherine Armstrong Bosanko
- Division of Clinical Genetics and Metabolism, Arkansas Children's HospitalUniversity of Arkansas for Medical SciencesLittle RockArkansas
| | | | - Laura Baker
- Division of Medical GeneticsAl DuPont Hospital for ChildrenWilmingtonDelaware
| | | | - Mario Bengala
- U.O.C Laboratorio di Genetica Medica, Dipartimento di OncoematologiaFondazione Policlinico di Tor VergataRomeItaly
| | - James T. Bennett
- Division of Genetic Medicine, Department of PediatricsUniversity of WashingtonSeattleWashington
| | - Chelsea Chambers
- Department of NeurologyUniversity of Virginia Medical CenterCharlottesvilleVirginia
| | | | - Maurizio Clementi
- Clinical Genetics Unit, Department of Women's and Children's HealthUniversity of PadovaPadovaItaly
| | | | - Mitch Cunningham
- Division of Genetic, Genomic, and Metabolic Disorders, Detroit Medical CenterChildren's Hospital of MichiganDetroitMichigan
| | | | - Martin B. Delatycki
- Bruce Lefroy Centre for Genetic Health ResearchMurdoch Childrens Research InstituteParkvilleVictoriaAustralia
| | - Maria C. Digilio
- Medical Genetics Unit, Bambino Gesù Children's HospitalIRCCSRomeItaly
| | - Laura Dosa
- SOC Genetica MedicaAOU MeyerFlorenceItaly
| | - Silvia Esposito
- Developmental Neurology UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Stephanie Fox
- Division of Medical GeneticsMcGill University Health CentreMontréalQuebecCanada
| | - Mary‐Louise Freckmann
- Department of Clinical GeneticsRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Christine Fauth
- Division of Human GeneticsMedical University of InnsbruckInnsbruckAustria
| | - Teresa Giugliano
- Department of Precision MedicineUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Sandra Giustini
- Department of Dermatology and Venereology, Policlinico Umberto ISapienza University of RomeRomeItaly
| | - Allison Goetsch
- Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Yael Goldberg
- The Raphael Recanati Genetics InstituteRabin Medical CenterPetah TikvaIsrael
| | - Robert S. Greenwood
- Division of Child NeurologyUniversity of North Carolina School of MedicineChapel HillNorth Carolina
| | | | - Karen W. Gripp
- Division of Medical GeneticsAl DuPont Hospital for ChildrenWilmingtonDelaware
| | - Punita Gupta
- Neurofibromatosis Diagnostic and Treatment ProgramSt. Joseph's Children's HospitalPatersonNew Jersey
| | - Eric Haan
- Adult Genetics UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Rachel K. Hachen
- Neurofibromatosis ProgramChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvania
| | - Tamara L. Haygarth
- Carolinas HealthCare SystemLevine Children's Specialty CenterCharlotteNorth Carolina
| | - Concepción Hernández‐Chico
- Department of Genetics, Hospital Universitario Ramón y CajalInstitute of Health Research (IRYCIS) and Center for Biomedical Research‐Network of Rare Diseases (CIBERER)MadridSpain
| | - Katelyn Hodge
- Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndiana
| | - Robert J. Hopkin
- Division of Human GeneticsCincinnati Children's Hospital Medical CenterCincinnatiOhio
| | - Louanne Hudgins
- Division of Medical GeneticsStanford University School of MedicineStanfordCalifornia
| | - Sandra Janssens
- Center for Medical GeneticsGhent University HospitalGhentBelgium
| | - Kory Keller
- Department of Molecular and Medical GeneticsOregon Health and Science UniversityPortlandOregon
| | | | - Aaina Kochhar
- Department of Medical Genetics and MetabolismValley Children's HealthcareMaderaCalifornia
| | - Bruce R. Korf
- Department of GeneticsUniversity of Alabama at BirminghamBirminghamAlbama
| | - Andrea M. Lewis
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas
| | - Jan Liebelt
- The South Australian Clinical Genetics Service at the Women's and Children's HospitalNorth AdelaideSouth AustraliaAustralia
| | | | - Robert H. Listernick
- Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinois
| | | | - Isabelle Maystadt
- Center for Human GeneticsInstitute of Pathology and Genetics (IPG)GosseliesBelgium
| | | | - Carey McDougall
- Division of Human Genetics, Children's Hospital of PhiladelphiaUniversity of Pennsylvania School of MedicinePhiladelphiaPennsylvania
| | - Lesley K. McGregor
- The South Australian Clinical Genetics Service at the Women's and Children's HospitalNorth AdelaideSouth AustraliaAustralia
| | - Daniela Melis
- Section of Pediatrics, Department of Translational Medical SciencesFederico II UniversityNaplesItaly
| | - Nancy Mendelsohn
- Genomics Medicine ProgramChildren's Hospital MinnesotaMinneapolisMinnesota
| | | | - June Ortenberg
- Division of Medical GeneticsMcGill University Health CentreMontréalQuebecCanada
| | - Karin Panzer
- University of Iowa Stead Family Children's HospitalIowa CityIowa
| | - John G. Pappas
- Division of Clinical Genetic Services, Department of PediatricsNYU School of MedicineNew YorkNew York
| | - Mary Ella Pierpont
- Department of Pediatrics and OpthalmologyUniversity of MinnesotaMinneapolisMinnesota
| | - Giulio Piluso
- Department of Precision MedicineUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Valentina Pinna
- Molecular Genetics UnitIRCCS Casa Sollievo della SofferenzaSan Giovanni RotondoFoggiaItaly
| | - Eniko K. Pivnick
- Department of Pediatrics and Department of OphthalmologyUniversity of Tennessee Health Science CenterMemphisTennessee
| | - Dinel A. Pond
- Genomics Medicine ProgramChildren's Hospital MinnesotaMinneapolisMinnesota
| | - Cynthia M. Powell
- Department of Genetics and Department of PediatricsUniversity of North Carolina School of MedicineChapel HillNorth Carolina
| | - Caleb Rogers
- Department of Molecular and Medical GeneticsOregon Health and Science UniversityPortlandOregon
| | - Noa Ruhrman Shahar
- The Raphael Recanati Genetics InstituteRabin Medical CenterPetah TikvaIsrael
| | - S. Lane Rutledge
- Department of GeneticsUniversity of Alabama at BirminghamBirminghamAlbama
| | - Veronica Saletti
- Developmental Neurology UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Sarah A. Sandaradura
- Division of Clinical Genetics, Department of Paediatrics and Child Health, Children's Hospital at WestmeadUniversity of SydneySydneyNew South WalesAustralia
| | - Claudia Santoro
- Specialistic and General Surgery Unit, Department of Woman and Child, Referral Centre of NeurofibromatosisUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Ulrich A. Schatz
- Division of Human GeneticsMedical University of InnsbruckInnsbruckAustria
| | | | - Daryl A. Scott
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas
| | - Elizabeth A. Sellars
- Division of Clinical Genetics and Metabolism, Arkansas Children's HospitalUniversity of Arkansas for Medical SciencesLittle RockArkansas
| | - Ruth Sheffer
- Department of Genetics and Metabolic DiseasesHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | | | - John M. Slopis
- Department of Neuro‐OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Rosemarie Smith
- Division of Genetics, Department of PediatricsMaine Medical CenterPortlandMaine
| | - Alberto Spalice
- Child Neurology Division, Department of PediatricsSapienza University of RomeRomeItaly
| | - David W. Stockton
- Division of Genetic, Genomic, and Metabolic Disorders, Detroit Medical CenterChildren's Hospital of MichiganDetroitMichigan
| | - Haley Streff
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas
| | - Amy Theos
- Department of DermatologyUniversity of Alabama at BirminghamBirminghamAlabama
| | - Gail E. Tomlinson
- Division of Pediatric Hematology–Oncology, Greehey Children's Cancer Research InstituteThe University of Texas Health Science CenterSan AntonioTexas
| | - Grace Tran
- Department of Clinical Cancer GeneticsThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Pamela L. Trapane
- Division of Pediatric Genetics, Department of PediatricsUniversity of Florida College of MedicineJacksonvilleFlorida
| | - Eva Trevisson
- Clinical Genetics Unit, Department of Women's and Children's HealthUniversity of PadovaPadovaItaly
| | - Nicole J. Ullrich
- Department of NeurologyBoston Children's HospitalBostonMassachusetts
| | - Jenneke Van den Ende
- Center for Medical GeneticsUniversity of Antwerp and Antwerp University HospitalAntwerpBelgium
| | | | - Stephanie E. Wallace
- Division of Genetic Medicine, Department of PediatricsUniversity of WashingtonSeattleWashington
| | - Michael F. Wangler
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas
| | - David D. Weaver
- Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndiana
| | - Kaleb H. Yohay
- Department of Neurology, New York University School of MedicineLangone Medical CenterNew YorkNew York
| | - Elaine Zackai
- Division of Human Genetics, Children's Hospital of PhiladelphiaUniversity of Pennsylvania School of MedicinePhiladelphiaPennsylvania
| | - Jonathan Zonana
- Department of Molecular and Medical GeneticsOregon Health and Science UniversityPortlandOregon
| | | | | | - Marica Eoli
- Division of Molecular Neuro‐OncologyFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Yolanda Martin
- Department of Genetics, Hospital Universitario Ramón y CajalInstitute of Health Research (IRYCIS) and Center for Biomedical Research‐Network of Rare Diseases (CIBERER)MadridSpain
| | - Katharina Wimmer
- Division of Human GeneticsMedical University of InnsbruckInnsbruckAustria
| | - Alessandro De Luca
- Molecular Genetics UnitIRCCS Casa Sollievo della SofferenzaSan Giovanni RotondoFoggiaItaly
| | - Eric Legius
- Department of Human GeneticsKU LeuvenLeuvenBelgium
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Giugliano T, Santoro C, Torella A, Del Vecchio Blanco F, Grandone A, Onore ME, Melone MAB, Straccia G, Melis D, Piccolo V, Limongelli G, Buono S, Perrotta S, Nigro V, Piluso G. Clinical and Genetic Findings in Children with Neurofibromatosis Type 1, Legius Syndrome, and Other Related Neurocutaneous Disorders. Genes (Basel) 2019; 10:genes10080580. [PMID: 31370276 PMCID: PMC6722641 DOI: 10.3390/genes10080580] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/27/2019] [Accepted: 07/30/2019] [Indexed: 02/07/2023] Open
Abstract
Pigmentary manifestations can represent an early clinical sign in children affected by Neurofibromatosis type 1 (NF1), Legius syndrome, and other neurocutaneous disorders. The differential molecular diagnosis of these pathologies is a challenge that can now be met by combining next generation sequencing of target genes with concurrent second-level tests, such as multiplex ligation-dependent probe amplification and RNA analysis. We clinically and genetically investigated 281 patients, almost all pediatric cases, presenting with either NF1 (n = 150), only pigmentary features (café au lait macules with or without freckling; (n = 95), or clinical suspicion of other RASopathies or neurocutaneous disorders (n = 36). The causative variant was identified in 239 out of the 281 patients analyzed (85.1%), while 42 patients remained undiagnosed (14.9%). The NF1 and SPRED1 genes were mutated in 73.3% and 2.8% of cases, respectively. The remaining 8.9% carried mutations in different genes associated with other disorders. We achieved a molecular diagnosis in 69.5% of cases with only pigmentary manifestations, allowing a more appropriate clinical management of these patients. Our findings, together with the increasing availability and sharing of clinical and genetic data, will help to identify further novel genotype–phenotype associations that may have a positive impact on patient follow-up.
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Affiliation(s)
- Teresa Giugliano
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 7, 80138 Napoli, Italy
| | - Claudia Santoro
- Departement of Women's and Children's Health and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138 Napoli, Italy
| | - Annalaura Torella
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 7, 80138 Napoli, Italy
| | - Francesca Del Vecchio Blanco
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 7, 80138 Napoli, Italy
| | - Anna Grandone
- Departement of Women's and Children's Health and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138 Napoli, Italy
| | - Maria Elena Onore
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 7, 80138 Napoli, Italy
| | - Mariarosa Anna Beatrice Melone
- Department of Medical Sciences and Advanced Surgery, University of Campania "Luigi Vanvitelli", Piazza L. Miraglia 2, 80138 Napoli, Italy
| | - Giulia Straccia
- Department of Medical Sciences and Advanced Surgery, University of Campania "Luigi Vanvitelli", Piazza L. Miraglia 2, 80138 Napoli, Italy
| | - Daniela Melis
- Department of Pediatrics, University of Naples "Federico II", Via Pansini 5, 80131 Napoli, Italy
| | - Vincenzo Piccolo
- Dermatology Unit, University of Campania "Luigi Vanvitelli", Via Pansini 5, 80131 Napoli, Italy
| | - Giuseppe Limongelli
- Department of Translational Medicine, University of Campania "Luigi Vanvitelli", Via L. Bianchi c/o Ospedale Monaldi, 80131 Napoli, Italy
| | - Salvatore Buono
- Department of Neurosciences, "Santobono-Pausilipon" Pediatric Hospital, Via Fiore 6, 80129 Napoli, Italy
| | - Silverio Perrotta
- Departement of Women's and Children's Health and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138 Napoli, Italy
| | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 7, 80138 Napoli, Italy
- Telethon Institute of Genetics and Medicine (TIGEM), Via Campi Flegrei 34, 80078 Pozzuoli, Italy
| | - Giulio Piluso
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 7, 80138 Napoli, Italy.
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Yapijakis C, Pachis N, Voumvourakis C. Neurofibromatosis-Noonan Syndrome: A Possible Paradigm of the Combination of Genetic and Epigenetic Factors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 987:151-159. [PMID: 28971455 DOI: 10.1007/978-3-319-57379-3_14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Neurofibromatosis-Noonan syndrome (NFNS) is a clinical entity possessing traits of autosomal dominant disorders neurofibromatosis type 1 (NF1) and Noonan syndrome (NS). Germline mutations that disrupt the RAS/MAPK pathway are involved in the pathogenesis of both NS and NF1. In light of a studied Greek family, a new theory for etiological pathogenesis of NFNS is suggested. The NFNS phenotype may be the final result of a combination of a genetic factor (a mutation in the NF1 gene) and an environmental factor with the epigenetic effects of muscle hypotonia (such as hydantoin in the reported Greek family), causing hypoplasia of the face and micrognathia.
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Affiliation(s)
- Christos Yapijakis
- Department of Oral and Maxillofacial Surgery, School of Medicine, University of Athens, Attikon Hospital, Athens, Greece. .,"Cephalogenetics" Genetic Center, Athens, Greece. .,Department of Neurology, School of Medicine, University of Athens, Eginition Hospital, Athens, Greece.
| | - Nikos Pachis
- "Cephalogenetics" Genetic Center, Athens, Greece
| | - Costas Voumvourakis
- 2nd Department of Neurology, School of Medicine, University of Athens, Attikon Hospital, Athens, Greece
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Vurallı D, Gönç N, Vidaud D, Özön A, Alikaşifoğlu A, Kandemir N. Growth Hormone Deficiency in a Child with Neurofibromatosis-Noonan Syndrome. J Clin Res Pediatr Endocrinol 2016; 8:96-100. [PMID: 26758488 PMCID: PMC4805056 DOI: 10.4274/jcrpe.2070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Neurofibromatosis-Noonan syndrome (NFNS) is a distinct entity which shows the features of both NF1 (neurofibromatosis 1) and Noonan syndrome (NS). While growth hormone deficiency (GHD) has been relatively frequently identified in NF1 and NS patients, there is limited experience in NFNS cases. The literature includes only one case report of a NFNS patient having GHD and that report primarily focuses on the dermatological lesions that accompany the syndrome and not on growth hormone (GH) treatment. Here, we present a 13-year-old girl who had clinical features of NFNS with a mutation in the NF1 gene. The case is the first NFNS patient reported in the literature who was diagnosed to have GHD and who received GH treatment until reaching final height. The findings in this patient show that short stature is a feature of NFNS and can be caused by GHD. Patients with NFNS who show poor growth should be evaluated for GHD.
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Affiliation(s)
- Doğuş Vurallı
- Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey, E-mail:
| | - Nazlı Gönç
- Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Dominique Vidaud
- EA7331, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Pharmacie de Paris, Paris, France
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Service de Biochimie et de Génétique Moléculaire, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alev Özön
- Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Ayfer Alikaşifoğlu
- Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Nurgün Kandemir
- Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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Zenker M, Kutsche K. RASopathien. MED GENET-BERLIN 2016. [DOI: 10.1007/s11825-016-0080-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung
Die RASopathien umfassen das Noonan-Syndrom, seltenere verwandte Syndrome (CFC-, Costello und LEOPARD-Syndrom) sowie die Neurofibromatose Typ 1 und ähnliche Erkrankungen (Legius-, NF1-Noonan-Syndrom). Die allen RASopathien zugrunde liegenden genetischen Veränderungen bedingen eine konstitutionelle Fehlregulation des RAS-MAPK-Signalwegs. Es resultiert ein typisches Muster an angeborenen Anomalien und Entwicklungsstörungen in variabler Ausprägung. Typische klinische Merkmale sind kardiale Anomalien, vermindertes Wachstum, kraniofaziale Dysmorphien und Entwicklungsverzögerung. Die Tumordisposition hängt von der jeweiligen Erkrankung und genetischen Veränderung ab. Die molekularen Erkenntnisse machen klinische Überschneidungen und Unterschiede zwischen den Entitäten verständlich. Die genetische Diagnostik ist breit verfügbar. Die Behandlung der Patienten ist bislang nur symptomatisch und erfordert ein interdisziplinäres Management und lebenslange Betreuung der Patienten.
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Affiliation(s)
- Martin Zenker
- Aff1 grid.411559.d 0000000095924695 Institut für Humangenetik Universitätsklinikum Magdeburg Leipziger Str. 44 39120 Magdeburg Deutschland
| | - Kerstin Kutsche
- Aff2 grid.13648.38 0000000121803484 Institut für Humangenetik Universitätsklinikum Hamburg-Eppendorf Hamburg Deutschland
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Ekvall S, Sjörs K, Jonzon A, Vihinen M, Annerén G, Bondeson ML. Novel association of neurofibromatosis type 1-causing mutations in families with neurofibromatosis-Noonan syndrome. Am J Med Genet A 2013; 164A:579-87. [PMID: 24357598 DOI: 10.1002/ajmg.a.36313] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 09/29/2013] [Indexed: 11/10/2022]
Abstract
Neurofibromatosis-Noonan syndrome (NFNS) is a rare condition with clinical features of both neurofibromatosis type 1 (NF1) and Noonan syndrome (NS). All three syndromes belong to the RASopathies, which are caused by dysregulation of the RAS-MAPK pathway. The major gene involved in NFNS is NF1, but co-occurring NF1 and PTPN11 mutations in NFNS have been reported. Knowledge about possible involvement of additional RASopathy-associated genes in NFNS is, however, very limited. We present a comprehensive clinical and molecular analysis of eight affected individuals from three unrelated families displaying features of NF1 and NFNS. The genetic etiology of the clinical phenotypes was investigated by mutation analysis, including NF1, PTPN11, SOS1, KRAS, NRAS, BRAF, RAF1, SHOC2, SPRED1, MAP2K1, MAP2K2, and CBL. All three families harbored a heterozygous NF1 variant, where the first family had a missense variant, c.5425C>T;p.R1809C, the second family a recurrent 4bp-deletion, c.6789_6792delTTAC;p.Y2264Tfs*6, and the third family a splice-site variant, c.2991-1G>A, resulting in skipping of exon 18 and an in-frame deletion of 41 amino acids. These NF1 variants have all previously been reported in NF1 patients. Surprisingly, both c.6789_6792delTTAC and c.2991-1G>A are frequently associated with NF1, but association to NFNS has, to our knowledge, not previously been reported. Our results support the notion that NFNS represents a variant of NF1, genetically distinct from NS, and is caused by mutations in NF1, some of which also cause classical NF1. Due to phenotypic overlap between NFNS and NS, we propose screening for NF1 mutations in NS patients, preferentially when café-au-lait spots are present.
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Affiliation(s)
- Sara Ekvall
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
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Takenouchi T, Shimizu A, Torii C, Kosaki R, Takahashi T, Saya H, Kosaki K. Multiple café au lait spots in familial patients with MAP2K2 mutation. Am J Med Genet A 2013; 164A:392-6. [PMID: 24311457 DOI: 10.1002/ajmg.a.36288] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 09/13/2013] [Indexed: 11/07/2022]
Abstract
Recent advances in genetic diagnostic technologies have made the classic disease nosology highly complicated. This situation is exemplified by rasopathies, among which neurofibromatosis type 1 and Noonan syndrome represent prototypic entities. The former condition is characterized by multiple café au lait spots and neurofibromas, while the latter is characterized by distinct facial features, webbed neck, congenital heart disease, and a short stature. On rare occasions, the features of both neurofibromatosis and Noonan syndrome co-exist within an individual; such patients are diagnosed as having neurofibromatosis-Noonan syndrome. Here, we report familial patients with multiple café au lait spots and Noonan syndrome-like facial features. A mutation analysis unexpectedly revealed a mutation in MAP2K2 in both the propositus and his mother. The propositus fulfilled the diagnostic criteria for neurofibromatosis type 1, but his mother did not. Their phenotype was not consistent with that of cardio-facio-cutaneous syndrome, which is classically known to be associated with MAP2K2 mutations. The mother of the propositus had cervical cancer at the age of 23 years, consistent with the oncogenic tendency associated with rasopathies. The phenotypic combination of multiple café au lait spots and Noonan syndrome-like facial features suggested a diagnosis of neurofibromatosis-Noonan syndrome. Whether this condition represents a discrete disease entity or a variable expression of neurofibromatosis type 1 has long been debated. The present observation suggests that some perturbation in the RAS/MAPK signaling cascade results in multiple café au lait spots, a key diagnostic phenotype of rasopathies, although the exact mechanism remains to be elucidated.
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Affiliation(s)
- Toshiki Takenouchi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
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Abstract
PURPOSE OF REVIEW Recent advances in molecular genetic research have led to the definition of the new group of genetic syndromes, the RAS-mitogen-activated protein kinase (MAPK) pathway disorders or 'RASopathies'. They comprise Noonan syndrome and related disorders (cardio-facio-cutaneous and Costello syndromes), as well as neurofibromatosis type 1. This review summarizes the recent literature with a special focus on genotype-phenotype correlations. RECENT FINDINGS Although the picture is still incomplete, and additional genes are likely to exist, the underlying genetic alteration can now be found in a large majority of patients with a RASopathy phenotype. The most recently discovered novel genes for Noonan syndrome or Noonan syndrome-like disorders, NRAS, SHOC2, and CBL, account for small fractions of the patient population. The increasing knowledge about the spectrum of gene mutations and associated clinical manifestations has led to a refinement of genotype-phenotype correlations. Recent studies have added new insights into tumor predisposition and prenatal manifestations. Model systems are being developed to investigate innovative treatment approaches. SUMMARY Constitutional overactivation at various levels of the RAS-MAPK pathway causes overlapping syndromes, comprising characteristic facial features, cardiac defects, cutaneous abnormalities, growth deficit, neurocognitive delay, and predisposition to malignancies. Each syndrome also exhibits unique features that probably reflect genotype-related specific biological effects.
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13
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Viskochil DH. Disorders of the ras pathway: an introduction. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2011; 157C:79-82. [PMID: 21495180 DOI: 10.1002/ajmg.c.30301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- David H Viskochil
- Division of Medical Genetics, Department of Pediatrics, School of Medicine, University of Utah, 2C412, 50 Mario Capecchi Drive, Salt Lake City, UT 84132, USA.
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Abstract
Noonan syndrome is a relatively common, clinically variable developmental disorder. Cardinal features include postnatally reduced growth, distinctive facial dysmorphism, congenital heart defects and hypertrophic cardiomyopathy, variable cognitive deficit and skeletal, ectodermal and hematologic anomalies. Noonan syndrome is transmitted as an autosomal dominant trait, and is genetically heterogeneous. So far, heterozygous mutations in nine genes (PTPN11, SOS1, KRAS, NRAS, RAF1, BRAF, SHOC2, MEK1 and CBL) have been documented to underlie this disorder or clinically related phenotypes. Based on these recent discoveries, the diagnosis can now be confirmed molecularly in approximately 75% of affected individuals. Affected genes encode for proteins participating in the RAS-mitogen-activated protein kinases (MAPK) signal transduction pathway, which is implicated in several developmental processes controlling morphology determination, organogenesis, synaptic plasticity and growth. Here, we provide an overview of clinical aspects of this disorder and closely related conditions, the molecular mechanisms underlying pathogenesis, and major genotype-phenotype correlations.
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Affiliation(s)
- Marco Tartaglia
- Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, Italy.
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Tartaglia M, Gelb BD. Disorders of dysregulated signal traffic through the RAS-MAPK pathway: phenotypic spectrum and molecular mechanisms. Ann N Y Acad Sci 2010; 1214:99-121. [PMID: 20958325 PMCID: PMC3010252 DOI: 10.1111/j.1749-6632.2010.05790.x] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
RAS GTPases control a major signaling network implicated in several cellular functions, including cell fate determination, proliferation, survival, differentiation, migration, and senescence. Within this network, signal flow through the RAF-MEK-ERK pathway-the first identified mitogen-associated protein kinase (MAPK) cascade-mediates early and late developmental processes controlling morphology determination, organogenesis, synaptic plasticity, and growth. Signaling through the RAS-MAPK cascade is tightly controlled; and its enhanced activation represents a well-known event in oncogenesis. Unexpectedly, in the past few years, inherited dysregulation of this pathway has been recognized as the cause underlying a group of clinically related disorders sharing facial dysmorphism, cardiac defects, reduced postnatal growth, ectodermal anomalies, variable cognitive deficits, and susceptibility to certain malignancies as major features. These disorders are caused by heterozygosity for mutations in genes encoding RAS proteins, regulators of RAS function, modulators of RAS interaction with effectors, or downstream signal transducers. Here, we provide an overview of the phenotypic spectrum associated with germline mutations perturbing RAS-MAPK signaling, the unpredicted molecular mechanisms converging toward the dysregulation of this signaling cascade, and major genotype-phenotype correlations.
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Affiliation(s)
- Marco Tartaglia
- Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Istituto Superiore di Sanità, Rome, Italy.
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Tartaglia M, Zampino G, Gelb BD. Noonan syndrome: clinical aspects and molecular pathogenesis. Mol Syndromol 2010; 1:2-26. [PMID: 20648242 DOI: 10.1159/000276766] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 10/30/2009] [Indexed: 01/20/2023] Open
Abstract
Noonan syndrome (NS) is a relatively common, clinically variable and genetically heterogeneous developmental disorder characterized by postnatally reduced growth, distinctive facial dysmorphism, cardiac defects and variable cognitive deficits. Other associated features include ectodermal and skeletal defects, cryptorchidism, lymphatic dysplasias, bleeding tendency, and, rarely, predisposition to hematologic malignancies during childhood. NS is caused by mutations in the PTPN11, SOS1, KRAS, RAF1, BRAF and MEK1 (MAP2K1) genes, accounting for approximately 70% of affected individuals. SHP2 (encoded by PTPN11), SOS1, BRAF, RAF1 and MEK1 positively contribute to RAS-MAPK signaling, and possess complex autoinhibitory mechanisms that are impaired by mutations. Similarly, reduced GTPase activity or increased guanine nucleotide release underlie the aberrant signal flow through the MAPK cascade promoted by most KRAS mutations. More recently, a single missense mutation in SHOC2, which encodes a cytoplasmic scaffold positively controlling RAF1 activation, has been discovered to cause a closely related phenotype previously termed Noonan-like syndrome with loose anagen hair. This mutation promotes aberrantly acquired N-myristoylation of the protein, resulting in its constitutive targeting to the plasma membrane and dysregulated function. PTPN11, BRAF and RAF1 mutations also account for approximately 95% of LEOPARD syndrome, a condition which resembles NS phenotypically but is characterized by multiple lentigines dispersed throughout the body, café-au-lait spots, and a higher prevalence of electrocardiographic conduction abnormalities, obstructive cardiomyopathy and sensorineural hearing deficits. These recent discoveries demonstrate that the substantial phenotypic variation characterizing NS and related conditions can be ascribed, in part, to the gene mutated and even the specific molecular lesion involved.
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Affiliation(s)
- M Tartaglia
- Dipartimento di Ematologia, Oncologia e Medicina Molecolare, Istituto Superiore di Sanità, Rome, Italy
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Nyström AM, Ekvall S, Allanson J, Edeby C, Elinder M, Holmström G, Bondeson ML, Annerén G. Noonan syndrome and neurofibromatosis type I in a family with a novel mutation inNF1. Clin Genet 2009; 76:524-34. [DOI: 10.1111/j.1399-0004.2009.01233.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Szczygiet M, Kurpisz M. Chromosomal anomalies in human gametes and pre-implantation embryos, and their potential effect on reproduction. Andrologia 2009. [DOI: 10.1111/j.1439-0272.2001.tb01493.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tumor development in three patients with Noonan syndrome. Eur J Pediatr 2008; 167:1025-31. [PMID: 18057963 DOI: 10.1007/s00431-007-0636-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 10/30/2007] [Indexed: 12/15/2022]
Abstract
The diagnosis of Noonan syndrome is essentially clinical, based upon the distinct phenotype and the involvement of the cardiovascular system. Tumor development is a rare manifestation of Noonan syndrome but can be explained by the molecular pathophysiology involved in the disorder. We present three Noonan patients who developed solid tumors. The first patient, a 4-year-old girl, developed granular cell tumors as did her mother in childhood. The second patient, a 1-year-old boy, had a low grade pilocytic astrocytoma, the clinical expression of which was persistent headache. MRI showed a pituitary mass in the posterior lobe. It was surgically removed. The third patient, a 7-year-old boy was found to have Sertoli tumors in his right cryptorchid testis. All three patients fulfilled the clinical criteria for Noonan syndrome. However, genetic testing was negative in patients 1 and 3. The diagnosis of Noonan syndrome was made based on distinct phenotypic findings in three patients who had different types of tumors.
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Sarkozy A, Digilio MC, Dallapiccola B. Leopard syndrome. Orphanet J Rare Dis 2008; 3:13. [PMID: 18505544 PMCID: PMC2467408 DOI: 10.1186/1750-1172-3-13] [Citation(s) in RCA: 185] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2008] [Accepted: 05/27/2008] [Indexed: 11/24/2022] Open
Abstract
LEOPARD syndrome (LS, OMIM 151100) is a rare multiple congenital anomalies condition, mainly characterized by skin, facial and cardiac anomalies. LEOPARD is an acronym for the major features of this disorder, including multiple Lentigines, ECG conduction abnormalities, Ocular hypertelorism, Pulmonic stenosis, Abnormal genitalia, Retardation of growth, and sensorineural Deafness. About 200 patients have been reported worldwide but the real incidence of LS has not been assessed. Facial dysmorphism includes ocular hypertelorism, palpebral ptosis and low-set ears. Stature is usually below the 25th centile. Cardiac defects, in particular hypertrophic cardiomyopathy mostly involving the left ventricle, and ECG anomalies are common. The lentigines may be congenital, although more frequently manifest by the age of 4–5 years and increase throughout puberty. Additional common features are café-au-lait spots (CLS), chest anomalies, cryptorchidism, delayed puberty, hypotonia, mild developmental delay, sensorineural deafness and learning difficulties. In about 85% of the cases, a heterozygous missense mutation is detected in exons 7, 12 or 13 of the PTPN11 gene. Recently, missense mutations in the RAF1 gene have been found in two out of six PTPN11-negative LS patients. Mutation analysis can be carried out on blood, chorionic villi and amniotic fluid samples. LS is largely overlapping Noonan syndrome and, during childhood, Neurofibromatosis type 1-Noonan syndrome. Diagnostic clues of LS are multiple lentigines and CLS, hypertrophic cardiomyopathy and deafness. Mutation-based differential diagnosis in patients with borderline clinical manifestations is warranted. LS is an autosomal dominant condition, with full penetrance and variable expressivity. If one parent is affected, a 50% recurrence risk is appropriate. LS should be suspected in foetuses with severe cardiac hypertrophy and prenatal DNA test may be performed. Clinical management should address growth and motor development and congenital anomalies, in particular cardiac defects that should be monitored annually. Hypertrophic cardiomyopathy needs careful risk assessment and prophylaxis against sudden death in patients at risk. Hearing should be evaluated annually until adulthood. With the only exception of ventricular hypertrophy, adults with LS do not require special medical care and long-term prognosis is favourable.
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Affiliation(s)
- Anna Sarkozy
- IRCCS-CSS, San Giovanni Rotondo and CSS-Mendel Institute, Viale Regina Elena 261, 00198, Rome, Italy.
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Sidwell RU, Rouse P, Owen RA, Green JSA. Granular cell tumor of the scrotum in a child with Noonan syndrome. Pediatr Dermatol 2008; 25:341-3. [PMID: 18577039 DOI: 10.1111/j.1525-1470.2008.00678.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Granular cell tumor is a rare neoplasm thought to be of neural origin, composed of cells with distinctive granular cytoplasm. Granular cell tumors most often arise on the tongue, but can occur at any body site, and therefore initial presentation to dermatologists is common. We report a granular cell tumor of the scrotum in a child with Noonan syndrome, known to have a mutation in the PTPN11 gene. No previous reports of granular cell tumor of the scrotum in a child are found. The tumor is usually benign; however, it can have a high local recurrence rate (variable between 2% and 50% dependent on whether initial excision is complete and on the occurrence of an infiltrative growth pattern) and therefore long-term follow-up is necessary. This case highlights the occurrence of granular cell tumor, a diagnosis not to be missed by the dermatologist. In addition, we postulate the possible role of PTPN11 mutations in the development of granular cell tumor.
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Affiliation(s)
- Rachel U Sidwell
- Department of Dermatology, Chelsea and Westminster Hospital, London, UK
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Sarkozy A, Schirinzi A, Lepri F, Bottillo I, De Luca A, Pizzuti A, Tartaglia M, Digilio MC, Dallapiccola B. Clinical lumping and molecular splitting of LEOPARD and NF1/NF1-Noonan syndromes. Am J Med Genet A 2007; 143A:1009-11. [PMID: 17366582 DOI: 10.1002/ajmg.a.31666] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Anna Sarkozy
- IRCCS-CSS, San Giovanni Rotondo and CSS-Mendel Institute, Rome, Italy.
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23
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Muscardin LM, Paradisi M, Provini A, Cota C, Marzetti G. Multiple cutaneous granular cell tumors, joint hypermobility and mild facial dysmorphism in a child. Int J Dermatol 2006; 45:847-50. [PMID: 16863524 DOI: 10.1111/j.1365-4632.2004.02476.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association of multiple cutaneous granular tumors with systemic defects is extremely rare. To date, 14 cases have been described. CASE REPORT A 14-year-old boy presented multiple nodular lesions on his arms and legs; facial dysmorphism and joint hypermobility were also present. Histopathologic examination of two nodules showed granular cell tumors. We review the literature regarding multiple granular cell cutaneous tumors in children with associated somatic defects and genetic syndromes. CONCLUSIONS The combination of multiple cutaneous granular tumors with alterations in other organs is not only fortuitous, justifying the proposal of a distinct syndrome, termed "Bakos's syndrome" after the author who first described this association. The relation with neurofibromatosis type 1 is discussed, and an association is suggested with the range of variants of this syndrome.
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Affiliation(s)
- Luca M Muscardin
- Institute San Gallicano, Rome, Italy, Istituto Dermopatico dell'Immacolata, Rome, Italy.
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24
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Digilio MC, Sarkozy A, de Zorzi A, Pacileo G, Limongelli G, Mingarelli R, Calabrò R, Marino B, Dallapiccola B. LEOPARD syndrome: clinical diagnosis in the first year of life. Am J Med Genet A 2006; 140:740-6. [PMID: 16523510 DOI: 10.1002/ajmg.a.31156] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
LEOPARD syndrome (LS) is an autosomal dominant syndrome characterized by multiple lentigines and café-au-lait spots, electrocardiographic-conduction abnormalities, ocular hypertelorism/obstructive cardiomyopathy, pulmonary stenosis, abnormalities of the genitalia in males, retardation of growth, and deafness. LS shares many features with Noonan syndrome (NS), in which lentigines and deafness are usually not present. Molecular studies have shown that LS and NS are allelic disorders, caused by different missense mutations in PTPN11, a gene encoding the protein tyrosine phosphatase SHP-2 located at chromosome 12q22-qter. The clinical diagnosis of LS is generally difficult in the first months of life because the distinctive lentigines are generally not present at birth and develop during childhood. From January 2002 to December 2004, we suspected LS clinically in 10 patients admitted to our genetic counseling services in the first 12 months of life. A PTPN11 gene mutation was detected in 8/10 (80%) patients. In one patient without a PTPN11 mutation a subsequent clinical diagnosis of neurofibromatosis type 1 (NF1) was made, following the evaluation of the mother, who had previously undiagnosed classic NF1. The age of LS patients with PTPN11 mutation ranged between 1 and 11 months (mean age +/- SD 7.5 +/- 3.96 months). Review of the clinical characteristics of patients with LS confirmed by molecular study during the first year of life demonstrates that the diagnosis of LS in the first months of age can be clinically suspected in patients presenting with three main features, that is, characteristic facial features (100%), hypertrophic cardiomyopathy (HCM) (87%), and cafe-au-lait spots (75%). Characteristic facial features can be mild or severe, and consist of hypertelorism, downslanting palpebral fissures, ptosis, and dysmorphic ears. The clinical suspicion of LS may be confirmed by molecular screening for PTPN11 mutations. An early diagnosis of the disease is useful for the prospective care of associated medical problems and for precise genetic counseling.
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Affiliation(s)
- M Cristina Digilio
- Medical Genetics and Pediatric Cardiology, Bambino Gesù Hospital, Rome, Italy.
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25
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Stevenson DA, Viskochil DH, Rope AF, Carey JC. Clinical and molecular aspects of an informative family with neurofibromatosis type 1 and Noonan phenotype. Clin Genet 2006; 69:246-53. [PMID: 16542390 PMCID: PMC3243644 DOI: 10.1111/j.1399-0004.2006.00576.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neurofibromatosis-Noonan syndrome (NFNS) has been described as a unique phenotype, combining manifestations of neurofibromatosis type 1 (NF1) and Noonan syndrome, which are separate syndromes. Potential etiologies of NFNS include a discrete syndrome of distinct etiology, co-segregation of two mutated common genes, variable clinical expressivity of NF1, and/or allelic heterogeneity. We present an informative family with an unusual NF1 mutation with variable features of NF1 and Noonan syndrome. We hypothesize that an NF1 mutant allele can lead to diagnostic manifestations of Noonan syndrome, supporting the hypothesis that NF1 allelic heterogeneity causes NFNS.
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Affiliation(s)
- D A Stevenson
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, UT 84132, USA
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26
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Oguzkan S, Terzi YK, Güler E, Derbent M, Agras PI, Saatci U, Ayter S. Two neurofibromatosis type 1 cases associated with rhabdomyosarcoma of bladder, one with a large deletion in the NF1 gene. ACTA ACUST UNITED AC 2006; 164:159-63. [PMID: 16434322 DOI: 10.1016/j.cancergencyto.2005.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Accepted: 08/02/2005] [Indexed: 10/25/2022]
Abstract
Neurofibromatosis type 1 (NF1) is the most common neurogenetic disorder, affecting approximately 1 in 3,500 individuals worldwide. Mutations of the NF1 tumor suppressor gene predispose individuals to a variety of benign and malignant tumors. Rhabdomyosarcoma (RMS) is an uncommon malignant soft tissue sarcoma and is also a rare tumor type in NF1 patients. We report two cases of NF1 with RMS. The first is that of an infant with overlapping phenotypic features of NF1 and Noonan syndrome (NS) who presented with RMS of the bladder. The second infant likewise exhibited NF1 features and was also associated with bladder RMS. DNA samples were extracted from peripheral blood and tumor tissue samples. We performed loss of heterozygosity (LOH) analysis of the NF1 gene by using seven intragenic markers (IVS27AAAT2.1, IVS27EVI-20, IVS27AC24.8, IVS27AC28.4, M98509, IVS27AC33.1, IVS38TG53.0) and one extragenic polymorphic marker (3'NF1). A large deletion was detected in the NF1 gene in the NF1-Noonan syndrome (NF-NS) case associated with RMS.
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Affiliation(s)
- Sibel Oguzkan
- Medical Biology, University of Gaziantep, Faculty of Medicine, Gaziantep, Turkey
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27
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Hüffmeier U, Zenker M, Hoyer J, Fahsold R, Rauch A. A variable combination of features of Noonan syndrome and neurofibromatosis type I are caused by mutations in theNF1 gene. Am J Med Genet A 2006; 140:2749-56. [PMID: 17103458 DOI: 10.1002/ajmg.a.31547] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Signs of neurofibromatosis type 1 (NF1) and Noonan syndrome (NS), two distinct autosomal dominant disorders, occur together in patients reported as Watson syndrome (WS), neurofibromatosis-Noonan syndrome (NFNS), partial LEOPARD syndrome, NS with features of NF1, and NF1 with Noonan-like features. The molecular basis of these combined phenotypes was poorly understood and controversially discussed over several decades. Only recently, there is increasing evidence for WS and NFNS being allelic to NF1 in the majority of patients. In this study we describe seven novel patients from five unrelated families with variable phenotypes of the NF1-NS spectrum which were systematically analyzed for mutations in the disease-causing genes NF1 for NF1 and PTPN11 for NS. Heterozygous mutations or deletions of NF1 were identified in all patients, while no PTPN11 mutation was found. The NF1 mutation segregated with the phenotype in both familial cases. These results support the hypothesis that variable phenotypes of the NF1-NS spectrum represent variants of NF1 in the majority of cases. Constitutive deregulation of the Ras pathway either through activating mutations of PTPN11 or through haploinsufficiency of neurofibromin, which acts as a Ras-inactivating GTP-ase, is probably the common pathogenetic mechanism explaining the phenotypic overlap of NS and NF1.
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Affiliation(s)
- Ulrike Hüffmeier
- Institute of Human Genetics, University Erlangen-Nuremberg, Erlangen, Germany
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28
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De Luca A, Bottillo I, Sarkozy A, Carta C, Neri C, Bellacchio E, Schirinzi A, Conti E, Zampino G, Battaglia A, Majore S, Rinaldi MM, Carella M, Marino B, Pizzuti A, Digilio MC, Tartaglia M, Dallapiccola B. NF1 gene mutations represent the major molecular event underlying neurofibromatosis-Noonan syndrome. Am J Hum Genet 2005; 77:1092-101. [PMID: 16380919 PMCID: PMC1285166 DOI: 10.1086/498454] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 09/23/2005] [Indexed: 11/03/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) demonstrates phenotypic overlap with Noonan syndrome (NS) in some patients, which results in the so-called neurofibromatosis-Noonan syndrome (NFNS). From a genetic point of view, NFNS is a poorly understood condition, and controversy remains as to whether it represents a variable manifestation of either NF1 or NS or is a distinct clinical entity. To answer this question, we screened a cohort with clinically well-characterized NFNS for mutations in the entire coding sequence of the NF1 and PTPN11 genes. Heterozygous NF1 defects were identified in 16 of the 17 unrelated subjects included in the study, which provides evidence that mutations in NF1 represent the major molecular event underlying this condition. Lesions included nonsense mutations, out-of-frame deletions, missense changes, small inframe deletions, and one large multiexon deletion. Remarkably, a high prevalence of inframe defects affecting exons 24 and 25, which encode a portion of the GAP-related domain of the protein, was observed. On the other hand, no defect in PTPN11 was observed, and no lesion affecting exons 11-27 of the NF1 gene was identified in 100 PTPN11 mutation-negative subjects with NS, which provides further evidence that NFNS and NS are genetically distinct disorders. These results support the view that NFNS represents a variant of NF1 and is caused by mutations of the NF1 gene, some of which have been demonstrated to cause classic NF1 in other individuals.
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Affiliation(s)
- Alessandro De Luca
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Irene Bottillo
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Anna Sarkozy
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Claudio Carta
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Cinzia Neri
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Emanuele Bellacchio
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Annalisa Schirinzi
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Emanuela Conti
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Giuseppe Zampino
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Agatino Battaglia
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Silvia Majore
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Maria M. Rinaldi
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Massimo Carella
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Bruno Marino
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Antonio Pizzuti
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Maria Cristina Digilio
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Marco Tartaglia
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
| | - Bruno Dallapiccola
- CSS Hospital, IRCCS, San Giovanni Rotondo and CSS-Mendel Institute, Department of Experimental Medicine and Pathology and Section of Pediatric Cardiology, Department of Pediatrics, University “La Sapienza,” Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, AO San Camillo-Forlanini, and Medical Genetics, Bambino Gesù Hospital, IRCCS, Rome; Stella Maris Scientific Research Institute, Calambrone, Pisa; Genetica Medica, Ospedale Cardarelli, Naples, Italy; and Department of Pediatrics, Mount Sinai School of Medicine, New York
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29
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Bertola DR, Pereira AC, Passetti F, de Oliveira PSL, Messiaen L, Gelb BD, Kim CA, Krieger JE. Neurofibromatosis-Noonan syndrome: Molecular evidence of the concurrence of both disorders in a patient. Am J Med Genet A 2005; 136:242-5. [PMID: 15948193 DOI: 10.1002/ajmg.a.30813] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Noonan syndrome (NS) is an autosomal dominant disorder characterized by short stature, facial anomalies, webbed neck, sternal deformity, heart defects, and, in males, cryptorchidism. PTPN11 encodes SHP2, an important component of several signal transduction pathways that acts as a positive regulator of RAS-mitogen activated protein kinase signaling. Neurofibromatosis type 1 (NF1) is another autosomal dominant disorder characterized by hamartomas in multiple organs. The NF1 gene encodes a GAP-related protein, which acts as a negative regulator of the Ras-mediated signal transduction pathway. Clinical overlap between both syndromes, neurofibromatosis-Noonan syndrome (NFNS) is well known. We studied a female patient with typical findings of NFNS and found two mutations: a novel PTPN11 transversion, 1909A --> G, resulting in Gln510Arg, and an NF1 transversion, 2531A --> G, resulting in Leu844Arg. She inherited the PTPN11 mutation from her father and had a de novo NF1 mutation. This is the first report of molecular concurrence of both disorders in the same patient.
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Affiliation(s)
- Debora R Bertola
- Genetics Clinic Unit, Instituto da Criança do Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
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30
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Agras PI, Baskin E, Sakallioglu AE, Arda IS, Ayter S, Oguzkan S, Derbent M, Alehan F, Hicsonmez A, Saatci U. Neurofibromatosis--Noonan's syndrome with associated rhabdomyosarcoma of the urinary bladder in an infant: case report. J Child Neurol 2003; 18:68-72. [PMID: 12661943 DOI: 10.1177/08830738030180011601] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neurofibromatosis 1 is an autosomal dominant disorder. Noonan's syndrome is known to be associated with neurofibromatoses. Patients with neurofibromatosis are predisposed to developing malignant tumors. The relationship between the genetic changes in the neurofibromin gene and mechanisms associated with tumor development in neurofibromatosis has been investigated. A non-sense mutation C2446T --> R816X of the neurofibromin gene has been detected in some patients with the neurofibromatosis 1-Noonan's syndrome phenotype. We describe a case of an infant with the overlapping features of neurofibromatosis 1 and Noonan's syndrome who presented with rhabdomyosarcoma of the urinary bladder. The genetic analysis of our patient revealed neither mutation in the neurofibromatosis 1-guanosine triphosphatase-activating protein-related domain nor the R816X nonsense mutation. The phenotypic and genotypic features of neurofibromatosis, Noonan's syndrome, and cases with the overlapping features of both syndromes have been reviewed. The presentation of our case underlines the importance of careful examination for the clinical features of neurofibromatosis and phenotypic traits of associated diseases, especially in patients with malignant tumors.
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31
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Szczygiet M, Kurpisz M. Chromosomal anomalies in human gametes and pre-implantation embryos, and their potential effect on reproduction. Andrologia 2001; 33:249-65. [PMID: 11683699 DOI: 10.1046/j.1439-0272.2001.00438.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This paper reviews the latest data on chromosomal abnormalities in human gametes and embryos. A close relationship between such anomalies and reproduction failure in humans has been postulated, thereby underscoring the importance of ongoing studies into the mechanisms leading to anomalies. Until recently, knowledge of chromosomal anomalies in human gametes and embryos has been limited. Newly developed strategies (in vitro fertilization combined with micromanipulation techniques followed by multicolour fluorescence in situ hybridization, and PCR analyses) allow precise investigation of this problem. This review of the available information on the etiology of chromosomal anomalies indicates that some of the genetic anomalies in human gametes and early embryos result in reproductive failure.
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Affiliation(s)
- M Szczygiet
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Strzeszynska 32, Poland
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32
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Ruggieri M, Pavone V, Polizzi A, Albanese S, Magro G, Merino M, Duray PH. Unusual form of recurrent giant cell granuloma of the mandible and lower extremities in a patient with neurofibromatosis type 1. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 87:67-72. [PMID: 9927083 DOI: 10.1016/s1079-2104(99)70297-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report on a girl with familial neurofibromatosis type 1 (Nf1) who at age 11 had multiple osteolytic lesions of the right mandible and the distal femoral and proximal tibial metaphyses bilaterally. No other skeletal component was affected, and no abnormalities were present on skeletal radiographs of her parents. Histologic examination of the mandibular and right femoral lesions revealed a "multinucleated giant cell process." Results of repeated routine laboratory and bone metabolic studies were within normal limits. The lack of reliable histologic criteria and the diagnostic problems in distinguishing among central giant cell granulomata, giant cell tumors of the jaw, cherubism, brown tumors resulting from (occult) hyperparathyroidism, Jaffe-Campanacci syndrome, McCune-Albright syndrome, Noonan-like/multiple giant cell lesion syndrome, and multiple nonossifying fibromas of bone are discussed.
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Affiliation(s)
- M Ruggieri
- Department of Paediatrics and IBFSNC, University of Catania, Italy
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33
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Abstract
Neurofibromatosis (NF) type 1 (NF-1) is one of the most common of the neurocutaneous conditions, whereas NF type 2 (NF-2) accounts for an extremely small percentage of the total cases of NF. Indeed, most physicians will probably encounter at least one or two patients with NF-1 during the course of their practice. The manifestations can be varied and subtle; thus, the condition can sometimes be difficult to recognize. Nonetheless, the diagnosis of NF-1 is often clinically possible by the time the person is 10 years old. In this article, the diagnostic criteria for the most common types of NF are discussed, the common and some of the serious manifestations of both NF-1 and NF-2 are described, and suggestions for follow-up care are offered. Of importance, physicians must recognize that, although NF-1 and NF-2 share a common name, they are due to mutations in two different genes. Cure is not yet possible; thus, treatment is primarily symptomatic. A multi-disciplinary treatment team is often helpful, particularly for patients with complicated problems.
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Affiliation(s)
- P S Karnes
- Department of Medical Genetics, Mayo Clinic Rochester, Minnesota 55905, USA
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34
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Bahuau M, Houdayer C, Assouline B, Blanchet-Bardon C, Le Merrer M, Lyonnet S, Giraud S, R�can D, Lakhdar H, Vidaud M, Vidaud D. Novel recurrent nonsense mutation causing neurofibromatosis type 1 (NF1) in a family segregating both NF1 and Noonan syndrome. ACTA ACUST UNITED AC 1998. [DOI: 10.1002/(sici)1096-8628(19980123)75:3<265::aid-ajmg8>3.0.co;2-p] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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35
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36
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Leppig KA, Kaplan P, Viskochil D, Weaver M, Ortenberg J, Stephens K. Familial neurofibromatosis 1 microdeletions: cosegregation with distinct facial phenotype and early onset of cutaneous neurofibromata. AMERICAN JOURNAL OF MEDICAL GENETICS 1997; 73:197-204. [PMID: 9409873 DOI: 10.1002/(sici)1096-8628(1997)73:2<197::aid-ajmg17>3.0.co;2-p] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A notable subset of the recent literature on the disorder neurofibromatosis type 1 (NF1) describes patients with NF1, facial anomalies, and other unusual findings. We describe a molecular re-evaluation of two such families reported previously by Kaplan and Rosenblatt [1985], who suggested that their NF1 manifestations, facial phenotype, and other findings could result from a disorder distinct from NF1. Submicroscopic deletions involving the NF1 gene were identified in both families by fluorescent in situ hybridization and analysis of somatic cell hybrids. Affected subjects of the first family were heterozygous for a microdeletion of approximately 2 Mb, which included the entire NF1 gene and flanking contiguous sequences. The family was remarkable for cosegregation of the NF1 microdeletion with facial abnormalities and a pattern of early onset of cutaneous neurofibromata upon transmission from an affected mother to her three affected children. The propositus of the second family carried a deletion that at the least involved NF1 exon 2 through intron 27, which is > 200 kilobases in length. Because all persons in the family were deceased, the size of the deletion could not be determined precisely. Facial anomalies were observed in the propositus and his NF1-affected mother and sister. The data from these families support our hypothesis, which was initially based solely on sporadic deletion cases, that deletion of the entire NF1 gene, or in conjunction with deletion of unknown contiguous genes, causes the facial anomalies and early onset of neurofibromata observed in this subset of NF1 patients. In addition, other features observed in the persons in these families suggest that some NF1 microdeletion patients may be at increased risk for connective tissue abnormalities and/or neoplasms.
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Affiliation(s)
- K A Leppig
- Department of Pediatrics, University of Washington, Seattle 98195, USA
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37
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Matsuoka H, Shibata E, Ikezaki A, Kim HS, Yamazaki K, Murata M. Ganglioneuroma of left adrenal gland in a patient with Turner syndrome during growth hormone therapy. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1997; 39:628-30. [PMID: 9363667 DOI: 10.1111/j.1442-200x.1997.tb03655.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report on a Japanese girl with Turner syndrome (45,XO) who developed ganglioneuroma of the left adrenal gland during growth hormone (GH) therapy. She had received GH replacement therapy from the age of 6.8 years. At the age of 10.3 years, abdominal ultrasonography revealed a mass which occupied the upper area of her left kidney. Computed tomography and magnetic resonance imaging of the abdomen showed a low density mass with a smooth surface located between the upper portion of the left renal vein and the pancreas. Microscopic examination resulted in a diagnosis of ganglioneuroma of the left adrenal gland. At present we cannot conclude that patients who have received GH replacement therapy are at higher risk for developing tumors compared to those without GH replacement therapy.
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Affiliation(s)
- H Matsuoka
- Department of Pediatrics, Tokyo Women's Medical College Daini Hospital, Japan
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38
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Wieczorek D, Majewski F, Gillessen-Kaesbach G. Cardio-facio-cutaneous (CFC) syndrome--a distinct entity? Report of three patients demonstrating the diagnostic difficulties in delineation of CFC syndrome. Clin Genet 1997; 52:37-46. [PMID: 9272711 DOI: 10.1111/j.1399-0004.1997.tb02512.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report on three patients with probable cardio-facio-cutaneous (CFC) syndrome. They present clinical findings of this condition such as: growth failure, heart defects, typical craniofacial appearance, ectodermal abnormalities, and developmental delay. We also give a detailed review of the previously published articles on CFC syndrome and discuss the differences between CFC, Noonan, and Costello syndromes. Other differential diagnoses are considered.
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Affiliation(s)
- D Wieczorek
- Institut für Humangenetik, Universitätsklinikum Essen, Germany
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39
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Abstract
There is a well-known association between neurofibromatosis-1 (NF1) and Noonan syndrome-like manifestations, including short stature, short broad neck, and hypertelorism. These anomalies are thought to be due to variable expression of the NF1 gene. We report on two girls with NF1 who were found to have the Ullrich-Turner syndrome. Case 1, a 12-year-old white girl, was followed in a Neurofibromatosis Clinic because of multiple café-au-lait spots and a family history of NF1 in her mother and sister. On examination, she had short stature, hypertelorism, and short neck with low posterior hairline. Karyotype was 86% 46,XY/14% 45,X. Case 2, the first child of a woman with NF1, presented at birth with lymphedema of hands and feet and a short broad neck. Karyotype was 45,X. At age 23 months she was short, had epicanthic folds, hypertelorism, narrow palate, right simian crease, 19 café-au-lait spots, and axillary freckling. We conclude that chromosome studies should be performed in girls with NF1 who have short stature and Noonan- or Ullrich-Turner-like findings. Dilemmas raised by the dual diagnoses of NF1 and Ullrich-Turner syndrome include potential risks of growth hormone therapy and estrogen replacement therapy.
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Affiliation(s)
- E K Schorry
- Division of Human Genetics, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA
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40
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Bahuau M, Flintoff W, Assouline B, Lyonnet S, Le Merrer M, Prieur M, Guilloud-Bataille M, Feingold N, Munnich A, Vidaud M, Vidaud D. Exclusion of allelism of Noonan syndrome and neurofibromatosis-type 1 in a large family with Noonan syndrome-neurofibromatosis association. AMERICAN JOURNAL OF MEDICAL GENETICS 1996; 66:347-55. [PMID: 8985499 DOI: 10.1002/(sici)1096-8628(19961218)66:3<347::aid-ajmg20>3.0.co;2-l] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A large four-generation family with Noonan syndrome (NS) and neurofibromatosis-type 1 (NF1) was studied for clinical association between the two diseases and for linkage analysis with polymorphic DNA markers of the NF1 region in 17q11.2. Nonrandom segregation between NS and NF1 phenotypes was observed. Neurofibromatosis was tightly linked to NF1 markers, whereas Noonan syndrome was found not be allelic to NF1. These results suggest that two mutations at two independent but closely linked loci are the cause of neurofibromatosis-Noonan syndrome (NF-NS) association in this family.
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Affiliation(s)
- M Bahuau
- Unité de Recherches sur les Handicaps Génétiques de l'Enfant INSERM U393, Paris, France
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41
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Colley A, Donnai D, Evans DG. Neurofibromatosis/Noonan phenotype: a variable feature of type 1 neurofibromatosis. Clin Genet 1996; 49:59-64. [PMID: 8740913 DOI: 10.1111/j.1399-0004.1996.tb04328.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Since January 1989 we have ascertained patients with neurofibromatosis type 1 (NF1) as part of our genetic register in the North West of England. This register has now identified 453 affected cases from 235 families. The first 94 individuals were specifically examined for features of the Noonan phenotype. This was present in 12/94 sequentially identified individuals with NF1 including six individuals from three families. However, three cases occurred in a further family, where Noonan syndrome appeared to segregate separately from NF1. We have provided evidence for the chance association of Noonan syndrome and NF1 and that the Noonan phenotype occurs as a feature in some NF1 families. However, there is now little evidence of a separate NF1/Noonan syndrome entity or of NF1 features occurring in classical Noonan syndrome.
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Affiliation(s)
- A Colley
- Department of Medical Genetics, St. Mary's Hospital, Manchester, UK
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42
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Abstract
Type I neurofibromatosis (NF-1) and Noonan syndrome (NS) are two fairly common genetic disorders. Patients with features of both disorders have been described, but considerable variability of phenotypic expression occurs. As a result, the correct nosology of this syndrome is uncertain. We present a patient with full expression of both NF-1 and NS phenotypes, and discuss the debate regarding the genetics of the combined syndrome.
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Affiliation(s)
- L Buehning
- Division of Dermatology, University of California at San Diego, La Jolla 92093-0645, USA
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43
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Ahlbom BE, Dahl N, Zetterqvist P, Annerén G. Noonan syndrome with café-au-lait spots and multiple lentigines syndrome are not linked to the neurofibromatosis type 1 locus. Clin Genet 1995; 48:85-9. [PMID: 7586657 DOI: 10.1111/j.1399-0004.1995.tb04061.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Noonan syndrome, multiple lentigines syndrome (LEOPARD syndrome), Watson syndrome and neurofibromatosis type 1 share certain clinical manifestations. We present a linkage analysis using microsatellite markers located in the neurofibromatosis type 1 region at 17q11 in a family with Noonan syndrome and café-au-lait spots and in another family with multiple lentigines syndrome. No linkage of the disease to the neurofibromatosis type 1 locus was found in the families investigated. On the basis of our results, we suggest that neither familial multiple lentigines syndrome nor Noonan syndrome is caused by a defect in the neurofibromatosis type 1 gene.
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Affiliation(s)
- B E Ahlbom
- Department of Clinical Genetics, University Hospital, Uppsala, Sweden
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44
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Meschede D, Froster UG, Gullotta F, Nieschlag E. Reproductive failure in a patient with neurofibromatosis-Noonan syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS 1993; 47:346-51. [PMID: 8135279 DOI: 10.1002/ajmg.1320470310] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report on a 39-year-old man with neurofibromatosis-Noonan syndrome and long-standing infertility. Comprehensive testing did not uncover any significant endocrine abnormalities, but the testicular seminiferous epithelium was found to be severely compromised. While the occasional association of neurofibromatosis with signs of Noonan syndrome has been reported, reproductive failure has not been previously described in this condition.
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Affiliation(s)
- D Meschede
- Institutes of Reproductive Medicine, Münster, Germany
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45
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Flintoff WF, Bahuau M, Lyonnet S, Gilgenkrantz S, Lacombe D, Marçon F, Levilliers J, Kachaner J, Munnich A, Le Merrer M. No evidence for linkage to the type 1 or type 2 neurofibromatosis loci in Noonan syndrome families. AMERICAN JOURNAL OF MEDICAL GENETICS 1993; 46:700-5. [PMID: 8362913 DOI: 10.1002/ajmg.1320460621] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A linkage analysis has been performed on 6 two-generation families with classical Noonan syndrome to determine whether the syndrome is linked to neurofibromatosis type 1 on chromosome 17q or to neurofibromatosis type 2 on chromosome 22q. A significantly negative location score was obtained between 10 cM centromeric to and 15 cM telomeric from the neurofibromatosis type 1 locus. A significantly negative lod score was obtained with a marker mapping within the region where neurofibromatosis type 2 is thought to be located. These data indicate that Noonan syndrome is not tightly linked to either neurofibromatosis type 1 or type 2.
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Affiliation(s)
- W F Flintoff
- Unité de Recherches sur les Handicaps Génétiques de l'Enfant INSERM, Paris, France
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46
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Abstract
Noonan syndrome is a genetic condition inherited in an autosomally dominant manner, characterised by congenital heart disease, short stature, abnormal facies and the somatic features of Turner's syndrome, but a normal Karyotype. The ophthalmological and orthoptic findings on 58 patients with Noonan syndrome are reported. External features were hypertelorism (74%), downward sloping palpebral apertures (38%), epicanthic folds (39%) and ptosis (48%). The orthoptic examination revealed strabismus in 48%, refractive errors in 61%, amblyopia in 33%, and nystagmus in 9% of cases. Sixty-three per cent of cases had anterior segment changes consisting of: Prominent corneal nerves (46%), anterior stromal dystrophy (4%), cataracts (8%) and panuveitis (2%). Fundal changes occurred in 20% of the study group, including optic nerve head drusen, optic disc hypoplasia, colobomas and myelinated nerves. Forty-seven per cent required non surgical treatment and a further 16% had undergone surgery for strabismus or ptosis. Only three patients had no visual defects. With such a high incidence of ophthalmic abnormalities it is clearly important that children with Noonan syndrome are screened by an ophthalmologist at an early age.
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Affiliation(s)
- N B Lee
- Ophthalmology Department, St. George's Hospital, London
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47
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Sharland M, Taylor R, Patton MA, Jeffery S. Absence of linkage of Noonan syndrome to the neurofibromatosis type 1 locus. J Med Genet 1992; 29:188-90. [PMID: 1348095 PMCID: PMC1015895 DOI: 10.1136/jmg.29.3.188] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Eleven families with Noonan syndrome in either two or three generations have been identified. Following the reports of subjects with features of both Noonan syndrome and neurofibromatosis type 1, these pedigrees have been studied using a number of probes at the neurofibromatosis type 1 locus (17q11). A significantly negative lod score was obtained with the intragenic probe NF1-C2, suggesting that the genes for Noonan syndrome and neurofibromatosis type 1 are not contiguous.
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Affiliation(s)
- M Sharland
- South West Thames Regional Genetic Service, St George's Hospital Medical School, London
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48
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Stern HJ, Saal HM, Lee JS, Fain PR, Goldgar DE, Rosenbaum KN, Barker DF. Clinical variability of type 1 neurofibromatosis: is there a neurofibromatosis-Noonan syndrome? J Med Genet 1992; 29:184-7. [PMID: 1348094 PMCID: PMC1015894 DOI: 10.1136/jmg.29.3.184] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Detailed clinical, ophthalmological, and molecular studies were performed on a multigeneration family in which there were many subjects with type 1 neurofibromatosis, a common autosomal dominant disorder. Affected family members displayed a wide range of clinical findings including, in two subjects, features seen in Noonan syndrome (triangular facies, downward slanting palpebral fissures, micrognathia, short stature, and learning disability). Subjects have been described previously whose features have overlapped with neurofibromatosis and Noonan syndrome, and it has been suggested that these persons might represent a separate condition. DNA haplotype analysis showed linkage of the neurofibromatosis phenotype seen in this family to the proximal long arm of chromosome 17 in the region where the type 1 neurofibromatosis gene has been mapped. These results imply that the Noonan phenotype seen in some patients with type 1 neurofibromatosis might be the result of variable or variant expression of the neurofibromatosis gene on chromosome 17. The possible role of non-specific factors, such as fetal hypotonia, in producing the neurofibromatosis-Noonan phenotype needs further investigation. The availability of closely linked and intragenic molecular markers for neurofibromatosis could potentially be useful in the diagnosis and characterisation of patients and families with atypical forms of neurofibromatosis.
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Affiliation(s)
- H J Stern
- Department of Medical Genetics, Children's National Medical Center, Washington, DC
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49
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Cohen MM, Gorlin RJ. Noonan-like/multiple giant cell lesion syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS 1991; 40:159-66. [PMID: 1897569 DOI: 10.1002/ajmg.1320400208] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A patient with the Noonan-like/multiple giant cell lesion syndrome is reported and the findings in 14 cases are reviewed. Impressive manifestations include short stature, low normal intelligence or developmental delay, ocular hypertelorism, prominent posteriorly angulated ears, giant cell lesions of bones, joints, and/or soft tissues, pectus excavatum, and pulmonic stenosis. It has been difficult to delineate the syndrome because problems in identifying the condition have resulted from incomplete or truncate ascertainment by various medical specialists.
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Affiliation(s)
- M M Cohen
- Department of Oral Biology, Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada
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50
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Neri G, Zollino M, Reynolds JF. The Noonan-CFC controversy. AMERICAN JOURNAL OF MEDICAL GENETICS 1991; 39:367-70. [PMID: 1867292 DOI: 10.1002/ajmg.1320390323] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The Noonan syndrome and the cardio-faciocutaneous (CFC) syndrome have been described as phenotypically and genetically distinct entities. However, the resemblance between them led some authors to question the validity of this separation. We review available clinical evidence to support the opposite view, namely, that the Noonan and CFC syndromes are indeed distinct and separate conditions, both falling within the broad and causally heterogeneous spectrum of the Noonan/congenital lymphedema phenotype.
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