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Zhou T, Liu K, Wei H, Zhong Q, Luo D, Yang W, Zhang P, Xiao Y. Histopathology and molecular pathology confirmed a diagnosis of atypical Caroli's syndrome: a case report. Diagn Pathol 2024; 19:36. [PMID: 38388441 PMCID: PMC10882844 DOI: 10.1186/s13000-024-01462-9] [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: 03/07/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Caroli's syndrome is a congenital disease characterized by dilation of intrahepatic bile ducts and congenital hepatic fibrosis. It is a rare condition in clinical work. Typically, the diagnosis of this disease is confirmed through medical imaging. Here, we report a case of atypical Caroli's syndrome in a patient who presented with recurrent upper gastrointestinal tract bleeding. The patient underwent imaging examinations, liver biopsy and whole exome sequencing. The results of the imaging examination were non-specific. However, with the aid of pathological examination, the patient was diagnosed with Caroli's syndrome. In conclusion, for cases where the imaging presentation of Caroli's syndrome is inconclusive, an accurate diagnosis should rely on pathology. By discussing this specific case, our aim is to enhance readers' understanding of this disease, provide valuable information that can aid in the early detection and appropriate management of Caroli's syndrome, ultimately improving patient outcomes.
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Affiliation(s)
- Tianmin Zhou
- Department of Pathology, Infectious Diseases Hospital of Nanchang University, Nanchang, 330001, Jiangxi, China
| | - Keyu Liu
- Queen Mary School, Nanchang University, Nanchang, 330006, China
| | - Hao Wei
- The First Clinical Department, Nanchang University, Nanchang, 330006, China
| | - Qingmei Zhong
- Department of Pathology, Infectious Diseases Hospital of Nanchang University, Nanchang, 330001, Jiangxi, China
| | - Daya Luo
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Nanchang University, Nanchang, 330006, China
| | - Wenjuan Yang
- Infectious Diseases Hospital of Nanchang University, Nanchang, 330001, Jiangxi, China
| | - Ping Zhang
- Department of Pathology, Infectious Diseases Hospital of Nanchang University, Nanchang, 330001, Jiangxi, China
| | - Yingqun Xiao
- Department of Pathology, Infectious Diseases Hospital of Nanchang University, Nanchang, 330001, Jiangxi, China.
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Giacobbe C, Di Dato F, Palma D, Amitrano M, Iorio R, Fortunato G. Rare variants in PKHD1 associated with Caroli syndrome: Two case reports. Mol Genet Genomic Med 2022; 10:e1998. [PMID: 35715958 PMCID: PMC9356553 DOI: 10.1002/mgg3.1998] [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: 06/28/2021] [Revised: 03/31/2022] [Accepted: 05/13/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Caroli disease (CD, OMIM #600643) is a rare autosomal recessive disorder characterized by polycystic segmental dilatation of the intrahepatic bile ducts and extreme variability in age of onset and clinical manifestations. When congenital hepatic fibrosis is associated with the polycystic dilatation of the biliary tract, the condition is referred as Caroli syndrome. The disease is thought to be caused by pathogenic variants in the PKHD1 gene (OMIM *606702). METHOD We report the clinical, biochemical, and molecular characterization of three patients with a clinical suspicion of CS belonging to two different families. The genetic screening was performed using a target custom panel and sequencing was performed on Illumina platform. RESULTS Genetic analysis revealed the presence of rare variants in the PKHD1 gene of the analyzed patients. In the first case, and his younger sister, two pathogenic variants (c.2702A>C and c.4870C>T) were found to be associated with a hepatic phenotype at clinical onset, followed by renal disease probably age-related; while in the second case, one pathogenic variant (c.5879C>G) and a complex allele with uncertain clinical significance [c.3407A>G; c.8345G>C; c.8606C>A] were found to be associated with a severe hepatic phenotype. CONCLUSION The identification of the genetic causes of the disease and their relationship with the clinical phenotype could have a favorable impact on clinical management and complication prevention.
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Affiliation(s)
- Carola Giacobbe
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
| | - Fabiola Di Dato
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Daniela Palma
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
| | - Michele Amitrano
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Raffaele Iorio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Giuliana Fortunato
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
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Yao X, Ao W, Fang J, Mao G, Chen C, Yu L, Cai H, Xu C. Imaging manifestations of Caroli disease with autosomal recessive polycystic kidney disease: a case report and literature review. BMC Pregnancy Childbirth 2021; 21:294. [PMID: 33845788 PMCID: PMC8042699 DOI: 10.1186/s12884-021-03768-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/30/2021] [Indexed: 12/22/2022] Open
Abstract
Background Both Caroli disease (CD) and autosomal recessive polycystic kidney disease (ARPKD) are autosomal recessive disorders, which are more commonly found in infants and children, for whom surviving to adulthood is rare. Early diagnosis and intervention can improve the survival rate to some extent. This study adopted the case of a 26-year-old pregnant woman to explore the clinical and imaging manifestations and progress of CD concomitant with ARPKD to enable a better understanding of the disease. Case presentation A 26-year-old pregnant woman was admitted to our hospital for more than 2 months following the discovery of pancytopenia and increased creatinine. Ultrasonography detected an enlarged left liver lobe, widened hepatic portal vein, splenomegaly, and dilated splenic vein. In addition, both kidneys were obviously enlarged and sonolucent areas of varying sizes were visible, but color Doppler flow imaging revealed no abnormal blood flow signals. The gestational age was approximately 25 weeks, which was consistent with the actual fetal age. Polyhydramnios was detected but no other abnormalities were identified. Magnetic resonance imaging revealed that the liver was plump, and polycystic liver disease was observed near the top of the diaphragm. The T1 and T2 weighted images were the low and high signals, respectively. The bile duct was slightly dilated; the portal vein was widened; and the spleen volume was enlarged. Moreover, the volume of both kidneys had increased to an abnormal shape, with multiple, long, roundish T1 and T2 abnormal signals being observed. Magnetic resonance cholangiopancreatography revealed that intrahepatic cystic lesions were connected with intrahepatic bile ducts. The patient underwent a genetic testing, the result showed she carried two heterozygous mutations in PKHD1. The patient was finally diagnosed with CD with concomitant ARPKD. The baby underwent a genetic test three months after birth, the result showed that the patient carried one heterozygous mutations in PKHD1, which indicated the baby was a PKHD1 carrier. Conclusions This case demonstrates that imaging examinations are of great significance for the diagnosis and evaluation of CD with concomitant ARPKD.
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Affiliation(s)
- Xiuzhen Yao
- Department of Ultrasound, Shanghai Putuo District People's Hospital, Shanghai, China
| | - Weiqun Ao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Jianhua Fang
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Guoqun Mao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Chuanghua Chen
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lifang Yu
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Huaijie Cai
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chenke Xu
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Abstract
We report the case of a 41-year-old man on conservative treatment for more than 20 years for chronic renal insufficiency, chronic hepatitis and recurrent cholangitis. Following lengthy and extensive diagnostics, the differential diagnosis included primary sclerosing cholangitis and Caroli’s disease (CD). To solve the diagnostic challenge, next generation sequencing (NGS) was performed to distinguish between the disorders possibly present in the patient. The diagnosis of CD became evident after two rare known pathogenic mutations were detected in the poly-ductin 1 (PKHD1) gene, c.370C>T (p.Arg124Ter) and c.4870C>T (p.Arg1624Trp). In this case, NGS was instrumental in solving the diagnostic challenge, allowing differentiation among the proposed genetic and non-genetic ethiologies.
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Tan K, Liu P, Pang L, Yang W, Hou F. A human ciliopathy with polycystic ovarian syndrome and multiple subcutaneous cysts: A rare case report. Medicine (Baltimore) 2018; 97:e13531. [PMID: 30558011 PMCID: PMC6320131 DOI: 10.1097/md.0000000000013531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Ciliopathies is a group of clinically and genetically overlapping disorders due to cilia abnormalities and multiple organ systems are involved in. PATIENT CONCERNS We present a young female patient who showed renal function impairment, Caroli syndrome (CS), liver cirrhosis, polycystic ovarian syndrome, and multiple subcutaneous cysts. DIAGNOSES The patient was diagnosed with ciliopathy according to the clinical manifestations and whole-genome sequencing. INTERVENTIONS She received treatment of intravenous albumin, polyene phosphatidyl choline, furosemide, and antisterone. OUTCOMES The patient showed clinical improvement in her edema and liver tests, and ultrasonography revealed that the ascites had disappeared. Unfortunately, the edema relapsed a year later. The patient received the same treatment as before, and there was clinical improvement of the edema. Since the family cannot afford liver and kidney transplantation, the patient only accepted symptomatic treatment. LESSONS Polycystic ovarian syndrome and multiple subcutaneous cysts have never before been reported to be associated with ciliopathy. This finding could remind doctors to consider the possibility of ciliopathy disease for patients suffering from similar conditions. In addition, the phenotype of the patient differs from those of patients reported with the same mutations, which also reminds doctors that the clinical manifestation of a given mutation may show patient-specific differences. This case report extends the phenotypic spectrum of ciliopathy, and these findings might represent a new ciliopathy syndrome, which could facilitate the diagnosis of ciliopathies.
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Affiliation(s)
- Kangan Tan
- Department of Infectious Diseases and the Center for Liver Diseases, Peking University First Hospital, Beijing
| | - Peng Liu
- Department of Cardiology, Ordos Central Hospital, Ordos School of Clinical Medicine, Inner Mongolia Medical University, Inner Mongolia
| | - Lili Pang
- Department of Infectious Diseases and the Center for Liver Diseases, Peking University First Hospital, Beijing
| | - Wanna Yang
- Department of Infectious Diseases and the Center for Liver Diseases, Peking University First Hospital, Beijing
| | - Fengqin Hou
- Department of Infectious Diseases and the Center for Liver Diseases, Peking University First Hospital, Beijing
- Department of Infectious Diseases, Peking University International Hospital, China
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Nambot S, Gavrilov D, Thevenon J, Bruel A, Bainbridge M, Rio M, Goizet C, Rötig A, Jaeken J, Niu N, Xia F, Vital A, Houcinat N, Mochel F, Kuentz P, Lehalle D, Duffourd Y, Rivière J, Thauvin-Robinet C, Beaudet A, Faivre L. Further delineation of a rare recessive encephalomyopathy linked to mutations in GFER thanks to data sharing of whole exome sequencing data. Clin Genet 2017; 92:188-198. [DOI: 10.1111/cge.12985] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/24/2016] [Accepted: 01/25/2017] [Indexed: 02/06/2023]
Affiliation(s)
- S. Nambot
- Centre de Génétique et Centre de référence «Anomalies du Développement et Syndromes Malformatifs», Hôpital d'Enfants; Centre Hospitalier Universitaire de Dijon; Dijon France
- Laboratoire de Génétique Moléculaire, Plateau Technique de Biologie; Centre Hospitalier Universitaire de Dijon; Dijon France
| | - D. Gavrilov
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology; Mayo Clinic College of Medicine; Rochester Minnesota
- Department of Genetics and Genomics; Mayo Clinic College of Medicine; Rochester Minnesota
| | - J. Thevenon
- Centre de Génétique et Centre de référence «Anomalies du Développement et Syndromes Malformatifs», Hôpital d'Enfants; Centre Hospitalier Universitaire de Dijon; Dijon France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (FHU TRANSLAD); Centre Hospitalier Universitaire de Dijon et Université de Bourgogne-Franche Comté; Dijon France
- Génétique des Anomalies du Développement; Université de Bourgogne; Dijon France
| | - A.L. Bruel
- Laboratoire de Génétique Moléculaire, Plateau Technique de Biologie; Centre Hospitalier Universitaire de Dijon; Dijon France
- Génétique des Anomalies du Développement; Université de Bourgogne; Dijon France
| | - M. Bainbridge
- Human Genome Sequencing Center; Baylor College of Medicine; Houston Texas
| | - M. Rio
- Service de Génétique Médicale; Hôpital Necker Enfants Malades; Paris France
| | - C. Goizet
- Service de Génétique Médicale; Centre Hospitalier Universitaire de Bordeaux-GH Pellegrin; Bordeaux France
| | - A. Rötig
- Laboratoire de Génétique Moléculaire, Institut de Recherche Necker Enfants Malades; Hôpital Necker Enfants Malades; Paris France
| | - J. Jaeken
- Center for Metabolic Diseases; University Hospital Gasthuisberg; Leuven Belgium
| | - N. Niu
- Department of Molecular and Human Genetics; Baylor College of Medicine; Houston Texas
| | - F. Xia
- Department of Molecular and Human Genetics; Baylor College of Medicine; Houston Texas
| | - A. Vital
- Service de Pathologie, Pôle Biologie et Pathologie; Centre Hospitalier Universitaire de Bordeaux-GH Pellegrin; Bordeaux France
| | - N. Houcinat
- Centre de Génétique et Centre de référence «Anomalies du Développement et Syndromes Malformatifs», Hôpital d'Enfants; Centre Hospitalier Universitaire de Dijon; Dijon France
| | - F. Mochel
- Service de Génétique médicale; Centre Hospitalier Universitaire La Pitié Salpêtrière-Charles Foix; Paris France
| | - P. Kuentz
- Laboratoire de Génétique Moléculaire, Plateau Technique de Biologie; Centre Hospitalier Universitaire de Dijon; Dijon France
| | - D. Lehalle
- Centre de Génétique et Centre de référence «Anomalies du Développement et Syndromes Malformatifs», Hôpital d'Enfants; Centre Hospitalier Universitaire de Dijon; Dijon France
| | - Y. Duffourd
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (FHU TRANSLAD); Centre Hospitalier Universitaire de Dijon et Université de Bourgogne-Franche Comté; Dijon France
- Génétique des Anomalies du Développement; Université de Bourgogne; Dijon France
| | - J.B. Rivière
- Laboratoire de Génétique Moléculaire, Plateau Technique de Biologie; Centre Hospitalier Universitaire de Dijon; Dijon France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (FHU TRANSLAD); Centre Hospitalier Universitaire de Dijon et Université de Bourgogne-Franche Comté; Dijon France
- Génétique des Anomalies du Développement; Université de Bourgogne; Dijon France
| | - C. Thauvin-Robinet
- Centre de Génétique et Centre de référence «Anomalies du Développement et Syndromes Malformatifs», Hôpital d'Enfants; Centre Hospitalier Universitaire de Dijon; Dijon France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (FHU TRANSLAD); Centre Hospitalier Universitaire de Dijon et Université de Bourgogne-Franche Comté; Dijon France
- Génétique des Anomalies du Développement; Université de Bourgogne; Dijon France
| | - A.L. Beaudet
- Department of Molecular and Human Genetics; Baylor College of Medicine; Houston Texas
| | - L. Faivre
- Centre de Génétique et Centre de référence «Anomalies du Développement et Syndromes Malformatifs», Hôpital d'Enfants; Centre Hospitalier Universitaire de Dijon; Dijon France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (FHU TRANSLAD); Centre Hospitalier Universitaire de Dijon et Université de Bourgogne-Franche Comté; Dijon France
- Génétique des Anomalies du Développement; Université de Bourgogne; Dijon France
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Vivante A, Hwang DY, Kohl S, Chen J, Shril S, Schulz J, van der Ven A, Daouk G, Soliman NA, Kumar AS, Senguttuvan P, Kehinde EO, Tasic V, Hildebrandt F. Exome Sequencing Discerns Syndromes in Patients from Consanguineous Families with Congenital Anomalies of the Kidneys and Urinary Tract. J Am Soc Nephrol 2016; 28:69-75. [PMID: 27151922 DOI: 10.1681/asn.2015080962] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 03/16/2016] [Indexed: 12/22/2022] Open
Abstract
Congenital anomalies of the kidneys and urinary tract (CAKUT) are the leading cause of CKD in children, featuring a broad variety of malformations. A monogenic cause can be detected in around 12% of patients. However, the morphologic clinical phenotype of CAKUT frequently does not indicate specific genes to be examined. To determine the likelihood of detecting causative recessive mutations by whole-exome sequencing (WES), we analyzed individuals with CAKUT from 33 different consanguineous families. Using homozygosity mapping and WES, we identified the causative mutations in nine of the 33 families studied (27%). We detected recessive mutations in nine known disease-causing genes: ZBTB24, WFS1, HPSE2, ATRX, ASPH, AGXT, AQP2, CTNS, and PKHD1 Notably, when mutated, these genes cause multiorgan syndromes that may include CAKUT as a feature (syndromic CAKUT) or cause renal diseases that may manifest as phenocopies of CAKUT. None of the above monogenic disease-causing genes were suspected on clinical grounds before this study. Follow-up clinical characterization of those patients allowed us to revise and detect relevant new clinical features in a more appropriate pathogenetic context. Thus, applying WES to the diagnostic approach in CAKUT provides opportunities for an accurate and early etiology-based diagnosis and improved clinical management.
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Affiliation(s)
- Asaf Vivante
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel
| | - Daw-Yang Hwang
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Nephrology, Department of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Stefan Kohl
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Cologne Children's Hospital, Cologne, Germany
| | - Jing Chen
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shirlee Shril
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julian Schulz
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amelie van der Ven
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ghaleb Daouk
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neveen A Soliman
- Department of Pediatrics, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.,Egyptian Group for Orphan Renal Diseases, Cairo, Egypt
| | - Aravind Selvin Kumar
- Pediatric Nephrology Department, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India
| | - Prabha Senguttuvan
- Pediatric Nephrology Department, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India
| | - Elijah O Kehinde
- Division of Urology, Department of Surgery, Kuwait University, Safat, Kuwait
| | - Velibor Tasic
- Medical Faculty Skopje, University Children's Hospital, Skopje, Macedonia; and
| | - Friedhelm Hildebrandt
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; .,Howard Hughes Medical Institute, Chevy Chase, Maryland
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