Macrocephaly–cutis marmorata telangiectatica congenita: A case report and review of salient features

Cutis marmorata telangiectatica congenita and major lower limb asymmetry

A 39-week-old male newborn presented at birth with atrophic erythematous and purpuric skin lesions, in a typical right-sided segmental distribution. Lesions were persistent and unaffected by rewarming in the postpartum period. Postnatal echocardiogram showed a predominance of the right cavities and an upper atrial septal defect. Cerebral and abdominal ultrasound were normal along with ophthalmological examination. On follow-up, lower limbs asymmetry was noted. The right lower limb was shorter in length and had a smaller diameter. At 6 months, the right lower limb was 1.5 cm shorter than the left, most likely related to nutritive vessels malformations. The discrepancy was even more pronounced at the age of 9 months. This leg-length asymmetry can lead to severe functional limitations in the future.

Limb length discrepancy in cutis marmorata telangiectatica congenita: an audit of assessment and management in a multidisciplinary setting

BACKGROUND

Cutis marmorata telangiectatica congenita (CMTC) is a vascular malformation, diagnosed based on cutaneous manifestations. It is associated with limb length discrepancy (LLD) and asymmetry, but the exact extent of this and its relationship to the site of the cutaneous manifestations have not been delineated.

OBJECTIVES

To review the orthopaedic problems associated with CMTC, concentrating on the assessment and management of the LLD.

METHODS

This study is a retrospective analysis of orthopaedic, dermatological and vascular data that were collected prospectively at our tertiary referral centre. We identified 80 patients with an initial diagnosis of CMTC; 57/69 patients with a confirmed diagnosis had lower-limb involvement.

RESULTS

An LLD was identified in 51% of cases. The discrepancy was significant (defined as ≥ 2 cm) in nine patients and was confirmed using standing leg-length radiographs. Of these patients, three had epiphysiodesis to correct the discrepancy, and surgery is planned in five others.

CONCLUSIONS

Limb length discrepancy and asymmetry are common in CMTC; however, this is below the significant threshold in most cases. It is therefore recommended that any discrepancy be initially monitored clinically. This should be followed by standing leg-length radiographs at the age of 10 years (girls) or 12 years (boys), or if the LLD is ≥ 2 cm. If this is confirmed radiologically, orthopaedic referral is advised to consider surgical intervention such as epiphysiodesis.

Cutis marmorata telangiectatica congenita in a preterm newborn - Case report and literature review

BACKGROUND

Cutis marmorata telangiectatica congenita (CMTC) is a sporadic congenital skin vascular abnormality. Significant number of patients has other congenital anomalies.

CASE REPORT

We report a case of a preterm male newborn with cutis marmorata pattern presented on the skin of the face, right side of front of the trunk, whole back, glutei and both legs. Besides, microretrognatia and asymmetric, bad-formed, low-set ears were notable. Ophthalmologic findings showed visual impairment and pale optic nerve papilla. Monitoring of child showed mental underdevelopment and motor retardation.

CONCLUSION

CMTC is a rare finding with good prognosis of skin malformations, with an obligation of dermatologist and paediatrician to investigate other associated congenital anomalies.

Megalencephaly-capillary malformation (MCAP) and megalencephaly-polydactyly-polymicrogyria-hydrocephalus (MPPH) syndromes: two closely related disorders of brain overgrowth and abnormal brain and body morphogenesis

The macrocephaly-capillary malformation syndrome (M-CM), which we here propose to rename the megalencephaly-capillary malformation syndrome (MCAP; alternatively the megalencephaly-capillary malformation-polymicrogyria syndrome), and the more recently described megalencephaly-polymicrogyria-polydactyly-hydrocephalus syndrome (MPPH) are two megalencephaly (MEG) disorders that involve a unique constellation of physical and neuroimaging anomalies. We compare the features in 42 patients evaluated for physical and neuroimaging characteristics of MCAP and MPPH and propose a more global view of these syndromes based on classes of developmental abnormalities that include primary MEG and growth dysregulation, developmental vascular anomalies (primarily capillary malformations), distal limb anomalies (such as syndactyly and polydactyly), cortical brain malformations (most distinctively polymicrogyria, PMG), and variable connective tissue dysplasia. Based on these classes of developmental abnormalities, we propose that MCAP diagnostic criteria include progressive MEG with either vascular anomalies or syndactyly. In parallel, we propose that MPPH diagnostic criteria include progressive MEG and PMG, absence of the vascular anomalies and syndactyly characteristic of MCAP, and absence of brain heterotopia.

Macrocephaly-capillary malformation syndrome: three new cases

Overgrowth syndromes can be associated with asymmetry, obesity and various vascular malformations. Macrocephaly-Capillary Malformation (M-CM) is a more recently defined overgrowth syndrome characterized by cutaneous capillary malformation occurring in association with macrocephaly with tendency to progressive enlargement, abnormalities of somatic growth with body asymmetry including brain asymmetry, developmental delay, typical face with full cheeks, nevus flammeus of the nose and/or philtrum and upper lip, joint laxity, thickened subcutaneous tissue and 2/3 syndactyly of the toes. We evaluated three patients who demonstrated characteristic features of the disorder. Patients seen in the Genetic clinic of a tertiary care center were subjects of the analysis. We present three cases of overgrowth syndrome with common features of macrocephaly, capillary malformation, dysmorphic face and abnormal neurocognitive profile. These features are consistent with the newly defined M-CM syndrome. This condition must be differentiated from other overgrowth syndromes for appropriate surveillance for known complications and genetic counseling. We discuss the diagnostic criteria for the disorder and also recommend to include typical face with full cheeks, nevus flammeus of the nose and/or philtrum and upper lip, considering it as minor criterion on the basis of findings in present cases. One of the cases had bluish white iris which has not been described earlier.

Macrocephaly-capillary malformation: Analysis of 13 patients and review of the diagnostic criteria

Macrocephaly-capillary malformation (M-CM) is a genetic syndrome of unknown etiology characterized by an enlarged head circumference and patchy, reticular capillary malformation. We describe the clinical features of 13 cases, report on the genome-wide Copy Number Variation characterization of these patients, analyze the main clinical features of this syndrome and propose a modification of the current diagnostic criteria: the inclusion of both overgrowth/asymmetry and neuroimaging alterations as major criteria.

Macrocephaly-capillary malformation: a report of three cases and review of the literature

Macrocephaly-Cutis Marmorata Telangiectatica Congenita (M-CMTC) is a rare syndrome that was first delineated as distinct from Cutis Marmorata Telangiectatica Congenita (CMTC) in 1997. Since that time, there have been over 75 cases reported in the literature, though few are in the dermatology literature. The syndrome is characterized by macrocephaly, neonatal hypotonia, developmental delay, segmental overgrowth, syndactyly, asymmetry, connective tissue defects, and vascular stains. We report three new patients seen at the University of Miami Genodermatoses Clinic with features of M-CMTC. We believe the skin findings in our patients and in the previously published cases of M-CMTC are more consistent with capillary malformations rather than true CMTC. Therefore, we agree with recent publications that this condition be renamed Macrocephaly-Capillary Malformation (M-CM). The differential diagnoses for patients with M-CMTC include Klippel Trenaunay Syndrome (KTS) and Proteus or Proteus-like syndromes. Given the significant prognostic and likely genetic differences among these conditions it is important to distinguish M-CMTC from these syndromes.