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Bessis D, Bursztejn AC, Morice-Picard F, Capri Y, Barbarot S, Aubert H, Bodet D, Bourrat E, Chiaverini C, Poujade L, Willems M, Rouanet J, Dompmartin-Blanchère A, Geneviève D, Gerard M, Ginglinger E, Hadj-Rabia S, Martin L, Mazereeuw-Hautier J, Bibas N, Molinari N, Herman F, Phan A, Rod J, Roger H, Sigaudy S, Ziegler A, Vial Y, Verloes A, Cavé H, Lacombe D. Dermatological manifestations in Costello syndrome: A prospective multicentric study of 31 HRAS-positive variant patients. J Eur Acad Dermatol Venereol 2024. [PMID: 38595321 DOI: 10.1111/jdv.19996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Data on dermatological manifestations of Costello syndrome (CS) remain heterogeneous and lack in validated description. OBJECTIVES To describe the dermatological manifestations of CS; compare them with the literature findings; assess those discriminating CS from other RASopathies, including cardiofaciocutaneous syndrome (CFCS) and the main types of Noonan syndrome (NS); and test for dermatological phenotype-genotype correlations. METHODS We performed a 10-year, large, prospective, multicentric, collaborative dermatological and genetic study. RESULTS Thirty-one patients were enrolled. Hair abnormalities were ubiquitous, including wavy or curly hair and excessive eyebrows, respectively in 68% and 56%. Acral excessive skin (AES), papillomas and keratotic papules (PKP), acanthosis nigricans (AN), palmoplantar hyperkeratosis (PPHK) and 'cobblestone' papillomatous papules of the upper lip (CPPUL), were noted respectively in 84%, 61%, 65%, 55% and 32%. Excessive eyebrows, PKP, AN, CCPUL and AES best differentiated CS from CFCS and NS. Multiple melanocytic naevi (>50) may constitute a new marker of attenuated CS associated with intragenic duplication in HRAS. Oral acitretin may be highly beneficial for therapeutic management of PPHK. No significant dermatological phenotype-genotype correlation was determined between patients with and without HRAS c.34G>A (p.G12S). CONCLUSIONS AND RELEVANCE This validated phenotypic characterization of a large number of patients with CS will allow future researchers to make a positive diagnosis, and to differentiate CS from CFCS and NS.
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Affiliation(s)
- Didier Bessis
- Department of Dermatology, Saint-Eloi Hospital, University of Montpellier, Montpellier, France
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
- INSERM U1058, Montpellier, France
| | | | - Fanny Morice-Picard
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
- Department of Paediatric Dermatology, Pellegrin University Hospital of Bordeaux, Bordeaux, France
| | - Yline Capri
- Department of Clinical Genetics, Robert-Debré Hospital, Paris, France
- French National Reference Centre for Developmental Anomalies and Malformative Syndromes - Ile de France, Robert-Debré Hospital, AP-HP, Paris, France
| | - Sébastien Barbarot
- Department of Dermatology, Hotel Dieu Hospital, University of Nantes, Nantes, France
| | - Hélène Aubert
- Department of Dermatology, Hotel Dieu Hospital, University of Nantes, Nantes, France
| | - Damien Bodet
- Department of Paediatric Haematology-Immunology-Oncology, Caen Normandie Hospital and University of Caen, Caen, France
| | - Emmanuelle Bourrat
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
- Department of Paediatric Dermatology, Robert-Debré Hospital, AP-HP, Paris, France
| | - Christine Chiaverini
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
- Department of Dermatology, l'Archet 2 Hospital, University of Nice, Nice, France
| | - Laura Poujade
- Department of Dermatology, Saint-Eloi Hospital, University of Montpellier, Montpellier, France
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
| | - Marjolaine Willems
- Department of Clinical Genetics, Arnaud de Villeneuve Hospital, University of Montpellier, Montpellier, France
- French National Reference Centre for Developmental Anomalies - and Malformative Syndromes Sud Ouest Occitanie, University hospital of Montpellier, Montpellier, France
| | - Jacques Rouanet
- Department of Dermatology, d'Estaing Hospital and University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - David Geneviève
- Department of Clinical Genetics, Arnaud de Villeneuve Hospital, University of Montpellier, Montpellier, France
- French National Reference Centre for Developmental Anomalies - and Malformative Syndromes Sud Ouest Occitanie, University hospital of Montpellier, Montpellier, France
| | - Marion Gerard
- Department of Clinical Genetics, Caen Normandie Hospital and University of Caen, Caen, France
| | | | - Smaïl Hadj-Rabia
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
- Department of Paediatric Dermatology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Ludovic Martin
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
- Department of Dermatology, Angers Hospital University, Angers, France
| | - Juliette Mazereeuw-Hautier
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
- Department of Dermatology, Larrey Hospital, University of Toulouse, Toulouse, France
| | - Nathalie Bibas
- Department of Dermatology, Larrey Hospital, University of Toulouse, Toulouse, France
| | - Nicolas Molinari
- Department of Statistics, La Colombière Hospital and University of Montpellier, Montpellier, France
| | - Fanchon Herman
- Department of Statistics, La Colombière Hospital and University of Montpellier, Montpellier, France
| | - Alice Phan
- Department of Paediatric Dermatology, Femme-Mère-Enfant Hospital-HCL, University of Lyon, Lyon, France
| | - Julien Rod
- Department of Paediatric Surgery, Caen Normandie Hospital and University of Caen, Caen, France
| | | | - Sabine Sigaudy
- French National Reference Centre for Developmental Anomalies and Malformative Syndromes - Ile de France, Robert-Debré Hospital, AP-HP, Paris, France
- Department of Clinical Genetics, La Timone Hospital, AP-HM and University of Marseille, Marseille, France
| | - Alban Ziegler
- Department of Clinical Genetics, Hospital and University of Angers, Angers, France
| | - Yoann Vial
- French National Reference Centre for Developmental Anomalies and Malformative Syndromes - Ile de France, Robert-Debré Hospital, AP-HP, Paris, France
- Department of Molecular Genetics, Robert-Debré Hospital, AP-HP, Paris, France
| | - Alain Verloes
- Department of Clinical Genetics, Robert-Debré Hospital, Paris, France
- French National Reference Centre for Developmental Anomalies and Malformative Syndromes - Ile de France, Robert-Debré Hospital, AP-HP, Paris, France
| | - Hélène Cavé
- French National Reference Centre for Developmental Anomalies and Malformative Syndromes - Ile de France, Robert-Debré Hospital, AP-HP, Paris, France
- Department of Molecular Genetics, Robert-Debré Hospital, AP-HP, Paris, France
| | - Didier Lacombe
- Department of Clinical Genetics, Pellegrin University Hospital of Bordeaux, Bordeaux, France
- French National Reference Centre for Developmental Anomalies - and Malformative Syndromes SOOR, University Hospital of Bordeaux, Bordeaux, France
- INSERM U1211, Bordeaux, France
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2
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Debbaut E, Steyaert J, El Bakkali M. Autism spectrum disorder profiles in RASopathies: A systematic review. Mol Genet Genomic Med 2024; 12:e2428. [PMID: 38581124 PMCID: PMC10997847 DOI: 10.1002/mgg3.2428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/10/2024] [Accepted: 03/19/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND RASopathies are associated with an increased risk of autism spectrum disorder (ASD). For neurofibromatosis type 1 (NF1) there is ample evidence for this increased risk, while for other RASopathies this association has been studied less. No specific ASD profile has been delineated so far for RASopathies or a specific RASopathy individually. METHODS We conducted a systematic review to investigate whether a specific RASopathy is associated with a specific ASD profile, or if RASopathies altogether have a distinct ASD profile compared to idiopathic ASD (iASD). We searched PubMed, Web of Science, and Open Grey for data about ASD features in RASopathies and potential modifiers. RESULTS We included 41 articles on ASD features in NF1, Noonan syndrome (NS), Costello syndrome (CS), and cardio-facio-cutaneous syndrome (CFC). Individuals with NF1, NS, CS, and CFC on average have higher ASD symptomatology than healthy controls and unaffected siblings, though less than people with iASD. There is insufficient evidence for a distinct ASD phenotype in RASopathies compared to iASD or when RASopathies are compared with each other. We identified several potentially modifying factors of ASD symptoms in RASopathies. CONCLUSIONS Our systematic review found no convincing evidence for a specific ASD profile in RASopathies compared to iASD, or in a specific RASopathy compared to other RASopathies. However, we identified important limitations in the research literature which may also account for this result. These limitations are discussed and recommendations for future research are formulated.
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Affiliation(s)
- Edward Debbaut
- Center for Developmental Psychiatry, Department of NeurosciencesKU LeuvenLeuvenBelgium
- Leuven Autism Research (LAuRes)KU LeuvenLeuvenBelgium
| | - Jean Steyaert
- Center for Developmental Psychiatry, Department of NeurosciencesKU LeuvenLeuvenBelgium
- Leuven Autism Research (LAuRes)KU LeuvenLeuvenBelgium
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3
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Asif M, Yousuf MH, Farooqui US, Nashwan AJ, Ullah I. Cutaneous signs of selected cardiovascular disorders: A narrative review. Open Med (Wars) 2024; 19:20240897. [PMID: 38463529 PMCID: PMC10921438 DOI: 10.1515/med-2024-0897] [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: 07/12/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 03/12/2024] Open
Abstract
Cardiovascular diseases are the leading cause of mortality and morbidity globally. Clinicians must know cutaneous signs of cardiovascular disease, including petechiae, macules, purpura, lentigines, and rashes. Although cutaneous manifestations of diseases like infectious endocarditis and acute rheumatic fever are well established, there is an indispensable need to evaluate other important cardiovascular diseases accompanied by cutaneous signs. Moreover, discussing the latest management strategies in this regard is equally imperative. This review discusses distinctive skin findings that help narrow the diagnosis of cardiovascular diseases and recommendations on appropriate treatment.
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Affiliation(s)
- Marium Asif
- Faculty of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | | | - Irfan Ullah
- Department of Internal Medicine, Khyber Teaching Hospital, Kabir Medical College, Gandhara University, Peshawar, Pakistan
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4
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Wang T, Lin Y, Sun L, Mao L, Gao X, Liu X, Liu H. An incomplete LEOPARD syndrome presented with generalized lentigines. J Cosmet Dermatol 2024; 23:711-713. [PMID: 37715542 DOI: 10.1111/jocd.15991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/03/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023]
Affiliation(s)
- Tianzi Wang
- Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yan Lin
- Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Lele Sun
- Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Lingyu Mao
- Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xiaoyuan Gao
- Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xiaodong Liu
- Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Huaxu Liu
- Shandong Provincial Hospital for Skin Diseases and Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
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5
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Palacios-Diaz RD, Pozuelo-Ruiz M, De Unamuno-Bustos B, Llavador-Ros M, Botella-Estrada R. Melanoma and LEOPARD Syndrome: Understanding the Role of PTPN11 Mutations in Melanomagenesis. Acta Derm Venereol 2024; 104:adv14720. [PMID: 38189222 PMCID: PMC10789164 DOI: 10.2340/actadv.v104.14720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/25/2023] [Indexed: 01/09/2024] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
| | - Mónica Pozuelo-Ruiz
- Dermatology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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6
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Zenker M. Clinical overview on RASopathies. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2022; 190:414-424. [PMID: 36428239 DOI: 10.1002/ajmg.c.32015] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/06/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022]
Abstract
RASopathies comprise a group of clinically overlapping developmental disorders caused by genetic variations affecting components or modulators of the RAS-MAPK signaling cascade, which lead to dysregulation of signal flow through this pathway. Noonan syndrome and the less frequent, clinically related disorders, Costello syndrome, cardiofaciocutaneous syndrome, Noonan syndrome with multiple lentigines, and Noonan syndrome-like disorder with loose anagen hair are part of the RASopathy spectrum and share a recognizable pattern of multisystem involvement. This review describes the "Noonan syndrome-like" phenotype as a common phenotypic signature of generalized developmental RAS pathway dysregulation. Distinctive features of the different entities are revisited against the background of the understanding of underlying genetic alterations and genotype correlations, which has evolved rapidly during the past 20 years, thereby leading to suggestions regarding the nosology of RASopathies.
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Affiliation(s)
- Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
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7
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Kavamura MI, Leoni C, Neri G. Dermatological manifestations, management, and care in RASopathies. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2022; 190:452-458. [PMID: 36541891 DOI: 10.1002/ajmg.c.32027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/20/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
RASopathies are rare genetic disorders caused by germline pathogenic variants in genes belonging to the RAS/MAPK pathway, which signals cell proliferation, differentiation, survival and death. The dysfunction of such signaling pathway causes syndromes with overlapping clinical manifestations. Skin and adnexal lesions are the cardinal clinical signs of RASopathies, such as cardiofaciocutaneous syndrome, Noonan syndrome with multiple lentigines, formerly known as LEOPARD syndrome, Costello syndrome, neurofibromatosis (NF1), Legius syndrome, Noonan-like syndrome with loose anagen hair (NSLH) and Noonan syndrome. As NF1, one of the most common RASopathies, described in 1882, has its clinical features well delineated, we will focus on the dermatological diagnosis, management and care of non-NF1 RASopathies, which are less known and more recently described. Dermatological manifestations are important clinical diagnostic elements that can aid differential diagnosis among RASopathies. They can affect dermis and epidermis, causing pigmented lesions (melanocytic nevi, café-au-lait spots, and lentigines), hyperkeratosis (keratosis pilaris, ulerythema ophryogenes, and palmoplantar keratosis) or hyperplasia. To date there are rare known links to malignancy, but oftentimes skin lesions require close attention because they can highly affect quality of life.
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Affiliation(s)
| | - Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Neri
- Institute of Genomic Medicine, Catholic University School of Medicine, Rome, Italy
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8
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Mercadante F, Piro E, Busè M, Salzano E, Ferrara A, Serra G, Passarello C, Corsello G, Piccione M. Cutis verticis gyrata and Noonan syndrome: report of two cases with pathogenetic variant in SOS1 gene. Ital J Pediatr 2022; 48:152. [PMID: 35986401 PMCID: PMC9392323 DOI: 10.1186/s13052-022-01340-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/08/2022] [Indexed: 11/22/2022] Open
Abstract
Background Noonan and Noonan-like syndromes are multisystem genetic disorders, mainly with autosomal dominant trasmission, caused by mutations in several genes. Missense pathogenetic variants of SOS1 gene are the second most common cause of Noonan syndrome (NS) and account approximately for 13% to 17% of cases. Subjects carrying a pathogenetic variant in SOS1 gene tend to exhibit a distinctive phenotype that is characterized by ectodermal abnormalities. Cutis verticis gyrata (CVG) is a rare disease, congenital or acquired, characterized by the redundancy of skin on scalp, forming thick skin folds and grooves of similar aspect to cerebral cortex gyri. Several references in the literature have reported association between nonessential primary form of CVG and NS. Case presentation we report two cases of newborns with CVG and phenotype suggestive for NS who have been diagnosed to harbour the same pathogenetic variant in SOS1 gene. Conclusions previously described patients with NS presenting CVG had received only clinical diagnosis. Therefore we report the first patients with CVG in which the clinical suspicion of NS is confirmed by molecolar analysis.
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9
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Abstract
The term RASopathy was originally created to describe a phenotypically similar group of medical genetic syndromes caused by germline pathogenic variants in components of the RAS/mitogen-activated protein kinase (RAS/MAPK) pathway. In defining a RASopathy syndrome, one needs to consider the complex nature of the RAS/MAPK pathway, the numerous genes and regulatory components involved, its crosstalk with other signaling pathways and the phenotypic spectrum among these syndromes. Three main guiding principles to the definition should be considered. First, a RASopathy is a clinical syndrome with overlapping phenotypic features caused by germline pathogenic variants associated with the RAS/MAPK pathway. Second, a RASopathy is caused by multiple pathogenetic mechanisms, all of which lead to a similar outcome of RAS/MAPK pathway activation/dysregulation. Finally, because a RASopathy has dysfunctional germline RAS/MAPK pathway activation/dysregulation, it may, therefore, be amenable to treatment with pathway modulators. Summary: RASopathy is a term used to unify a phenotypically similar group of medical genetic syndromes, yet its definition is challenging and should consider the perspectives of clinicians, scientists and the patients.
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Affiliation(s)
- Katherine A Rauen
- Department of Pediatrics, Division of Genomic Medicine, University of California Davis, Sacramento, CA 95817, USA.,Department of Pediatrics, UC Davis MIND Institute, Sacramento, CA 95817, USA
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10
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Lozano-Masdemont B, Rojas-Calva J, Darnaude-Ortiz M. Noonan Syndrome With Multiple Lentigines: Subtle Key Skin Clues to the Diagnosis. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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Pérez-Feal P, Moreiras-Arias N, Buján-Bonino C, Suárez-Peñaranda JM, Fernández-Redondo V. Disseminated lymphangiomas as a cutaneous manifestation of Noonan syndrome. Clin Exp Dermatol 2021; 47:180-182. [PMID: 34363648 DOI: 10.1111/ced.14873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/05/2021] [Indexed: 12/01/2022]
Abstract
Lymphangioma is a known, but rare manifestation of Noonan syndrome. We present the case of disseminated and circumscribed cutaneous lymphangiomas in the context of Noonan syndrome. Oral rapamycin is a promising treatment in these extensive and morbidity-causing cases.
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Affiliation(s)
- P Pérez-Feal
- Departments of Dermatology, Clinical University, Hospital of Santiago de Compostela, A Coruña, Spain
| | - N Moreiras-Arias
- Departments of Dermatology, Clinical University, Hospital of Santiago de Compostela, A Coruña, Spain
| | - C Buján-Bonino
- Departments of Dermatology, Clinical University, Hospital of Santiago de Compostela, A Coruña, Spain
| | - J M Suárez-Peñaranda
- Departments of Pathology, Clinical University, Hospital of Santiago de Compostela, A Coruña, Spain
| | - V Fernández-Redondo
- Departments of Dermatology, Clinical University, Hospital of Santiago de Compostela, A Coruña, Spain
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12
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Ali MM, Gilliam AE, Ruben BS, Tidyman WE, Rauen KA. Juvenile xanthogranuloma in Noonan syndrome. Am J Med Genet A 2021; 185:3048-3052. [PMID: 34032360 DOI: 10.1002/ajmg.a.62353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/16/2021] [Accepted: 05/06/2021] [Indexed: 12/19/2022]
Abstract
Noonan syndrome (NS) is one of the common RASopathies. While the clinical phenotype in NS is variable, it is typically characterized by distinctive craniofacial features, cardiac defects, reduced growth, bleeding disorders, learning issues, and an increased risk of cancer. Several different genes cause NS, all of which are involved in the Ras/mitogen-activated protein kinase (Ras/MAPK) pathway. Juvenile xanthogranuloma (JXG) is an uncommon, proliferative, self-limited cutaneous disorder that affects young individuals and may be overlooked or misdiagnosed due to its transient nature. A RASopathy that is known to be associated with JXG is neurofibromatosis type 1 (NF1). JXG in NF1 has also been reported in association with a juvenile myelomonocytic leukemia (JMML). As RASopathies, both NS and NF1 have an increased incidence of JMML. We report a 10-month-old female with NS who has a PTPN11 pathogenic variant resulting in a heterozygous SHP2 p.Y62D missense mutation. She was found to have numerous, small, yellow-pink smooth papules that were histopathologically confirmed to be JXG. In understanding the common underlying pathogenetic dysregulation of the Ras/MAPK pathway in both NS and NF1, this report suggests a possible molecular association for why NS individuals may be predisposed to JXG.
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Affiliation(s)
- Marwan M Ali
- California Maternal Fetal Medicine, Folsom, California, USA
| | - Amy E Gilliam
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA.,Dermatology and Dermatopathology, Palo Alto Medical Foundation Medical Group, Palo Alto, California, USA
| | - Beth S Ruben
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA.,Dermatology and Dermatopathology, Palo Alto Medical Foundation Medical Group, Palo Alto, California, USA
| | - William E Tidyman
- Department of Pediatrics, University of California Davis, Sacramento, California, USA.,MIND Institute, University of California Davis, Sacramento, California, USA
| | - Katherine A Rauen
- Department of Pediatrics, University of California Davis, Sacramento, California, USA.,MIND Institute, University of California Davis, Sacramento, California, USA
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13
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Lozano-Masdemont B, Rojas-Calva J, Darnaude-Ortiz MT. Noonan Syndrome With Multiple Lentigines: Subtle Key Skin Clues to the Diagnosis. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00103-4. [PMID: 33675723 DOI: 10.1016/j.ad.2019.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/07/2019] [Accepted: 07/13/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- B Lozano-Masdemont
- Servicio de Dermatología. Hospital Universitario de Móstoles, Madrid, España.
| | | | - M T Darnaude-Ortiz
- Servicio de Genética. Hospital Universitario de Móstoles, Madrid, España
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14
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Lee Y, Choi Y, Seo GH, Kim GH, Choi IH, Keum C, Ko JM, Cheon CK, Jeon J, Choi JH, Yoo HW, Lee BH. Clinical and molecular spectra of BRAF-associated RASopathy. J Hum Genet 2020; 66:389-399. [PMID: 33040082 DOI: 10.1038/s10038-020-00852-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 01/13/2023]
Abstract
Noonan syndrome (NS) and cardio-facio-cutaneous (CFC) syndrome are the most common subtypes of RASopathy. As an effector of Ras, BRAF is one of the molecules responsible for RASopathy. We investigated the phenotypic and genotypic features of 26 patients with BRAF-associated RASopathy. The clinical diagnoses were CFC (n = 21, 80.8%), NS (n = 3, 11.5%), NS/CFC (n = 1, 3.8%), and undefined syndromic intellectual disability (ID) (n = 1, 3.8%). The mostly shared phenotypes were ID (90.5%), cutaneous manifestations (84.6%), congenital heart defects (76.9%), short stature (76.9%), and dysmorphic features such as short neck (65.4%) and low-set ears (65.4%). Importantly, moderate to severe ID (57.1%) and epilepsy (26.9%) were noted. Eighteen different missense mutations were found, including a novel mutation, p.Phe498Tyr. p.Gln257Arg (n = 9, 34.6%) was the most common mutation, and the mutations were clustered in the cysteine-rich domain or protein kinase domain. A review of previously reported cases along with our findings revealed the existence of multiple sub-phenotypes of RASopathy within a single genotype, indicating that BRAF-associated RASopathy is not variant-specific. Our study further delineated the diverse and expanded clinical phenotypes of BRAF-associated RASopathy with their molecular genetic characteristics.
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Affiliation(s)
- Yena Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yunha Choi
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Gu-Hwan Kim
- Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - In Hee Choi
- Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Jung Min Ko
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Kun Cheon
- Department of Pediatrics, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Jihyun Jeon
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Jin-Ho Choi
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Han-Wook Yoo
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea.,Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Beom Hee Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea. .,Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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15
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Lodi M, Boccuto L, Carai A, Cacchione A, Miele E, Colafati GS, Diomedi Camassei F, De Palma L, De Benedictis A, Ferretti E, Catanzaro G, Pò A, De Luca A, Rinelli M, Lepri FR, Agolini E, Tartaglia M, Locatelli F, Mastronuzzi A. Low-Grade Gliomas in Patients with Noonan Syndrome: Case-Based Review of the Literature. Diagnostics (Basel) 2020; 10:diagnostics10080582. [PMID: 32806529 PMCID: PMC7460327 DOI: 10.3390/diagnostics10080582] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022] Open
Abstract
Noonan syndrome (NS) is a congenital autosomic dominant condition characterized by a variable spectrum from a clinical and genetical point of view. Germline mutations in more than ten genes involved in RAS-MAPK signal pathway have been demonstrated to cause the disease. An higher risk for leukemia and solid malignancies, including brain tumors, is related to NS. A review of the published literature concerning low grade gliomas (LGGs) in NS is presented. We described also a 13-year-old girl with NS associated with a recurrent mutation in PTPN11, who developed three different types of brain tumors, i.e., an optic pathway glioma, a glioneuronal neoplasm of the left temporal lobe and a cerebellar pilocytic astrocytoma. Molecular characterization of the glioneuronal tumor allowed to detect high levels of phosphorylated MTOR (pMTOR); therefore, a therapeutic approach based on an mTOR inhibitor (everolimus) was elected. The treatment was well tolerated and proved to be effective, leading to a stabilization of the tumor, which was surgical removed. The positive outcome of the present case suggests considering this approach for patients with RASopathies and brain tumors with hyperactivated MTOR signaling.
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Affiliation(s)
- Mariachiara Lodi
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.); (A.C.); (E.M.); (F.L.)
| | - Luigi Boccuto
- School of Nursing, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC 29634, USA;
- JC Self Research Institute of the Greenwood Genetic Center, Greenwood, SC 29646, USA
| | - Andrea Carai
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (A.D.B.)
| | - Antonella Cacchione
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.); (A.C.); (E.M.); (F.L.)
| | - Evelina Miele
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.); (A.C.); (E.M.); (F.L.)
| | | | | | - Luca De Palma
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.D.P.); (E.F.)
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (A.D.B.)
| | - Elisabetta Ferretti
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.D.P.); (E.F.)
| | | | - Agnese Pò
- Department of Molecular Medicine, Sapienza University, 00161 Rome, Italy;
| | - Alessandro De Luca
- Medical Genetics Division, Fondazione IRCCS-Casa Sollievo della Sofferenza, 71043 San Giovanni Rotondo, Italy;
| | - Martina Rinelli
- Laboratory of Medical Genetics, Department of Laboratories, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.R.); (F.R.L.); (E.A.)
| | - Francesca Romana Lepri
- Laboratory of Medical Genetics, Department of Laboratories, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.R.); (F.R.L.); (E.A.)
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Department of Laboratories, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.R.); (F.R.L.); (E.A.)
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Franco Locatelli
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.); (A.C.); (E.M.); (F.L.)
- Department of Pediatric Hematology and Oncology Cell and Gene Therapy, Bambino Gesù Hospital, IRCCS, University La Sapienza, 00165 Rome, Italy
| | - Angela Mastronuzzi
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.); (A.C.); (E.M.); (F.L.)
- Correspondence: ; Tel.: +39-0668594664; Fax: +39-0668592292
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16
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Variants of SOS2 are a rare cause of Noonan syndrome with particular predisposition for lymphatic complications. Eur J Hum Genet 2020; 29:51-60. [PMID: 32788663 DOI: 10.1038/s41431-020-00708-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 11/09/2022] Open
Abstract
RASopathies are caused by variants in genes encoding components or modulators of the RAS/MAPK signaling pathway. Noonan syndrome is the most common entity among this group of disorders and is characterized by heart defects, short stature, variable developmental delay, and typical facial features. Heterozygous variants in SOS2, encoding a guanine nucleotide exchange factor for RAS, have recently been identified in patients with Noonan syndrome. The number of published cases with SOS2-related Noonan syndrome is still limited and little is known about genotype-phenotype correlations. We collected previously unpublished clinical and genotype data from 17 individuals carrying a disease-causing SOS2 variant. Most individuals had one of the previously reported dominant pathogenic variants; only four had novel changes at the established hotspots for variants that affect protein function. The overall phenotype of the 17 patients fits well into the spectrum of Noonan syndrome and is most similar to the phenotype observed in patients with SOS1-related Noonan syndrome, with ectodermal anomalies as common features and short stature and learning disabilities as relatively infrequent findings compared to the average Noonan syndrome phenotype. The spectrum of heart defects in SOS2-related Noonan syndrome was consistent with the known spectrum of cardiac anomalies in RASopathies, but no specific heart defect was particularly predominating. Notably, lymphatic anomalies were extraordinarily frequent, affecting more than half of the patients. We therefore conclude that SOS2-related Noonan syndrome is associated with a particularly high risk of lymphatic complications that may have a significant impact on morbidity and quality of life.
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17
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Quoi de neuf en dermatologie pédiatrique ? Ann Dermatol Venereol 2019; 146:12S32-12S38. [DOI: 10.1016/s0151-9638(20)30104-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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18
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Garren B, Stephan M, Hogue JS. NRAS associated RASopathy and embryonal rhabdomyosarcoma. Am J Med Genet A 2019; 182:195-200. [PMID: 31697451 DOI: 10.1002/ajmg.a.61395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/30/2019] [Accepted: 10/13/2019] [Indexed: 01/29/2023]
Abstract
RASopathies are a group of phenotypically overlapping disorders that arise from dysregulation of the RAS/MAPK pathway. These disorders include Noonan syndrome, Costello syndrome, cardiofaciocutaneous syndrome, and neurofibromatosis-Type 1. While somatic mutations in the three human Ras genes (KRAS, HRAS, and NRAS) are a common finding in a variety of cancers, germline mutations in each of the these genes cause developmental RASopathy phenotypes with mutations in specific genes typically correlating with specific phenotypes. We present the case of a germline heterozygous NRAS mutation producing a severe phenotype involving embryonal rhabdomyosarcoma, severe intellectual disability, and numerous melanocytic nevi in addition to more typical manifestations of Noonan syndrome. Additionally, the specific p.G12R NRAS mutation in this case is a common somatic mutation in cancer cells, and analysis of previously reported NRAS-RASopathy cases suggests that mutations at traditionally oncogenic codons are associated with elevated cancer risk not present with mutations at other sites.
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Affiliation(s)
- Benjamin Garren
- Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington
| | - Mark Stephan
- Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington
| | - Jacob S Hogue
- Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington
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19
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Carcavilla A. The value of dermatological phenotyping in the clinical diagnosis of
RAS
opathies. Br J Dermatol 2019; 180:1293. [DOI: 10.1111/bjd.17731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A. Carcavilla
- Pediatric Endocrinology Hospital Universitario La Paz Madrid Spain
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20
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Abstract
Solitary congenital or early apparent pigmented macules are usually without relevance; however, when multiple, extensive or in a patterned arrangement, they are not uncommonly the first sign of an underlying genetic syndrome. The present article gives an overview on the clinical significance of multiple café-au-lait macules, multiple lentigines and pigmentary mosaicism and discusses the differential diagnosis of associated syndromes. Early diagnosis with the essential contribution of the dermatologist is not only important for genetic counseling but can also contribute to avoidance of sometimes life-threatening complications.
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Affiliation(s)
- H Hamm
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland.
| | - K Emmerich
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland
| | - J Olk
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland
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