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Anderson S. Hyaline Fibromatosis Syndrome Diagnosed by Whole Genome Sequencing. J Pediatr Health Care 2024:S0891-5245(24)00022-1. [PMID: 38385928 DOI: 10.1016/j.pedhc.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/02/2023] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
Hyaline fibromatosis syndrome is an extremely rare autosomal recessive condition caused by biallelic pathogenic variants in the ANTXR2 gene that leads to abnormal growth of hyalinized fibrous tissue. Severity ranges from life-threatening intractable diarrhea, recurrent infection, and acute pain to milder disease resulting in skin lesions and less severe contractures. Here, we report the case of a 3-month-old female who presented with joint contractures and severe pain followed by failure to thrive. Diagnosis via ultra-rapid whole genome sequencing allowed our team to provide appropriate care and anticipatory guidance for this patient and family.
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Liu Y, Zeng X, Ding Y, Xu Y, Duan D. Hyaline fibromatosis syndrome: a case presenting with gingival enlargement as the only clinical manifestation and a report of two new mutations in the ANTXR2 gene. BMC Oral Health 2021; 21:508. [PMID: 34627224 PMCID: PMC8501544 DOI: 10.1186/s12903-021-01840-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/17/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hyaline fibromatosis syndrome (HFS) is a rare autosomal recessive disorder caused by mutations in the gene for anthrax toxin receptor-2 (ANTXR2). The clinical features of HFS include skin thickening with nodules, papules and plaques, gingival enlargement, joint stiffness and contractures, and systemic manifestations. Notably, in all patients with HFS reported in the literature, gingival enlargement has never occurred alone. CASE PRESENTATION A case of a child with gingival enlargement as the only clinical manifestation, who was later diagnosed with HFS, is described. In this case, the absence of skin and joint lesions and other characteristic clinical presentations gave rise to a diagnostic problem. This uncommon condition was clinically indistinguishable from other diseases or conditions that presented with diffuse gingival enlargement. A definitive diagnosis of HFS was reached through genetic analysis. Trio whole exome sequencing revealed compound heterozygous mutations of ANTXR2 in this patient and two new mutations were reported. CONCLUSIONS The findings of this case serve as an important reminder to clinicians. When dental practitioners encounter gingival manifestations of HFS without accompanied skin or joint involvement, there is a need to pay attention to the differential diagnosis and increase awareness of HFS.
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Affiliation(s)
- Yiying Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Periodontology, West China Hospital of Stomatology, Sichuan University, No.14, Section 3, Renmin South Road, Chengdu, 610041, China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi Ding
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Periodontology, West China Hospital of Stomatology, Sichuan University, No.14, Section 3, Renmin South Road, Chengdu, 610041, China
| | - Yi Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Periodontology, West China Hospital of Stomatology, Sichuan University, No.14, Section 3, Renmin South Road, Chengdu, 610041, China
| | - Dingyu Duan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Periodontology, West China Hospital of Stomatology, Sichuan University, No.14, Section 3, Renmin South Road, Chengdu, 610041, China.
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Pereira TDSF, Sales JFD, Travassos DV, Lanza CR, Castro WH, Gomes CC, Fonseca FP, Silva TA, Gomez RS. Hyaline fibromatosis syndrome: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:e328-e335. [PMID: 32771412 DOI: 10.1016/j.oooo.2020.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/11/2020] [Accepted: 06/26/2020] [Indexed: 11/18/2022]
Abstract
Hyaline fibromatosis syndrome (HFS) is a rare monogenic disease inherited in an autosomal recessive pattern and characterized by hyaline deposits on the skin, mucosa, and multiple organs; osteoporosis; and joint contractures. This progressive condition is caused by mutations in the gene encoding the anthrax toxin receptor 2 protein (ANTXR2). HFS is a disabling disease, and patients suffer from progressive pain and disfiguring symptoms. There are few published case reports detailing oral findings in patients with this condition. The present case report describes a 4-year-old female patient who showed severe manifestations of HFS, emphasizing the oral manifestations, the histopathologic aspects of HFS, the molecular pathogenesis, and the interdisciplinary management of patients affected by this condition.
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Affiliation(s)
- Thaís Dos Santos Fontes Pereira
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Jéssica Félix de Sales
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas, Universidade Federal de Minas Gerais
| | - Denise Vieira Travassos
- Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais
| | - Célia Regina Lanza
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Wagner Henriques Castro
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tarcília Aparecida Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Braizat O, Badran S, Hammouda A. Juvenile Hyaline Fibromatosis: Literature Review and a Case Treated With Surgical Excision and Corticosteroid. Cureus 2020; 12:e10823. [PMID: 33173631 PMCID: PMC7645300 DOI: 10.7759/cureus.10823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Juvenile hyaline fibromatosis (JHF) is an extremely rare autosomal recessive disease with less than a hundred cases reported worldwide and is more prevalent in the middle east due to higher rates of interfamilial marriages. Manifestations can be debilitating, and patients typically present with decreased joint mobility, gingival hypertrophy, nodular skin lesions, papulonodular skin lesions and osteolytic bone disease. JHF is a relatively mild presentation of the hyaline fibromatosis syndrome (HFS) family of diseases, with Infantile hyaline fibromatosis (IHF) being the more lethal form. A mutation of the (CMG2) gene on chromosome 4q21 is hypothesized to result in the abnormal deposition of amorphous hyaline substance in different body tissues. There are few studies that evaluated the role of surgery, corticosteroid therapy and physiotherapy or a combination of these modalities in providing symptomatic relief. In our paper, we present a literature review and case presentation for 28-year-old women with JHF, treated with surgical excision and corticosteroid therapy. Early surgical treatment provided instantaneous and more sustainable results, while corticosteroids can be used as alternative modalities with temporary outcomes.
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Affiliation(s)
- Omar Braizat
- Department of Plastic Surgery, Hamad Medical Corporation, Doha, QAT
| | - Saif Badran
- Department of Plastic Surgery, Hamad Medical Corporation, Doha, QAT.,Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, QAT
| | - Atalla Hammouda
- Department of Plastic Surgery, Hamad Medical Corporation, Doha, QAT
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Härter B, Benedicenti F, Karall D, Lausch E, Schweigmann G, Stanzial F, Superti‐Furga A, Scholl‐Bürgi S. Clinical aspects of Hyaline Fibromatosis Syndrome and identification of a novel mutation. Mol Genet Genomic Med 2020; 8:e1203. [PMID: 32196989 PMCID: PMC7284039 DOI: 10.1002/mgg3.1203] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Hyaline fibromatosis syndrome is an autosomal recessive disease caused by mutations in ANTXR2 which leads to loss of function of the transmembrane protein anthrax toxin receptor 2. It is distinguished by characteristic skin lesions, gingival hyperplasia, joint and bone disease, and systemic involvement. METHODS Based on the case of an 11-year-old female patient with typical features of hyaline fibromatosis syndrome and the underlying pathogenic compound heterozygote variants in ANTXR2 we discuss the genetic and clinical aspects of hyaline fibromatosis syndrome. RESULTS The novel mutation in ANTXR2 (c.1223T>C, p.Leu408Pro variant) seems to allow for a protracted course of the disease. CONCLUSION Our findings add to the phenotypic, genetic, and biochemical spectrum of hyaline fibromatosis syndrome.
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Affiliation(s)
- Bettina Härter
- Division of Pediatric SurgeryDepartment of Visceral, Transplant and Thoracic SurgeryCenter of Operative MedicineInnsbruck Medical UniversityInnsbruckAustria
| | - Francesco Benedicenti
- Clinical Genetics Service and South Tyrol Coordination Center for Rare DiseasesDepartment of PediatricsRegional Hospital of BolzanoBolzanoItaly
| | - Daniela Karall
- Department of Pediatrics IInnsbruck Medical UniversityInnsbruckAustria
| | - Ekkehard Lausch
- Pediatric Genetics SectionDepartment of PediatricsUniversity of FreiburgFreiburgGermany
| | | | - Franco Stanzial
- Clinical Genetics Service and South Tyrol Coordination Center for Rare DiseasesDepartment of PediatricsRegional Hospital of BolzanoBolzanoItaly
| | - Andrea Superti‐Furga
- Division of Genetic MedicineLausanne University HospitalUniversity of LausanneLausanneSwitzerland
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Gao Y, Bai J, Wang J, Liu X. Two novel mutations in the ANTXR2 gene in a Chinese patient suffering from hyaline fibromatosis syndrome: A case report. Mol Med Rep 2018; 18:4004-4008. [PMID: 30152846 DOI: 10.3892/mmr.2018.9421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/14/2018] [Indexed: 11/06/2022] Open
Abstract
Hyaline fibromatosis syndrome (HFS; MIM 228600) is a rare autosomal recessive disorder characterized by the abnormal growth of hyalinized fibrous tissue at subcutaneous regions on the scalp, ears and neck. The disease is caused by either a homozygous or compound heterozygous mutation of the anthrax toxin receptor 2 (ANTXR2) gene. The present study describes a patient with HFS confirmed by clinical examination as well as histopathological and genetic analyses. Numerous painless and variable‑sized subcutaneous nodules were observed on the scalp, ear, trunk and four extremities of the patient. With increasing age, the number and size of the nodules gradually increased in the patient. The patient additionally presented with severe gingival thickening and developed pearly papules on the ears, back and penis foreskin. Biopsies of ear nodules revealed that the tumor was located in the dermis, and no marked alterations were observed in the epidermis compared with healthy patients. Spindle‑shaped or round tumor cells were revealed to be immersed in the eosinophilic hyaline ground substance. Furthermore, a skeletal X‑ray of the patient revealed multiple low‑density imaging on the right distal humerus. Compound heterozygous mutations in the ANTXR2 gene were identified in the patient: c.470_472del in exon 5 and c.1073 delC in exon 13. c.470_472del were revealed to be inherited from his mother and father, respectively. These two mutations, c.470_472del and c.1073 delC, to the best of our knowledge, have not previously been identified. Identification of the mutations in ANTXR2 may make prenatal diagnosis of HFS possible during future pregnancies.
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Affiliation(s)
- Ying Gao
- Department of Dermatology, Capital Institute of Pediatrics, Peking University Teaching Hospital, Beijing 100020, P.R. China
| | - Jinli Bai
- Department of Medical Genetics, Capital Institute of Pediatrics, Peking University Teaching Hospital, Beijing 100020, P.R. China
| | - Jiancai Wang
- Department of Dermatology, Capital Institute of Pediatrics, Peking University Teaching Hospital, Beijing 100020, P.R. China
| | - Xiaoyan Liu
- Department of Dermatology, Capital Institute of Pediatrics, Peking University Teaching Hospital, Beijing 100020, P.R. China
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Haidar Z, Temanni R, Chouery E, Jitesh P, Liu W, Al-Ali R, Wang E, Marincola FM, Jalkh N, Haddad S, Haidar W, Chouchane L, Mégarbané A. Diagnosis implications of the whole genome sequencing in a large Lebanese family with hyaline fibromatosis syndrome. BMC Genet 2017; 18:3. [PMID: 28103792 PMCID: PMC5244738 DOI: 10.1186/s12863-017-0471-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hyaline fibromatosis syndrome (HFS) is a recently introduced alternative term for two disorders that were previously known as juvenile hyaline fibromatosis (JHF) and infantile systemic hyalinosis (ISH). These two variants are secondary to mutations in the anthrax toxin receptor 2 gene (ANTXR2) located on chromosome 4q21. The main clinical features of both entities include papular and/or nodular skin lesions, gingival hyperplasia, joint contractures and osteolytic bone lesions that appear in the first few years of life, and the syndrome typically progresses with the appearance of new lesions. METHODS We describe five Lebanese patients from one family, aged between 28 and 58 years, and presenting with nodular and papular skin lesions, gingival hyperplasia, joint contractures and bone lesions. Because of the particular clinical features and the absence of a clinical diagnosis, Whole Genome Sequencing (WGS) was carried out on DNA samples from the proband and his parents. RESULTS A mutation in ANTXR2 (p. Gly116Val) that yielded a diagnosis of HFS was noted. CONCLUSIONS The main goal of this paper is to add to the knowledge related to the clinical and radiographic aspects of HFS in adulthood and to show the importance of Next-Generation Sequencing (NGS) techniques in resolving such puzzling cases.
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Affiliation(s)
- Zahraa Haidar
- Unité de Génétique Médicale, Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
| | - Ramzi Temanni
- Bioinformatics Division, Sidra Medical & Research Center, Doha, Qatar
| | - Eliane Chouery
- Unité de Génétique Médicale, Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
| | - Puthen Jitesh
- Bioinformatics Division, Sidra Medical & Research Center, Doha, Qatar
| | - Wei Liu
- Genomics Core Laboratory, Translational Medicine Division, Sidra Medical & Research Center, Doha, Qatar
| | - Rashid Al-Ali
- Bioinformatics Division, Sidra Medical & Research Center, Doha, Qatar
| | - Ena Wang
- Genomics Core Laboratory, Translational Medicine Division, Sidra Medical & Research Center, Doha, Qatar
| | | | - Nadine Jalkh
- Unité de Génétique Médicale, Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
| | - Soha Haddad
- Department of Radiology, Hotel Dieu de France University hospital–Beirut, Beirut, Lebanon
| | - Wassim Haidar
- Department of General surgery, Dar Al Amal University Hospital-Baalbeck, Baalbeck, Lebanon
| | - Lotfi Chouchane
- Laboratory of Genetic Medicine and Immunology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - André Mégarbané
- Institut Jérôme Lejeune, 37, rue des Volontaires, Paris, 75015 France
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Marques SA, Stolf HO, Polizel JO, Munhoz T, Brandão MC, Marques MEA. Hyaline fibromatosis syndrome: cutaneous manifestations. An Bras Dermatol 2016; 91:226-9. [PMID: 27192526 PMCID: PMC4861574 DOI: 10.1590/abd1806-4841.20163799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 10/13/2014] [Indexed: 11/22/2022] Open
Abstract
Hyaline fibromatosis syndrome is the current name for clinical manifestations of diseases previously known as "infantile systemic hyalinosis" and "juvenile hyaline fibromatosis". The authors report representative clinical cases of each one of the above subtypes with emphasis on cutaneous manifestations and difficulties for early diagnosis in this syndrome, essentially of multidisciplinary approach.
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Affiliation(s)
- Silvio Alencar Marques
- Universidade Estadual Paulista “Júlio de
Mesquita Filho” (Unesp) – Botucatu (SP), Brazil
| | - Hamilton Ometto Stolf
- Universidade Estadual Paulista “Júlio de
Mesquita Filho” (Unesp) – Botucatu (SP), Brazil
| | - Juliana Ocanha Polizel
- Universidade Estadual Paulista “Júlio de
Mesquita Filho” (Unesp) – Botucatu (SP), Brazil
| | - Tânia Munhoz
- Universidade Estadual Paulista “Júlio de
Mesquita Filho” (Unesp) – Botucatu (SP), Brazil
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Yonel Z, Parma S, Chapple ILC. Juvenile Hyaline Fibromatosis: Impact of Periodontal Care on Quality of Life and a Patient Perspective. DENTAL UPDATE 2015; 42:656-8, 660-2, 665-6. [PMID: 26630863 DOI: 10.12968/denu.2015.42.7.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Juvenile hyaline fibromatosis (JHF) is a rare autosomal recessive inherited condition presenting early in life and characterized by the accumulation of hyaline-like tissue in the skin as well as various organs. Gingival overgrowth is a significant oral manifestation. This paper highlights how early and essential periodontal intervention may be necessary to improve mastication and subsequent weight gain, and to eliminate pain and improve the patient's quality of life. Here we highlight the key features of this condition and demonstrate how appropriate surgical management can have a significant impact on a patient's wellbeing. CPD/CLINICAL RELEVANCE: Juvenile hyaline fibromatosis has a significant impact on patient wellbeing and it is therefore important that clinicians are able to recognize the condition and ensure that patients receive appropriate care and management.
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Abduljabbar MH. A case report of juvenile hyaline fibromatosis. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2014. [DOI: 10.1016/j.jdds.2014.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Denadai R, Bertola DR, Raposo-Amaral CE. Systemic hyalinosis: new terminology, severity grading system, and surgical approach. J Pediatr 2012; 161:173; author reply 173-4. [PMID: 22575244 DOI: 10.1016/j.jpeds.2012.03.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 03/19/2012] [Indexed: 02/08/2023]
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Denadai R, Raposo-Amaral CE, Bertola D, Kim C, Alonso N, Hart T, Han S, Stelini RF, Buzzo CL, Raposo-Amaral CA, Hart PS. Identification of 2 novel ANTXR2 mutations in patients with hyaline fibromatosis syndrome and proposal of a modified grading system. Am J Med Genet A 2012; 158A:732-42. [PMID: 22383261 PMCID: PMC4264531 DOI: 10.1002/ajmg.a.35228] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 12/15/2011] [Indexed: 02/05/2023]
Abstract
Juvenile hyaline fibromatosis (JHF) and infantile systemic hyalinosis (ISH) are rare, autosomal recessive disorders of the connective tissue caused by mutations in the gene encoding the anthrax toxin receptor 2 protein (ANTXR2) located on chromosome 4q21. Characteristically, these conditions present with overlapping clinical features, such as nodules and/or pearly papules, gingival hyperplasia, flexion contractures of the joints, and osteolytic bone defects. The present report describes a pair of sibs and three other JHF/ISH patients whose diagnoses were based on typical clinical manifestations and confirmed by histopathologic analyses and/or molecular analysis. A comparison of ISH and JHF, additional thoughts about new terminology (hyaline fibromatosis syndrome) and a modified grading system are also included.
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Affiliation(s)
- Rafael Denadai
- School of Medical Sciences, Marília University, Marília, SP, Brazil
| | - Cassio E. Raposo-Amaral
- Institute of Plastic and Craniofacial Surgery, Brazilian Society of Research and Assistance to Craniofacial Rehabilitation Hospital (SOBRAPAR), Campinas, SP, Brazil
| | - Débora Bertola
- Genetics Unit, Department of Pediatrics, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Chong Kim
- Genetics Unit, Department of Pediatrics, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Nivaldo Alonso
- Division of Plastic Surgery, Department of Surgery, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Thomas Hart
- Human Craniofacial Genetics Section, National Institute of Dental and Craniofacial Research (NIDCR), National Institutes of Health (NIH), Bethesda, Maryland
| | - Sangwoo Han
- National Institute of Dental Research, National Institutes of Health (NIH), Bethesda, Maryland
| | - Rafael F. Stelini
- Department of Anatomic Pathology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Celso L. Buzzo
- Institute of Plastic and Craniofacial Surgery, Brazilian Society of Research and Assistance to Craniofacial Rehabilitation Hospital (SOBRAPAR), Campinas, SP, Brazil
| | - Cesar A. Raposo-Amaral
- Institute of Plastic and Craniofacial Surgery, Brazilian Society of Research and Assistance to Craniofacial Rehabilitation Hospital (SOBRAPAR), Campinas, SP, Brazil
| | - P. Suzanne Hart
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, Maryland
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