The multiple basal cell naevi syndrome

Nevoid Basal Cell Carcinoma Syndrome: A Long-Term Study in a Family

We present a family case series with 10 individuals having nevoid basal cell carcinoma syndrome (NBCCS) with a 10-year follow-up. All articles published in the literature between 1967 and 2011 on familial Gorlin-Goltz syndrome in any language were surveyed to determine the mapping of cases per country of occurrence of this disease. All patients in the present series were presented with calcification of the falx cerebri, mild hypertelorism, and frontal bossing. Odontogenic keratocystic tumors, palmar and plantar pits, and multiple basal cell carcinomas occurred in 90, 40, and 20%, respectively, of the patients. One of the patients died of skin cancer. Diagnosis of odontogenic keratocyst tumors was confirmed by histopathological examination. NBCCS is a rare autosomal dominant cancer predisposition syndrome; it is important to recognize it when a patient has multiple odontogenic keratocyst tumors because life-long monitoring is essential for patient management.

[Calcification of the falx cerebri. A pathognomonic symptom of Gorlin-Goltz syndrome]

BACKGROUND

Gorlin-Goltz syndrome is an autosomal dominant disorder with variable penetration characterized primarily by keratocysts of the jaws, multiple basal cell carcinomas, skeletal abnormalities and intracranial calcifications.

METHOD

In this study, 4787 radiographs with occipitomental x-rays from the hospital archives for oral and maxillofacial surgery of the Christian Albrechts University Kiel were examined for calcifications in the area of the falx cerebri.

RESULTS

Four characteristic alterations in the falx cerebri could be assigned to four groups of structures. Those in group 4 could be found only within Gorlin-Goltz syndrome patients, and differed significantly in form and extent from the remaining three groups.

CONCLUSION

The plurilamellar appearance of this group could be rated as a pathognomonic symptom of the Gorlin-Goltz syndrome.

Proliferation kinetics-study of the growth of keratocysts. Morpho-functional explanation for recurrences

The mode of growth of the odontogenic keratocyst is of decisive importance in the strategy and radicality of its surgical removal. The high rate of recurrence reported in the literature is striking. Staining with haematoxylin-eosin for histological examination provides only limited information on growth. Serial sections of a keratocyst obtained by fractionated curettage were prepared and the proliferation patterns of epithelium and connective tissue were studied by means of autoradiography and DNA cytophotometry and compared with those of an odontogenic reference cyst of the radicular type. The epithelium of the keratocyst examined clearly showed a higher rate of proliferation than that of the radicular cyst. The connective tissue was also growing very actively with a high rate of proliferation and this growth behaviour is at least partly responsible for the invasive and destructive growth of the keratocyst. In contrast to the radicular cyst, proliferation of the epithelium of the keratocyst is multicentric being simultaneous within the growth centres. As a result the epithelium "buds" with formation of satellite cysts in the alveolar bone and peripheral epithelial islands located in the connective tissue. A case is reported of a keratocyst treated by radical curettage with subsequent freshening of adjacent bone with a bur. Our morphological findings are an important contribution to the present discussion of the various methods of treating keratocysts.

Nevoid basal cell carcinoma syndrome associated with renal cysts and hypertension

A case of nevoid basal cell carcinoma syndrome with a coincidental finding is presented. In addition to the odontogenic cysts, hypertelorism, scapula deformity, rib fusion, dural calcification, and short fourth metacarpal bones of the syndrome, the patient had cystic disease of both kidneys with a large cyst of the right kidney. This case also illustrates that the presence of painful jaw lesions may lead the patient with this syndrome to seek treatment initially.

The multiple nevoid basal cell carcinoma syndrome. Report of its occurrence in four generations of a family

Four patients representing four generations of one family suffered from the multiple nevoid basal cell carcinoma syndrome. These cases are described and the importance of examination and careful supervision of the progeny of such patients is discussed. A unique finding in this series was a large congenital lung cyst occupying the left thoracic cavity of 1 patient.

Recurrence of the odontogenic keratocyst in 13 patients with the nevoid basal cell carcinoma syndrome. A 6-year follow-up

A 6-year follow-up study of 44 primarily enucleated odontogenic keratocysts from 13 patients with the characteristics signs and symptoms of the nevoid basal cell carcinoma syndrome (NBS) is presented. The 2-, 3-, 4-, 5- and 6-year follow-ups revealed an incidence of recurrence by the single keratocyst of 20, 30, 39, 50 and 55%, respectively. These figures demonstrate that the majority of the recurrences occurred within a period of 5 years postoperatively. However, as the proportion of increased recurrence in the period from 5 to 6 years postoperatively was 5%, a follow-up period of more than 6 years is necessary in order to make the diagnosis of recurrence without any delay in all patients with NBS. The occurrence of odontogenic epithelium and/or microcysts in the cyst wall of keratocysts without any recurrence at the 5-year follow-up was compared with the occurrence of similar histopathologic features in keratocysts which at the 5-year follow-up had shown recurrence. The occurrence of odontogenic epithelium and/or microcysts was demonstrated in 43% of the group of keratocysts without recurrence and in 57% of the group of keratocysts with recurrence. However, this difference is not statistically significant (P > 0.10) and indicates that the high occurrence (50%) of odontogenic epithelium and/or microcysts in NBS-keratocysts is not significantly correlated to the recurrence.

Multiple basal cell naevi syndrome: management of the young patient

The principal features of the Multiple Basal Cell Naevi Syndrome are reviewed and the case of a seven-year-old child is described. The diagnosis and the management of young patients with this syndrome are discussed.

What is Gorlin's syndrome? The diagnosis and management of the basal cell naevus syndrome, based on a study of thirty-seven patients

A series of 37 patients with Gorlin's syndrome is described; 23 had the typical naevi, 19 had jaw cysts and only 10 had both. A wide range of associated deformities was noted. The need for early identification of patients at risk is stressed; follow-up is essential for 2 reasons: The naevi although indistinguishable histologically from basal cell carcinomas only rarely require radical removal. The jaw cysts are locally invasive and should be radically removed when small. In 8 patients examined there was a low level of alpha-globulins in the plasma. Spontaneous involution of the naevi may occur in un-irradiated skin.

Clinical, radiologic, and histopathologic aspects of 13 cases of nevoid basal cell carcinoma syndrome

Thirteeen patients with the characteristic signs and symptoms of the nevoid basal cell carcinoma syndrome (NBS) are presented. It is suggested that the chromosomal anomalies sporadically reported have hardly any connection with the syndrome. The jaw cysts removed from the patients with NBS were clinically, radiologically, and histopathologically typical keratocysts with a high occurrence of epithelial islands and/or microcyts in the connective tissue of the capsule. The significantly higher occurrence of proliferative epithelial remnants in the connective tissue of the cyst wall may be an explanation of the high recurrence rate seen in patients with NBS and of the recurrence of some solitary keratocysts in patients without any signs or symptoms of NBS. In a follow-up period of 2 years, 85% of the patients with NBS showed recurrence. One-third of these patients did not show any recurrence at the 1-year follow-up. Therefore, a follow-up period of 2 years or more is mandatory in the care of patients with the nevoid basal cell carcinoma syndrome.

Gorlin's syndrome

The uncommon familial syndrome of multiple odontogenic keratocysts, basal cell naevi and skeletal anomalies is reviewed, and seven cases are described, including one patient who developed squamous cell carcinoma in a previous odontogenic keratocyst of the maxilla. We wish to thank Consultants from the Royal National Throat, Nose and Ear Hospital, The Middlesex Hospital and the Eastman Dental Hospital, who allowed us access to their patients; Mr. D. Garfield Davies, Dr. M. F. Spittle, Mr. D. Winstock, Mr. H. P. Cook, Professor H. C. Killey and Mr. L. W. Kay. We are grateful to Professor L. Michaels and Mr. D. J. Connolly for preparation of the illustrations and to Mrs. A. Matthews for the typescript.