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Castle AMR, Empringham B, Pinto LM, Villani A, Kanwar N, Abbott LS, Sawyer SL. Rhabdomyosarcoma as the first presentation in Neurofibromatosis Type 1: case series and review of the literature. Pediatr Hematol Oncol 2023:1-10. [PMID: 36625737 DOI: 10.1080/08880018.2022.2153951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Neurofibromatosis Type 1 (NF1) is a neurocutaneous syndrome characterized by multiple café-au-lait macules, neurofibromas, and predisposition to malignancies, including rhabdomyosarcomas (RMS). Somatic NF1 mutations occur in RMS and other cancers, and ∼1% of patients with RMS have NF1. We describe three patients who presented prior to one year of age with RMS and were subsequently diagnosed with NF1. Compared to sporadic RMS, patients with this cancer predisposition syndrome are diagnosed younger, genitourinary sites are more common, and tumors are almost exclusively the embryonal subtype. Genomic sequencing of the tumor was initiated in one patient, and we identified a second sequence variant in NF1. The identification of molecular drivers in tumors is changing the nature of pediatric oncology by informing therapeutics targeted to specific molecular pathways and selecting patients who are likely to harbor germline variants in cancer predisposition genes who would benefit from a Medical Genetics assessment.
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Affiliation(s)
- Alison M R Castle
- Department of Genetics, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
| | - Brianna Empringham
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
| | - Lisa M Pinto
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
| | - Anita Villani
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Nisha Kanwar
- Division of Genome Diagnostics, Department of Paediatric Laboratory Medicine and Pathobiology, The Hospital for Sick Children, Toronto, Canada
| | - Lesleigh S Abbott
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
| | - Sarah L Sawyer
- Department of Genetics, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada.,Children's Hospital of Eastern Ontario (CHEO) Research Institute, University of Ottawa, Ottawa, Canada
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2
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Kinori M, Hodgson N, Zeid JL. Ophthalmic manifestations in neurofibromatosis type 1. Surv Ophthalmol 2017; 63:518-533. [PMID: 29080631 DOI: 10.1016/j.survophthal.2017.10.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a relatively common multisystemic inherited disease and has been extensively studied by multiple disciplines. Although genetic testing and confirmation are available, NF1 remains a clinical diagnosis. Many manifestations of NF1 involve the eye and orbit, and the ophthalmologist, therefore, plays a significant role in the diagnosis and treatment of NF1 patients. Improvements in diagnostic and imaging instruments have provided new insight to study the ophthalmic manifestations of the disease. We provide a comprehensive and up-to-date overview of the ocular and orbital manifestations of NF1.
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Affiliation(s)
- Michael Kinori
- Department of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Nickisa Hodgson
- Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, California, USA
| | - Janice Lasky Zeid
- Department of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
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3
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Crucis A, Richer W, Brugières L, Bergeron C, Marie-Cardine A, Stephan JL, Girard P, Corradini N, Munzer M, Lacour B, Minard-Colin V, Sarnacki S, Ranchere-Vince D, Orbach D, Bourdeaut F. Rhabdomyosarcomas in children with neurofibromatosis type I: A national historical cohort. Pediatr Blood Cancer 2015; 62:1733-8. [PMID: 25893277 DOI: 10.1002/pbc.25556] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/20/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rhabdomyosarcoma (RMS) occasionally occurs in a context of a predisposition syndrome. The most common predisposition syndromes include germline TP53 mutations and constitutive alterations in RAS pathway activation, such as Costello syndrome, Noonan syndrome and neurofibromatosis type 1. We report a national retrospective series of 16 RMS occurring in neurofibromatosis type 1 (NF1) patients during childhood, within a 20-year period. RESULTS The mean age at diagnosis of the cancer was 2.5 years. All were embryonal subtype. Most tumours developed in the pelvis. One was metastatic. Chemotherapy and radiotherapy were normally scheduled without any specific toxicity. The 5-year event-free survival and overall survival were 67% and 87%, respectively. Long-term sequel related to chemotherapy consisted in two chronic tubulopathies, hence not obviously different from non-NF1 patients. No second cancer was reported so far with a median follow-up of 9.7 years. The genomic analysis performed on six samples revealed the abnormalities commonly observed in sporadic RMS: gain of chromosome 2 (5/6), 8 (6/6) and chromosome 11p loss of heterozygosity (5/6). Interestingly, we identified small deletions in tumour suppressor genes that may synergize with NF1 inactivation. CONCLUSIONS Patients with neurofibromatosis are prone to develop embryonal-type RMS that require the same treatment as sporadic cases.
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Affiliation(s)
- Anne Crucis
- Hopital Necker Enfants-Malades, Service de Reanimation pédiatrique, Paris, France
| | - Wilfrid Richer
- INSERMU830, Laboratoire de génétique et biologie des cancers, Institut Curie, Paris, France.,SIRIC, Recherche Translationnelle en Oncologie Pediatrique, Institut Curie, Paris, France
| | - Laurence Brugières
- Département d'Oncologie de l'Enfant et l'Adolescent, Institut Gustave Roussy, Villejuif, France
| | | | | | - Jean-Louis Stephan
- CHU de Saint-Etienne, Service d'hémato-oncologie pédiatrique, Saint-Etienne, France.,Universite Saint-Etienne, Saint-Etienne, France
| | - Pauline Girard
- CHU de Grenoble, Service d'hémato-oncologie pédiatrique, Grenoble, France
| | - Nadege Corradini
- CHU d'Amiens, Service d'hémato-oncologie pédiatrique, Amiens, France
| | - Martine Munzer
- CHU de Nantes, Service d'hémato-oncologie pédiatrique, Nantes, France
| | - Brigitte Lacour
- Registre national des tumeurs solides de l'enfant, CESP INSERM, Vandoeuvre-les-Nancy, France
| | - Veronique Minard-Colin
- Département d'Oncologie de l'Enfant et l'Adolescent, Institut Gustave Roussy, Villejuif, France
| | - Sabine Sarnacki
- Université Paris Rene Descartes, Paris, France.,Hopital Necker Enfants-Malades, Service de chirurgie infantile, Paris, France
| | | | - Daniel Orbach
- INSERMU830, Laboratoire de génétique et biologie des cancers, Institut Curie, Paris, France
| | - Franck Bourdeaut
- INSERMU830, Laboratoire de génétique et biologie des cancers, Institut Curie, Paris, France.,SIRIC, Recherche Translationnelle en Oncologie Pediatrique, Institut Curie, Paris, France.,Institut Curie, Departement d'oncologie pédiatrique adolescent jeune adulte, Paris, France
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4
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[Orbitotemporal facial involvement in type 1 neurofibromatosis (NF1)]. Neurochirurgie 2010; 56:257-70. [PMID: 20303131 DOI: 10.1016/j.neuchi.2010.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/17/2009] [Indexed: 11/24/2022]
Abstract
Plexiform neurofibromas of the orbit, sometimes extending to the temporal region and the face, are considered to be a rare but devastating and disfiguring complication of neurofibromatosis type 1. The first symptoms appear in infancy and the involvement of the orbit and the face is present in nearly all children after the age of 5. The disease is unilateral in most cases but can exceptionally involve both sides of the face. Progressive deformation of the orbital frame due to the expanding plexiform neurofibroma and buphthalmos occurs in a large proportion of cases. The associated sphenoidal dysplasia, which is thought to be, according to the most recent hypothesis, genetically determined, will inescapably increase the burden to the orbital content, cause pulsating proptosis and will endanger noble structures, finally resulting in loss of vision. Using the Jackson classification, the authors report their personal series of 22 cases (19 operated). Until now, there has been no effective medical treatment for plexiform neurofibroma and surgery remains the standard care for these patients. Controversies remain about the timing of the first operation and today most multidisciplinary teams involving plastic, maxillofacial, ophthalmologic, and neurosurgeons favor early intervention to try to minimize the secondary deformation of the orbital and facial skeleton. A number of cases of plexiform neurofibromas are illustrated within the three Jackson groups and treatment results of the rare elephantiasis neuromatosa cases are presented. Special techniques such as preoperative embolization of heavily vascularized plexiform neurofibroma are also discussed.
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Ferrari A, Bisogno G, Macaluso A, Casanova M, D'Angelo P, Pierani P, Zanetti I, Alaggio R, Cecchetto G, Carli M. Soft-tissue sarcomas in children and adolescents with neurofibromatosis type 1. Cancer 2007; 109:1406-12. [PMID: 17330850 DOI: 10.1002/cncr.22533] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients affected by neurofibromatosis type 1 (NF1) are at higher risk of developing soft-tissue sarcomas (STS) than the general population. The clinical findings and outcome in 43 children and adolescents with NF1 treated for STS in the Italian protocols between 1988 and 2004 are reported. METHODS The study included 37 patients with neurogenic sarcomas (36 malignant peripheral nerve sheath tumors [MPNST], 1 triton tumor) and 6 cases of rhabdomyosarcoma (RMS). The prevalence of NF1 observed during the study period was 43% in the MPNST population and 1% in the RMS group. RESULTS Most patients with neurogenic sarcomas had large, invasive tumors. Five-year event-free and overall survival rates were 19% and 28%, respectively. Two of 16 patients with evaluable disease responded to chemotherapy. All 6 RMS patients were </=3 years old and had embryonal subtype, 5 of 6 arising in the genitourinary tract or pelvis (paravesical); 4 were alive in first remission at the time of the analysis, 1 was alive in second remission after a local recurrence, and 1 died of disease. CONCLUSIONS The occurrence of STS in pediatric patients with NF1 syndrome in Italy is discussed, confirming that NF1 patients have a high risk of developing STS, and particularly MPNST, often with an aggressive clinical presentation and poor outcome. Cases of RMS tended to have particular features (early age, embryonal histotype, genitourinary site) and their outcome seemed to resemble that of the general RMS population.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Istituto Nazionale Tumori, Milano, Italy.
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6
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Shome D, Honavar SG, Reddy VAP, Vemuganti GK. Orbital Embryonal Rhabdomyosarcoma in Association with Neurofibromatosis Type 1. Ophthalmic Plast Reconstr Surg 2007; 23:147-8. [PMID: 17413633 DOI: 10.1097/iop.0b013e318032af94] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 20-month-old child with systemic features of neurofibromatosis type 1 presented with sudden-onset proptosis. Biopsy and histopathology confirmed the diagnosis of an embryonal rhabdomyosarcoma. The tumor regressed completely with chemotherapy and external beam radiotherapy. This case highlights the association of rhabdomyosarcoma with neurofibromatosis type 1.
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Affiliation(s)
- Debraj Shome
- Department of Ophthalmic Plastic Surgery, Orbit and Ocular Oncology, L.V. Prasad Eye Institute, Hyderabad, India
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Nikas I, Theofanopoulou M, Lampropoulou P, Pourtsidis A, Hadjigeorgi C, Kosmidis H. Optic pathway glioma associated with orbital rhabdomyosarcoma and bilateral optic nerve sheath dural ectasia in a child with neurofibromatosis-1. Pediatr Radiol 2006; 36:1200-3. [PMID: 16941184 DOI: 10.1007/s00247-006-0283-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 06/21/2006] [Accepted: 07/08/2006] [Indexed: 11/30/2022]
Abstract
Neurofibromatosis-1 (NF-1) is a multisystem disorder presenting with a variety of clinical and imaging manifestations. Neural and non-neural tumours, and unusual benign miscellaneous conditions, separately or combined, are encountered in variable locations. We present a 2(1/2)-year-old boy with NF-1 who demonstrated coexisting optic pathway glioma with involvement of the chiasm and optic nerve, orbital alveolar rhabdomyosarcoma and bilateral optic nerve sheath dural ectasia.
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Affiliation(s)
- Ioannis Nikas
- Imaging Department, Aghia Sophia Children's Hospital, Athens, Greece
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Coffin CM, Cassity J, Viskochil D, Lor Randall R, Albritton K. Non-neurogenic sarcomas in four children and young adults with neurofibromatosis type 1. ACTA ACUST UNITED AC 2004; 127A:40-43. [PMID: 15103715 DOI: 10.1002/ajmg.a.20651] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
It is well known that children and young adults with neurofibromatosis type 1 (NF1) have a higher risk for non-neurogenic sarcomas than the general population, in addition to an increased risk for malignant peripheral nerve sheath tumor. When non-neurogenic sarcomas occur in early childhood, a subsequent malignant peripheral nerve sheath tumor can occur as a second malignant neoplasm, especially after alkylating agent chemotherapy and irradiation. This report includes the clinicopathologic features of non-neurogenic sarcomas and secondary malignant peripheral nerve sheath tumor in the context of four cases of NF1. The purpose is to emphasize that early diagnosis of NF1 and recognition of potential manifestations of non-neurogenic sarcomas are important for clinical care of these patients and their families.
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Affiliation(s)
- Cheryl M Coffin
- Departments of Pathology, Pediatrics, Orthopedic Surgery, and Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Jamie Cassity
- Departments of Pathology, Pediatrics, Orthopedic Surgery, and Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
| | - David Viskochil
- Departments of Pathology, Pediatrics, Orthopedic Surgery, and Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
| | - R Lor Randall
- Departments of Pathology, Pediatrics, Orthopedic Surgery, and Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Karen Albritton
- Departments of Pathology, Pediatrics, Orthopedic Surgery, and Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
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