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Lukas M, Harald G, Sanz J, Trippel M, Sabina G, Jochen R. Cutaneous squamous cell carcinoma in an autosomal-recessive Adams-Oliver syndrome patient with a novel frameshift pathogenic variant in the EOGT gene. Am J Med Genet A 2022; 188:3318-3323. [PMID: 36059114 PMCID: PMC9826191 DOI: 10.1002/ajmg.a.62961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 06/20/2022] [Accepted: 07/16/2022] [Indexed: 01/31/2023]
Abstract
Aplasia cutis congenita (ACC) of the scalp and terminal transverse limb defects (TTLD) are the characteristic findings of Adams-Oliver syndrome (AOS). The variable clinical spectrum further includes cardiac, neurologic, renal, and ophthalmological findings. Associated genes in AOS are in the Notch and the CDC42/Rac1 signaling pathways. Both autosomal-dominant and autosomal-recessive inheritances have been reported, the latter with pathogenic variants in DOCK6 or EOGT. The EOGT-associated recessive type of AOS has been postulated to present a more favorable prognosis. We here report a 12-year-old girl from a refugee family of Iraq with consanguineous parents. She was born with a severe phenotype of AOS presenting a large ACC of the scalp with an underlying skull defect, which was often infected and inflamed. Afterward, additional ulceration developed. Furthermore, the girl showed microcephaly, TTLD on both hands and feet, and neurological findings: spastic paresis, epilepsy and suspicion of intellectual deficit. Molecular genetic analysis (next-generation sequencing) revealed a novel frameshift mutation in the EOGT gene in Exon 13 in homozygous constellation: c.1013dupA p.(Asn338Lysfs*24). A biopsy within an ulceration at the scalp ACC showed a cutaneous squamous cell carcinoma (cSCC) with local invasive growth into the dura, the meninges, and the cortex. Treatment including surgical resection and focal irradiation was not curative and the girl deceased 6 months after initial diagnosis. This report on a patient with AOS and an autosomal-recessive EOGT gene variant dying of a local aggressive cSCC at an ACC lesion shows that close monitoring of ACC is essential.
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Affiliation(s)
- Meyer‐Landolt Lukas
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, InselspitalUniversity Hospital, University of BernBernSwitzerland
| | - Gaspar Harald
- Department of Human Genetics, InselspitalBern University Hospital, University of BernBernSwitzerland,Present address:
Medical Genetics MainzMainzGermany
| | - Javier Sanz
- Department of Human Genetics, InselspitalBern University Hospital, University of BernBernSwitzerland
| | | | - Gallati Sabina
- Department of Human Genetics, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Rössler Jochen
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, InselspitalUniversity Hospital, University of BernBernSwitzerland
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Ngeow A, Hui C, Chua AWC, Koh M, Ong YS, Poon WB. Challenges in the management of extensive aplasia cutis congenita. BMJ Case Rep 2022; 15:e246627. [PMID: 35165127 PMCID: PMC8845208 DOI: 10.1136/bcr-2021-246627] [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] [Accepted: 01/20/2022] [Indexed: 11/04/2022] Open
Abstract
Aplasia cutis congenita (ACC) is a rare group of congenital disorders characterised by focal or widespread absence of skin, predominantly affecting the scalp. A Malay female infant was born at 37 weeks with extensive ACC, affecting 37% of total body surface area, including her scalp and trunk. There is no consensus on the management of ACC given the rarity and variable presentation. A multi-disciplinary team comprising neonatologists, paediatric dermatologists, plastic surgeons and medical laboratory scientists at the skin bank, employed a more aggressive surgical approach with the aim of avoiding potentially catastrophic morbidity, including sagittal sinus haemorrhage and brain herniation. Out of several surgical options, the team used a staged artificial dermal matrix (Integra) and cultured epithelial autograft application, followed by regular wound dressing, and eventually allowed the child to achieve complete epithelialisation of her trunk, and most of scalp before she was discharged from hospital.
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Affiliation(s)
- Alvin Ngeow
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Cheryl Hui
- Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | | | - Mark Koh
- Department of Dermatology, KK Women's and Children's Hospital, Singapore
| | - Yee Siang Ong
- Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Woei Bing Poon
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
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Brockman SE, Ottolini KM, Schulz EV. Lumbar Skin Lesion in a Term Infant. Pediatr Rev 2021; 42:624-627. [PMID: 34725223 DOI: 10.1542/pir.2020-001834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Shannon E Brockman
- United States Navy Medicine Readiness and Training Command Okinawa, Okinawa, Japan.,Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD
| | - Katherine M Ottolini
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD.,Department of Neonatology, 18th Healthcare Operations Squadron, Kadena AB, Okinawa, Japan
| | - Elizabeth V Schulz
- Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD.,Department of Neonatology, 18th Healthcare Operations Squadron, Kadena AB, Okinawa, Japan
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Sezgin B, Sibar S, Findikcioglu K, Sencan A, Emmez H, Baykaner K, Ozmen S. Use of an epidermal growth factor-infused foam dressing in a complicated case of Adams-Oliver syndrome. J Wound Care 2019; 26:342-345. [PMID: 28598754 DOI: 10.12968/jowc.2017.26.6.342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Adams-Oliver syndrome is a rare disorder with varying degrees of scalp and cranial bone defects as well as limb anomalies, which can range from mild to more pronounced manifestations. In mild cases, closure of these defects can be achieved with a conservative approach. However, surgical closure is recommended in cases where the defect is extensive and includes cranial involvement. Several complicated cases of Adams-Oliver syndrome have been reported, in which flap failures were encountered and other alternatives had to be used to close critical scalp defects. Here, the case of a 4-year-old child with Adams-Oliver syndrome and a complex cranial defect with exposed titanium mesh is described. The patient was successfully treated with epidermal growth factor (EGF) infused foam dressings and subsequent split-thickness skin grafting. The EGF has been highlighted for its essential role in dermal wound repair through the stimulation of the proliferation and migration of keratinocytes, and showed accelerated wound healing when used in partial or full-thickness skin wounds.
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Affiliation(s)
- B Sezgin
- Koç University School of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey
| | - S Sibar
- Gazi University Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara, Turkey
| | - K Findikcioglu
- Gazi University Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara, Turkey
| | - A Sencan
- Bagcilar Training and Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey
| | - H Emmez
- Gazi University Hospital, Department of Neurosurgery, Ankara, Turkey
| | - K Baykaner
- Gazi University Hospital, Department of Neurosurgery, Ankara, Turkey
| | - S Ozmen
- Koç University School of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey
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Lara DA, Loar RW, Allen HD. Visual Diagnosis: A Baby with a Scalp Lesion, Rash, and Left-Foot Deformity. Pediatr Rev 2017; 38:e20-e23. [PMID: 28572145 DOI: 10.1542/pir.2016-0078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Diego A Lara
- Pediatric Cardiology, Department of Pediatrics, Ochsner Health Center for Children, New Orleans, LA
| | - Robert W Loar
- Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Hugh D Allen
- Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
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Aplasia Cutis Congenita Associated With Aplasia of the Superficial Temporal Artery. J Craniofac Surg 2017; 27:1065-7. [PMID: 27213745 DOI: 10.1097/scs.0000000000002678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aplasia cutis congenita with or without congenital anomalies is a rare congenital disorder most commonly involving the skin of the scalp, as well as the skull and dura.The etiology is uncertain, and several theories, including vascular accident intrauterine period, vascular anomaly, intrauterine infection, teratogen, and aminiotic adhesion, have been proposed. One theory is that lesions of the scalp are usually caused by vascular anomalies.The authors report on a patient with aplasia cutis congenita presenting with a huge skin and skull defect combined with aplasia of the superficial temporal artery, which was thought to be the etiology.
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Winston KR, Ketch LL. Aplasia Cutis Congenita of the Scalp, Composite Type: The Criticality and Inseparability of Neurosurgical and Plastic Surgical Management. Pediatr Neurosurg 2016; 51:111-20. [PMID: 26937970 DOI: 10.1159/000442989] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 12/01/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The object of this report is to review the management of patients having the composite type of aplasia cutis congenita in the context of the relevant literature on this condition. METHODS Clinical records, neuroimaging and photographic documentation of identified cases of composite type aplasia cutis congenita, with a comprehensive review of the literature, are the material basis of this report. RESULTS Two neonates with composite type aplasia cutis congenita are described as examples of this disorder, and their management, including complications, is discussed. Both had satisfactory outcomes. CONCLUSIONS Early aggressive surgical management with scalp rotation flaps has a low rate of complications, provides satisfactory functional and esthetic outcome, minimizes hospital stays, and should provide cost-effective care by reduction of the time to secure wound closure. Most bony defects, even large ones, commonly ossify completely. Optimal case management requires a synchronized neurosurgical and plastic surgical team. Intuitive nonsurgical and surgical approaches by the inexperienced can be hazardous.
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Affiliation(s)
- Ken R Winston
- Department of Neurosurgery, University of Colorado Denver School of Medicine, Aurora, Colo., USA
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Parental allografts in the management of Adams-Oliver syndrome. Childs Nerv Syst 2013; 29:1223-4. [PMID: 23740178 DOI: 10.1007/s00381-013-2174-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
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