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Frudit P, Vitturi BK, Navarro FC, Rondelli I, Pozzan G. Multiple cardiac rhabdomyomas in tuberous sclerosis complex: case report and review of the literature. AUTOPSY AND CASE REPORTS 2019; 9:e2019125. [PMID: 31641665 PMCID: PMC6771448 DOI: 10.4322/acr.2019.125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/04/2019] [Indexed: 11/23/2022] Open
Abstract
Cardiac rhabdomyoma is a benign tumor which constitutes the most common cardiovascular feature of the tuberous sclerosis complex, a multisystem genetically determined neurocutaneous disorder. Cardiac rhabdomyomas can be detected in the prenatal ultrasound, are usually asymptomatic and spontaneously regress within the first three years of life. Less often, the tumors' size, number, and location can produce a mass effect that may lead to blood flow abnormalities or organ dysfunction (heart failure and arrhythmia). In this setting, severe morbidity, and eventually, a lethal outcome despite clinical and surgical treatment may ensue. We describe a fatal case of multiple cardiac rhabdomyomas in a newborn girl. One of the rhabdomyomas was large and unfavorably located, causing significant obstruction of the left ventricular outflow tract. The autopsy identified, in addition to cardiac rhabdomyomas, brain glioneuronal hamartomas (cortical tubers), subependymal nodules and subependymal giant cell tumors, characteristic of the tuberous sclerosis complex. The newborn's family was investigated for the presence of typical clinical symptoms of the complex and image findings showed significant phenotypical variations and a broad symptom spectrum among the family members. This interesting case underscores the variability of tuberous sclerosis complex and the importance of performing a comprehensive postmortem examination in the identification of the cause of death, especially in the setting of familial disease.
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Affiliation(s)
- Paula Frudit
- Santa Casa de São Paulo School of Medical Sciences. São Paulo, SP, Brazil
| | | | - Flavia Cristina Navarro
- Irmandade da Santa Casa de Misericórdia de São Paulo, Department of Pediatrics. São Paulo, SP, Brazil
| | - Ivan Rondelli
- Irmandade da Santa Casa de Misericórdia de São Paulo, Department of Pathology. São Paulo, SP, Brazil
| | - Geanete Pozzan
- Irmandade da Santa Casa de Misericórdia de São Paulo, Department of Pathology. São Paulo, SP, Brazil
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Aw F, Goyer I, Raboisson MJ, Boutin C, Major P, Dahdah N. Accelerated Cardiac Rhabdomyoma Regression with Everolimus in Infants with Tuberous Sclerosis Complex. Pediatr Cardiol 2017; 38:394-400. [PMID: 27878332 DOI: 10.1007/s00246-016-1528-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 11/11/2016] [Indexed: 01/25/2023]
Abstract
Tuberous sclerosis complex is associated with benign tumors such as cardiac rhabdomyomas (RHM) caused by the disinhibition of the mammalian target of rapamycin (mTOR) protein. Recent reports on everolimus, an mTOR inhibitor, have shown size reduction of RHM. We compared cases recently treated with everolimus to historic controls whose first echocardiography was within first month of life. The largest dimension of the largest RHM was reported as a percentage compared to the earliest echocardiography study. Treatment of the four cases was started at a median age of 6.5 days (range 2-20) with an initial enteral dose of 0.1 mg daily, aiming at a therapeutic serum trough level of 5-15 ng/mL. Median duration of everolimus treatment was 73 days (range 34-138). Compared to 10 historic controls, everolimus-treated patients had 11.8 times faster RHM size regression rate (slope -0.0285 vs. -0.0024; p < 0.001). The average time to 50% size reduction was 1.13 ± 0.33 month (range 0.66-1.4 months) with everolimus versus 72.9 ± 53.03 months in controls (p = 0.026). Following treatment with everolimus, one case was operated for congenital heart disease, without requirement of RHM resection, two others had the massive left ventricle RHM shrink to non-consequential size. The latter had a disappearance of RHM, but everolimus therapy was maintained to prevent the regrowth of a significant cerebral tumor. Everolimus is efficacious for size reduction of RHM during the neonatal period. With limited safety data, this approach should be used with caution in selective cases.
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Affiliation(s)
- Fatou Aw
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, 3175, Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
- Aristide le Dantec Hospital, Cheikh Anta Diop University, Dakar, Senegal
| | - Isabelle Goyer
- Division of Clinical Pharmacology, Department of Pharmacy, CHU Sainte-Justine, University of Montreal, Montréal, QC, Canada
| | - Marie-Josée Raboisson
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, 3175, Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Christine Boutin
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, 3175, Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Philippe Major
- Department of Neurological Sciences, CHU Sainte-Justine, University of Montreal, Montréal, QC, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, 3175, Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
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Jordan CP, Costello JP, Endicott KM, Reyes C, Hougen TJ, Cummings SD, Nath DS. Intracardiac tumor causing left-ventricular outflow-tract obstruction in a newborn. J Saudi Heart Assoc 2016; 28:170-2. [PMID: 27358535 PMCID: PMC4917640 DOI: 10.1016/j.jsha.2015.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/10/2015] [Accepted: 12/23/2015] [Indexed: 12/03/2022] Open
Abstract
The following report describes the case of newborn girl with an asymptomatic systolic murmur, which on imaging revealed a nearly obstructive mass in the left-ventricular outflow tract. The mass was resected and found to be consistent with a rhabdomyoma. Here, we describe the pathologic and clinical characteristics of this tumor.
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Fuller MY, Wolf DA, Buja LM. Sudden death in a 15-year-old with diffuse cardiac rhabdomyomatosis: an autopsy case report. Cardiovasc Pathol 2014; 23:351-3. [DOI: 10.1016/j.carpath.2014.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 07/16/2014] [Indexed: 10/25/2022] Open
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