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Martinez-Rios C, De Leon Benedetti LS, Tierradentro-Garcia LO, Kilicarslan OA, Caro-Dominguez P, Otero HJ. Imaging findings of children with PTEN-related hamartoma tumor syndrome: a 20-year multicentric pediatric cohort. Pediatr Radiol 2024; 54:1116-1127. [PMID: 38644431 DOI: 10.1007/s00247-024-05922-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND PTEN-related hamartoma tumor syndrome results from a mutation in the PTEN gene located at 10q23.31. This syndrome represents a spectrum of different phenotypes of variable expressions, now recognized as part of the same condition. Patients with this mutation have an increased risk of developing a wide range of findings, including malignancies. Although widely described in adults, there are no large series describing the imaging findings in patients before adulthood. Knowledge of the findings seen in children and adolescents with PTEN-related hamartoma tumor syndrome can help guide further management and improve surveillance recommendations. OBJECTIVE To describe the spectrum of imaging abnormalities in pediatric patients with PTEN-related hamartoma tumor syndrome. MATERIALS AND METHODS We performed a retrospective, cross-sectional, multicenter study conducted between January 2000 and October 2021 in three tertiary pediatric institutions evaluating the imaging findings in children and adolescents (≤ 18 years) with confirmed diagnoses of a PTEN mutation. For each patient, the imaging findings, histopathology reports, and at least a 2-year follow-up of clinical outcomes for non-operative cases were documented. RESULTS The cohort included 78 children (37 girls), with a mean age at diagnosis of 7.5 years (range 0 days to 18 years). Benign brain findings included enlarged Virchow-Robin perivascular spaces, white matter changes, developmental venous anomalies, and cerebellar hamartomas. Benign thyroid findings were common, but 5/45 (11.1%) with thyroid abnormalities had a malignant nodule. Soft tissue adipocytic tumors, GI/GU polyps, other soft tissue abnormalities, along with vascular anomalies in various anatomic locations were common. CONCLUSION Brain abnormalities, benign non-vascular soft tissue abnormalities, and vascular anomalies are commonly seen in children and adolescents with PTEN-related hamartoma tumor syndrome. However, malignancies involving the thyroid gland are not uncommon. Familiarity with the phenotype of PTEN-related hamartoma tumor syndrome in the pediatric population can improve diagnosis and prompt appropriate clinical surveillance of abnormal findings that warrant further management.
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Affiliation(s)
- Claudia Martinez-Rios
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Department of Radiology, University of Toronto, 555 University Avenue, Toronto, ON, M5G1X8, Canada.
| | - Laura S De Leon Benedetti
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | | | - Ozge Aksel Kilicarslan
- Medical Imaging Department, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, K1H8L1, Canada
| | - Pablo Caro-Dominguez
- Unidad de Radiologia Pediatrica, Servicio de Radiodiagnostico, Hospital Universitario Virgen del Rocio Sevilla, Sevilla, 41013, Spain
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Li R, Skeik N. A rare case of Bannayan-Riley-Ruvalcaba syndrome with concurrent arteriovenous malformation. J Vasc Surg Cases Innov Tech 2024; 10:101428. [PMID: 38379611 PMCID: PMC10877428 DOI: 10.1016/j.jvscit.2024.101428] [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: 10/05/2023] [Accepted: 12/26/2023] [Indexed: 02/22/2024] Open
Abstract
Bannayan-Riley-Ruvalcaba syndrome (BRRS) is a congenital, autosomal-dominant disorder characterized by a triad of macrocephaly, lipomatosis, and pigmentation of the glans penis. The symptoms of this rare syndrome vary greatly and include multiple hamartomatous polyps, macrocephaly, increased birth weight, developmental delay, and intellectual disability. Vascular abnormalities, including arteriovenous malformations (AVMs), have rarely been reported as part of the vascular manifestations associated with BRRS. Congenital AVMs can rarely progress, resulting in limb- or life-threatening complications. We present the case of a young man with BRRS diagnosed in childhood and presenting with three AVMs involving the right upper extremity and chest. We also provide a brief literature summary of reported cases of BRRS with AVMs. Our paper highlights the importance of recognizing and understanding the vascular manifestations in patients with BRRS. Knowledge of the association between BRRS and AVMs is crucial for guiding patient diagnosis and management, optimizing treatment strategies, and improving overall patient outcomes.
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Affiliation(s)
- Rina Li
- Minneapolis Heart Institute Foundation, Minneapolis, MN
| | - Nedaa Skeik
- Division of Vascular Medicine, Thrombophilia and Anticoagulation Clinic, Vein Center, Abbott Northwestern Hospital/Minneapolis Heart Institute, Minneapolis, MN
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Gupta R, Bhandari A, Navarro OM. Pediatric Vascular Anomalies: A Clinical and Radiological Perspective. Indian J Radiol Imaging 2024; 34:103-127. [PMID: 38106867 PMCID: PMC10723972 DOI: 10.1055/s-0043-1774391] [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] [Indexed: 12/19/2023] Open
Abstract
According to the International Society for the Study of Vascular Anomalies (ISSVA) classification, vascular anomalies include a diverse range of pathologies, classified as either vascular tumors or vascular malformations. This classification, last revised in 2018, aims to explain the biological basis of vascular lesions and help clinicians to manage the anomalies. In vascular tumors, there are proliferative changes of endothelial cells, while vascular malformations primarily consist of structural vascular abnormalities. Infantile hemangioma is the most common soft-tissue vascular tumor. Vascular malformations are an extensive group of malformations of the arterial, venous, and lymphatic systems, either in isolation or in combination. Radiological evaluation plays a key part in the management of pediatric patients with these entities. The understanding of sonography and magnetic resonance imaging findings entails its correlation with clinical findings at the time of scanning.
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Affiliation(s)
- Rahul Gupta
- Department of Paediatric Surgery, SMS Medical College, JLN Marg, Jaipur, Rajasthan, India
| | - Anu Bhandari
- Department of Radiodiagnosis, SMS Medical College, JLN Marg, Jaipur, Rajasthan, India
| | - Oscar M. Navarro
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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Bali D, Tabaku M, Gjikopulli A, Velmishi V, Tocilla B, Godo A, Cullufi P. The First Familiar Case of PTEN-Related Disorder Reported in Albania. Turk Arch Pediatr 2023; 58:559-561. [PMID: 37534462 PMCID: PMC10543923 DOI: 10.5152/turkarchpediatr.2023.23093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/22/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Donjeta Bali
- Department of Pediatrics, University Hospital “Mother Teresa”, Tirana, Albania
| | - Mirela Tabaku
- Department of Pediatrics, University of Medicine of Tirana, Tirana, Albania
| | - Agim Gjikopulli
- Department of Pediatrics, University Hospital “Mother Teresa”, Tirana, Albania
| | - Virtut Velmishi
- Department of Pediatrics, University Hospital “Mother Teresa”, Tirana, Albania
| | - Behar Tocilla
- Department of Advanced Imaging, American Hospital of Tirana, Albania
| | - Anila Godo
- Department of Pediatrics, University Hospital “Mother Teresa”, Tirana, Albania
| | - Paskal Cullufi
- Department of Pediatrics, University Hospital “Mother Teresa”, Tirana, Albania
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5
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Kozman D, Kao CS, Nguyen JK, Smith SC, Kehr EL, Tretiakova M, Przybycin CG, Williamson SR, Argani P, Eng C, Campbell SC, McKenney JK, Alaghehbandan R. Renal Neoplasia Occurring in Patients With PTEN Hamartoma Tumor Syndrome : Clinicopathologic Study of 12 Renal Cell Carcinomas From 9 Patients and Association With Intrarenal "Lipomas". Am J Surg Pathol 2023; 47:1001-1010. [PMID: 37357918 DOI: 10.1097/pas.0000000000002079] [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: 06/27/2023]
Abstract
The aim of this study was to assess the histopathologic spectrum of renal tumors in patients with PTEN hamartoma tumor syndrome (PHTS), with a specific focus on potential features predictive of the underlying syndrome. A multi-institutional study was conducted to obtain clinical and pathologic data on renal tumors arising in patients with PHTS, either diagnosed by germline mutational analysis or clinical criteria for Cowden syndrome. Histologic sections of the renal tumors were re-reviewed for classification. Twelve renal epithelial tumors from 9 patients were identified (4 males and 5 females, with a mean age of 41.8 y), 7 of whom carried germline PTEN mutations. All 12 renal epithelial tumors were renal cell carcinomas (RCCs): 5 were chromophobe RCCs, 4 papillary RCCs, and 3 RCC not otherwise specified. Pathologic stage distribution was: 7 (59%) pT1a, 2 (17%) pT1b, 1 (8%) pT2a, 1 (8%) pT2b, and 1 (8%) pT3a. World Health Organization/International Society of Urological Pathology (WHO/ISUP) histologic grade was applicable in 7 (54%) nonchromophobe tumors: 4 (57%) G2, 2 (29%) G3, and 1 (14%) G4. An unexpected histologic finding was the presence of 2 patients with incidental microscopic collections of intrarenal adipocytes that had no features of angiomyolipoma (and were negative with 2 sensitive PEComa markers: cathepsin-K and GPNMB); both were classified as lipoma/"lipomatous hamartomas." The average follow-up interval was 67.8 months (13 to 172 mo): 5 patients had no evidence of disease, 2 were lost to follow-up, 1 died of other (non-PHTS) causes (ie, prostate cancer), and 1 was alive with metastatic RCC to the lung (RCC not otherwise specified with rhabdoid differentiation). All tumors showed loss of nuclear PTEN staining by immunohistochemistry. Fumarate hydratase was retained and 2SC was negative in all papillary RCCs. CK7 was moderate-strong/diffuse positive in 4 of 5 chromophobe RCCs and in 3 of 4 papillary RCCs. Renal epithelial tumors associated with PHTS represent a heterogeneous group of RCCs, but classic chromophobe and papillary RCC are most common. The majority have a favorable clinical behavior as would be predicted by subtype. In contrast to other hereditary renal neoplasia syndromes, morphologic features of the RCCs do not allow identification of PHTS-associated neoplasia with any degree of specificity in the absence of clinical setting and/or prior history, but the presence of microscopic "lipomas" within the kidney may provide a clue in rare cases. Therefore, clinical suspicion and genetic counseling with germline testing remain necessary for identifying PHTS-associated RCC.
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Affiliation(s)
- Diana Kozman
- Robert J. Tomsich Pathology and Laboratory Medicine Institute
| | - Chia-Sui Kao
- Department of Pathology, Stanford Medical Center, Stanford, CA
| | - Jane K Nguyen
- Robert J. Tomsich Pathology and Laboratory Medicine Institute
| | - Steven C Smith
- Departments of Departments of Pathology, Urology, and Massey Cancer Center, VCU School of Medicine
- Richmond VA Medical Center, Richmond, VA
| | | | - Maria Tretiakova
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | | | | | - Pedram Argani
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Steven C Campbell
- Section of Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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Orly J, Bisdorff A, Fraissenon A, Joly A, Boulouis G, Guibaud L, Tavernier E, Mallet S, Marcelin C, Miquel J, Martin L, Droitcourt C, Gusdorf L, Abasq C, Dadban A, Chiaverini C, Vabres P, Herbreteau D, Boccara O, Wassef M, Maruani A. Intramuscular capillary-type hemangioma: Diagnosis, treatment, and outcomes. A French multicentric retrospective study of 66 cases. Eur J Radiol 2023; 165:110962. [PMID: 37423018 DOI: 10.1016/j.ejrad.2023.110962] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Intramuscular capillary-type hemangiomas (ICTHs) are rare entities, belonging to the group of intramuscular "hemangiomas." The diagnosis remains challenging. We aimed to assess the diagnostic criteria, treatments and outcomes of ICTHs. METHODS This retrospective study collected all cases of ICTH followed up in 9 French hospital centers, reviewed by an adjudication expert group. RESULTS Among 133 patients screened, 66 with ICTH were included. The median age of patients at diagnosis was 28.0 years, interquartile range (21.0---36.0). The lesion, mainly presenting as a gradually increasing mass (83.9%), was painless (88.9%) and was located in the head and neck (42.4%). MRI (available in all cases) mainly revealed a well-delineated lesion, isointense to the muscle on T1-weighted images, with enhancement after contrast injection; hyperintense on T2-weighted images; and containing flow voids. Among the 66 cases, 59 exhibited typical ICTH features and 7 shared some imaging features with arteriovenous malformations. These latter were larger than typical ICTHs and more painful and appeared on imaging as less well delimited and more heterogeneous tissue masses, with larger tortuous afferent arteries, earlier draining vein opacification and mild arteriovenous shunting. We propose to name these lesions arteriovenous malformation (AVM)-like ICTH. Pathological reports were similar in typical and AVM-like ICTH, showing capillary proliferation with mainly small-size vessels, negative for GLUT-1 and positive for ERG, AML, CD31 and CD34, with low Ki67 proliferation index (<10%), and adipose tissue. The most frequent treatment for ICTH was complete surgical resection (17/47, 36.2%), preceded in some cases by embolization, which led to complete remission. CONCLUSIONS ICTH can be diagnosed on MRI when it is typical. Biopsy or angiography are required for atypical forms.
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Affiliation(s)
- Jordan Orly
- CHRU Tours, Department of Dermatology, Unit of Pediatric Dermatology, Tours, France; Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Tours), Tours, France
| | - Annouk Bisdorff
- Reference Center for Vascular Anomalies FAVA-multi, University Hospital of Lariboisière, Coordinator of the Constitutive Center for Superficial Arteriovenous Malformations in Children and Adults, AP-HP, Department of Neuroradiology, Paris, France
| | - Antoine Fraissenon
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon-Bron, France; Service de Radiologie Mère-Enfant, Hôpital Nord, Saint-Etienne, France; CREATIS, UMR 5220, U1294 Lyon, France
| | - Aline Joly
- Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Tours), Tours, France; CHRU Tours, Department of Maxillo-facial Surgery, Tours, France
| | - Grégoire Boulouis
- Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Tours), Tours, France; CHRU Tours, Department of Neuroradiology and Interventional Radiology, Tours, France
| | - Laurent Guibaud
- Service d'Imagerie, Consultation Multidisciplinaire des Angiomes, Centre de Compétence National Malformations Vasculaires Superficielles, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon 1, Lyon-Bron, France
| | - Elsa Tavernier
- University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France; CHRU Tours, Clinical Investigation Center INSERM 1415, Tours, France
| | - Stéphanie Mallet
- University Hospital Center of Marseille, Department of Dermatology, Marseille, France
| | - Clément Marcelin
- University Hospital Center of Bordeaux, Department of Radiology, Bordeaux, France
| | - Juliette Miquel
- University Hospital Center of La Réunion, Department of Pediatric Dermatology, Saint-Pierre, La Réunion, France
| | - Ludovic Martin
- University Hospital Center of Angers, Department of Dermatology, Angers, France
| | | | - Laurence Gusdorf
- University Hospital Center of Reims, Department of Dermatology, Reims, France
| | - Claire Abasq
- University Hospital Center of Brest, Department of Dermatology, Brest, France
| | - Ali Dadban
- University Hospital Center of Amiens, Department of Dermatology, Amiens, France
| | | | - Pierre Vabres
- University of Bourgogne, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Dijon, France
| | - Denis Herbreteau
- Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Tours), Tours, France; CHRU Tours, Department of Neuroradiology and Interventional Radiology, Tours, France
| | - Olivia Boccara
- Department of Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Necker), University Hospital Necker-Enfants Malades, Paris, France
| | - Michel Wassef
- University Hospital of Lariboisière, AP-HP, Department of Pathology, Paris, France
| | - Annabel Maruani
- CHRU Tours, Department of Dermatology, Unit of Pediatric Dermatology, Tours, France; Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC-Tours), Tours, France; University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France.
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7
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Howard EL, Singleton M, Soulakvelidze I. Amputation for Complex Regional Pain Syndrome: Meta-Analysis and Validation of a Histopathology Scoring System. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:425-441. [PMID: 36355456 PMCID: PMC10069857 DOI: 10.1093/pm/pnac168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/02/2022] [Accepted: 09/15/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pathology can provide crucial insights into the etiology of disease. The goal of this review is to evaluate the rigor of histopathology reports of Complex Regional Pain Syndrome (CRPS). METHODS A systematic search of multiple databases identified papers that described amputation for CRPS with pathology findings. Control pathology articles were randomly chosen from the same journals. Landmark articles in Surgical Pathology were previously identified. Papers were categorized by the use of histology: Anatomic (microscopic description), Diagnostic (binary result), and Substrate (special studies only). A novel Histopathology Score assigned 1 point for each of 10 History elements and 15 Pathology elements. All articles were scored and analyzed by appropriate statistics. RESULTS The search identified 22 CRPS, 50 Control and 50 Landmark articles. Multivariable analysis of the Pathology Score showed a significantly higher score for Anatomic vs Non-Anatomic papers (Incidence Rate Ratio (IRR) 1.54, P < .001) and Landmark vs CRPS articles (IRR 1.39, P value .003). CRPS papers reported some elements infrequently: diagnostic criteria (31.8%), routine stain (50%), any clinic-pathologic correlation (40.9%), and sample size >2 (27.3%). CONCLUSIONS The Pathology Score is a useful quality assessment tool to evaluate studies. As expected, Anatomic papers scored significantly higher than Non-Anatomic papers. CRPS papers had small sample sizes (median 1) and infrequent reporting of diagnostic criteria, routine stain, any clinical pathologic correlation. These particular elements are crucial for analyzing and reviewing pathologic features. The analysis explains why it is quite difficult to write a meaningful systematic review of CRPS histology at this time.
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Affiliation(s)
- Emily L Howard
- Department of Biology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael Singleton
- Institute of Translational Health Sciences, Seattle, Washington, USA
| | - Irakli Soulakvelidze
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
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Aru MG, Davis JL, Stacy GS, Mills MK, Yablon CM, Hanrahan CJ, McCallum R, Nomura EC, Hansford BG. Beyond schwannomas and neurofibromas: a radiological and histopathological review of lesser-known benign lesions that arise in association with peripheral nerves. Skeletal Radiol 2023; 52:649-669. [PMID: 36280619 DOI: 10.1007/s00256-022-04207-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 02/02/2023]
Abstract
Peripheral nerve sheath tumors comprise a significant percentage of both benign and malignant soft tissue tumors. The vast majority of these lesions are schwannomas and neurofibromas, which most radiologists are familiar with including the well-described multimodality imaging features. However, numerous additional often under-recognized benign entities associated with nerves exist. These rarer entities are becoming increasingly encountered with the proliferation of cross-sectional imaging, particularly magnetic resonance imaging (MRI). It is important for the radiologist to have a basic understanding of these entities as many have near-pathognomonic MR imaging features as well as specific clinical presentations that when interpreted in concert, often allows for a limited differential or single best diagnosis. The ability to provide a prospective, pre-intervention diagnosis based solely on imaging and clinical presentation is crucial as several of these entities are "do not touch" lesions, for which even a biopsy may have deleterious consequences. To our knowledge, the majority of these benign entities associated with nerves have only been described in scattered case reports or small case series. Therefore, the aim of this article is to provide a radiopathologic comprehensive review of these benign entities that arise in association with nerves with a focus on characteristic MRI features, unique histopathologic findings, and entity specific clinical exam findings/presentation.
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Affiliation(s)
- Marco G Aru
- Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Jessica L Davis
- Department of Pathology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-471, Portland, OR, 97239, USA
| | - Gregory S Stacy
- Department of Diagnostic Radiology, University of Chicago, 5841 South Maryland Avenue, MC2026, Chicago, IL, 60637, USA
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E, Rm #1A71, Salt Lake City, UT, 84132, USA
| | - Corrie M Yablon
- Department of Diagnostic Radiology, University of Michigan Health System, 1500 E. Medical Center Dr, TC2910Q, Ann Arbor, MI, 48109, USA
| | - Christopher J Hanrahan
- Department of Diagnostic Radiology, University of Utah School of Medicine, Intermountain Healthcare, Salt Lake City, UT, 84132, USA
| | - Raluca McCallum
- Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Eric C Nomura
- Department of Pathology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-471, Portland, OR, 97239, USA
| | - Barry G Hansford
- Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
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Orly J, Bisdorff A, Joly A, Edee AE, Tavernier E, Herbreteau D, Boccara O, Wassef M, Maruani A. Characteristics, Natural Course and Treatment of Intramuscular Capillary-type Haemangioma: A Systematic Literature Review. Acta Derm Venereol 2023; 103:adv00893. [PMID: 36939537 PMCID: PMC10041649 DOI: 10.2340/actadv.v103.4432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/29/2022] [Indexed: 03/21/2023] Open
Abstract
Intramuscular capillary-type haemangiomas (ICTH) are rare vascular anomalies that can easily be misdiagnosed as other entities. A systematic review was performed of all cases of ICTH in the literature since its first description in 1972. An adjudication committee reviewed cases to include only ICTHs. Among 1,143 reports screened, 43 were included, involving 75 patients. The most frequent differential diagnosis was intramuscular venous malformations. The mean age of patients at diagnosis was 21.2 years. ICTH was mainly described as a gradually increasing mass (81.8%), painless (73.9%), that could occur anywhere in the body but most frequently on the head and neck (44.0%). Magnetic resonance imaging (MRI) was mainly used for diagnosis (69.1%) and displayed specific features. The most frequent treatment was complete surgical removal (73.9%), which could be preceded by embolization, and led to complete remission without recurrence in all but 1 case.
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Affiliation(s)
- Jordan Orly
- CHRU Tours, Department of Dermatology, Unit of Pediatric dermatology, Tours, France; Reference center for genodermatoses and rare skin diseases (MAGEC-Tours), Tours.
| | - Annouk Bisdorff
- 3Reference center for vascular anomalies FAVA-multi, University Hospital of Lariboisière; Coordinator of the constitutive center for superficial arteriovenous malformations in children and adults; AP-HP, Department of Neuroradiology, Paris, France
| | - Aline Joly
- Reference center for genodermatoses and rare skin diseases (MAGEC-Tours), Tours, France; Reference center for vascular anomalies FAVA-multi, University Hospital of Lariboisière; Coordinator of the constitutive center for superficial arteriovenous malformations in children and adults; AP-HP, Department of Neuroradiology, Paris, France; CHRU Tours, Department of Maxillo-facial surgery, Tours, France
| | - Afi-Emiliène Edee
- Reference center for genodermatoses and rare skin diseases (MAGEC-Tours), Tours, France
| | - Elsa Tavernier
- University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France; CHRU Tours, Clinical Investigation Center INSERM 1415, Tours, France
| | | | - Olivia Boccara
- Department of Dermatology and Reference center for genodermatoses and rare skin diseases (MAGEC-Necker), University Hospital Necker-Enfants Malades, Paris, France
| | - Michel Wassef
- Department of Pathology, University Hospital of Lariboisière, AP-HP, Paris, France
| | - Annabel Maruani
- CHRU Tours, Department of Dermatology, Unit of Pediatric dermatology, Tours, France; Reference center for genodermatoses and rare skin diseases (MAGEC-Tours), Tours, France; University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France
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10
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Hernandez PV, King KA, Evenson MJ, Corliss MM, Schroeder MC, Heusel JW, Neidich JA, Cao Y. High-depth next-generation sequencing panel testing in the evaluation of arteriovenous malformations. Am J Med Genet A 2023; 191:1518-1524. [PMID: 36924216 DOI: 10.1002/ajmg.a.63171] [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: 09/16/2022] [Revised: 02/07/2023] [Accepted: 02/21/2023] [Indexed: 03/18/2023]
Abstract
Arteriovenous malformations (AVMs) are vascular lesions in which an overgrowth of blood vessels of varying sizes develops with one or more direct connections between the arterial and venous circulation. We performed a retrospective review of a cohort of 54 patients with AVMs referred to our clinical genomic laboratory for high-depth next-generation sequencing (NGS) panel of Disorders of Somatic Mosaicism (DoSM). Thirty-seven of 54 patients were female (68.5%). Among the 54 cases, 37 (68.5%) cases had pathogenic and/or likely pathogenic (P/LP) variants identified, two cases (3.7%) had variants of uncertain clinical significance, and the remaining 15 cases (27.8%) had negative results. MAP2K1 variants were found in 12 cases, followed by eight cases with KRAS variants and seven with TEK variants, and the remainder being identified in several other genes on the panel. Among the 37 positive cases, 32 cases had somatic alterations only; the remaining five cases had at least one germline P/LP variant, including four cases with PTEN and one with RASA1. Of note, two cases had the unexpected co-existence of two P/LP variants. In summary, this study illustrated the molecular diagnostic yield (68.5%) of this cohort of patients with a clinical indication of AVMs by our high-depth DoSM NGS panel.
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Affiliation(s)
- Patricia V Hernandez
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Katherine A King
- Department of Pediatrics, Division of Genetics and Genomic Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Michael J Evenson
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Meagan M Corliss
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Molly C Schroeder
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Jonathan W Heusel
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA.,Department of Genetics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Julie A Neidich
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA.,Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Yang Cao
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
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11
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Hu W, Gong Y, Ma J, Wu G. Fibro-Adipose Vascular Anomaly: Characteristic Imaging Features on Sonography and Magnetic Resonance Imaging. Vasc Endovascular Surg 2023; 57:106-113. [PMID: 36168791 DOI: 10.1177/15385744221129973] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To analyse the image characteristics of fibro-adipose vascular anomaly (FAVA) and the value of ultrasound and magnetic resonance imaging (MRI) for its diagnosis. METHODS The clinical and imaging data characteristics of 10 patients with FAVA admitted to our hospital between January 2018 and December 2020 who underwent ultrasound and MRI diagnosis were retrospectively analysed. RESULTS A total of 10 patients (six males and four females) with pathologically confirmed FAVA, aged from 3 to 27 years (median: 13 years), underwent ultrasound and MRI; of these, two patients underwent MRI-enhanced examinations. All lesions involved mainly muscle, with a few disruptions and involvements of subcutaneous fat. Five cases were located subcutaneously near the fascia; one case was adjacent to the periosteum. Ultrasound showed fascial tail in seven cases, and MRI showed fascial tail in six cases. Both ultrasound and MRI showed the lesions to be oval-shaped masses with blurred borders and a mean maximum diameter of 99.8 ± 48.7 mm. Ultrasound showed a mass with a mixture of high and low echoic areas. Magnetic resonance imaging imaging showed a heterogeneous, mixed-signal intensity on T1-weighted images, probably influenced by the fibrous and fatty components of the lesion. T2-weighted images showed a mixed-high signal. Enhanced computed tomography scans showed significant heterogeneous enhancement of the lesions. CONCLUSION Both ultrasound and MRI showed that fascial tail sign is an important imaging feature for FAVA disease; this provides a reliable basis for its diagnosis and can be used to distinguish it from venous malformations, which have no fascial tail signs. Therefore, fascial tail signs can be used as imaging features and require special attention in the diagnosis of FAVA disease.
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Affiliation(s)
- WenJia Hu
- Department of Ultrasound, People's Hospital of Henan Province, Zhengzhou, China
| | - YuBin Gong
- Department of Ultrasound, People's Hospital of Henan Province, Zhengzhou, China
| | - JingJing Ma
- Department of Hemangioma, People's Hospital of Henan Province, Zhengzhou, China
| | - Gang Wu
- Department of Ultrasound, People's Hospital of Henan Province, Zhengzhou, China
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12
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Das A, Goyal A, Sangwan A, Kumar A, Bhalla AS, Kandasamy D, Chauhan S. Vascular anomalies: diagnostic features and step-wise approach. Acta Radiol 2023; 64:850-867. [PMID: 35300505 DOI: 10.1177/02841851221085379] [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: 11/16/2022]
Abstract
The first part of this review article emphasized correct nomenclature, classification systems, and imaging algorithm of vascular anomalies. The second part of the review discusses the individual entities, highlighting the characteristic clinico-radiological features of the commonly encountered ones. A step-wise algorithmic approach is also proposed for the evaluation of a suspected case of vascular anomaly.
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Affiliation(s)
- Abanti Das
- Department of Radiodiagnosis and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Sangwan
- Department of Radiodiagnosis and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Devasenathipathy Kandasamy
- Department of Radiodiagnosis and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Chauhan
- Department of Plastic Reconstructive Surgery, 28730All India Institute of Medical Sciences, New Delhi, India
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13
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Marechal E, Poliard A, Henry K, Moreno M, Legrix M, Macagno N, Mondielli G, Fauquier T, Barlier A, Etchevers HC. Multiple congenital malformations arise from somatic mosaicism for constitutively active Pik3ca signaling. Front Cell Dev Biol 2022; 10:1013001. [PMID: 36353506 PMCID: PMC9637999 DOI: 10.3389/fcell.2022.1013001] [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: 08/06/2022] [Accepted: 10/07/2022] [Indexed: 11/17/2022] Open
Abstract
Recurrent missense mutations of the PIK3CA oncogene are among the most frequent drivers of human cancers. These often lead to constitutive activation of its product p110α, a phosphatidylinositol 3-kinase (PI3K) catalytic subunit. In addition to causing a broad range of cancers, the H1047R mutation is also found in affected tissues of a distinct set of congenital tumors and malformations. Collectively termed PIK3CA-related disorders (PRDs), these lead to overgrowth of brain, adipose, connective and musculoskeletal tissues and/or blood and lymphatic vessel components. Vascular malformations are frequently observed in PRD, due to cell-autonomous activation of PI3K signaling within endothelial cells. These, like most muscle, connective tissue and bone, are derived from the embryonic mesoderm. However, important organ systems affected in PRDs are neuroectodermal derivatives. To further examine their development, we drove the most common post-zygotic activating mutation of Pik3ca in neural crest and related embryonic lineages. Outcomes included macrocephaly, cleft secondary palate and more subtle skull anomalies. Surprisingly, Pik3ca-mutant subpopulations of neural crest origin were also associated with widespread cephalic vascular anomalies. Mesectodermal neural crest is a major source of non-endothelial connective tissue in the head, but not the body. To examine the response of vascular connective tissues of the body to constitutive Pik3ca activity during development, we expressed the mutation by way of an Egr2 (Krox20) Cre driver. Lineage tracing led us to observe new lineages that had normally once expressed Krox20 and that may be co-opted in pathogenesis, including vascular pericytes and perimysial fibroblasts. Finally, Schwann cell precursors having transcribed either Krox20 or Sox10 and induced to express constitutively active PI3K were associated with vascular and other tumors. These murine phenotypes may aid discovery of new candidate human PRDs affecting craniofacial and vascular smooth muscle development as well as the reciprocal paracrine signaling mechanisms leading to tissue overgrowth.
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Affiliation(s)
- Elise Marechal
- INSERM, MMG, U1251, MarMaRa Institute, Aix Marseille University, Marseille, France
| | - Anne Poliard
- URP 2496 Orofacial Pathologies, Imagery and Biotherapies, CNRS, GDR 2031 CREST-NET, Université Paris Cité, Montrouge, France
- School of Dentistry, Université Paris Cité, Montrouge, France
| | - Kilian Henry
- School of Dentistry, Université Paris Cité, Montrouge, France
| | - Mathias Moreno
- INSERM, MMG, U1251, MarMaRa Institute, Aix Marseille University, Marseille, France
| | - Mathilde Legrix
- INSERM, MMG, U1251, MarMaRa Institute, Aix Marseille University, Marseille, France
| | - Nicolas Macagno
- INSERM, MMG, U1251, MarMaRa Institute, Aix Marseille University, Marseille, France
| | - Grégoire Mondielli
- INSERM, MMG, U1251, MarMaRa Institute, Aix Marseille University, Marseille, France
| | - Teddy Fauquier
- INSERM, MMG, U1251, MarMaRa Institute, Aix Marseille University, Marseille, France
| | - Anne Barlier
- INSERM, MMG, U1251, MarMaRa Institute, Aix Marseille University, Marseille, France
- AP-HM, MMG, MarMaRa Institute, La Conception Hospital Laboratory of Molecular Biology, Marseille, France
| | - Heather C. Etchevers
- INSERM, MMG, U1251, CNRS, GDR 2031 CREST-NET, MarMaRa Institute, Aix Marseille University, Marseille, France
- *Correspondence: Heather C. Etchevers,
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14
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Update of Pediatric Lipomatous Lesions: A Clinicopathological, Immunohistochemical and Molecular Overview. J Clin Med 2022; 11:jcm11071938. [PMID: 35407546 PMCID: PMC8999862 DOI: 10.3390/jcm11071938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 01/27/2023] Open
Abstract
Lipomatous neoplasms are a rare entity in the pediatric population, comprising less than 10% of soft tissue tumors in the first two decades of life. Some characteristics of pediatric adipocytic tumors are analogous to their adult counterparts, some pediatric lipomatous lesions however harbor unique features. In recent years, there have been significant advances in the understanding of the pathogenesis and hence in the classification and treatment of pediatric adipocytic tumors. This literature-based article will provide a review of the presently known clinicopathological, immunohistochemical and molecular features of pediatric lipomatous lesions.
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15
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Morin G, Canaud G. Treatment strategies for mosaic overgrowth syndromes of the PI3K-AKT-mTOR pathway. Br Med Bull 2021; 140:36-49. [PMID: 34530449 DOI: 10.1093/bmb/ldab023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/05/2021] [Accepted: 08/27/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION OR BACKGROUND Mosaic overgrowth syndromes (OS) are a proteiform ensemble of rare diseases displaying asymmetric overgrowth involving any tissue type, with degrees of severity ranging from isolated malformation to life-threatening conditions such as pulmonary embolism. Despite discordant clinical presentations, all those syndromes share common genetic anomalies: somatic mutations of genes involved in cell growth and proliferation. The PI3K-AKT-mTOR signaling pathway is one of the most prominent regulators of cell homeostasis, and somatic oncogenic mutations affecting this pathway are responsible for mosaic OS. This review aims to describe the clinical and molecular characteristics of the main OS involving the PI3K-AKT-mTOR pathway, along with the treatments available or under development. SOURCES OF DATA This review summarizes available data regarding OS in scientific articles published in peer-reviewed journals. AREAS OF AGREEMENT OS care requires a multidisciplinary approach relying on clinical and radiological follow-up along with symptomatic treatment. However, no specific treatment has yet shown efficacy in randomized control trials. AREAS OF CONTROVERSY Clinical classifications of OS led to frequent misdiagnosis. Moreover, targeted therapies directed at causal mutated proteins are developing in OSs through cancer drugs repositioning, but the evidence of efficacy and tolerance is still lacking for most of them. GROWING POINTS The genetic landscape of OS is constantly widening and molecular classifications tend to increase the accuracy of diagnosis, opening opportunities for targeted therapies. AREAS TIMELY FOR DEVELOPING RESEARCH OS are a dynamic, expanding field of research. Studies focusing on the identification of genetic anomalies and their pharmacological inhibition are needed.
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Affiliation(s)
- Gabriel Morin
- Université de Paris, Paris, France.,INSERM U1151, Institut Necker-Enfants Malades, Paris, France.,Unité d'hypercroissance dysharmonieuse et centre d'anomalies vasculaires, hôpital Necker Enfants Malades, AP-HP, France
| | - Guillaume Canaud
- Université de Paris, Paris, France.,INSERM U1151, Institut Necker-Enfants Malades, Paris, France.,Unité d'hypercroissance dysharmonieuse et centre d'anomalies vasculaires, hôpital Necker Enfants Malades, AP-HP, France
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16
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Schimmel K, Ali MK, Tan SY, Teng J, Do HM, Steinberg GK, Stevenson DA, Spiekerkoetter E. Arteriovenous Malformations-Current Understanding of the Pathogenesis with Implications for Treatment. Int J Mol Sci 2021; 22:ijms22169037. [PMID: 34445743 PMCID: PMC8396465 DOI: 10.3390/ijms22169037] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/18/2022] Open
Abstract
Arteriovenous malformations are a vascular anomaly typically present at birth, characterized by an abnormal connection between an artery and a vein (bypassing the capillaries). These high flow lesions can vary in size and location. Therapeutic approaches are limited, and AVMs can cause significant morbidity and mortality. Here, we describe our current understanding of the pathogenesis of arteriovenous malformations based on preclinical and clinical findings. We discuss past and present accomplishments and challenges in the field and identify research gaps that need to be filled for the successful development of therapeutic strategies in the future.
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Affiliation(s)
- Katharina Schimmel
- Division Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA; (K.S.); (M.K.A.)
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA 94305, USA
| | - Md Khadem Ali
- Division Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA; (K.S.); (M.K.A.)
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA 94305, USA
| | - Serena Y. Tan
- Department of Pathology, Stanford University, Stanford, CA 94305, USA;
| | - Joyce Teng
- Department of Dermatology, Lucile Packard Children’s Hospital, Stanford University, Stanford, CA 94305, USA;
| | - Huy M. Do
- Department of Radiology (Neuroimaging and Neurointervention), Stanford University, Stanford, CA 94305, USA;
- Department of Neurosurgery and Stanford Stroke Center, Stanford University, Stanford, CA 94305, USA;
| | - Gary K. Steinberg
- Department of Neurosurgery and Stanford Stroke Center, Stanford University, Stanford, CA 94305, USA;
| | - David A. Stevenson
- Department of Pediatrics, Division of Medical Genetics, Stanford University, Stanford, CA 94305, USA;
| | - Edda Spiekerkoetter
- Division Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA; (K.S.); (M.K.A.)
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +1-(650)-739-5031
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17
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Schmidt VF, Wieland I, Wohlgemuth WA, Ricke J, Wildgruber M, Zenker M. Mosaic RASopathy due to KRAS variant G12D with segmental overgrowth and associated peripheral vascular malformations. Am J Med Genet A 2021; 185:3122-3128. [PMID: 34114335 DOI: 10.1002/ajmg.a.62386] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/11/2021] [Accepted: 05/27/2021] [Indexed: 01/19/2023]
Abstract
Oncogenic RAS variants lead to constitutive overactivation and increased signal transduction into downstream pathways. They are found as somatic driver events in various types of human cancer. In a somatic mosaic status, the same RAS variants have been associated with a wide spectrum of focal or segmental tissue dysplasia and overgrowth including various types of congenital nevi, vascular malformations, and other changes (mosaic RASopathies). We present a 3-year-old male patient with segmental overgrowth of the subcutaneous fatty tissue of the right lower extremity with colocalized arteriovenous and capillary malformations and dysplastic draining veins in combination with talipes equinovarus of the right foot. In tissue biopsies of the affected extremity, we identified a mosaic KRAS variant, c.35G>A (p.Gly12Asp), while this variant was absent in the DNA extracted from a biopsy of the normal extremity. This report provides further evidence for the wide clinical and phenotypic variability associated with mosaic KRAS variants. The described pattern confirms that the combination of segmental overgrowth and vascular anomalies in the form of arteriovenous and capillary malformations is a possible manifestation of a mosaic RASopathy. The accurate genetic diagnosis is crucial for molecular-targeted therapy, which might be a future therapeutic target for mosaic RASopathies.
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Affiliation(s)
| | - Ilse Wieland
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - Walter A Wohlgemuth
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
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18
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Abstract
Cowden syndrome (CS) is an autosomal dominant condition caused by mutations in the phosphatase and tensin homolog (PTEN) gene, and is characterized by multiple hamartomas and a predisposition to malignant tumors. Characteristic skin lesions include trichilemmomas, acral keratosis, mucocutaneous neuromas, oral papillomas, and penile macules, and are often the first clues to the underlying diagnosis. Here, we discuss the mucocutaneous manifestations of CS, differential diagnoses of genetic causes of each cutaneous finding, genetic analyses for patients with skin manifestations, management of patients with CS, and potential new targeted therapies for CS.
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Affiliation(s)
- Agnes Lim
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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19
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Cameselle-Teijeiro JM, Mete O, Asa SL, LiVolsi V. Inherited Follicular Epithelial-Derived Thyroid Carcinomas: From Molecular Biology to Histological Correlates. Endocr Pathol 2021; 32:77-101. [PMID: 33495912 PMCID: PMC7960606 DOI: 10.1007/s12022-020-09661-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/12/2022]
Abstract
Cancer derived from thyroid follicular epithelial cells is common; it represents the most common endocrine malignancy. The molecular features of sporadic tumors have been clarified in the past decade. However the incidence of familial disease has not been emphasized and is often overlooked in routine practice. A careful clinical documentation of family history or familial syndromes that can be associated with thyroid disease can help identify germline susceptibility-driven thyroid neoplasia. In this review, we summarize a large body of information about both syndromic and non-syndromic familial thyroid carcinomas. A significant number of patients with inherited non-medullary thyroid carcinomas manifest disease that appears to be sporadic disease even in some syndromic cases. The cytomorphology of the tumor(s), molecular immunohistochemistry, the findings in the non-tumorous thyroid parenchyma and other associated lesions may provide insight into the underlying syndromic disorder. However, the increasing evidence of familial predisposition to non-syndromic thyroid cancers is raising questions about the importance of genetics and epigenetics. What appears to be "sporadic" is becoming less often truly so and more often an opportunity to identify and understand novel genetic variants that underlie tumorigenesis. Pathologists must be aware of the unusual morphologic features that should prompt germline screening. Therefore, recognition of harbingers of specific germline susceptibility syndromes can assist in providing information to facilitate early detection to prevent aggressive disease.
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Affiliation(s)
- José Manuel Cameselle-Teijeiro
- Department of Pathology, Galician Healthcare Service (SERGAS), Clinical University Hospital, Travesía Choupana s/n, 15706, Santiago de Compostela, Spain.
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
- Medical Faculty, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Ozgur Mete
- Department of Pathology and Endocrine Oncology Site, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sylvia L Asa
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Virginia LiVolsi
- Department of Pathology and Laboratory Medicine, Perelmann School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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20
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Wassef M, Borsik M, Cerceau P, Faucon B, Laurian C, Le Clerc N, Lemarchand-Venencie F, Massoni C, Salvan D, Bisdorff-Bresson A. [Classification of vascular tumours and vascular malformations. Contribution of the ISSVA 2014/2018 classification]. Ann Pathol 2020; 41:58-70. [PMID: 33309330 DOI: 10.1016/j.annpat.2020.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022]
Abstract
The study of vascular anomalies, "angiomas", vascular tumours and vascular malformations is made difficult by the great variety and confusion of the names used in the literature for these diseases, some of which are rare. The great merit of the classification proposed by the International Society for the Study of Vascular Anomalies (ISSVA), adopted in 2014 and modified in 2018, is to propose a unambiguous nomenclature and to try to group these lesions in a logical way, contrasting with the lists of the usual "classifications". This classification is based on the distinction between proliferative lesions (tumours and reactive lesions) and those which are due to a congenital anomaly of vascular morphogenesis (vascular malformations). It incorporates recent data on the molecular causes of these diseases. The major groups of lesions recognised in this classification will be presented and some lesions of interest briefly discussed. This classification aims to be usable by all medical specialties and applicable to all tissues and organs, even if efforts are still needed to integrate organ-specific names in order to unify the nomenclature and eliminate confusion. Even if it does not solve all the problems in this complex field, the unification of the nomenclature is a major contribution of this classification and pathologists are strongly encouraged to refer to it in daily practice.
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Affiliation(s)
- Michel Wassef
- Service d'anatomie et cytologie pathologiques, hôpital Lariboisière, APHP ; UFR de médecine Paris nord, université de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex, France; Consultation des angiomes, service de neuroradiologie, hôpital Lariboisière, APHP, 2, rue Ambroise-Paré 75475 Paris cedex, France.
| | - Michel Borsik
- Consultation des angiomes, service de neuroradiologie, hôpital Lariboisière, APHP, 2, rue Ambroise-Paré 75475 Paris cedex, France; Maison médicale, 9, rue Jean-Jacques-Bernard, 60200 Compiègne, France
| | - Pierre Cerceau
- Consultation des angiomes, service de neuroradiologie, hôpital Lariboisière, APHP, 2, rue Ambroise-Paré 75475 Paris cedex, France; Service de chirurgie vasculaire et thoracique, hôpital Bichat, APHP, 46, rue Henri-Huchard, 75018 Paris, France
| | - Benoit Faucon
- Consultation des angiomes, service de neuroradiologie, hôpital Lariboisière, APHP, 2, rue Ambroise-Paré 75475 Paris cedex, France; Service d'ORL, Centre hospitalier de Pontoise, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - Claude Laurian
- Consultation des angiomes, service de neuroradiologie, hôpital Lariboisière, APHP, 2, rue Ambroise-Paré 75475 Paris cedex, France; Service de chirurgie vasculaire, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Nicolas Le Clerc
- Consultation des angiomes, service de neuroradiologie, hôpital Lariboisière, APHP, 2, rue Ambroise-Paré 75475 Paris cedex, France; Service d'ORL, hôpital Lariboisière, APHP, 2, rue Ambroise-Paré 75475 Paris cedex, France
| | - Françoise Lemarchand-Venencie
- Consultation des angiomes, service de neuroradiologie, hôpital Lariboisière, APHP, 2, rue Ambroise-Paré 75475 Paris cedex, France
| | - Claudine Massoni
- Consultation des angiomes, service de neuroradiologie, hôpital Lariboisière, APHP, 2, rue Ambroise-Paré 75475 Paris cedex, France; Cabinet médical, 7, rue Chalgrin, 75116 Paris, France
| | - Didier Salvan
- Consultation des angiomes, service de neuroradiologie, hôpital Lariboisière, APHP, 2, rue Ambroise-Paré 75475 Paris cedex, France; Service d'ORL, centre hospitalier Sud Francilien, 40, avenue Serge-Dassault, 91100 Corbeil Essonnes, France
| | - Annouk Bisdorff-Bresson
- Consultation des angiomes, service de neuroradiologie, hôpital Lariboisière, APHP, 2, rue Ambroise-Paré 75475 Paris cedex, France
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21
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Hedjoudje A, Peng X, Gautam A, Pardo CA, Sciubba D, Gailloud P. Case of Cowden Syndrome with 15 Spinal Arteriovenous Fistulas. World Neurosurg 2020; 139:567-576. [PMID: 32344142 DOI: 10.1016/j.wneu.2020.04.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Spinal vascular malformations are rarely multiple: fewer than 50 observations have been documented so far, with a maximum of 4 coexisting lesions per patient, always restricted to a single vertebral region (e.g., cervical or thoracic). CASE DESCRIPTION We describe the case of a 61-year-old woman with Cowden syndrome with 15 spinal arteriovenous fistulas (AVFs) at the cervical, thoracic, and lumbar levels and an adrenal AVF. She was initially referred for reevaluation of an upper cervical spinal epidural spinal arteriovenous fistula diagnosed 6 years earlier. Her history included breast carcinoma, a malignant salivary gland tumor, and removal of multiple ovarian, thyroid, and gastric hamartomas. Computed tomography and magnetic resonance imaging confirmed the presence of a prominent cervical vascular lesion. Spinal digital subtraction angiography revealed the presence of 15 additional vascular anomalies. CONCLUSIONS This multiplicity of AVFs appears to result from a combination of various factors including local regional hemodynamic changes, growth factor-mediated alterations involving notably vascular endothelial growth factor pathways, and the prothrombotic state associated with abnormalities in blood vessel structure.
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Affiliation(s)
- Abderrahmane Hedjoudje
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
| | - Xiao Peng
- Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ayushi Gautam
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Carlos A Pardo
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Daniel Sciubba
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Philippe Gailloud
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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22
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Smerdel MP, Skytte AB, Jelsig AM, Ebbehøj E, Stochholm K. Revised Danish guidelines for the cancer surveillance of patients with Cowden Syndrome. Eur J Med Genet 2020; 63:103873. [PMID: 32058060 DOI: 10.1016/j.ejmg.2020.103873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 11/05/2019] [Accepted: 02/01/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Cowden syndrome is a cancer predisposition syndrome caused by pathogenic variants in PTEN. The affected patients possess an increased risk of breast, thyroid, renal, colorectal, endometrial cancers as well as malignant melanoma. Thus prophylactic surveillance and follow up is crucial for these patients. METHODS A review of the literature including existing guidelines from the years 1996 until 2017 was carried out. In total, 2078 scientific papers were identified through database searches on Cowden syndrome. Among these, 11 manuscripts were included based on scientific relevance and quality. Expert consensus was reached to define management guidelines. RESULTS The literature revealed a high risk of cancer in specific organs for patients diagnosed with Cowden Syndrome. Alternative management guidelines were proposed and discussed. CONCLUSIONS Here we propose a revised set of management guidelines for patients with Cowden syndrome in Denmark to address the increased risk of various cancer types.
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Affiliation(s)
- Maja Patricia Smerdel
- Department of Clinical Genetics, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark.
| | - Anne-Bine Skytte
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Anne Marie Jelsig
- Clinical Genetic Clinic, Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Eva Ebbehøj
- Department of Internal Medicine and Diabetes, Aarhus University Hospital, Aarhus, Denmark.
| | - Kirstine Stochholm
- Department of Pediatrics, Center of Rare Diseases, Aarhus University Hospital and Department of Internal Medicine and Diabetes, Aarhus University Hospital, Aarhus, Denmark.
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Yotsumoto Y, Harada A, Tsugawa J, Ikura Y, Utsunomiya H, Miyatake S, Matsumoto N, Kanemura Y, Hashimoto-Tamaoki T. Infantile macrocephaly and multiple subcutaneous lipomas diagnosed with PTEN hamartoma tumor syndrome: A case report. Mol Clin Oncol 2020; 12:329-335. [PMID: 32190315 PMCID: PMC7058917 DOI: 10.3892/mco.2020.1988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/18/2019] [Indexed: 11/06/2022] Open
Abstract
A heterozygous loss-of-function mutation of the PTEN gene, one of the tumor suppressor genes, causes a wide variety of disorders, ranging from macrocephaly/autism syndrome to PTEN hamartoma tumor syndrome, including Cowden disease that causes thyroid and breast cancer mainly in the adolescence and young adult generation. An 8-month-old male infant with simple macrocephaly developed a café-au-lait spot and two subcutaneous tumors at the age of 1 year. One of the tumors developed rapidly was resected at the age of 1 year and 9 months and identified as benign lipoma. From the age of 2 years, the patient often threw a tantrum. At the age of 2 years and 9 months, a pathogenic germline mutation was identified in the PTEN gene (NM_000314.7), c.195C>A, p.Y65* in the form of a heterozygous germline variant. Developmental delay was noted but no tumors were found in the thyroid gland and breasts. Immunohistochemistry for PTEN in the resected lipoma demonstrated that the PTEN expression pattern was similar to that in a subcutaneous adipose tissue from a normal subject, suggesting that two-hit was not likely involved in the rapid growth of this lipoma. At the age of 5 years, the patient was diagnosed with autism spectrum disorders with moderate developmental delay. A long-term follow-up is underway to examine developmental changes in psychomotor disorders and possible tumor formation.
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Affiliation(s)
- Yuka Yotsumoto
- Department of Pediatrics, Takatsuki General Hospital, Takatsuki, Osaka 569-1192, Japan.,Department of Genetic Medicine, Takatsuki General Hospital, Takatsuki, Osaka 569-1192, Japan
| | - Atsuko Harada
- Department of Genetic Medicine, Takatsuki General Hospital, Takatsuki, Osaka 569-1192, Japan.,Department of Pediatric Neurosurgery, Takatsuki General Hospital, Osaka 569-1192, Japan
| | - Jiro Tsugawa
- Department of Pediatric Surgery, Takatsuki General Hospital, Takatsuki, Osaka 569-1192, Japan
| | - Yoshihiro Ikura
- Department of Pathology, Takatsuki General Hospital, Takatsuki, Osaka 569-1192, Japan
| | - Hidetsuna Utsunomiya
- Department of Pediatric Neuroradiology, Takatsuki General Hospital, Takatsuki, Osaka 569-1192, Japan
| | - Satoko Miyatake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan.,Clinical Genetics Department, Yokohama City University Hospital, Yokohama 236-0004, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Yonehiro Kanemura
- Department of Neurosurgery, National Hospital Organization Osaka National Hospital, Osaka 540-0006, Japan.,Department of Biomedical Research and Innovation, Institute for Clinical Research, National Hospital Organization Osaka National Hospital, Osaka 540-0006, Japan
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24
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Boccara O, Galmiche‐Rolland L, Dadone‐Montaudié B, Ariche‐Maman S, Coulet F, Eyries M, Pannier S, Soupre V, Molina T, Pedeutour F, Fraitag S. Soft tissue angiomatosis: another
PIK3CA
‐related disorder. Histopathology 2020; 76:540-549. [DOI: 10.1111/his.14021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/17/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Olivia Boccara
- Department of Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC) Université Paris, Paris‐centre Institut Imagine Hôpital Universitaire Necker‐Enfants Malades APHP ParisFrance
| | | | - Bérengère Dadone‐Montaudié
- Laboratory of Solid Tumour Genetics Institute for Research on Cancer and Aging of Nice (IRCAN) CNRS UMR 7284/INSERM U1081 Université Côte d'Azur Centre Hospitalier Universitaire de Nice Nice France
| | - Sonia Ariche‐Maman
- Department of Pediatric Radiology Hôpital Universitaire Necker‐Enfants Malades APHP Paris France
| | - Florence Coulet
- Genetics Groupe hospitalier Pitié‐Salpêtrière Université Pierre et Marie Curie APHP Paris France
| | - Mélanie Eyries
- Genetics Groupe hospitalier Pitié‐Salpêtrière Université Pierre et Marie Curie APHP Paris France
| | - Stéphanie Pannier
- Department of Orthopedic Surgery Hôpital Universitaire Necker‐Enfants Malades APHP Paris France
| | - Véronique Soupre
- Maxillofacial Surgery and Stomatology Department Hôpital Universitaire Necker‐Enfants Malades APHP Paris France
| | - Thierry Molina
- Department of Pathology Hôpital Universitaire Necker‐Enfants Malades APHP Paris France
| | - Florence Pedeutour
- Laboratory of Solid Tumour Genetics Institute for Research on Cancer and Aging of Nice (IRCAN) CNRS UMR 7284/INSERM U1081 Université Côte d'Azur Centre Hospitalier Universitaire de Nice Nice France
| | - Sylvie Fraitag
- Department of Pathology Hôpital Universitaire Necker‐Enfants Malades APHP Paris France
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25
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Cheung K, Taghinia AH, Sood RF, Alomari AI, Spencer SA, Al-Ibraheemi A, Kozakewich HPW, Chaudry G, Greene AK, Mulliken JB, Trenor CC, Fishman SJ, Upton J. Fibroadipose Vascular Anomaly in the Upper Extremity: A Distinct Entity With Characteristic Clinical, Radiological, and Histopathological Findings. J Hand Surg Am 2020; 45:68.e1-68.e13. [PMID: 31279623 DOI: 10.1016/j.jhsa.2019.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 05/07/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Fibroadipose vascular anomaly (FAVA) is an intramuscular vascular malformation that has been recently described as a distinct clinical entity. The clinical, radiological, and histopathological characteristics of FAVA in the upper extremity are reviewed. METHODS This was a retrospective case series of upper-extremity FAVA lesions. RESULTS We reviewed 19 patients with FAVA of the upper limb. Pain, stiffness, swelling, and flexion contractures were the most common presentations. Except for one lesion confined to the hand, all lesions either presented with or developed a contracture within 10 years. Ten patients underwent surgical debulking. Six required tendon transfer reconstruction and 3 necessitated a free functional muscle transfer. CONCLUSIONS Fibroadipose vascular anomaly in the upper extremity requires an accurate diagnosis and may benefit from early referral to a multidisciplinary vascular anomaly center with experienced hand surgeons. Compression garments, propranolol, and sclerotherapy seem to be ineffective. Surgical resection focused on symptomatic regions with appropriate reconstruction may have benefit in salvage of limbs with compromised function. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Kevin Cheung
- Department of Plastic and Oral Surgery, Vascular Anomalies Center, Boston Children's Hospital, Harvard University, Boston, MA.
| | - Amir H Taghinia
- Department of Plastic and Oral Surgery, Vascular Anomalies Center, Boston Children's Hospital, Harvard University, Boston, MA
| | - Ravi F Sood
- Department of Plastic and Oral Surgery, Vascular Anomalies Center, Boston Children's Hospital, Harvard University, Boston, MA
| | - Ahmad I Alomari
- Division of Vascular and Interventional Radiology, Vascular Anomalies Center, Boston Children's Hospital, Harvard University, Boston, MA
| | - Samantha A Spencer
- Department of Orthopedic Surgery, Vascular Anomalies Center, Boston Children's Hospital, Harvard University, Boston, MA
| | - Alyaa Al-Ibraheemi
- Department of Pathology, Vascular Anomalies Center, Boston Children's Hospital, Harvard University, Boston, MA
| | - Harry P W Kozakewich
- Department of Pathology, Vascular Anomalies Center, Boston Children's Hospital, Harvard University, Boston, MA
| | - Gulraiz Chaudry
- Division of Vascular and Interventional Radiology, Vascular Anomalies Center, Boston Children's Hospital, Harvard University, Boston, MA
| | - Arin K Greene
- Department of Plastic and Oral Surgery, Vascular Anomalies Center, Boston Children's Hospital, Harvard University, Boston, MA
| | - John B Mulliken
- Department of Plastic and Oral Surgery, Vascular Anomalies Center, Boston Children's Hospital, Harvard University, Boston, MA
| | - Cameron C Trenor
- Department of Hematology and Oncology, Vascular Anomalies Center, Boston Children's Hospital, Harvard University, Boston, MA
| | - Steven J Fishman
- Department of Pediatric Surgery, Vascular Anomalies Center, Boston Children's Hospital, Harvard University, Boston, MA
| | - Joseph Upton
- Department of Plastic and Oral Surgery, Vascular Anomalies Center, Boston Children's Hospital, Harvard University, Boston, MA
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26
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Soulez G, Gilbert, MD, FRCPC P, Giroux, MD, FRCPC MF, Racicot, MD, FRCPC JN, Dubois J. Interventional Management of Arteriovenous Malformations. Tech Vasc Interv Radiol 2019; 22:100633. [DOI: 10.1016/j.tvir.2019.100633] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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27
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Johnson AB, Richter GT. Surgical Considerations in Vascular Malformations. Tech Vasc Interv Radiol 2019; 22:100635. [DOI: 10.1016/j.tvir.2019.100635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Macken WL, Tischkowitz M, Lachlan KL. PTEN Hamartoma tumor syndrome in childhood: A review of the clinical literature. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:591-610. [PMID: 31609537 DOI: 10.1002/ajmg.c.31743] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/28/2019] [Accepted: 09/05/2019] [Indexed: 01/06/2023]
Abstract
PTEN hamartoma tumor syndrome (PHTS) is a highly variable autosomal dominant condition associated with intellectual disability, overgrowth, and tumor predisposition phenotypes, which often overlap. PHTS incorporates a number of historical clinical presentations including Bannayan-Riley-Ruvalcaba syndrome, Cowden syndrome, and a macrocephaly-autism/developmental delay syndrome. Many reviews in the literature focus on PHTS as an adult hamartoma and malignancy predisposition condition. Here, we review the current literature with a focus on pediatric presentations. The review starts with a summary of the main conditions encompassed within PHTS. We then discuss PHTS diagnostic criteria, and clinical features. We briefly address rarer PTEN associations, and the possible role of mTOR inhibitors in treatment. We acknowledge the limited understanding of the natural history of childhood-onset PHTS as a cancer predisposition syndrome and present a summary of important management considerations.
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Affiliation(s)
- William L Macken
- Wessex Clinical Genetics Service, University Hospitals Southampton NHS Trust, Southampton, United Kingdom
| | - Marc Tischkowitz
- Department of Clinical Genetics, East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,Department of Medical Genetics, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Katherine L Lachlan
- Wessex Clinical Genetics Service, University Hospitals Southampton NHS Trust, Southampton, United Kingdom.,Human Genetics and Genomic Medicine, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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29
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Evert K, Kühnel T, Weiß KT, Wohlgemuth WA, Vielsmeier V. [Diagnosis and management of vascular malformations : Interdisciplinary teamwork in demand]. DER PATHOLOGE 2019; 40:422-430. [PMID: 31243549 DOI: 10.1007/s00292-019-0625-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Vascular anomalies are very rare, but can occur in children and adults in almost every region of the body. Due to the complexity of this disease, the path to a definitive diagnosis is often difficult. It requires interdisciplinary teamwork with close exchange of information between the individual treatment partners to reach the correct diagnosis and then to start the best therapy. This article provides an overview of the main types of vascular malformations from a clinical, imaging, and histological point of view, following the current classification of the International Society for the Study of Vascular Anomalies (ISSVA).
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Affiliation(s)
- K Evert
- Institut für Pathologie, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
- Interdisziplinäres Zentrum für Gefäßanomalien, Universitätsklinikum Regensburg, Regensburg, Deutschland.
- Deutsche interdisziplinäre Gesellschaft für Gefäßanomalien e. V., Halle, Deutschland.
| | - T Kühnel
- Interdisziplinäres Zentrum für Gefäßanomalien, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Deutsche interdisziplinäre Gesellschaft für Gefäßanomalien e. V., Halle, Deutschland
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - K T Weiß
- Interdisziplinäres Zentrum für Gefäßanomalien, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - W A Wohlgemuth
- Deutsche interdisziplinäre Gesellschaft für Gefäßanomalien e. V., Halle, Deutschland
- Department für Strahlenmedizin, Universitätsklinik und Poliklinik für Radiologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
- Interdisziplinäres Zentrum für Gefäßanomalien, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - V Vielsmeier
- Interdisziplinäres Zentrum für Gefäßanomalien, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
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30
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Pilarski R. PTEN Hamartoma Tumor Syndrome: A Clinical Overview. Cancers (Basel) 2019; 11:cancers11060844. [PMID: 31216739 PMCID: PMC6627214 DOI: 10.3390/cancers11060844] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/12/2022] Open
Abstract
The phosphatase and tensin homolog (PTEN) hamartoma tumor syndrome (PHTS) is a grouping of related genetic disorders that has been linked to germline mutations in the PTEN gene. These disorders include Cowden syndrome (CS), Bannayan–Riley–Ruvalcaba syndrome, adult Lhermitte–Duclos disease, and autism spectrum disorders associated with macrocephaly. The majority of the clinical information available on PHTS, however, is related to individuals diagnosed with CS. There is still much to be learned about this disorder, since diagnostic criteria for CS were only established in 1996, before the identification of the PTEN gene, and were based primarily on features seen in cases reported in the existing literature. More recently, however, data from several large series of patients have shown that a number of the clinical features associated with PTEN mutations are either more or less common than previously reported. In addition, we now know that only about 30–35% of patients meeting clinical diagnostic criteria for Cowden syndrome actually have a detectable PTEN mutation. Thus, our understanding of PTEN-related diseases and their management has evolved significantly over time. The United States National Comprehensive Cancer Network (NCCN) has produced and regularly updates practice guidelines which include clinical diagnostic criteria as well as guidelines for PTEN testing and management of patients with mutations. This review will summarize the overall literature on PHTS as well as recent findings which are broadening our understanding of this set of disorders.
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Affiliation(s)
- Robert Pilarski
- Division of Human Genetics, Department of Internal Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43221, USA.
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31
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Fereydooni A, Dardik A, Nassiri N. Molecular changes associated with vascular malformations. J Vasc Surg 2019; 70:314-326.e1. [PMID: 30922748 DOI: 10.1016/j.jvs.2018.12.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/10/2018] [Indexed: 01/19/2023]
Abstract
Vascular anomalies are typically classified into two major categories, vascular tumors and vascular malformations. Most vascular malformations are caused sporadically by somatic mosaic gene mutations, and genetic analyses have advanced our understanding of the biomolecular mechanisms involved in their pathogenesis. Culprit gene mutations typically involve two major signaling pathways; the RAS/MAPK/ERK pathway is typically involved in fast-flow arteriovenous malformations, whereas the PI3K/AKT/mTOR pathway is typically mutated in slow-flow venous and lymphatic malformations. These findings suggest new therapeutic approaches to vascular malformations, focusing on targeting the etiologic mutated pathways. This review summarizes the currently available literature reflecting the updated International Society for Study of Vascular Anomalies classification system with emphasis on potential therapeutic targets that will provide vascular surgeons with an updated perspective on the etiologic basis of vascular malformations, allowing improved multidisciplinary collaboration.
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Affiliation(s)
| | - Alan Dardik
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn; Department of Surgery, VA Connecticut Healthcare Systems, West Haven, Conn
| | - Naiem Nassiri
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn; Department of Surgery, VA Connecticut Healthcare Systems, West Haven, Conn.
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32
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Toh K, Suzuki K, Miyaoka R, Kitagawa T, Saito T, Nakano Y, Yamamoto J. Giant Cerebral Aneurysm in a Patient with Cowden Syndrome Treated with Surgical Clipping. World Neurosurg 2019; 126:336-340. [PMID: 30904793 DOI: 10.1016/j.wneu.2019.02.245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cowden syndrome is characterized by multiple hamartomas and accompanied by a germline mutation of the phosphatase and tensin homolog gene. Cowden syndrome has been described to be associated with vascular anomalies such as arteriovenous malformation and developmental venous anomalies with high frequency. However, the association of cerebral aneurysms with this syndrome has not been reported yet. CASE DESCRIPTION A 39-year-old Japanese man presented with a subarachnoid hemorrhage due to a ruptured giant fusiform middle cerebral artery aneurysm. We diagnosed him with Cowden syndrome by clinical presentations as outlined in the National Comprehensive Cancer Network's criteria. As the ruptured fusiform aneurysm involved a middle cerebral artery bifurcation, we prepared for extracranial-intracranial bypass surgery. We successfully performed a surgical clipping using multiple tandem clipping techniques and suction decompression techniques. Bypass surgery was not performed as reconstruction of the M2 trunks was successfully completed. CONCLUSIONS We present this rare case that potentially indicates an association between cerebral aneurysms and Cowden syndrome. Because vascular anomalies are not included in the diagnostic criteria for Cowden syndrome, intracranial vascular anomalies may be underestimated. We therefore recommended a careful search of vascular diseases, including cerebral aneurysms, in cases of Cowden syndrome.
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Affiliation(s)
- Keita Toh
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kohei Suzuki
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
| | - Ryo Miyaoka
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takehiro Kitagawa
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takeshi Saito
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiteru Nakano
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Junkoh Yamamoto
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
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Abstract
Adipocytic neoplasms in the pediatric population demonstrate a different histologic spectrum and frequency than in adults. The vast majority of these tumors are benign, with lipoma being the most common entity. The identification of signature cytogenetic and molecular alterations for certain lesions, such as PLAG1 gene rearrangement in lipoblastoma and FUS-DDIT3 fusion in myxoid liposarcoma, has been helpful in approaching these neoplasms and aiding in confirming the diagnosis. Furthermore, it is important for pathologists to recognize that adipocytic neoplasms may be associated with different syndromes with potential impact in managing such patients. This review provides a summary of the clinical pictures, histologic characteristics, molecular alterations, differential diagnoses, and syndromic associations of the commonly encountered fatty tumors in children.
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Affiliation(s)
- Juan Putra
- Paediatric Pathologist, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, 555 University Ave Rm. 3119, Toronto, ON M5G 1X8, Canada.
| | - Alyaa Al-Ibraheemi
- Department of Pathology, Children's Hospital Boston and Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.
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34
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Yehia L, Ngeow J, Eng C. PTEN-opathies: from biological insights to evidence-based precision medicine. J Clin Invest 2019; 129:452-464. [PMID: 30614812 DOI: 10.1172/jci121277] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The tumor suppressor phosphatase and tensin homolog (PTEN) classically counteracts the PI3K/AKT/mTOR signaling cascade. Germline pathogenic PTEN mutations cause PTEN hamartoma tumor syndrome (PHTS), featuring various benign and malignant tumors, as well as neurodevelopmental disorders such as autism spectrum disorder. Germline and somatic mosaic mutations in genes encoding components of the PI3K/AKT/mTOR pathway downstream of PTEN predispose to syndromes with partially overlapping clinical features, termed the "PTEN-opathies." Experimental models of PTEN pathway disruption uncover the molecular and cellular processes influencing clinical phenotypic manifestations. Such insights not only teach us about biological mechanisms in states of health and disease, but also enable more accurate gene-informed cancer risk assessment, medical management, and targeted therapeutics. Hence, the PTEN-opathies serve as a prototype for bedside to bench, and back to the bedside, practice of evidence-based precision medicine.
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Affiliation(s)
- Lamis Yehia
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joanne Ngeow
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre, Singapore.,Oncology Academic Program, Duke-NUS Graduate Medical School, Singapore
| | - Charis Eng
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Germline High Risk Cancer Focus Group, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
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35
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Sundararajan SR, Rajagopalakrishnan R, Rajasekaran S. Arthroscopic Excision of Angio-Fibro-Lipomatous Hamartoma of the Knee: A Rare Case Report. Indian J Orthop 2019; 53:732-735. [PMID: 31673174 PMCID: PMC6804391 DOI: 10.4103/ortho.ijortho_330_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Angio-fibro-lipomatous hamartoma is a benign adipose tissue tumor very rarely seen in musculoskeletal distribution, and its incidence in the knee joint has never been reported. The patient in our case presented with knee pain of 2 years' duration, following blunt trauma. Preoperatively, veno-lymphatic malformation/hemangioma was considered as the diagnosis. Only after arthroscopic excision biopsy, histopathological examination, retrospective radiological analysis, and a review of literature, we were able to diagnose this rare condition. The histopathological picture of this benign adipose tissue tumor contained a mixture of mature adipose tissue and fibrous and vascular tissues. Here, in this case report, we discuss about PTEN gene causing PTEN hamartoma of soft tissue and angiolipoma presentations and its variants.
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Affiliation(s)
| | - Ramakanth Rajagopalakrishnan
- Department of Arthroscopy and Sports Medicine, Ganga Hospital, Coimbatore, Tamil Nadu, India,Address for correspondence: Dr. Ramakanth Rajagopalakrishnan, Ganga Hospital, Coimbatore, Tamil Nadu, India. E-mail:
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36
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North PE. Classification and Pathology of Congenital and Perinatal Vascular Anomalies of the Head and Neck. Otolaryngol Clin North Am 2018; 51:1-39. [PMID: 29217054 DOI: 10.1016/j.otc.2017.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Accurate histopathologic description in correlation with clinical and radiological evaluation is required for treatment of vascular anomalies, both neoplastic and malformative. It is important to examine current clinical, histologic, and immunophenotypical features that distinguish the major types of congenital and perinatal vascular anomalies affecting the head and neck. General discussions of pathogenesis and molecular diagnosis must also be taken into account. This article provides an overview of the features that distinguish the major types of congenital and perinatal vascular anomalies affecting the head and neck, and summarizes the diagnostic histopathologic criteria and nomenclature currently applied to these lesions.
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37
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Habeshian K, Huppmann A, Ferreira C, Kirkorian AY. Segmental storiform collagenomas: Expanding the spectrum of PTEN hamartoma tumor syndrome in children. Pediatr Dermatol 2018; 35:e253-e254. [PMID: 29806868 DOI: 10.1111/pde.13535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A 4-year-old girl with autism spectrum disorder and congenital heart disease presented to dermatology clinic for evaluation of skin growths present since infancy. Physical examination was significant for macrocephaly and agminated skin-colored to pink papulonodules in a segmental distribution on the right lower back and buttocks, biopsy of which showed storiform collagenomas (sclerotic fibromas). Genetic testing revealed a pathogenic missense mutation in the PTEN gene, and a diagnosis of PTEN hamartoma tumor syndrome was made. The segmental nature of her storiform collagenomas is unique, to our knowledge, and may be explained by a postzygotic second-hit PTEN mutation, contributing to the growing spectrum of clinical findings associated with PTEN hamartoma tumor syndrome.
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Affiliation(s)
- Kaiane Habeshian
- Department of Dermatology, MedStar Georgetown University-Washington Hospital Center, Washington, District of Columbia
| | - Alison Huppmann
- Department of Pathology, Children's National Health System, Washington, District of Columbia
| | - Carlos Ferreira
- Division of Genetics and Metabolism, Children's National Health System, Washington, District of Columbia
| | - A Yasmine Kirkorian
- Division of Dermatology, Children's National Health System, Washington, District of Columbia
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Pimpalwar S, Yoo R, Chau A, Ashton D, Margolin J, Iacobas I. Temporal Evolution and Management of Fast Flow Vascular Anomalies in PTEN Hamartoma Tumor Syndrome. Int J Angiol 2018; 27:158-164. [PMID: 30154635 DOI: 10.1055/s-0038-1661377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Phosphatase and tensin homolog (PTEN) hamartoma tumor syndrome (PHTS) is characterized by formation of recurrent benign tumors described as PTEN hamartoma of soft tissue that may contain fast flow vascular anomalies (FFVA). The purpose of this study is to review the temporal evolution and management of FFVA in PHTS. A retrospective review of 22 patients (9 males), age 1 to 18 (median 9) years diagnosed with PHTS at a tertiary care pediatric hospital between October 2002 and August 2017 revealed 4 patients with FFVA. Imaging, management, and treatment complications were reviewed. During median follow-up of 8 (range: 4-13) years, ultrasound and magnetic resonance imaging performed for recurrent pain, showed progressive increase in the size of hamartomas and development of new FFVA in three-fourth patients. Medical management included pain medications, oral sirolimus, and physical and psychiatric therapy. Surgical excision of hamartoma ( n = 1) resulted in recurrence within 3 months. Between 4 and 24 (average 1.5/year) embolizations were performed per patient. Pain related to FFVA responded well to embolization. Pain secondary to PTEN hamartoma responded poorly to percutaneous sclerosant injection, but demonstrated improvement with sirolimus. There was no correlation between serum sirolimus levels and frequency/timing of recurrence of FFVA/hamartoma. Complications included sclerosant migration into digital arteries ( n = 1), subclavian vein stenosis due to glue migration ( n = 1), oral mucositis ( n = 4), and elevated triglycerides ( n = 4). Patients with PHTS present with recurrent pain requiring life-long management with a multi-disciplinary team. Pain due to FFVA responds to embolization, and pain due to hamartoma responds to sirolimus. This improves quality of life, but does not prevent disease progression.
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Affiliation(s)
- Sheena Pimpalwar
- Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, Houston Texas
| | - Raphael Yoo
- Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, Houston Texas
| | - Alex Chau
- Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, Houston Texas
| | - Daniel Ashton
- Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, Houston Texas
| | - Judith Margolin
- Cancer and Hematology Centers, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Ionela Iacobas
- Cancer and Hematology Centers, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Anomalies vasculaires bénignes agressives de l’enfant et de l’adolescent. Bull Cancer 2018; 105:610-625. [DOI: 10.1016/j.bulcan.2018.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/15/2018] [Accepted: 01/20/2018] [Indexed: 01/11/2023]
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Tachibana N, Touahri Y, Dixit R, David LA, Adnani L, Cantrup R, Aavani T, Wong RO, Logan C, Kurek KC, Schuurmans C. Hamartoma-like lesions in the mouse retina: an animal model of Pten hamartoma tumour syndrome. Dis Model Mech 2018; 11:dmm.031005. [PMID: 29716894 PMCID: PMC5992614 DOI: 10.1242/dmm.031005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 04/16/2018] [Indexed: 12/15/2022] Open
Abstract
PTEN hamartoma tumour syndrome (PHTS) is a heterogeneous group of rare, autosomal dominant disorders associated with PTEN germline mutations. PHTS patients routinely develop hamartomas, which are benign tissue overgrowths comprised of disorganized 'normal' cells. Efforts to generate PHTS animal models have been largely unsuccessful due to the early lethality of homozygous germline mutations in Pten, together with the lack of hamartoma formation in most conditional mutants generated to date. We report herein a novel PHTS mouse model that reproducibly forms hamartoma-like lesions in the central retina by postnatal day 21. Specifically, we generated a Pten conditional knockout (cKO) using a retinal-specific Pax6::Cre driver that leads to a nearly complete deletion of Pten in the peripheral retina but produces a mosaic of 'wild-type' and Pten cKO cells centrally. Structural defects were only observed in the mosaic central retina, including in Müller glia and in the outer and inner limiting membranes, suggesting that defective mechanical integrity partly underlies the hamartoma-like pathology. Finally, we used this newly developed model to test whether rapamycin, an mTOR inhibitor that is currently the only PHTS therapy, can block hamartoma growth. When administered in the early postnatal period, prior to hamartoma formation, rapamycin reduces hamartoma size, but also induces new morphological abnormalities in the Pten cKO retinal periphery. In contrast, administration of rapamycin after hamartoma initiation fails to reduce lesion size. We have thus generated and used an animal model of retinal PHTS to show that, although current therapies can reduce hamartoma formation, they might also induce new retinal dysmorphologies.This article has an associated First Person interview with the first author of the paper.
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Affiliation(s)
- Nobuhiko Tachibana
- Biological Sciences Platform, Sunnybrook Research Institute, Room 116, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Department of Biochemistry and Molecular Biology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Yacine Touahri
- Biological Sciences Platform, Sunnybrook Research Institute, Room 116, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Department of Biochemistry and Molecular Biology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Rajiv Dixit
- Biological Sciences Platform, Sunnybrook Research Institute, Room 116, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Department of Biochemistry and Molecular Biology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Luke Ajay David
- Biological Sciences Platform, Sunnybrook Research Institute, Room 116, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Lata Adnani
- Biological Sciences Platform, Sunnybrook Research Institute, Room 116, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Department of Biochemistry and Molecular Biology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Robert Cantrup
- Department of Biochemistry and Molecular Biology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Tooka Aavani
- Biological Sciences Platform, Sunnybrook Research Institute, Room 116, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Rachel O Wong
- Department of Biological Structure, University of Washington, Seattle, WA 98195-7420, USA
| | - Cairine Logan
- Department of Cell Biology and Anatomy, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Kyle C Kurek
- Department of Pathology and Laboratory Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Carol Schuurmans
- Biological Sciences Platform, Sunnybrook Research Institute, Room 116, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada .,Department of Biochemistry and Molecular Biology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 4N1, Canada
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Happle R. The concept of type 2 segmental mosaicism, expanding from dermatology to general medicine. J Eur Acad Dermatol Venereol 2018; 32:1075-1088. [PMID: 29405433 DOI: 10.1111/jdv.14838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022]
Abstract
In autosomal dominant skin disorders, the well-known type 1 segmental mosaicism reflects heterozygosity for a postzygotic new mutation. By contrast, type 2 segmental mosaicism originates in a heterozygous embryo from an early postzygotic mutational event giving rise to loss of the corresponding wild-type allele, which results in a pronounced segmental involvement being superimposed on the ordinary, non-segmental phenotype. Today, this concept has been proven by molecular analysis in many cutaneous traits. The purpose of this review was to seek publications of cases suggesting an extracutaneous manifestation of type 2 segmental mosaicism. Case reports documenting a pronounced extracutaneous segmental involvement were collected from the literature available in PubMed and from personal communications to the author. Pertinent cases are compared to the description of cutaneous segmental mosaicism of type 1 or type 2 as reported in a given trait. In total, reports suggesting extracutaneous type 2 segmental mosaicism were found in 14 different autosomal dominant skin disorders. In this way, clinical evidence is accumulated that extracutaneous type 2 segmental mosaicism does likewise occur in many autosomal dominant skin disorders. So far, however, molecular proof of this particular form of mosaicism is lacking. The present review may stimulate readers to inform colleagues of other specialties on this new concept, in order to initiate further research in this particular field of knowledge that has important implications for diagnosis, treatment and genetic counselling.
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Affiliation(s)
- R Happle
- Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany
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Abstract
This overview of mesenchymal tumors presenting in the skin and/or subcutis in children brings together the range of neoplasms and hamartomas which are seen in this age-group. It is not surprising from the perspective of the pediatric or general surgical pathologist that vascular anomalies, including true neoplasms and vascular malformations, are the common phenotypic category. Since there is considerable morphologic overlap among these lesions, clinicopathologic correlation may be more important than for many of the other mesenchymal tumors. The skin and subcutis are the most common sites of clinical presentation for the infantile myofibroma which is the most common of fibrous mesenchymal tumors in children. Several of the other mesenchymal tumors are more common adults-like dermatofibrosarcoma protuberans, but nonetheless have an important presence in children, even as a congenital neoplasm. A lipomatous tumor in a young child should be considered as a possible manifestation of an overgrowth syndrome.
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Affiliation(s)
- Louis P Dehner
- 1 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri.,2 Dermatopathology Center and Division of Dermatology, Washington University Medical Center, St. Louis, Missouri
| | - Alejandro A Gru
- 3 Department of Pathology, University of Virginia, Charlottesville, Virginia.,4 Department of Dermatology, University of Virginia, Charlottesville, Virginia
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Barreras P, Gailloud P, Pardo CA. A longitudinally extensive myelopathy associated with multiple spinal arteriovenous fistulas in a patient with Cowden syndrome: a case report. Spine J 2018; 18:e1-e5. [PMID: 26795104 DOI: 10.1016/j.spinee.2016.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/16/2015] [Accepted: 01/01/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cowden syndrome is an autosomal dominant syndrome characterized by multiple hamartomas and an increased cancer risk. It is associated with mutations in the phosphatase and tensin homologue (PTEN) gene that encodes a tumor suppressant phosphatase. PURPOSE The study aimed to report an unusual case of multiple spinal epidural arteriovenous fistulas in a patient diagnosed with Cowden syndrome. STUDY DESIGN This is a case report. PATIENT SAMPLE The patient is a 57-year-old woman. METHODS We report the case of a 57-year-old woman with a history of multiple cancers, with acute exacerbation of lower extremity weakness and numbness that had progressed over a month. RESULTS Magnetic resonance imaging showed abnormal signal in the thoracolumbar spinal cord, with enhancement after contrast administration. A spinal angiogram confirmed the presence of multiple spinal epidural arteriovenous fistulas. Genetic testing confirmed the diagnosis of Cowden syndrome with a mutation in intron 3 of the PTEN gene. CONCLUSIONS Spinal vascular malformations occur in patients with Cowden syndrome, and they can be multifocal and locally aggressive. It is important to raise the suspicion of Cowden syndrome in patients with spinal cord vascular anomalies and a history of multiple cancers, as the correct genetic diagnosis may have implications for management and cancer screening.
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Affiliation(s)
- Paula Barreras
- Department of Neurology & Division of Neuroimmunology and Neuroinfectious Disorders, Johns Hopkins University School of Medicine, 600 North Wolfe St, 627 Pathology Blvd, Baltimore, MD 21287, USA; Johns Hopkins Transverse Myelitis Center, Johns Hopkins University School of Medicine, 600 North Wolfe St, 627 Pathology Blvd, Baltimore, MD 21287, USA
| | - Philippe Gailloud
- Department of Radiology & Division of Interventional Neuroradiology, Johns Hopkins University School of Medicine, 1800 E Orleans Street, Bloomberg 7218, Baltimore, MD 21287, USA
| | - Carlos A Pardo
- Department of Neurology & Division of Neuroimmunology and Neuroinfectious Disorders, Johns Hopkins University School of Medicine, 600 North Wolfe St, 627 Pathology Blvd, Baltimore, MD 21287, USA; Johns Hopkins Transverse Myelitis Center, Johns Hopkins University School of Medicine, 600 North Wolfe St, 627 Pathology Blvd, Baltimore, MD 21287, USA.
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Chism CB, Crawford L, Tchakarov A, Al-Ibraheemi A, Beckmann NM. PTEN hamartoma of the soft tissue: the initial manifestation of an underlying PTEN hamartoma tumor syndrome in a 4-year-old female. Skeletal Radiol 2017; 46:1591-1595. [PMID: 28756566 DOI: 10.1007/s00256-017-2732-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 06/20/2017] [Accepted: 07/13/2017] [Indexed: 02/02/2023]
Abstract
A 4-year-old female was referred to pediatric orthopedic surgery for left leg pain and limping for 3 months following a motor vehicle collision. Recently, the patient's mother had noted left knee swelling and dragging of the left leg when walking. Past medical history was significant for hip dysplasia with slight leg length discrepancy. The patient was otherwise healthy. Physical examination was remarkable for left pre-patellar soft tissue fullness with normal range of motion. There was no warmth or tenderness. Subsequent ultrasound revealed a heterogeneous soft tissue mass superior and medial to the patella with a moderate degree of internal vascularity. MR exhibited a heterogeneous soft tissue mass with heterogeneous signal on both T1- and T2-weighted images centered within the vastus medialis obliquus muscle infiltrating the quadriceps tendon. Excisional biopsy was performed with a histopathologic diagnosis of fibroadipose tissue with anomalous vessels, suggestive of phosphatase and tensin homolog (PTEN) hamartoma of the soft tissue (PHOST). The patient was found to be positive for the PTEN gene mutation on genetic testing. The child was also determined to be macrocephalic, a major criterion for PTEN hamartoma tumor syndrome (PHTS). The geneticist advised the patient to undergo yearly physical examinations and early, routine surveillance for several malignancies occurring with PHTS. This case report presents the ultrasound and MRI appearance of a rare benign tumor typically appearing in pediatric patients. The strong association between PHOST and other soft tissue malignancies and the resulting need for life-long surveillance make PHOST an important pathology to recognize.
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Affiliation(s)
- Charles B Chism
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.130B, Houston, TX, 77030, USA.
| | - Lindsay Crawford
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amanda Tchakarov
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alyaa Al-Ibraheemi
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicholas M Beckmann
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.130B, Houston, TX, 77030, USA
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Abstract
This article describes three hereditary conditions known to be associated with arteriovenous malformation (AVM), along with their clinical and imaging features and angiographic angioarchitecture. Hereditary hemorrhagic telangiectasia, capillary malformation-AVM (CM-AVM), and PTEN tumor hamartoma syndrome are conditions with autosomal dominant inheritance, caused by mutations in different molecular pathways, which frequently present with symptomatic AVMs. Imaging biomarkers, including sites of predilection, angioarchitecture, and tissue overgrowth patterns, are helpful in identifying these patients and selecting appropriate treatment.
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Affiliation(s)
- Patricia E Burrows
- Department of Radiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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46
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Gilbert P, Dubois J, Giroux MF, Soulez G. New Treatment Approaches to Arteriovenous Malformations. Semin Intervent Radiol 2017; 34:258-271. [PMID: 28955115 DOI: 10.1055/s-0037-1604299] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Arteriovenous malformations (AVMs) are high-flow vascular anomalies that have demonstrated a very high recurrence rate after endovascular treatment, surgical treatment, or a combination of both. Surgical treatments have shown good response when they are small and well localized but a poor response when diffuse. A better understanding of the nature of the lesion has led to a better response rate and a safer treatment for these patients. This has been accomplished through a detailed understanding of the angioarchitecture of the lesion, enabling a tailored approach in reaching and targeting the nidus of the AVM with different liquid embolic agents, more specifically ethanol. Flow reduction techniques help in exposing the nidus to sclerosant agents. A clinical classification, the Schobinger classification, will help determine the appropriate time to start or to pursue therapy.
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Affiliation(s)
- Patrick Gilbert
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Josée Dubois
- Department of Radiology, Centre Hospitalier Universitaire Ste Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie France Giroux
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
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Abstract
Vascular anomalies present both a diagnostic and therapeutic challenge to physicians. Identification of these lesions is difficult due to their immense phenotypic variability, and naming conventions for vascular anomalies have historically been inconsistent. Terms such as "hemangioma" are informative when used correctly, but can cause confusion and miscommunication if applied indiscriminately to all vascular anomalies. Accuracy in classification is essential, as both disease course and therapeutic options differ greatly depending on the particular vascular anomaly present. In order for clinicians to properly diagnose and treat patients with these diseases, a unified nomenclature must be employed. This section provides an update on the current classification of vascular anomalies, with clinical descriptions of the most commonly encountered lesions, and clarifies the ambiguous nomenclature present in the existing literature.
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Affiliation(s)
- Jack E Steiner
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Beth A Drolet
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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48
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Johnson CM, Navarro OM. Clinical and sonographic features of pediatric soft-tissue vascular anomalies part 2: vascular malformations. Pediatr Radiol 2017; 47:1196-1208. [PMID: 28779187 DOI: 10.1007/s00247-017-3906-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/19/2017] [Accepted: 05/11/2017] [Indexed: 12/11/2022]
Abstract
Vascular malformations are a heterogeneous group of entities, many of which present in the pediatric age group. Sonography plays a major role in the management of children with these vascular anomalies by providing information that helps in diagnosing them, in assessing lesion extent and complications, and in monitoring response to therapy. The interpretation of sonographic findings requires correlation with clinical findings, some of which can be easily obtained at the time of scanning. This has to be combined with the use of appropriate nomenclature and the most updated classification in order to categorize these patients into the appropriate management pathway. Some vascular malformations are part of combined vascular anomalies or are associated with syndromes that include other disorders, frequently limb overgrowth, and these are now being reclassified based on their underlying genetic mutation. Sonography has limitations in the evaluation of some vascular malformations and in these cases MR imaging might be considered the imaging modality of choice, particularly for lesions that are large, that involve multiple compartments or are associated with other soft-tissue and bone abnormalities. In this article, which is part 2 of a two-part series, the authors review the most relevant clinical and sonographic features of arteriovenous, capillary, venous and lymphatic malformations as well as vascular malformations that are part of more complex conditions or associated with syndromes, including Parkes-Weber syndrome, phosphatase and tensin homologue (PTEN) hamartoma tumor syndromes, Klippel-Trénaunay syndrome, CLOVES (congenital lipomatous overgrowth, vascular malformations, epidermal nevi and skeletal anomalies) syndrome, fibro-adipose vascular anomaly and Proteus syndrome.
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Affiliation(s)
- Craig M Johnson
- Division of Interventional Radiology, Department of Radiology, Nemours Children's Hospital, Orlando, FL, USA
| | - Oscar M Navarro
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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Aurora N, Hashmi I, Misra S, Aydin N. A rare presentation: A case report of osseous metaplasia and mature bone formation in a follicular adenoma of the thyroid. Int J Surg Case Rep 2017. [PMID: 28648877 PMCID: PMC5484983 DOI: 10.1016/j.ijscr.2017.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Osseous metaplasia and bone formation may be seen in a broad spectrum of diseases involving the thyroid gland especially in malignant neoplasms of the thyroid gland. However, this differentiation is not unique to malignant neoplasms. It may also be encountered in follicular adenomas of the thyroid. Awareness of thyroid nodules undergoing hemorrhagic, cystic, and fibrotic changes, as well as calcification and ossification is paramount in proper diagnosis and treatment of these pathologies. Particularly, patient’s history, associated risk factors and clinical presentation are the most important factors to consider in clinical differentiation of malignant and benign diagnoses. All ossifications in a thyroid nodule should be considered suspicious for malignancy until proven otherwise.
Introduction Cases of multinodular goiter, thyroid hyperplasia, follicular adenoma, papillary thyroid carcinoma, and anaplastic thyroid carcinoma have been reported with histopathologic findings of osseous metaplasia (OM), bone marrow metaplasia (BMM), ectopic bone formation (EBF), ossification, and extramedullary hematopoiesis (EMH). To date no report of a follicular adenoma with OM and mature EBF in the absence of EMH has been reported in the English language. Presentation of case 63-year-old woman with an incidental finding of thyroid nodule unable to be biopsied. One area was found to contain OM with mature EBF and without vascular invasion. The surrounding tissue was unremarkable, and no malignancy was found. Discussion Ectopic bone formation and osseous metaplasia in a thyroid nodule has an extensive differential diagnosis, from thyroid related pathologies to parathyroid causes, congenital syndromes, and hamartomas. A common theory amongst these is the role of basic fibroblast growth factor (bFGF) and bone morphogenetic protein-2 (BMP-2), signaling factors involved in cellular proliferation and growth. Conclusion This is the first case report of a follicular adenoma with OM and EBF in the absence of EMH. In this case, this adenoma was an incidental finding and the patient had no symptoms or accompanying laboratory abnormalities. Her benign presentation underscores the importance of awareness of the more common changes a thyroid nodule can undergo, such as hemorrhagic, cystic, and fibrotic changes, as well as the rarer changes of calcification with eventual ossification.
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Affiliation(s)
- Nadia Aurora
- Texas Tech University School of Medicine, Amarillo, TX, USA.
| | - Insia Hashmi
- Texas Tech University School of Medicine, Amarillo, TX, USA.
| | - Subhasis Misra
- Surgical Oncologist, Department of Surgery, Texas Tech University School of Medicine, Amarillo, TX, USA.
| | - Nail Aydin
- Surgical Oncologist, Department of Surgery, Texas Tech University School of Medicine, Amarillo, TX, USA.
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Kennedy RA, Thavaraj S, Diaz-Cano S. An Overview of Autosomal Dominant Tumour Syndromes with Prominent Features in the Oral and Maxillofacial Region. Head Neck Pathol 2017; 11:364-376. [PMID: 28110467 PMCID: PMC5550396 DOI: 10.1007/s12105-017-0778-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 01/07/2017] [Indexed: 12/16/2022]
Abstract
Several autosomal dominant inherited tumour syndromes demonstrate prominent features in the oral and maxillofacial region. Although multiple organ systems are frequently involved, the target organs more frequently affected are the skin (nevoid basal cell carcinoma syndrome, Brooke-Spiegler syndrome, Birt-Hogg-Dube syndrome and Muir-Torre syndrome), gastrointestinal tract (Peutz-Jegher syndrome and Gardner syndrome) or endocrine system (multiple endocrine neoplasia type 2b and hyperparathyroidism-jaw tumour syndrome). In some syndromes, the disease is multisystem with skin index lesions presenting in the head and neck (Cowden syndrome and tuberous sclerosis complex). The pertinent features of these syndromes are reviewed with a systems-based approach, emphasising their clinical impact and diagnosis.
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Affiliation(s)
- Robert A. Kennedy
- Head and Neck Pathology, King’s College London Dental Institute, Guy’s & St, NHS Foundation Trust, London, SE1 9RT UK ,Head and Neck Pathology, Guy’s Hospital, Floor 4, Tower Wing, Great Maze Pond, London, SE1 9RT UK
| | - Selvam Thavaraj
- Head and Neck Pathology, King’s College London Dental Institute, Guy’s & St, NHS Foundation Trust, London, SE1 9RT UK
| | - Salvador Diaz-Cano
- Department of Histopathology, King’s College Hospital, London, SE5 9R UK
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