1
|
Bentivegna K, Saba NJ, Shinder R, Grant-Kels JM. Ocular and orbital tumors in childhood. Clin Dermatol 2024; 42:396-405. [PMID: 38301859 DOI: 10.1016/j.clindermatol.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Pediatric tumors of the eye and orbit can be benign or malignant as well as congenital or acquired and are usually distinctively different than those seen in adults. Although most of these neoplasms are benign (eg, dermoid cyst, chalazion, molluscum), their location near and within a vital organ can result in serious dermatologic and ophthalmologic sequelae. Lesions discussed include vascular lesions, retinoblastomas (the most common primary pediatric intraocular malignancy), rhabdomyosarcoma (the most common primary pediatric orbital malignancy), Langerhans cell histiocytosis, and metastatic lesions to the orbit (neuroblastoma, Ewing sarcoma). Although cysts and ocular melanoma can occur within the pediatric population, these conditions are covered in other contributions in this issue of Clinics in Dermatology.
Collapse
Affiliation(s)
- Kathryn Bentivegna
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Nicholas J Saba
- Department of Ophthalmology, SUNY Downstate, Brooklyn, New York, USA
| | - Roman Shinder
- Department of Ophthalmology, SUNY Downstate, Brooklyn, New York, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
| |
Collapse
|
2
|
O'Riordan MM, Behan C, O'Leary F, Hudson N, Doherty CP, Cahill MT, Campbell M. Multimodal Analysis of the Retinal Manifestations of Tuberous Sclerosis Complex: A Case Series. Ophthalmic Surg Lasers Imaging Retina 2024:1-7. [PMID: 39037361 DOI: 10.3928/23258160-20240523-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
BACKGROUND AND OBJECTIVE We used a multi-modal imaging approach including fundus fluorescein angiography (FFA) to assess the retinal lesions in tuberous sclerosis complex (TSC) and evaluate their correlation with intracranial tuber burden on magnetic resonance imaging (MRI). PATIENTS AND METHODS Participants with TSC underwent bilateral fundus photography, optical coherence tomography (OCT), infrared (IR) imaging, and FFA. Participants' most recent MRI brain scans were analyzed to determine intracranial tuber load. RESULTS Nine participants were included. OCT identified all retinal astrocytic hamartoma (RAH) lesions, IR identified 75%, fundus photography identified 63%, and FFA detected just 57%. On FFA, 20% of flat-type hamartomas and all multi-nodular and transitional types were hyperfluorescent. There were significant positive correlations between the quantities of intracranial tubers and all TSC-retinal lesions (r = 0.8, P < 0.01) and all RAH lesions (r = 0.8, P = 0.01). CONCLUSIONS A multimodal imaging-based approach with fundal photography, IR imaging, and OCT should be used to assess the retina in TSC as it may indicate the intracranial tuber burden. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].
Collapse
|
3
|
Yeager LB, Kassotis A, Frank T, Li CY, Marr BP. A Review of Pediatric Ophthalmic Tumors. Pediatr Rev 2024; 45:119-131. [PMID: 38425168 DOI: 10.1542/pir.2023-006163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Tumors of the eye, orbit, and ocular adnexa can arise in the pediatric population. These entities can be both vision- and life-threatening and may be associated with systemic disease. Given their relative rarity, pediatricians must be aware of these conditions and understand what findings warrant immediate referral to an ophthalmologist for initiation of further testing. We aimed to review these conditions and highlight clinical features to promote awareness and expedite diagnosis. Tumors are subdivided into the following categories for review: anterior tumors of the eyelid and ocular surface, orbital tumors, and intraocular tumors.
Collapse
Affiliation(s)
- Lauren B Yeager
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Alexis Kassotis
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Tahvi Frank
- Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - Chloe Y Li
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Brian P Marr
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| |
Collapse
|
4
|
Patra S, Patra SS. An atypical presentation of retinal astrocytic hamartoma with co-occurring SEGA in a tuberous sclerosis patient. Radiol Case Rep 2024; 19:1046-1050. [PMID: 38226050 PMCID: PMC10788374 DOI: 10.1016/j.radcr.2023.11.039] [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: 09/01/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 01/17/2024] Open
Abstract
Tuberous sclerosis complex (TSC) is a genetic disorder that causes noncancerous growths and tumors in various body systems. This case report discusses an unusual eye condition called retinal astrocytic hamartoma (RAH) in a TSC patient, along with a brain tumor called subependymal giant cell astrocytoma (SEGA). These conditions, linked to TSC gene mutations, can be atypical in size and cause complications like vitreous hemorrhage. Surgical treatment is generally effective. Recognizing similarities between SEGA and RAH can help with early detection and comprehensive care for TSC patients.
Collapse
Affiliation(s)
- Sayantan Patra
- Department of Radiology, VMMC & Safdarjung Hospital, New Delhi, India
| | | |
Collapse
|
5
|
Dias PB, Linhares ACB, Urzedo ABDL, Preti RC, Zacharias LC, Cunha LP, Monteiro MLR, Hokazono K. Optical coherence tomography detection of retinal neural loss in patients with tuberous sclerosis. Int J Retina Vitreous 2024; 10:15. [PMID: 38311784 PMCID: PMC10840160 DOI: 10.1186/s40942-024-00535-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/19/2024] [Indexed: 02/06/2024] Open
Abstract
PURPOSE Tuberous Sclerosis (TS) is a rare, multisystem genetic disease caused by mutations in the TSC1 and TSC2 genes, leading to abnormalities in cell differentiation and proliferation. This study aimed to evaluate the neural integrity of individuals with TS by using Optical Coherence Tomography (OCT) to examine the peripapillary retinal nerve fiber layer (RNFL) thickness and the macular thickness in patients with TS and to compare with healthy controls. METHODS Peripapillary and macular OCT scans (Optopol Revo NX SD OCT) were performed on 41 eyes from 22 TS patients, divided into two groups based on the presence of retinal hamartomas, and compared to 20 eyes from a control group. The average peripapillary RNFL thickness was measured for each quadrant. The macular total thickness and ganglion cell layer (GCL) + inner plexiform layer (IPL) thickness were measured based on the Early Treatment Diabetic Retinopathy Study (ETDRS) map. All measurements were then compared between the groups and controls. RESULTS The TS group showed significantly reduced RNFL thickness and macular thickness when compared to the control group. Specifically, patients with retinal hamartomas exhibited an even more pronounced thinning of both RNFL and macular thickness. CONCLUSIONS These findings suggest that TS patients undergo significant changes in retinal neurodevelopment and experience axonal loss. This finding may have significant prognostic utility regarding central nervous system degeneration in TS, particularly among patients with retinal hamartomas. OCT may serve as a valuable tool for assessing axonal structural abnormalities in TS patients. TRIAL REGISTRATION NUMBER Not applicable.
Collapse
Affiliation(s)
- Paula Basso Dias
- Department of Ophthalmology, Hospital de Clínicas, Federal University of Paraná (HC UFPR), R. da Paz, 195 (123), Curitiba, Paraná, 80060-160, Brazil
| | - Anna Carolina Badotti Linhares
- Department of Ophthalmology, Hospital de Clínicas, Federal University of Paraná (HC UFPR), R. da Paz, 195 (123), Curitiba, Paraná, 80060-160, Brazil
| | - Ana Barbara Dias Lopes Urzedo
- Department of Ophthalmology, Hospital de Clínicas, Federal University of Paraná (HC UFPR), R. da Paz, 195 (123), Curitiba, Paraná, 80060-160, Brazil
| | - Rony Carlos Preti
- Department of Ophthalmology, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Leandro Cabral Zacharias
- Department of Ophthalmology, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Leonardo Provetti Cunha
- Department of Ophthalmology, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | | | - Kenzo Hokazono
- Department of Ophthalmology, Hospital de Clínicas, Federal University of Paraná (HC UFPR), R. da Paz, 195 (123), Curitiba, Paraná, 80060-160, Brazil.
- Department of Ophthalmology, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil.
| |
Collapse
|
6
|
Afshar P, Zeidabadinejad H, Ghassemi F, Riazi-Esfahani H, Khalili Pour E. Retinal astrocytic hamartoma complicated by branch retinal vein occlusion in a patient with tuberous sclerosis complex. Am J Ophthalmol Case Rep 2023; 32:101920. [PMID: 37663994 PMCID: PMC10470416 DOI: 10.1016/j.ajoc.2023.101920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/08/2023] [Accepted: 08/20/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose To report a case with branch retinal vein occlusion secondary to a retinal astrocytic hamartoma in a patient with tuberous sclerosis complex. Observations A fourteen-year-old boy, a known case of tuberous sclerosis complex, with multiple bilateral retinal astrocytic hamartomas was followed by 6 months intervals. In his last follow-up, 6 months after initial presentation, the patient developed angiographic signs of branch retinal vein occlusion (BRVO) in the superotemporal arcade of the right eye distal to one of the retinal astrocytic hamartomas. He underwent targeted retinal laser photocoagulation. No secondary complication related to BRVO was observed during the next six-month follow-up. Conclusion And Importance: Although the co-occurrence of branch retinal vein occlusion and astrocytic hamartoma may represent an incidental finding, awareness of BRVO as a possible complication associated with retinal astrocytic hamartoma helps timely diagnosis and prompt treatment of this complication, improving the visual prognosis of these patients.
Collapse
Affiliation(s)
- Pedram Afshar
- Retina Ward, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fariba Ghassemi
- Retina Ward, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Retina Ward, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elias Khalili Pour
- Retina Ward, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
7
|
Yang B, Li D, Xiao J. Spontaneous regression of an isolated retinal astrocytic hamartoma in a newborn: a case report. BMC Ophthalmol 2023; 23:395. [PMID: 37752483 PMCID: PMC10523719 DOI: 10.1186/s12886-023-03135-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND To report the spontaneous regression of an isolated retinal astrocytic hamartoma in a newborn. During the seven-month follow-up duration, fundus photography and fluorescein angiography examinations were performed. CASE PRESENTATION An isolated retinal astrocytic hamartoma was detected in the nasal retina of the left eye of a 4-day-old male infant. At the time of initial presentation, we detected a solitary yellowish-white flat mass with an approximate size of 1.5 disc diameters in the nasal retina. Fluorescein angiography (FA) revealed a diffuse hyperfluorescence with slight fluorescence leakage. Seven months later, the fundus examination showed no lesion in the left eye, FA revealed mild tortuous vessels without leakage. CONCLUSIONS In the present case, we established that the isolated retinal astrocytic hamartoma in this infant has underwent spontaneous regression. This case can point out that follow -up reexaminations are advisable for a solitary yellowish-white flat mass of the fundus in a newborn.
Collapse
Affiliation(s)
- Bo Yang
- Department of Ophthalmology, The Second Hospital of Jilin University, No.218, Ziqiang Street, Nanguan District, Changchun City, Jilin Province, China
| | - Danfeng Li
- Department of Ophthalmology, The Second Hospital of Jilin University, No.218, Ziqiang Street, Nanguan District, Changchun City, Jilin Province, China
| | - Jun Xiao
- Department of Ophthalmology, The Second Hospital of Jilin University, No.218, Ziqiang Street, Nanguan District, Changchun City, Jilin Province, China.
| |
Collapse
|
8
|
Ryu S, Kang HC, Lee SC, Byeon SH, Kim SS, Lee CS. Refractive Errors, Retinal Findings, and Genotype of Tuberous Sclerosis Complex: A Retrospective Cohort Study. Yonsei Med J 2023; 64:133-138. [PMID: 36719021 PMCID: PMC9892541 DOI: 10.3349/ymj.2022.0451] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To examine the refractive errors, retinal manifestations, and genotype in tuberous sclerosis complex (TSC) patients in a Korean population. MATERIALS AND METHODS A total of 98 patients with TSC were enrolled in Severance Hospital for a retrospective cohort study. The number of retinal astrocytic hamartoma and retinal achromic patch within a patient, as well as the size, bilaterality, and morphological type were studied. In addition, the refractive status of patients and the comorbidity of intellectual disability and epilepsy were also examined. RESULTS Retinal astrocytic hamartoma was found in 37 patients, and bilateral invasion was observed in 20 patients (54%). TSC1 mutation was associated with myopia (p=0.01), while TSC2 mutation was associated with emmetropia (p=0.01). Retinal astrocytic hamartoma was categorized into three morphological types and examined as follows: type I (87%), type II (35%), and type III (14%). Single invasion of retinal astrocytic hamartoma was identified in 32% of the patients, and multiple invasions in 68%. The TSC1/TSC2 detection rate was 91% (41/45). Among them, TSC1 variant was detected in 23 patients (54%), whereas TSC2 variant was detected in 18 patients (40%). The results showed that TSC2 mutations are correlated with a higher rate of retinal astrocytic hamartoma involvement (all p<0.05), and multiple and bilateral involvement of retinal hamartomas (all p<0.05). However, the size of retinal astrocytic hamartomas, comorbidity of epilepsy, or intellectual disability did not show correlation with the genetic variant. CONCLUSION TSC1 variant patients were more myopic, while TSC2 variant patients showed association with more extensive involvement of retinal astrocytic hamartoma.
Collapse
Affiliation(s)
- Soyoung Ryu
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Hoon-Chul Kang
- Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Suk Ho Byeon
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Christopher Seungkyu Lee
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
9
|
Caudill GB, Sen M, Shields CL. Moth-Eaten Retinal Tumor in a Teenager. J Pediatr Ophthalmol Strabismus 2022; 59:361. [PMID: 36441152 DOI: 10.3928/01913913-20220921-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Allan KC, Hua HU, Singh AD, Yuan A. Rapid symptomatic and structural improvement of a retinal astrocytic hamartoma in response to anti-VEGF therapy: A case report. Am J Ophthalmol Case Rep 2022; 27:101606. [PMID: 35692434 PMCID: PMC9184888 DOI: 10.1016/j.ajoc.2022.101606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/22/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe a patient with bilateral peripapillary astrocytic hamartomas with exudation of subretinal fluid into the macula and loss of vision without evidence of choroidal neovascularization. The patient rapidly responded to intravitreal bevacizumab injections resulting in reduced subretinal fluid and clinical improvement. Observation A 70-year-old female presented with worsening vision in her left eye due to subretinal fluid exudation from a peripapillary astrocytic hamartoma. The patient was treated with two doses of bevacizumab with rapid improvement in vision and resolution of subretinal fluid. Genetic testing was negative for common pathogenic variants for tuberous sclerosis and neurofibromatosis, which are highly associated with bilateral optic nerve and retinal astrocytic hamartomas. Conclusion Astrocytic hamartomas with exudation may be responsive to bevacizumab suggesting a dependence of these lesions on vascular endothelial growth factor (VEGF) independent of secondary choroidal neovascularization. Furthermore, this case describes a patient with bilateral astrocytic hamartomas without genetic or clinical confirmation of associated phakomatoses, such as tuberous sclerosis and neurofibromatosis.
Collapse
Affiliation(s)
- Kevin C. Allan
- Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, 44106, USA
| | - Hong-Uyen Hua
- Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave i32, Cleveland, OH, 44195, USA
| | - Arun D. Singh
- Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave i32, Cleveland, OH, 44195, USA
| | - Alex Yuan
- Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Ave i32, Cleveland, OH, 44195, USA
| |
Collapse
|
11
|
Fan J, Venkateswaran N, Fan KC, Cernichiaro LA, Negron CI, McKeown CA, Berrocal AM. Familial exudative vitreoretinopathy associated with retinal astrocytic hamartoma. Am J Ophthalmol Case Rep 2022; 25:101312. [PMID: 35128159 PMCID: PMC8807981 DOI: 10.1016/j.ajoc.2022.101312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/07/2022] [Accepted: 01/18/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To report the first case of retinal astrocytic hamartoma (RAH) arising in the setting of Familial Exudative Vitreoretinopathy (FEVR). Observations An otherwise healthy 3-month-old male was clinically diagnosed with Familial Exudative Vitreoretinopathy, with subsequent confirmation of a Frizzled-4 nonsense gene mutation. He was treated with multiple rounds of laser photocoagulation after demonstrated peripheral non-perfusion on fluorescein angiography. At 4 years of age, he was noted to have a solitary retinal astrocytic hamartoma in an area of anterior retinal traction which remains under observation. Conclusions and Importance This case describes the first reported instance of a retinal astrocytic hamartoma arising in the setting of FEVR. Multiple factors may have contributed to the formation of this benign tumor, including retinal dysgenesis, genetic background, or even laser photocoagulation. More case reports and/or molecular studies are required to further clarify the potential role of these insults in the pathogenesis of RAH.
Collapse
|
12
|
Wu F, McGarrey MP, Geenen KR, Skalet AH, Guillot FH, Wilson JL, Shah AS, Gonzalez E, Thiele EA, Kim IK, Aronow ME. Treatment of Aggressive Retinal Astrocytic Hamartoma with Oral mTOR Inhibition. Ophthalmol Retina 2022; 6:411-420. [PMID: 35007768 DOI: 10.1016/j.oret.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVE OR PURPOSE To describe the clinical course and outcomes of aggressive retinal astrocytic hamartoma (RAH) treated with oral mTOR inhibitors (mTORi). DESIGN Retrospective clinical case series. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS Five patients with genetically confirmed TSC and visually significant RAH due to tumor growth or exudation. METHODS, INTERVENTION, OR TESTING Review of the electronic medical record in this retrospective clinical case series was performed to determine baseline and follow-up ophthalmologic examination characteristics along with ancillary imaging findings, in patients receiving off-label treatment with either oral sirolimus or everolimus for symptomatic RAH. MAIN OUTCOME MEASURES Visual acuity, change in tumor size, degree of exudation, and adverse effects of mTORi were evaluated. RESULTS The five patients in this series ranged in age from 8 months to 54 years. Four were treated with sirolimus, and one received everolimus. In all cases, tumor height was stable or decreased following treatment (median follow-up: 39 months, range 11-73 months). Exudation improved following treatment in all cases. In the 8-month-old infant, frequent upper respiratory tract infections prompted cessation of treatment. In one patient, the mTORi was temporarily held due to elevated liver enzymes. No other significant adverse effects were noted. CONCLUSIONS Sirolimus and everolimus should be considered in the management of vision-threatening RAH, particularly in the setting of exudative and rapidly growing tumors. Four out of five patients in this series tolerated oral mTORi and continued on therapy. There were no serious complications.
Collapse
Affiliation(s)
- Frances Wu
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Mark P McGarrey
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Kennedy R Geenen
- Herscot Center for Tuberous Sclerosis Complex, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Alison H Skalet
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR; Department of Radiation Medicine, Oregon Health & Science University, Portland, OR; Department of Dermatology, Oregon Health & Science University, Portland, OR
| | - Florian H Guillot
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR
| | - Jenny L Wilson
- Department of Pediatric Neurology, Oregon Health & Science University, Portland, OR
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Efren Gonzalez
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Elizabeth A Thiele
- Herscot Center for Tuberous Sclerosis Complex, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ivana K Kim
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Mary E Aronow
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA.
| |
Collapse
|
13
|
Ashkenazy N, Yannuzzi NA, Berrocal AM. Genetics and optical coherence tomography features in a child with an achromatic retinal patch. Ophthalmic Genet 2021; 43:123-125. [PMID: 34886749 DOI: 10.1080/13816810.2021.1989599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Achromatic retinal patch is associated with tuberous sclerosis. Its role as a diagnostic feature is often overlooked. MATERIALS AND METHODS A clinical case was retrospectively reviewed and reported. RESULTS A 5-year-old male with a history of seizure disorder and a germline TSC2 variant was found to have a hypopigmented lesion in the nasal macula, most consistent with an achromatic retinal patch. The optical coherence tomography features of the retinal finding is illustrated. CONCLUSIONS We highlight the importance of performing a retinal exam and genetic testing in cases that do not otherwise meet the clinical diagnostic criteria for tuberous sclerosis. The significance of an achromatic retinal patch in the setting of a TSC gene mutation of unclear pathogenic potential remains unknown.
Collapse
Affiliation(s)
- Noy Ashkenazy
- Bascom Palmer Eye Institute, Retina Service, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nicolas A Yannuzzi
- Bascom Palmer Eye Institute, Retina Service, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Audina M Berrocal
- Bascom Palmer Eye Institute, Retina Service, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
14
|
Updated International Tuberous Sclerosis Complex Diagnostic Criteria and Surveillance and Management Recommendations. Pediatr Neurol 2021; 123:50-66. [PMID: 34399110 DOI: 10.1016/j.pediatrneurol.2021.07.011] [Citation(s) in RCA: 257] [Impact Index Per Article: 85.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disease affecting multiple body systems with wide variability in presentation. In 2013, Pediatric Neurology published articles outlining updated diagnostic criteria and recommendations for surveillance and management of disease manifestations. Advances in knowledge and approvals of new therapies necessitated a revision of those criteria and recommendations. METHODS Chairs and working group cochairs from the 2012 International TSC Consensus Group were invited to meet face-to-face over two days at the 2018 World TSC Conference on July 25 and 26 in Dallas, TX, USA. Before the meeting, working group cochairs worked with group members via e-mail and telephone to (1) review TSC literature since the 2013 publication, (2) confirm or amend prior recommendations, and (3) provide new recommendations as required. RESULTS Only two changes were made to clinical diagnostic criteria reported in 2013: "multiple cortical tubers and/or radial migration lines" replaced the more general term "cortical dysplasias," and sclerotic bone lesions were reinstated as a minor criterion. Genetic diagnostic criteria were reaffirmed, including highlighting recent findings that some individuals with TSC are genetically mosaic for variants in TSC1 or TSC2. Changes to surveillance and management criteria largely reflected increased emphasis on early screening for electroencephalographic abnormalities, enhanced surveillance and management of TSC-associated neuropsychiatric disorders, and new medication approvals. CONCLUSIONS Updated TSC diagnostic criteria and surveillance and management recommendations presented here should provide an improved framework for optimal care of those living with TSC and their families.
Collapse
|
15
|
Kumar P, Zadjali F, Yao Y, Siroky B, Astrinidis A, Gross KW, Bissler JJ. Tsc Gene Locus Disruption and Differences in Renal Epithelial Extracellular Vesicles. Front Physiol 2021; 12:630933. [PMID: 34262466 PMCID: PMC8273388 DOI: 10.3389/fphys.2021.630933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/29/2021] [Indexed: 12/31/2022] Open
Abstract
In tuberous sclerosis complex (TSC), Tsc2 mutations are associated with more severe disease manifestations than Tsc1 mutations and the role of extracellular vesicles (EVs) in this context is not yet studied. We report a comparative analysis of EVs derived from isogenic renal cells except for Tsc1 or Tsc2 gene status and hypothesized that in spite of having similar physical characteristics, EVs modulate signaling pathways differently, thus leading to TSC heterogenicity. We used mouse inner medullary collecting duct (mIMCD3) cells with the Tsc1 (T1G cells) or Tsc2 (T2J cells) gene disrupted by CRISPR/CAS9. EVs were isolated from the cell culture media by size-exclusion column chromatography followed by detailed physical and chemical characterization. Physical characterization of EVs was accessed by tunable resistive pulse sensing and dynamic light scattering, revealing similar average sizes and zeta potentials (at pH 7.4) for EVs from mIMCD3 (123.5 ± 5.7 nm and −16.3 ± 2.1 mV), T1G cells (131.5 ± 8.3 nm and −19.8 ± 2.7 mV), and T2J cells (127.3 ± 4.9 nm and −20.2 ± 2.1 mV). EVs derived from parental mIMCD3 cells and both mutated cell lines were heterogeneous (>90% of EVs < 150 nm) in nature. Immunoblotting detected cilial Hedgehog signaling protein Arl13b; intercellular proteins TSG101 and Alix; and transmembrane proteins CD63, CD9, and CD81. Compared to Tsc2 deletion, Tsc1 deletion cells had reduced EV production and release rates. EVs from Tsc1 mutant cells altered mTORC1, autophagy, and β-catenin pathways differently than EVs from Tsc2-mutated cells. Quantitative PCR analysis revealed the down regulation of miR-212a-3p and miR-99a-5p in EVs from Tsc2-mutated cells compared to EVs from Tsc1-mutant cells. Thus, EV-derived miR-212-3p and mIR-99a-5p axes may represent therapeutic targets or biomarkers for TSC disease.
Collapse
Affiliation(s)
- Prashant Kumar
- Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, United States
| | - Fahad Zadjali
- Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, United States.,Department of Clinical Biochemistry, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ying Yao
- Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, United States
| | - Brian Siroky
- Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, United States
| | - Aristotelis Astrinidis
- Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, United States
| | - Kenneth W Gross
- Department of Molecular and Cellular Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - John J Bissler
- Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, United States.,Department of Pediatrics, St. Jude Children's Research Hospital, Memphis, TN, United States
| |
Collapse
|
16
|
Liu Y, Moore AT. Congenital focal abnormalities of the retina and retinal pigment epithelium. Eye (Lond) 2020; 34:1973-1988. [PMID: 32367006 PMCID: PMC7784997 DOI: 10.1038/s41433-020-0902-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 11/09/2022] Open
Abstract
This paper reviews the published literature on a group of developmental disorders of the retina and retinal pigment epithelium which result in focal abnormalities in one or both eyes. They are often asymptomatic, found on routine examination and are generally non-progressive. Some are associated with other systemic abnormalities.
Collapse
Affiliation(s)
- Yingna Liu
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Anthony T Moore
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.
- University College London Institute of Ophthalmology, London, UK.
| |
Collapse
|
17
|
Ledesma-Gil G, Essilfie J, Onishi A, Wald KJ, Fisher YL, Fawzi AA, Shields CL, Freund KB, Chhablani J. Presumed retinal pericapillary astrocytic hamartoma: multimodal imaging findings of a novel hamartomatous lesion. Br J Ophthalmol 2020; 105:1711-1715. [PMID: 32980819 DOI: 10.1136/bjophthalmol-2020-317670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/09/2020] [Accepted: 09/13/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE To describe the multimodal imaging findings of retinal lesions that clinically resemble retinal astrocytic hamartomas (RAHs), but also have unique characteristics that we believe represent a novel variant. METHODS Observational study. Five eyes in five patients with solitary retinal lesion evaluated at the retina division of three institutions. We describe the multimodal imaging findings including fundus photography, fundus autofluorescence, fluorescein angiography, spectral-domain optical coherence tomography (OCT), swept-source OCT, swept-source OCT angiography and ultrasonography. RESULTS The retinal lesions described shared similar appearance to RAHs but demonstrated unique features such as glistening granular appearance on fundus photographs with perivascular hyperreflectivity with OCT and OCT angiography. CONCLUSION The lesions described herein appear to have unique characteristics that warrant a designation as a novel RAH variant. The name presumed retinal pericapillary astrocytic hamartoma is suggested.
Collapse
Affiliation(s)
| | - Juliet Essilfie
- Vitreous Retina Macula Consultants of New York, New York, New York, USA
| | - Alex Onishi
- Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kenneth J Wald
- Ophthalmology, New York University School of Medicine, New York, New York, USA
| | - Yale L Fisher
- Vitreous Retina Macula Consultants of New York, New York, New York, USA
| | - Amani A Fawzi
- Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Carol L Shields
- Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, USA
| | | |
Collapse
|
18
|
Losiewicz MK, Elghazi L, Fingar DC, Rajala RVS, Lentz SI, Fort PE, Abcouwer SF, Gardner TW. mTORC1 and mTORC2 expression in inner retinal neurons and glial cells. Exp Eye Res 2020; 197:108131. [PMID: 32622801 DOI: 10.1016/j.exer.2020.108131] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/09/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023]
Abstract
The retina is one of the most metabolically active tissues, yet the processes that control retinal metabolism remains poorly understood. The mTOR complex (mTORC) that drives protein and lipid biogenesis and autophagy has been studied extensively in regards to retinal development and responses to optic nerve injury but the processes that regulate homeostasis in the adult retina have not been determined. We previously demonstrated that normal adult retina has high rates of protein synthesis compared to skeletal muscle, associated with high levels of mechanistic target of rapamycin (mTOR), a kinase that forms multi-subunit complexes that sense and integrate diverse environmental cues to control cell and tissue physiology. This study was undertaken to: 1) quantify expression of mTOR complex 1 (mTORC1)- and mTORC2-specific partner proteins in normal adult rat retina, brain and liver; and 2) to localize these components in normal human, rat, and mouse retinas. Immunoblotting and immunoprecipitation studies revealed greater expression of raptor (exclusive to mTORC1) and rictor (exclusive for mTORC2) in normal rat retina relative to liver or brain, as well as the activating mTORC components, pSIN1 and pPRAS40. By contrast, liver exhibits greater amounts of the mTORC inhibitor, DEPTOR. Immunolocalization studies for all three species showed that mTOR, raptor, and rictor, as well as most other known components of mTORC1 and mTORC2, were primarily localized in the inner retina with mTORC1 primarily in retinal ganglion cells (RGCs) and mTORC2 primarily in glial cells. In addition, phosphorylated ribosomal protein S6, a direct target of the mTORC1 substrate ribosomal protein S6 kinase beta-1 (S6K1), was readily detectable in RGCs, indicating active mTORC1 signaling, and was preserved in human donor eyes. Collectively, this study demonstrates that the inner retina expresses high levels of mTORC1 and mTORC2 and possesses active mTORC1 signaling that may provide cell- and tissue-specific regulation of homeostatic activity. These findings help to define the physiology of the inner retina, which is key for understanding the pathophysiology of optic neuropathies, glaucoma and diabetic retinopathy.
Collapse
Affiliation(s)
| | | | | | - Raju V S Rajala
- Departments of Ophthalmology and Physiology, University of Oklahoma Health Sciences Center, United States
| | - Stephen I Lentz
- Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, United States
| | - Patrice E Fort
- Ophthalmology & Visual Sciences, United States; Molecular and Integrative Physiology, University of Michigan Medical School, United States
| | | | - Thomas W Gardner
- Ophthalmology & Visual Sciences, United States; Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, United States; Molecular and Integrative Physiology, University of Michigan Medical School, United States.
| |
Collapse
|
19
|
Geffrey AL, Geenen KR, Abati E, Greenstein SH, VanderVeen DK, Levy RL, Davidson SL, McGarrey MP, Thiele EA, Aronow ME. Juvenile cataract in association with tuberous sclerosis complex. Ophthalmic Genet 2020; 41:345-349. [PMID: 32340510 DOI: 10.1080/13816810.2020.1755989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder characterized by benign hamartomas occurring in multiple organ systems including the brain, kidneys, heart, lungs, liver, skin, and the eyes. Typical retinal findings associated with TSC include astrocytic hamartoma and achromic patch. While rare cases of cataract occurring in the setting of TSC have been reported, this is the first analysis of a large series of individuals with TSC that aims to quantify the frequency of this finding and to describe its clinical and genetic associations. MATERIALS AND METHODS This is a retrospective chart review of 244 patients from the Herscot Center for Tuberous Sclerosis Complex at the Massachusetts General Hospital who underwent complete ophthalmic examination. We describe the clinical and genetic findings in five individuals with TSC and juvenile cataract. RESULTS Four of five cases (80%) were unilateral. The cataract was described as having an anterior subcapsular component in 3 of 5 cases (60%). Three individuals (60%) underwent lensectomy with intraocular lens (IOL) implant and two individuals (40%) were observed. Genetic testing revealed a known disease-causing mutation in TSC2 in 100% of cases. CONCLUSIONS Recent evidence suggests that mTOR signaling may play a role in cataract formation which could explain the relatively high incidence of juvenile cataract in this population. Juvenile cataract is a potentially under-recognized ocular manifestation of TSC.
Collapse
Affiliation(s)
- A L Geffrey
- Herscot Center for Tuberous Sclerosis Complex, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts, USA
| | - K R Geenen
- Herscot Center for Tuberous Sclerosis Complex, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts, USA
| | - E Abati
- Neurology Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Policlinico Ca'Granda Foundation , Milan, Italy
| | - S H Greenstein
- Massachusetts Eye and Ear, Harvard Medical School , Boston, Massachusetts, USA
| | - D K VanderVeen
- Department of Ophthalmology, Boston Children's Hospital , Boston, Massachusetts, USA
| | - R L Levy
- Department of Ophthalmology, Weill Cornell Medical College , New York, New York, USA
| | - S L Davidson
- Department of Ophthalmology, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania, USA
| | - M P McGarrey
- Massachusetts Eye and Ear, Harvard Medical School , Boston, Massachusetts, USA
| | - E A Thiele
- Herscot Center for Tuberous Sclerosis Complex, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts, USA
| | - M E Aronow
- Massachusetts Eye and Ear, Harvard Medical School , Boston, Massachusetts, USA
| |
Collapse
|
20
|
Zöllner JP, Franz DN, Hertzberg C, Nabbout R, Rosenow F, Sauter M, Schubert-Bast S, Wiemer-Kruel A, Strzelczyk A. A systematic review on the burden of illness in individuals with tuberous sclerosis complex (TSC). Orphanet J Rare Dis 2020; 15:23. [PMID: 31964424 PMCID: PMC6975094 DOI: 10.1186/s13023-019-1258-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 11/19/2019] [Indexed: 01/10/2023] Open
Abstract
Objective This review will summarize current knowledge on the burden of illness (BOI) in tuberous sclerosis complex (TSC), a multisystem genetic disorder manifesting with hamartomas throughout the body, including mainly the kidneys, brain, skin, eyes, heart, and lungs. Methods We performed a systematic analysis of the available literature on BOI in TSC according to the PRISMA guidelines. All studies irrespective of participant age that reported on individual and societal measures of disease burden (e.g. health care resource use, costs, quality of life) were included. Results We identified 33 studies reporting BOI in TSC patients. Most studies (21) reported health care resource use, while 14 studies reported quality of life and 10 studies mentioned costs associated with TSC. Only eight research papers reported caregiver BOI. Substantial BOI occurs from most manifestations of the disorder, particularly from pharmacoresistant epilepsy, neuropsychiatric, renal and skin manifestations. While less frequent, pulmonary complications also lead to a high individual BOI. The range for the mean annual direct costs varied widely between 424 and 98,008 International Dollar purchasing power parities (PPP-$). Brain surgery, end-stage renal disease with dialysis, and pulmonary complications all incur particularly high costs. There is a dearth of information regarding indirect costs in TSC. Mortality overall is increased compared to general population; and most TSC related deaths occur as a result of complications from seizures as well as renal complications. Long term studies report mortality between 4.8 and 8.3% for a follow-up of 8 to 17.4 years. Conclusions TSC patients and their caregivers have a high burden of illness, and TSC patients incur high costs in health care systems. At the same time, the provision of inadequate treatment that does not adhere to published guidelines is common and centralized TSC care is received by no more than half of individuals who need it, especially adults. Further studies focusing on the cost effectiveness and BOI outcomes of coordinated TSC care as well as of new treatment options such as mTOR inhibitors are necessary.
Collapse
Affiliation(s)
- Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - David Neal Franz
- Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Christoph Hertzberg
- Zentrum für Sozialpädiatrie & Neuropädiatrie (DBZ), Vivantes Klinikum Neukölln, Berlin, Germany
| | - Rima Nabbout
- Department of Pediatric Neurology, Necker Enfants Malades Hospital, Paris Descartes University, Imagine Institute UMR1136, Paris, France
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.,Department of Neuropediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany. .,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany. .,Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany. .,Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany.
| |
Collapse
|
21
|
Mellen PL, Sioufi K, Shields JA, Shields CL. INVISIBLE, HONEYCOMB-LIKE, CAVITARY RETINAL ASTROCYTIC HAMARTOMA. Retin Cases Brief Rep 2020; 14:211-214. [PMID: 29286955 DOI: 10.1097/icb.0000000000000697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To report a patient with clinically invisible retinal astrocytic hamartomas (RAHs) detected on optical coherence tomography (OCT) and studied with OCT angiography (OCTA). METHOD Case report. RESULTS An 11-year-old healthy girl was evaluated for reduced visual acuity in the right eye. On examination, best-corrected visual acuity was 20/50 in the right eye and 20/20 in the left eye. Fundus examination revealed blunted foveal reflex in the right eye and normal findings in the left eye. Optical coherence tomography disclosed an abruptly elevated, honeycomb-like macular mass with thin filamentous walls in the right eye, limited to the nerve fiber layer and measuring 756 μm in thickness. The numerous intralesional cavities (optically empty spaces) displayed no calcification. These findings were consistent with Type IV RAH. Optical coherence tomography of the left eye revealed intact foveola and focal nerve fiber layer thickening inferiorly without cavity, measuring 136 μm in thickness, consistent with Type I RAH. En face OCTA detected microvascular flow within the walls of the cavitary RAH in the right eye. Bilateral RAH in a child with no systemic evidence of tuberous sclerosis syndrome was established. CONCLUSION Multimodal imaging is important in revealing causes of visual loss and in the detection of subclinical fundus tumors. In this case, clinically invisible RAHs were detected only by OCT and surrounding vascular flow by OCTA.
Collapse
Affiliation(s)
- Phoebe L Mellen
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | | | | |
Collapse
|
22
|
Wan MJ, Chan KL, Jastrzembski BG, Ali A. Neuro-ophthalmological manifestations of tuberous sclerosis: current perspectives. Eye Brain 2019; 11:13-23. [PMID: 31417327 PMCID: PMC6592065 DOI: 10.2147/eb.s186306] [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: 02/28/2019] [Accepted: 04/24/2019] [Indexed: 12/11/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a complex, multi-system disorder with a well-described underlying genetic etiology. While retinal findings are common in TSC and important in establishing the diagnosis, TSC also has many potential neuro-ophthalmology manifestations. The neuro-ophthalmology manifestations of TSC can have a significant impact on visual function and are sometimes a sign of serious neurological disease. The purpose of this review is to describe the neuro-ophthalmological manifestations of TSC. These manifestations include optic nerve hamartomas, elevated intracranial pressure, cranial nerve palsies, cortical visual impairment, visual field deficits, and ocular toxicity from vigabatrin treatment of infantile spasms. It is important to be aware of potential neuro-ophthalmological manifestations in these patients in order to detect signs of vision- or life-threatening disease and to optimize visual function and quality-of-life.
Collapse
Affiliation(s)
- Michael J Wan
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ka Lo Chan
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,School of Medicine, Griffith University, Brisbane, QLD, Australia
| | - Benjamin G Jastrzembski
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Asim Ali
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
23
|
Vitreous haemorrhage a rare manifestation of retinal astrocytic hamartoma: a paediatric case report. ACTA ACUST UNITED AC 2019; 94:449-452. [PMID: 31202691 DOI: 10.1016/j.oftal.2019.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/10/2019] [Accepted: 04/30/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Retinal astrocytic hamartoma is generally an asymptomatic benign tumour that may or may not be associated with the tuberous sclerosis complex. Haemorrhage is a rare presentation. CASE REPORT The case concerns a 12-year-old patient with "a black spot" vision in the upper temporal hemifield of the right eye, who referred a similar episode 2 years ago. The anterior pole was normal in the slit lamp. A mass of translucent white-yellow peri-papillary appearance and vitreous peri-papillary haemorrhage was observed in funduscopy. The autofluorescence, fluorescence angiography, and optical coherence tomography characteristics were all compatible with retinal astrocytic hamartoma. Complementary studies (serology and X-rays) and the complete clinical examination rule out associated systemic involvement. The patient was followed-up closely until the vitreous haemorrhage was reabsorbed. CONCLUSION Vitreous haemorrhage is a rare complication of Retinal astrocytic hamartoma and funduscopic exploration is difficult. Systemic involvement should be ruled out.
Collapse
|
24
|
Gürsoy S, Erçal D. Genetic Evaluation of Common Neurocutaneous Syndromes. Pediatr Neurol 2018; 89:3-10. [PMID: 30424961 DOI: 10.1016/j.pediatrneurol.2018.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 12/12/2022]
Abstract
The neurocutaneous syndromes are a group of multisystem disorders that affect the skin and central nervous system. Neurofibromatosis 1, neurofibromatosis 2, tuberous sclerosis complex, and Sturge-Weber syndrome are the four major neurocutaneous disorders that mainly present in childhood. In this review, we discuss the clinical findings and genetic diagnosis, related genes/pathways and genotype-phenotype correlations of these four neurocutaneous syndromes.
Collapse
Affiliation(s)
- Semra Gürsoy
- Department of Pediatric Genetics, Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
| | - Derya Erçal
- Department of Pediatric Genetics, Dokuz Eylül University Medical School, Izmir, Turkey
| |
Collapse
|
25
|
Yan S, Chen Y, Chen R, Tian B, Li Z. Subthreshold micropulse laser photocoagulation therapy in a case of bilateral retinal astrocytic hamartomas with tuberous sclerosis complex: A case report. Medicine (Baltimore) 2018; 97:e13265. [PMID: 30557970 PMCID: PMC6320095 DOI: 10.1097/md.0000000000013265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Report a case of bilateral multiple retinal hamartomas (RAHs) in a patient with tuberous sclerosis complex (TSC) and introduced a new method (subthreshold micropulse laser photocoagulation) for the treatment of RAHs. PATIENT CONCERNS A 20-year-old man with TSC complained of decreased vision and metamorphosia in both eyes for 2 months. At presentation, visual acuity (VA) was 20/32 in the right eye and 20/40 in the left eye. Fundus photographs, optical coherence tomography, fundus fluorescein angiography (FFA), and indocyanine green angiography indicated multiple RAHs in both eyes. DIAGNOSES Bilateral retinal astrocytic hamartomas. INTERVENTIONS In the right eye, 577 nm photocoagulation was adopted to treat the RAHs with obvious fluorescein leakage in FFA. The paramacular RAHs were treated by subthreshold micropulse mode to minimize the damage to macula. Photocoagulation therapy was administrated in the left eye after 1 dose of intravitreal ranibizumab treatment. OUTCOMES After photocoagulation therapy (including subthreshold micropulse laser photocoagulation for the paramacular RAHs in both eyes), the VA improved to 20/25 OD and 20/32 OS with no recurrence of exudation. LESSONS About 577 nm photocoagulation for the peripheral RAHs in combination with subthreshold micropulse laser photocoagulation for RAHs in the macular zone is a good option for multiple RAHs in patients with TSC.
Collapse
Affiliation(s)
- Shenshen Yan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University
| | - Yanyun Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University
| | - Rui Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University
| | - Bei Tian
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University
| | - Zheqing Li
- Department of Ophthalmology, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, China
| |
Collapse
|
26
|
Lu DS, Karas PJ, Krueger DA, Weiner HL. Central nervous system manifestations of tuberous sclerosis complex. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2018; 178:291-298. [PMID: 30230171 DOI: 10.1002/ajmg.c.31647] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/28/2018] [Accepted: 06/30/2018] [Indexed: 01/21/2023]
Abstract
Tuberous sclerosis complex (TSC) is a neurocutaneous autosomal-dominant genetic syndrome marked by development of hamartomatous lesions arising from dysfunction of the mammalian target of rapamycin (mTOR) pathway. Although TSC remains a heterogeneous clinical entity, the recent inclusion of genetic diagnostic criteria reflects advancement in our understanding of its underlying etiopathogenesis. Abnormal cellular growth, differentiation, and migration result in multisystem sequelae, with neurologic manifestations of TSC representing the primary cause of morbidity and mortality for the majority of individuals. Modern imaging techniques aid in the diagnosis of TSC and guide treatment strategies by revealing central nervous system findings. Cortical tubers are the namesake lesion of the disorder and occur in up to 90% of cases, often exerting significant epileptogenic potential. Subependymal nodules are found in 80% of patients as calcified tumors lining the ependyma of the lateral ventricles. In some cases, these nodules are thought to progress to subependymal giant cell astrocytomas and may present with obstructive hydrocephalus. Retinal astrocytic hamartomas are also common, present in 50% of patients. Surgery remains the treatment of choice for large or symptomatic lesions, though clinical trials have highlighted a potential role for mTOR pathway antagonism. A multidisciplinary approach is necessary for achieving optimal patient outcomes.
Collapse
Affiliation(s)
- Derek S Lu
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Patrick J Karas
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Darcy A Krueger
- Division of Child Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Howard L Weiner
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.,Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| |
Collapse
|
27
|
Thavikulwat AT, Edward DP, AlDarrab A, Vajaranant TS. Pathophysiology and management of glaucoma associated with phakomatoses. J Neurosci Res 2018; 97:57-69. [DOI: 10.1002/jnr.24241] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/10/2018] [Accepted: 03/12/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Alisa T. Thavikulwat
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois
| | - Deepak P. Edward
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois
- King Khaled Eye Specialist Hospital; Riyadh Saudi Arabia
| | - Abdulrahman AlDarrab
- King Khaled Eye Specialist Hospital; Riyadh Saudi Arabia
- Department of Surgery, College of Medicine; Prince Sattam Bin Abdulaziz University; Alkharj Saudi Arabia
| | - Thasarat S. Vajaranant
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois
| |
Collapse
|
28
|
NEWLY DIAGNOSED ASYMPTOMATIC RETINAL ASTROCYTIC HAMARTOMA IN AN OLDER ADULT. Retin Cases Brief Rep 2018; 14:352-354. [PMID: 29443803 DOI: 10.1097/icb.0000000000000710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To report a coincidentally discovered retinal astrocytic hamartoma in an asymptomatic older woman with no history of tuberous sclerosis or neurofibromatosis. METHODS A 63-year-old Turkish woman underwent routine ophthalmic examination. RESULTS Visual acuity was 20/25 in each eye. On fundus examination, the right eye showed a flat yellow-white superficial retinal lesion in the inferotemporal macula and measuring 1 mm in diameter. The lesion was unmeasurable using B-mode ultrasonography. Spectral domain optical coherence tomography revealed the mass with thickening in the retinal nerve fiber layer, with minor disorganization of the underlying retina and no retinal or vitreoretinal traction. Fluorescein angiography disclosed the mass as early isofluorescence with late mild hyperfluorescence, without leakage. Findings in the left eye were normal. Based on the clinical and imaging results, a diagnosis of noncalcified small retinal astrocytic hamartoma was rendered. The lesion remained unchanged at 1-year follow-up. CONCLUSION Small coincidentally discovered retinal astrocytic hamartomas in older patients can be difficult to diagnose and possibly cause diagnostic confusion with other conditions including myelinated nerve fiber and cotton wool spot. Retinal astrocytic hamartoma is characterized by thickening of the retinal nerve fiber layer and mild compression and disorganization of the underlying retinal layers on spectral domain optical coherence tomography.
Collapse
|
29
|
OPTICAL COHERENCE TOMOGRAPHY AND INFRARED IMAGES OF ASTROCYTIC HAMARTOMAS NOT REVEALED BY FUNDUSCOPY IN TUBEROUS SCLEROSIS COMPLEX. Retina 2018; 37:1383-1392. [PMID: 27787447 DOI: 10.1097/iae.0000000000001373] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To detect, describe, and classify the morphologic characteristics of astrocytic hamartomas in tuberous sclerosis complex, using both spectral-domain optical coherence tomography (OCT) and infrared images. METHODS Ten subjects (20 eyes) with tuberous sclerosis complex underwent a complete ophthalmologic examination and multimodality imaging with spectral-domain OCT and infrared images. The imaging protocol included a 30°scan angle of the posterior pole and of the four quadrants. Line scans, detail, raster, and posterior pole patterns were used. The identified astrocytic hamartomas were described and characterized qualitatively and quantitatively. RESULTS Forty-four hamartomas were detected in 8 patients. In five cases, lesions were bilateral. Thirty of these hamartomas had not been revealed by previous ophthalmoscopy. Through multimodality imaging, it was possible to define multiple lesions with characteristic optical reflective qualities. All the 44 hamartomas were measured and morphologically characterized in terms of the type of tumor, retinal and/or vitreous involvement, calcifications, and posterior optical shadowing. CONCLUSION The combined imaging with spectral-domain OCT and infrared images improves the detection of hamartomas if compared with the spectral-domain OCT technique alone. Moreover, a new subtype of hamartoma is proposed to complete a previous classification based on OCT.
Collapse
|
30
|
Shrot S, Hwang M, Stafstrom CE, Huisman TAGM, Soares BP. Dysplasia and overgrowth: magnetic resonance imaging of pediatric brain abnormalities secondary to alterations in the mechanistic target of rapamycin pathway. Neuroradiology 2017; 60:137-150. [PMID: 29279945 DOI: 10.1007/s00234-017-1961-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/07/2017] [Indexed: 12/22/2022]
Abstract
The current classification of malformations of cortical development is based on the type of disrupted embryological process (cell proliferation, migration, or cortical organization/post-migrational development) and the resulting morphological anomalous pattern of findings. An ideal classification would include knowledge of biological pathways. It has recently been demonstrated that alterations affecting the mechanistic target of rapamycin (mTOR) signaling pathway result in diverse abnormalities such as dysplastic megalencephaly, hemimegalencephaly, ganglioglioma, dysplastic cerebellar gangliocytoma, focal cortical dysplasia type IIb, and brain lesions associated with tuberous sclerosis. We review the neuroimaging findings in brain abnormalities related to alterations in the mTOR pathway, following the emerging trend from morphology towards genetics in the classification of malformations of cortical development. This approach improves the understanding of anomalous brain development and allows precise diagnosis and potentially targeted therapies that may regulate mTOR pathway function.
Collapse
Affiliation(s)
- Shai Shrot
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 4174, Baltimore, MD, 21287, USA
- Department of Diagnostic Imaging, Sheba Medical Center, 52621, Ramat-Gan, Israel
| | - Misun Hwang
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 4174, Baltimore, MD, 21287, USA
| | - Carl E Stafstrom
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Thierry A G M Huisman
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 4174, Baltimore, MD, 21287, USA
| | - Bruno P Soares
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 4174, Baltimore, MD, 21287, USA.
| |
Collapse
|
31
|
Rosset C, Vairo F, Bandeira IC, Correia RL, de Goes FV, da Silva RTB, Bueno LSM, de Miranda Gomes MCS, Galvão HDCR, Neri JICF, Achatz MI, Netto CBO, Ashton-Prolla P. Molecular analysis of TSC1 and TSC2 genes and phenotypic correlations in Brazilian families with tuberous sclerosis. PLoS One 2017; 12:e0185713. [PMID: 28968464 PMCID: PMC5624610 DOI: 10.1371/journal.pone.0185713] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/18/2017] [Indexed: 12/22/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant multisystem disorder characterized by the development of multiple hamartomas in many organs and tissues. It occurs due to inactivating mutations in either of the two genes, TSC1 and TSC2, following a second hit in a tumor suppressor gene in most hamartomas. Comprehensive screening for mutations in both the TSC1 and TSC2 loci has been performed in several cohorts of patients and a broad spectrum of pathogenic mutations have been described. In Brazil, there is no data regarding incidence and prevalence of tuberous sclerosis and mutations in TSC1 and TSC2. We analyzed both genes in 53 patients with high suspicion of tuberous sclerosis using multiplex-ligation dependent probe amplification and a customized next generation sequencing panel. Confirmation of all variants was done by the Sanger method. We identified 50 distinct variants in 47 (89%) of the patients. Five were large rearrangements and 45 were point mutations. The symptoms presented by our series of patients were not different between male and female individuals, except for the more common occurrence of shagreen patch in women (p = 0.028). In our series, consistent with other studies, TSC2 mutations were associated with a more severe phenotypic spectrum than TSC1 mutations. This is the first study that sought to characterize the molecular spectrum of Brazilian individuals with tuberous sclerosis.
Collapse
Affiliation(s)
- Clévia Rosset
- Laboratório de Medicina Genômica – Centro de Pesquisa Experimental – Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Programa de pós-graduação em genética e biologia molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Filippo Vairo
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Isabel Cristina Bandeira
- Laboratório de Medicina Genômica – Centro de Pesquisa Experimental – Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rudinei Luis Correia
- Laboratório de Medicina Genômica – Centro de Pesquisa Experimental – Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda Veiga de Goes
- Instituto Fernandes Figueira, Fundação Osvaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | - João I. C. F. Neri
- Centro Especializado em Reabilitação e Habilitação, Natal, Rio Grande do Norte, Brazil
| | - Maria Isabel Achatz
- A.C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
- Clinical Genetics Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Rockville, United States of America
| | | | - Patricia Ashton-Prolla
- Laboratório de Medicina Genômica – Centro de Pesquisa Experimental – Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Programa de pós-graduação em genética e biologia molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Departamento de Genética - Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
32
|
Nallasamy N, Seider MI, Gururangan S, Mruthyunjaya P. Everolimus to treat aggressive retinal astrocytic hamartoma in tuberous sclerosis complex. J AAPOS 2017; 21:328-331. [PMID: 28733147 DOI: 10.1016/j.jaapos.2017.04.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/22/2016] [Accepted: 04/07/2017] [Indexed: 11/26/2022]
Abstract
Retinal astrocytic hamartomas (RAH) are the most frequent ocular manifestation of tuberous sclerosis complex and are usually indolent, requiring only observation. We report an aggressive RAH subtype in a child unresponsive to anti-VEGF and laser therapy. Treatment with systemic everolimus was well-tolerated and significantly reduced ocular (and nonocular) tumor size and fluid exudation.
Collapse
Affiliation(s)
- Nambi Nallasamy
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Michael I Seider
- Permanente Medical Group, San Francisco, California; University of California, San Francisco, California
| | - Sridharan Gururangan
- Preston A. Wells Center for Brain Tumor Therapy, University of Florida, Gainesville, Florida
| | - Prithvi Mruthyunjaya
- Department of Ophthalmology, Duke University, Durham, North Carolina; Byers Eye Institute at Stanford University, Palo Alto, California.
| |
Collapse
|
33
|
Wataya-Kaneda M, Uemura M, Fujita K, Hirata H, Osuga K, Kagitani-Shimono K, Nonomura N. Tuberous sclerosis complex: Recent advances in manifestations and therapy. Int J Urol 2017; 24:681-691. [DOI: 10.1111/iju.13390] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/01/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Mari Wataya-Kaneda
- Department of Dermatology; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | - Motohide Uemura
- Department of Urology; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | - Kazutoshi Fujita
- Department of Urology; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | - Haruhiko Hirata
- Department of Respiratory Medicine; Allergy and Rheumatic Diseases; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | - Kuriko Kagitani-Shimono
- Department of United Graduate School of Child Development; Osaka University; Suita Osaka Japan
| | - Norio Nonomura
- Department of Urology; Graduate School of Medicine; Osaka University; Suita Osaka Japan
| | | |
Collapse
|
34
|
Yang G, Shi ZN, Meng Y, Shi XY, Pang LY, Ma SF, Zhang MN, Wang YY, Zou LP. Phenotypic and genotypic characterization of Chinese children diagnosed with tuberous sclerosis complex. Clin Genet 2017; 91:764-768. [PMID: 27859028 DOI: 10.1111/cge.12920] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 01/22/2023]
Abstract
We investigated the clinical phenotypes and genetic mutations in Chinese children diagnosed with tuberous sclerosis complex (TSC). Sequencing of TSC1 and TSC2 genes was performed in 117 children with TSC and their parents. Association of TSC gene mutations with clinical manifestations was investigated. All gene mutations were heterozygous including in 16 patients (13.7%) with mutations in TSC1 gene and 101 patients (86.3%) with mutations in TSC2 gene. Among the 16 patients with TSC1 gene mutations, 15 different types of mutations were found, which included 5 novel mutations; all patients had skin manifestations and epilepsy. Among the 101 patients with TSC2 mutations, 85 different types of mutations were found, which included 25 novel mutations; 97 patients (96.0%) had skin manifestations; 97 (96.0%) had epilepsy; 74 (73.3%) had intellectual disability and 25 patients (24.8%) were autistic. The clinical phenotype of the 14 children with familial TSC was more severe than that of their parents.
Collapse
Affiliation(s)
- G Yang
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - Z N Shi
- Bethune Medical Academy, Shijiazhuang, China
| | - Y Meng
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - X Y Shi
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - L Y Pang
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - S F Ma
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - M N Zhang
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - Y Y Wang
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - L P Zou
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| |
Collapse
|
35
|
Rosset C, Netto CBO, Ashton-Prolla P. TSC1 and TSC2 gene mutations and their implications for treatment in Tuberous Sclerosis Complex: a review. Genet Mol Biol 2017; 40:69-79. [PMID: 28222202 PMCID: PMC5409767 DOI: 10.1590/1678-4685-gmb-2015-0321] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/01/2016] [Indexed: 01/08/2023] Open
Abstract
Tuberous sclerosis complex is an autosomal dominant disorder characterized by skin
manifestations and formation of multiple tumors in different organs, mainly in the
central nervous system. Tuberous sclerosis is caused by the mutation of one of two
tumor suppressor genes, TSC1 or TSC2. Currently,
the development of novel techniques and great advances in high-throughput genetic
analysis made mutation screening of the TSC1 and
TSC2 genes more widely available. Extensive studies of the
TSC1 and TSC2 genes in patients with TSC
worldwide have revealed a wide spectrum of mutations. Consequently, the discovery of
the underlying genetic defects in TSC has furthered our
understanding of this complex genetic disorder, and genotype-phenotype correlations
are becoming possible, although there are still only a few clearly established
correlations. This review focuses on the main symptoms and genetic alterations
described in TSC patients from 13 countries in three continents, as well as on
genotype-phenotype correlations established to date. The determination of
genotype-phenotype correlations may contribute to the establishment of successful
personalized treatment for TSC.
Collapse
Affiliation(s)
- Clévia Rosset
- Laboratório de Medicina Genômica, Centro de Pesquisa Experimental. Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | - Patricia Ashton-Prolla
- Laboratório de Medicina Genômica, Centro de Pesquisa Experimental. Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Departamento de Genética, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| |
Collapse
|
36
|
Shields CL, Shields JA. The American Society of Retina Specialists 2016 Founders Award Lecture. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/2474126416677898] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To review the current state of the art of retinal tumors with respect to clinical features, imaging, and management. Methods: Review of published literature and personal experience from an ocular oncology service. Results: There are several tumors that arise from the sensory retina including those of glial origin (astrocytic hamartoma, acquired astrocytoma, and solitary circumscribed retinal astrocytic proliferation), neural origin (retinoblastoma), and vascular origin (hemangioblastoma, cavernous hemangioma, racemose hemangioma, and vasoproliferative tumor). Most retinal tumors are benign with the exception of retinoblastoma and retinal metastasis. Some retinal tumors are associated with systemic oculoneurocutaneous syndromes such as tuberous sclerosis complex (TSC), 13q deletion syndrome, Von Hippel–Lindau disease, and systemic cavernous and racemose hemangioma syndromes with ocular, cutaneous, neurologic, and other findings. Regarding management, recent data indicate that retinal astrocytic hamartoma and retinal achromic patch are key to the diagnosis of TSC and imply greater risk for brain and kidney tumors. Some children with TSC respond to mammalian target of rapamycin inhibitors, controlling brain, kidney, and eye tumors. Children with retinoblastoma are all screened genetically, and systemic evaluation is provided for detection of metastasis and secondary-related tumors. Newer chemotherapy regimens by intravenous or intra-arterial routes have revolutionized retinoblastoma control. Retinal vascular tumors are uncommon but can have serious systemic implications. Therefore, imaging of the brain for related cerebellar hemangioblastoma, midbrain racemose hemangioma, or multifocal cavernomas is performed. Genetic testing for each disease can be revealing. Conclusions: Retinal tumors are often benign, can be recognized by clinical and imaging features, and can be associated with important systemic syndromes.
Collapse
Affiliation(s)
- Carol L. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jerry A. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
37
|
Abstract
PURPOSE Establishing the correct diagnosis of a growing choroidal tumor can be difficult. METHODS Clinical examination and ultrasound of a patient followed for what was thought to be a uveal melanoma. Fine-needle biopsy established the correct diagnosis. RESULTS We demonstrate that fine-needle biopsy can correctly identify a very rare tumor, a myomelanocytic neoplasm. CONCLUSION Myomelanocytic choroidal tumors can be diagnosed on fine-needle biopsy.
Collapse
|
38
|
Hodgson N, Kinori M, Goldbaum MH, Robbins SL. Ophthalmic manifestations of tuberous sclerosis: a review. Clin Exp Ophthalmol 2016; 45:81-86. [DOI: 10.1111/ceo.12806] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/08/2016] [Accepted: 06/29/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Nickisa Hodgson
- Department of Ophthalmology, Ratner Children's Eye Center of the Shiley Eye Institute; University of California; San Diego California USA
- Department of Ophthalmology, Jacobs Retina Center of the Shiley Eye Institute; University of California; San Diego California USA
| | - Michael Kinori
- Department of Ophthalmology, Ratner Children's Eye Center of the Shiley Eye Institute; University of California; San Diego California USA
| | - Michael H Goldbaum
- Department of Ophthalmology, Jacobs Retina Center of the Shiley Eye Institute; University of California; San Diego California USA
| | - Shira L Robbins
- Department of Ophthalmology, Ratner Children's Eye Center of the Shiley Eye Institute; University of California; San Diego California USA
| |
Collapse
|
39
|
Shields CL, Say EA, Fuller T, Arora S, Samara WA, Shields JA. Retinal Astrocytic Hamartoma Arises in Nerve Fiber Layer and Shows “Moth-Eaten” Optically Empty Spaces on Optical Coherence Tomography. Ophthalmology 2016; 123:1809-1816. [DOI: 10.1016/j.ophtha.2016.04.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022] Open
|
40
|
Jeong A, Wong M. Systemic disease manifestations associated with epilepsy in tuberous sclerosis complex. Epilepsia 2016; 57:1443-9. [PMID: 27417921 DOI: 10.1111/epi.13467] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Epilepsy is one of the most disabling symptoms of tuberous sclerosis complex (TSC) and is a leading cause of morbidity and mortality in affected individuals. The relationship between systemic disease manifestations and the presence of epilepsy has not been thoroughly investigated. This study utilizes a multicenter TSC Natural History Database including 1,816 individuals to test the hypothesis that systemic disease manifestations of TSC are associated with epilepsy. METHODS Univariate analysis was used to identify patient characteristics (e.g., age, gender, race, and TSC mutation status) associated with the presence of epilepsy. Individual logistic regression models were built to examine the association between epilepsy and each candidate systemic or neurologic disease variable, controlling for the patient characteristics found to be significant on univariate analysis. Finally, a multivariable logistic regression model was constructed, using the variables found to be significant on the individual analyses as well as the patient characteristics that were significant on univariate analysis. RESULTS Nearly 88% of our cohort had a history of epilepsy. After adjusting for age, gender, and TSC mutation status, multiple systemic disease manifestations including cardiac rhabdomyomas (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.3-3.9, p = 0.002), retinal hamartomas (OR 2.1, CI 1.0-4.3, p = 0.04), renal cysts (OR 2.1, CI 1.3-3.4, p = 0.002), renal angiomyolipomas (OR 3.0, CI 1.8-5.1, p < 0.001), shagreen patches (OR 1.7, CI 1.0-2.7, p = 0.04), and facial angiofibromas (OR 1.7, CI 1.1-2.9, p = 0.03) were associated with a higher likelihood of epilepsy. In the multivariable logistic regression model, cardiac rhabdomyomas (OR 1.9, CI 1.0-3.5, p = 0.04) remained significantly associated with the presence of epilepsy. SIGNIFICANCE The identification of systemic disease manifestations such as cardiac rhabdomyomas that confer a higher risk of epilepsy development in TSC could contribute to disease prognostication and assist in the identification of individuals who may receive maximal benefit from potentially novel, targeted, preventative therapies.
Collapse
Affiliation(s)
- Anna Jeong
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Michael Wong
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, U.S.A.,Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| |
Collapse
|
41
|
|
42
|
Abstract
Purpose Cross-characterization of retinal astrocytomas (RA) using ocular diagnostic imaging techniques. Methods Fundus photography, fluorescein angiography, optical coherence tomography, fundus autofluorescence images, and ultrasonography were used to define characteristics of RA. Results Thirteen patients had sporadic RA and 12 had tuberous sclerosis. Of the latter, 1 patient had multiple (n = 14), bilateral tumors and was excluded so as not to skew the analysis. Of those patients with a solitary RA, 63% were juxtapapillary. All were white to yellow. A mulberry-shaped surface was observed in 33%. Fluorescein angiography revealed intrinsic tumor vessels and late diffuse tumor staining in 42%. Optical coherence tomography revealed cells spreading from the tumor surface into the vitreous (75%), intraretinal fluid (25%), and multiple, ovoid hypolucencies within the tumor stroma (54%). Fundus autofluorescent imaging revealed that hypolucencies were hyperautofluorescent and solid tumor stroma appeared hypoautofluorescent. B-scan imaging revealed moderate to high internal tumor reflectivity (100%) with orbital shadowing (46%). Optical coherence tomography revealed a mean tumor thickness of 0.8 mm. Ultrasound imaging showed a mean thickness of 1.4 mm (range 1.0–1.7). Of the 21 patients subsequently followed in our centers, no tumor growth was noted (mean 54 months, range 1–96). Conclusions This study reveals unique characteristics of RA and suggests that RA were most commonly amelanotic, moderate to high echoic, ≤1.7 mm in thickness, near the optic disc, and nonprogressive. When observed, a mulberry-shaped surface was pathognomonic.
Collapse
|
43
|
Curatolo P, Moavero R, Roberto D, Graziola F. Genotype/Phenotype Correlations in Tuberous Sclerosis Complex. Semin Pediatr Neurol 2015; 22:259-73. [PMID: 26706013 DOI: 10.1016/j.spen.2015.10.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by the development of widespread hamartomatous lesions in various organs, including brain, skin, kidneys, heart, and eyes. Central nervous system is almost invariably involved, with up to 85% of patients presenting with epilepsy, and at least half of patients having intellectual disability or other neuropsychiatric disorders including autism spectrum disorder. TSC is caused by the mutation in one of the 2 genes TSC1, at 9q34, and TSC2, at 16p13.3. They respectively encode for hamartin and tuberin, which form an intracellular complex inhibiting the mammalian target of rapamycin. Mammalian target of rapamycin overactivation following the genetic defect determines the cell growth and proliferation responsible for TSC-related lesions, as well as the alterations in neuronal excitability and synaptogenesis leading to epilepsy and neuropsychiatric disorders. A causative mutation for the disorder is identified in about 85% of patients with a clinical diagnosis of TSC. Mosaicism and technology limits likely explain most of the no mutation identified cases. This review confirms that patients with TSC2 mutations considered as a group usually present a more severe phenotype, characterized by higher number of tubers, earlier age at seizure onset and higher prevalence of intellectual disability. However, the clinical phenotype of the disease presents a high variability, thus making the prediction of the phenotype on an individual basis still challenging. The increasing application of new molecular techniques to subjects with TSC has the potential to significantly reduce the rate of patients with no mutation demonstrated and to identify an increasing higher number of mutations. This would hopefully allow a better characterization of higher risk mutations, which might help clinicians to plan individualized surveillance plans. Furthermore, the increasing availability of disease registries to collect clinical and genetics data of patients help to define more valid and clinically oriented genotype or phenotype correlations.
Collapse
Affiliation(s)
- Paolo Curatolo
- (⁎)Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy.
| | - Romina Moavero
- (⁎)Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy; Child Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Denis Roberto
- (⁎)Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Federica Graziola
- (⁎)Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy
| |
Collapse
|
44
|
Abstract
Neurocutaneous syndromes are a heterogeneous group of congenital and hereditary disorders with manifestations in the skin and the nervous system, usually together with ocular features that represent diagnostic clues and potential sources of morbidity. Dermatologists and ophthalmologists often need to work together in identifying and managing patients with these conditions; herein, we focus on classic and under-recognized neurocutaneous syndromes. We begin with autosomal dominant genodermatoses characterized by hamartomas and tumors in the skin, eyes, and central nervous system: neurofibromatosis type 1, tuberous sclerosis complex, and PTEN hamartoma-tumor syndrome. This is followed by a discussion of two mosaic disorders, Sturge-Weber syndrome and neurocutaneous melanocytosis. In addition to providing an update on clinical presentations and evaluation of patients with these conditions, we review recent insights into their pathogenesis, drawing attention to relationships among the diseases on a molecular level and implications regarding treatment. We also highlight the major features of other neurocutaneous syndromes that have ocular findings plus pigmentary, vascular, hyperkeratotic, adnexal, connective tissue, photosensitive, and inflammatory manifestations in the skin.
Collapse
Affiliation(s)
- Karen A Chernoff
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY 10016, USA
| | - Julie V Schaffer
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY 10016, USA.
| |
Collapse
|
45
|
Cerman E, Çekiç O. Clinical use of photodynamic therapy in ocular tumors. Surv Ophthalmol 2015; 60:557-74. [PMID: 26079736 DOI: 10.1016/j.survophthal.2015.05.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 01/10/2023]
Abstract
Although the introduction of intravitreal anti-vascular endothelial growth factor drugs reduced the indications for photodynamic therapy in ophthalmology, it may still be used in various ocular tumors. Although many studies have shown that photodynamic therapy is effective in ocular tumors, the literature consists of case reports and series. In this review, we systematically performed a meta-analysis for the use of photodynamic therapy in circumscribed choroidal hemangioma, diffuse choroidal hemangioma, retinal capillary hemangioma, von Hippel-Lindau angiomatosis, choroidal melanoma, retinal astrocytoma, retinoblastoma, eyelid tumors, conjunctival tumors, and choroidal metastasis.
Collapse
Affiliation(s)
- Eren Cerman
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Osman Çekiç
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey.
| |
Collapse
|
46
|
Zitte K, Farguette F, Bonnin N, Bacin F, Chiambaretta F. Syndrome des taches blanches évanescentes associé à une sclérose tubéreuse de Bourneville : à propos d’un cas. J Fr Ophtalmol 2015; 38:e77-85. [DOI: 10.1016/j.jfo.2014.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/28/2014] [Indexed: 10/23/2022]
|
47
|
Abstract
Tuberous sclerosis complex (TSC) is a neurocutaneous syndrome that can affect the brain, skin, eyes, kidneys, heart, and lungs. TSC alters cellular proliferation and differentiation, resulting in hamartomas of various organs, tumor formation, and altered neuronal migration. The phenotype is highly variable. Most individuals have seizures, commonly including infantile spasms, and there is variable intellectual disability and autism. Neonates can present with cardiac failure due to intracardiac rhabdomyomas. The likelihood of renal angiomyolipomas increases with age, and renal disease is the most common cause of death in adults with TSC. Pulmonary involvement occurs predominantly in women and carries a high morbidity and mortality. TSC is inherited as an autosomal dominant trait, but spontaneous mutations are common. A mutation of either TSC1 on chromosome 9 or TSC2 on chromosome 16 leads to dysfunction of hamartin or tuberin, respectively. These two proteins form a functional complex that modulates the mammalian target of rapamycin (mTOR) pathway. Medications that inhibit mTOR are being used to treat TSC-related tumors, and current studies are investigating whether these agents could alleviate other TSC complications. Consensus statements guide identification and optimal management of many of the TSC-related complications at diagnosis and throughout the lifespan. A multidisciplinary approach is necessary for optimal management of individuals with TSC.
Collapse
Affiliation(s)
- Monica P Islam
- Department of Child Neurology, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA.
| | - E Steve Roach
- Department of Child Neurology, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
48
|
Hafidi Z, Handor H, Laghmari M, Daoudi R. [Bilateral retinal astrocytic hamartomas in Bourneville's tuberous sclerosis]. Ann Dermatol Venereol 2014; 141:241-3. [PMID: 24635963 DOI: 10.1016/j.annder.2013.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 10/01/2013] [Accepted: 10/21/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Z Hafidi
- Service d'ophtalmologie A de l'hôpital des spécialités, CHU de Rabat, université Mohammed V Souissi, rue Lamfadal Cherkaoui, Rabat-Instituts, BP 6527, Rabat, Maroc.
| | - H Handor
- Service d'ophtalmologie A de l'hôpital des spécialités, CHU de Rabat, université Mohammed V Souissi, rue Lamfadal Cherkaoui, Rabat-Instituts, BP 6527, Rabat, Maroc
| | - M Laghmari
- Service d'ophtalmologie A de l'hôpital des spécialités, CHU de Rabat, université Mohammed V Souissi, rue Lamfadal Cherkaoui, Rabat-Instituts, BP 6527, Rabat, Maroc
| | - R Daoudi
- Service d'ophtalmologie A de l'hôpital des spécialités, CHU de Rabat, université Mohammed V Souissi, rue Lamfadal Cherkaoui, Rabat-Instituts, BP 6527, Rabat, Maroc
| |
Collapse
|
49
|
Northrup H, Krueger DA. Tuberous sclerosis complex diagnostic criteria update: recommendations of the 2012 Iinternational Tuberous Sclerosis Complex Consensus Conference. Pediatr Neurol 2013; 49:243-54. [PMID: 24053982 PMCID: PMC4080684 DOI: 10.1016/j.pediatrneurol.2013.08.001] [Citation(s) in RCA: 933] [Impact Index Per Article: 84.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 07/30/2013] [Accepted: 08/01/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tuberous sclerosis complex is highly variable in clinical presentation and findings. Disease manifestations continue to develop over the lifetime of an affected individual. Accurate diagnosis is fundamental to implementation of appropriate medical surveillance and treatment. Although significant advances have been made in the past 15 years in the understanding and treatment of tuberous sclerosis complex, current clinical diagnostic criteria have not been critically evaluated or updated since the last clinical consensus conference in 1998. METHODS The 2012 International Tuberous Sclerosis Complex Consensus Group, comprising 79 specialists from 14 countries, was organized into 12 subcommittees, each led by a clinician with advanced expertise in tuberous sclerosis complex and the relevant medical subspecialty. Each subcommittee focused on a specific disease area with important diagnostic implications and was charged with reviewing prevalence and specificity of disease-associated clinical findings and their impact on suspecting and confirming the diagnosis of tuberous sclerosis complex. RESULTS Clinical features of tuberous sclerosis complex continue to be a principal means of diagnosis. Key changes compared with 1998 criteria are the new inclusion of genetic testing results and reducing diagnostic classes from three (possible, probable, and definite) to two (possible, definite). Additional minor changes to specific criterion were made for additional clarification and simplification. CONCLUSIONS The 2012 International Tuberous Sclerosis Complex Diagnostic Criteria provide current, updated means using best available evidence to establish diagnosis of tuberous sclerosis complex in affected individuals.
Collapse
Affiliation(s)
- Hope Northrup
- Division of Medical Genetics, Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas.
| | - Darcy A. Krueger
- Division of Neurology, Department of Pediatrics, Cincinnati Children?s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | |
Collapse
|
50
|
Abstract
Phototherapy can be translated to mean 'light or radiant energy-induced treatment.' Lasers have become the exclusive source of light or radiant energy for all applications of phototherapy. Depending on the wavelength, intensity, and duration of exposure, tissues can either absorb the energy (photocoagulation, thermotherapy, and photodynamic therapy (PDT)) or undergo ionization (photodisruption). For phototherapy to be effective, the energy has to be absorbed by tissues or more specifically by naturally occurring pigment (xanthophyll, haemoglobin, and melanin) within them. In tissues or tumours that lack natural pigment, dyes (verteporphin, Visudyne) with narrow absorption spectrum can be injected intravenously that act as focal absorbent of laser energy after they have preferentially localized within the tumour. Ocular phototherapy has broad applications in treatment of ocular tumours. Laser photocoagulation, thermotherapy, and PDT can be delivered with low rates of complications and with ease in the outpatient setting. Review of the current literature suggests excellent results when these treatments are applied for benign tumours, particularly for vascular tumours such as circumscribed choroidal haemangioma. For primary malignant tumours, such as choroidal melanoma, thermotherapy, and PDT do not offer local tumour control rates that are equivalent or higher than those achieved with plaque or proton radiation therapy. However, for secondary malignant tumours (choroidal metastases), thermotherapy and PDT can be applied as a palliative treatment. Greater experience is necessary to fully comprehend risks, comparative benefits, and complication of ocular phototherapy of ocular tumours.
Collapse
Affiliation(s)
- A D Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
| |
Collapse
|