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Saettini F, Coliva TA, Vendemini F, Galbiati M, Bugarin C, Masetti R, Moratto D, Chiarini M, Guerra F, Iascone M, Badolato R, Cazzaniga G, Niemeyer C, Flotho C, Biondi A. Abnormal B-Cell Maturation and Increased Transitional B Cells in CBL Syndrome. Front Pediatr 2022; 10:935951. [PMID: 35967575 PMCID: PMC9366004 DOI: 10.3389/fped.2022.935951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
CBL syndrome is a Noonan-like RASopathy with heterogeneous clinical phenotype and predisposition to juvenile myelomonocytic leukemia (JMML). Here we describe two patients with identical germline CBL mutation and clinical and immune-hematological overlapping features with autoimmune lymphoproliferative syndrome (ALPS) and B-cell expansion with NF-κB and T-cell anergy (BENTA) syndrome. Increased immature/transitional B cells can be depicted in CBL syndrome, ALPS, and BENTA. Nonetheless, our patients here described showed peculiar B-cell phenotype due to increased immature/transitional CD34+ B cells. This feature differentiates CBL syndrome from BENTA, pointing toward an abnormal proliferation of B-cell early precursors.
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Affiliation(s)
- Francesco Saettini
- Department of Pediatric Hematology, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), University of Milano Bicocca, Monza, Italy
| | - Tiziana Angela Coliva
- Department of Pediatric Hematology, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), University of Milano Bicocca, Monza, Italy
| | - Francesca Vendemini
- Department of Pediatric Hematology, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), University of Milano Bicocca, Monza, Italy
| | - Marta Galbiati
- Centro Ricerca Tettamanti, University of Milano Bicocca, Monza, Italy
| | - Cristina Bugarin
- Centro Ricerca Tettamanti, University of Milano Bicocca, Monza, Italy
| | - Riccardo Masetti
- Pediatric Hematology-Oncology Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Daniele Moratto
- Flow Cytometry, Clinical Chemistry Laboratory, Brescia, Italy
| | - Marco Chiarini
- Flow Cytometry, Clinical Chemistry Laboratory, Brescia, Italy
| | - Fabiola Guerra
- Department of Pediatric Hematology, Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM), University of Milano Bicocca, Monza, Italy.,Centro Ricerca Tettamanti, University of Milano Bicocca, Monza, Italy
| | - Maria Iascone
- Laboratorio di Genetica Medica, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Raffaele Badolato
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia and ASST-Spedali Civili of Brescia, Brescia, Italy
| | | | - Charlotte Niemeyer
- Department of Pediatrics and Adolescent Medicine, University Children's Hospital, University of Freiburg, Freiburg, Germany
| | - Christian Flotho
- Department of Pediatrics and Adolescent Medicine, University Children's Hospital, University of Freiburg, Freiburg, Germany
| | - Andrea Biondi
- Pediatric Department and Centro Tettamanti-European Reference Network PaedCan, EuroBloodNet, MetabERN-University of Milano-Bicocca-Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM)-Ospedale, San Gerardo, Monza, Italy
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Schönfeld M, Selig M, Russo A, Lindner C, Kampmann C, Mildenberger E, Whybra C. Rapid detection by hydrops panel of Noonan syndrome with PTPN11 mutation (p.Thr73Ile) and persistent thrombocytopenia. Mol Genet Genomic Med 2020; 8:e1174. [PMID: 32144894 PMCID: PMC7216795 DOI: 10.1002/mgg3.1174] [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] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/21/2020] [Accepted: 01/30/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Nonimmune hydrops fetalis (NIHF) is still a challenging diagnosis. The differential diagnosis is extensive and the success of identifying a cause depends on the thoroughness of efforts to establish a diagnosis. For the early diagnosis of NIHF, a virtual gene panel diagnostic tool was developed. The female premature baby in question was delivered via emergency cesarean at 30 + 1 weeks of gestational age (GA) due to rapidly developing NIHF to a healthy mother. The family history was noncontributory. METHODS DNA of the family was extracted and sequenced by the virtual hydrops panel with whole-exome sequencing. RESULTS The hydrops panel revealed Noonan syndrome (NS) with a germline mutation in PTPN11 c.218C>T (p.Thr73Ile). CONCLUSION The diagnosis of our patient was rapidly confirmed by the hydrops panel. The variant of c.218C>T (p.Thr73Ile) has not yet been described in literature relating to NIHF. Only a few case reports of this variant are known. This particular mutation is associated with Noonan syndrome, congenital heart defect and persistent thrombocytopenia. Few reveal juvenile myelomonocytic leukemia.
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Affiliation(s)
- Mascha Schönfeld
- Neonatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mareike Selig
- Institute of Human Genetics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Alexandra Russo
- Hematology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Christine Lindner
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Christoph Kampmann
- Pediatric Cardiology, Department of Pediatrics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Eva Mildenberger
- Neonatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Catharina Whybra
- Neonatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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