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Smeijers S, Brems H, Verhaeghe A, van Paesschen W, van Loon J, Van der Auweraer S, Sciot R, Thal DR, Lagae L, Legius E, Theys T. Encephalocraniocutaneous lipomatosis phenotype associated with mosaic biallelic pathogenic variants in the NF1 gene. J Med Genet 2024; 61:904-907. [PMID: 38825366 DOI: 10.1136/jmg-2023-109785] [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: 11/27/2023] [Accepted: 05/21/2024] [Indexed: 06/04/2024]
Abstract
Encephalocraniocutaneous lipomatosis (ECCL) is a sporadic congenital condition characterised by ocular, cutaneous and central nervous system involvement. Mosaic activating variants in FGFR1 and KRAS have been reported in several individuals with this syndrome. We report on a patient with neurofibromatosis type 1 (NF1) with a germline pathogenic variant in the NF1 gene and an ECCL phenotype, suggesting ECCL to be part of a spectrum of malformations associated with NF1 pathogenic variants. An anatomical hemispherectomy was performed for intractable epilepsy. Through genetic analysis of blood, cerebral tissue and giant cell lesions in both jaws, we identified the germline NF1 pathogenic variant in all samples and a second-hit pathogenic NF1 variant in cerebral tissue and both giant cell lesions. Both NF1 variants were located on different alleles resulting in somatic mosaicism for a biallelic NF1 inactivation originating in early embryogenesis (second-hit mosaicism or Happle type 2 mosaicism). The biallelic deficit in NF1 in the left hemicranium explains the severe localised, congenital abnormality in this patient. Identical first and second-hit variants in a giant cell lesion of both upper and lower jaws provide confirmatory evidence for an early embryonic second hit involving at least the neural crest. We suggest that the ECCL phenotype may be part of a spectrum of congenital problems associated with mosaic NF1 nullisomy originating during early embryogenesis. The biallelic NF1 inactivation during early embryogenesis mimics the severe activation of the RAS-MAPK pathway seen in ECCL caused by embryonic mosaic activating FGFR1 and KRAS variants in the cranial region. We propose that distinct mechanisms of mosaicism can cause the ECCL phenotype through convergence on the RAS-MAPK pathway.
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Affiliation(s)
- Steven Smeijers
- Department of Neurosurgery, KU Leuven University Hospitals, Leuven, Belgium
| | - Hilde Brems
- Center for Human Genetics and Department of Human Genetics, KU Leuven University Hospitals, Leuven, Belgium
| | | | - Wim van Paesschen
- Department of Neurology, KU Leuven University Hospitals, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, KU Leuven University Hospitals, Leuven, Belgium
| | - Seppe Van der Auweraer
- Center for Human Genetics and Department of Human Genetics, KU Leuven University Hospitals, Leuven, Belgium
| | - Raf Sciot
- Department of Pathology, KU Leuven University Hospitals, Leuven, Belgium
| | - Dietmar Rudolf Thal
- Department of Pathology, KU Leuven University Hospitals, Leuven, Belgium
- Laboratory for Neuropathology, Department of Imaging and Pathology and Leuven Brain Institute, KULeuven, Leuven, Belgium
| | - Lieven Lagae
- Department of Paediatric Neurology, University of Leuven, Leuven, Belgium
| | - Eric Legius
- Center for Human Genetics and Department of Human Genetics, KU Leuven University Hospitals, Leuven, Belgium
| | - Tom Theys
- Department of Neurosurgery, KU Leuven University Hospitals, Leuven, Belgium
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Grodecki BM, Potluri SC, Olsen K, Eldib A, Scanga HL, Pihlblad MS, Nischal KK. Calcified Sclero-Choroidal Choristomas in Mosaic RASopathies: A Description of a New Imaging Sign. Ophthalmol Retina 2024; 8:710-722. [PMID: 38302056 DOI: 10.1016/j.oret.2024.01.022] [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: 10/25/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE To evaluate the imaging and clinical features of unusual calcified lesions seen in the fundus of patients with mosaic RASopathy. DESIGN Single-center retrospective observational study. SUBJECTS Ten eyes with calcified fundus lesions in 7 patients with mosaic RASopathy. METHODS The lesions were evaluated with fundus photography, oral fundus fluorescein angiography, B-scan ultrasonography, magnetic resonance imaging (MRI), and computed tomography (CT) scan where available. MAIN OUTCOME MEASURES The imaging characteristics of calcified fundus lesions were assessed. RESULTS We found 7 patients with mosaic RASopathies, 5 men and 2 women (3 with linear sebaceous nevus syndrome, 3 with oculoectodermal syndrome, and 1 with encephalocraniocutaneous lipomatosis) with molecular confirmation in 5 cases, all 5 having KRAS-pathogenic variants. Calcified fundus lesions were identified in 10 eyes (bilateral in 3 patients), appearing as slightly elevated, creamy-yellow lesions around or adjacent to the optic nerve, extending supero-nasally; all but 2 of these lesions involved both the choroid and sclera, with 2 of them only involving the sclera at the time of examination. One case developed a choroidal neovascular membrane necessitating intravitreal bevacizumab injections. All 7 patients had B-scan ultrasonography, and the lesion appeared as a hyperechogenic area with an acoustic shadow posteriorly despite reduced gain. Five patients had MRI, and where fundus lesions were present, there was a focal defect in the sclero-choroidal layer. Four patients had a CT scan, and all 4 showed calcifications affecting both the posteromedial sclero-choroid and adjacent medial rectus muscle. Two of these patients had normal eye movements, 1 had a unilateral fixed adducted eye and a vestigial fibrous medial rectus muscle seen in imaging and intraoperatively, and the fourth had marked exotropia with a right gaze deficit affecting both eyes. CONCLUSIONS We propose that the lesions seen in this cohort are calcified sclero-choroidal choristomas and should be suspected in mosaic RASopathies when creamy-yellow lesions are seen in the fundus. If identified, the possibility of choroidal neovascularization should be considered during follow-up. In all cases where a CT scan was performed, a novel sign of sclero-muscular calcification involving the medial rectus muscle was seen. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Brian M Grodecki
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Children's Eye Center, Pittsburgh, Pennsylvania; Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Saipriya C Potluri
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Children's Eye Center, Pittsburgh, Pennsylvania; Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Karl Olsen
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Retina Vitreous Consultants, Pittsburgh, Pennsylvania
| | - Amgad Eldib
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Children's Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Vision Institute, Pittsburgh, Pennsylvania
| | - Hannah L Scanga
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Children's Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Vision Institute, Pittsburgh, Pennsylvania
| | - Matthew S Pihlblad
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Children's Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Vision Institute, Pittsburgh, Pennsylvania
| | - Ken K Nischal
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Children's Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh Medical Center, Vision Institute, Pittsburgh, Pennsylvania.
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3
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Morren MA, Fodstad H, Brems H, Bedoni N, Guenova E, Jacot-Guillarmod M, Busiah K, Giuliano F, Gilliet M, Atallah I. Mosaic RASopathies concept: different skin lesions, same systemic manifestations? J Med Genet 2024; 61:411-419. [PMID: 38290824 DOI: 10.1136/jmg-2023-109306] [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: 04/01/2023] [Accepted: 12/30/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Cutaneous epidermal nevi are genotypically diverse mosaic disorders. Pathogenic hotspot variants in HRAS, KRAS, and less frequently, NRAS and BRAF may cause isolated keratinocytic epidermal nevi and sebaceous nevi or several different syndromes when associated with extracutaneous anomalies. Therefore, some authors suggest the concept of mosaic RASopathies to group these different disorders. METHODS In this paper, we describe three new cases of syndromic epidermal nevi caused by mosaic HRAS variants: one associating an extensive keratinocytic epidermal nevus with hypomastia, another with extensive mucosal involvement and a third combining a small sebaceous nevus with seizures and intellectual deficiency. Moreover, we performed extensive literature of all cases of syndromic epidermal nevi and related disorders with confirmed pathogenic postzygotic variants in HRAS, KRAS, NRAS or BRAF. RESULTS Most patients presented with bone, ophthalmological or neurological anomalies. Rhabdomyosarcoma, urothelial cell carcinoma and pubertas praecox are also repeatedly reported. KRAS pathogenic variants are involved in 50% of the cases, especially in sebaceous nevi, oculoectodermal syndrome and encephalocraniocutaneous lipomatosis. They are frequently associated with eye and brain anomalies. Pathogenic variants in HRAS are rather present in syndromic keratinocytic epidermal nevi and phacomatosis pigmentokeratotica. CONCLUSION This review delineates genotype/phenotype correlations of syndromic epidermal nevi with somatic RAS and BRAF pathogenic variants and may help improve their follow-up.
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Affiliation(s)
- Marie-Anne Morren
- Pediatric Dermatology Unit, Department of Dermatology and Venereology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Heidi Fodstad
- Division of Genetic Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hilde Brems
- Department of Human Genetics, University of Leuven, Leuven, Belgium
| | - Nicola Bedoni
- Division of Genetic Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Emmanuella Guenova
- Department of Dermatology and Venereology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martine Jacot-Guillarmod
- Pediatric Gynecology Unit, Department of Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kanetee Busiah
- Pediatric Endocrinology, Diabetology, and Obesity Unit, Department of Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Michel Gilliet
- Dermatology and Venereology Department, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Isis Atallah
- Division of Genetic Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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4
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Zaworski E, Gruber E, Regent-Smith A, Jones KL, Chalhoub MS, Lin K. Encephalocraniocutaneous Lipomatosis: A Case Report. Ann Plast Surg 2024; 92:e29-e31. [PMID: 38527346 DOI: 10.1097/sap.0000000000003814] [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: 03/27/2024]
Abstract
ABSTRACT Encephalocraniocutaneous lipomatosis (ECCL) is a rare congenital syndrome and subclassification of oculoectodermal syndrome. Encephalocraniocutaneous lipomatosis may be associated with postzygotic mutations. However, absence of an identifiable mutation does not preclude a diagnosis of ECCL. Encephalocraniocutaneous lipomatosis commonly causes skin, eye, and central nervous system anomalies. Diagnosis can be made through genetic sequencing or standardized clinical criteria. One clinically apparent major criterion for the diagnosis of ECCL is nevus psiloliparus (NP), a fatty nevus with overlying nonscarring alopecia. In this case, a 50-day-old female infant with uncomplicated birth history presented to dermatology clinic for evaluation of 2 superficial cranial masses that had been present since birth without regression or evolution. One of the masses was located within the hairline and demonstrated overlying nonscarring alopecia, suspicious of NP. Because of concern for ECCL, brain magnetic resonance imaging was ordered and revealed 2 intracranial lipomas. Genetic testing was inconclusive. Excision of the masses was performed at the request of the parents for cosmetic purposes. Histologic evaluation of the surgical specimens confirmed the diagnosis of NP and ECCL. A suspected NP should raise concern for ECCL and prompt further evaluation for systemic involvement. In particular, patients with suspected ECCL should be screened for ocular and CNS involvement. Early identification and diagnosis are important for prognostication because patients with ECCL are at increased risk of developing neoplasms of the head and neck and may require more frequent screening examinations.
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Affiliation(s)
| | | | | | - Kelly L Jones
- Division of Medical Genetics, Department of Pediatrics
| | - Mario Saab Chalhoub
- Division of Dermatopathology, Department of Pathology, Medical College of Wisconsin, Hudson, WI
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5
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Barry KK, Liang MG, Balkin DM, Srivastava S, Church AJ, Eng W. Next generation sequencing aids diagnosis and management in a case of encephalocraniocutaneous lipomatosis. Pediatr Dermatol 2024; 41:76-79. [PMID: 37486073 DOI: 10.1111/pde.15353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/30/2023] [Indexed: 07/25/2023]
Abstract
Encephalocraniocutaneous lipomatosis (ECCL) is a rare neurocutaneous disorder caused by somatic FGFR1 and KRAS variants. It shares significant phenotypic overlap with several closely related disorders caused by mutations in the RAS-MAPK pathway (mosaic RASopathies). We report a diagnostically challenging case of ECCL in which next-generation sequencing of affected tissue identified a pathologic FGFR1 p.K656E variant, thereby establishing a molecular diagnosis. Patients with FGFR1-associated ECCL carry a risk of developing malignant brain tumors; thus, genetic testing of patients with suspected ECCL has important management implications.
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Affiliation(s)
- Kelly K Barry
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marilyn G Liang
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel M Balkin
- Department of Plastic & Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Siddharth Srivastava
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alanna J Church
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Whitney Eng
- Division of Hematology/Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Sturgis MR, Wrobel KE, Bosco GN, Jones CH. Utility of Neonatal Findings in Early Diagnosis of a Case of Haberland Syndrome. J Pediatr Genet 2023; 12:335-338. [PMID: 38162153 PMCID: PMC10756718 DOI: 10.1055/s-0041-1731687] [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: 01/20/2021] [Accepted: 05/30/2021] [Indexed: 10/20/2022]
Abstract
Haberland syndrome or encephalocraniocutaneous lipomatosis (ECCL) is a rare, congenital syndrome characterized by lipomas and noncancerous tumors of the scalp, skin, and eyes, in addition to intellectual disability, early onset seizures, and ectomesodermal dysgenesis. The diagnosis of ECCL is classically made by clinical presentation, imaging, and histopathological findings, but due to the spectrum of clinical presentation and symptom severity, diagnosis is often delayed until adolescence or adulthood. Here we present a newborn male infant, one of the earliest case diagnoses to our knowledge, with a unique constellation of physical exam and neuroimaging findings consistent with this diagnosis. We aim to address important neonatal findings to aid in early detection and diagnosis of this unique disease, which is thought to improve clinical outcomes and patient quality of life.
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Affiliation(s)
| | | | - Gianna N. Bosco
- Department of Internal Medicine-Pediatrics, Rush University Medical Center, Chicago, Illinois, United States
| | - Carolyn H. Jones
- Division of Pathology and Pediatrics and Pediatric Clinical Genetics, Department of Cytogenetics, Rush Medical College of Rush University, Chicago, Illinois, United States
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7
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Sheppard SE, March ME, Seiler C, Matsuoka LS, Kim SE, Kao C, Rubin AI, Battig MR, Khalek N, Schindewolf E, O’Connor N, Pinto E, Priestley JR, Sanders VR, Niazi R, Ganguly A, Hou C, Slater D, Frieden IJ, Huynh T, Shieh JT, Krantz ID, Guerrero JC, Surrey LF, Biko DM, Laje P, Castelo-Soccio L, Nakano TA, Snyder K, Smith CL, Li D, Dori Y, Hakonarson H. Lymphatic disorders caused by mosaic, activating KRAS variants respond to MEK inhibition. JCI Insight 2023; 8:e155888. [PMID: 37154160 PMCID: PMC10243805 DOI: 10.1172/jci.insight.155888] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/17/2023] [Indexed: 05/10/2023] Open
Abstract
Central conducting lymphatic anomaly (CCLA) due to congenital maldevelopment of the lymphatics can result in debilitating and life-threatening disease with limited treatment options. We identified 4 individuals with CCLA, lymphedema, and microcystic lymphatic malformation due to pathogenic, mosaic variants in KRAS. To determine the functional impact of these variants and identify a targeted therapy for these individuals, we used primary human dermal lymphatic endothelial cells (HDLECs) and zebrafish larvae to model the lymphatic dysplasia. Expression of the p.Gly12Asp and p.Gly13Asp variants in HDLECs in a 2‑dimensional (2D) model and 3D organoid model led to increased ERK phosphorylation, demonstrating these variants activate the RAS/MAPK pathway. Expression of activating KRAS variants in the venous and lymphatic endothelium in zebrafish resulted in lymphatic dysplasia and edema similar to the individuals in the study. Treatment with MEK inhibition significantly reduced the phenotypes in both the organoid and the zebrafish model systems. In conclusion, we present the molecular characterization of the observed lymphatic anomalies due to pathogenic, somatic, activating KRAS variants in humans. Our preclinical studies suggest that MEK inhibition should be studied in future clinical trials for CCLA due to activating KRAS pathogenic variants.
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Affiliation(s)
| | | | - Christoph Seiler
- Zebrafish Core, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Adam I. Rubin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Nahla Khalek
- Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment and
| | | | | | - Erin Pinto
- Jill and Mark Fishman Center for Lymphatic Disorders, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | - Rojeen Niazi
- Genetic Diagnostic Laboratory, Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arupa Ganguly
- Genetic Diagnostic Laboratory, Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | - Joseph T. Shieh
- Division of Medical Genetics, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Ian D. Krantz
- Division of Human Genetics, and
- Roberts Individualized Medical Genetics Center, Division of Human Genetics
| | | | | | | | | | - Leslie Castelo-Soccio
- Dermatology Section, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Taizo A. Nakano
- Center for Cancer and Blood Disorders, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Kristen Snyder
- Division of Oncology, Cancer Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christopher L. Smith
- Jill and Mark Fishman Center for Lymphatic Disorders, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Yoav Dori
- Jill and Mark Fishman Center for Lymphatic Disorders, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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8
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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: 22] [Impact Index Per Article: 11.0] [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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9
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Carli D, Resta N, Ferrero GB, Ruggieri M, Mussa A. Mosaic RASopathies: A review of disorders caused by somatic pathogenic variants in the genes of the RAS/MAPK pathway. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2022; 190:520-529. [PMID: 36461154 DOI: 10.1002/ajmg.c.32021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 12/04/2022]
Abstract
Mosaic RASopathies are a heterogeneous group of diseases characterized by the presence at birth or early onset of congenital anomalies, cutaneous and vascular anomalies, segmental overgrowth, and increased cancer risk. They are caused by somatic pathogenic variants of the genes belonging the RAt Sarcoma Mitogen-activated protein kinase (RAS/MAPK) pathway causing its hyperactivation. Here, we review the clinical and molecular characteristics of this heterogeneous group of diseases, including the possibilities of molecular diagnosis and new therapeutic perspectives.
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Affiliation(s)
- Diana Carli
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy.,Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Nicoletta Resta
- Division of Medical Genetics, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari "Aldo Moro", Bari, Italy
| | | | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alessandro Mussa
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy.,Pediatric Clinical Genetics Unit, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Torino, Italy
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10
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Dong X, Png NCY, Fortier MV, Lim JY, Wong KPL, Choo JTL, Tan EC, Jamuar SS. Fibrous dysplasia in cardio-facio-cutaneous syndrome: A case report and review of literature. Am J Med Genet A 2022; 188:2732-2737. [PMID: 35801299 DOI: 10.1002/ajmg.a.62879] [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: 01/18/2022] [Revised: 05/16/2022] [Accepted: 05/30/2022] [Indexed: 01/25/2023]
Abstract
Cardio-facio-cutaneous (CFC) syndrome (OMIM #:115150, 615278, 615279, 615280) is a rare genetic condition caused by variants in the RAS/mitogen-activated protein kinase (MAPK) signal transduction pathway. Up to 75% of cases are caused by mutations in the BRAF gene, whereas KRAS gene mutation has only been reported in <2% of cases. CFC syndrome is characterized by cardiac abnormalities, distinctive craniofacial dysmorphism, and various cutaneous abnormalities. Musculoskeletal and orthopedic manifestations are also prevalent in patients with CFC syndrome, among which the most common are skeletal deformities and joint laxities. Dysplastic bone disorders, on the other hand, have not been reported in CFC syndrome before. We report on a case of symmetrical polyostotic fibrous dysplasia (FD) in a patient with CFC syndrome with the KRAS(NM_004985.5):c.57G>C; p.Leu19Phe variant. The FDs were incidentally picked up, and patient was conservatively managed and remained asymptomatic on follow-up. The same variant was reported previously in a patient with Oculoectodermal Syndrome (OES), who developed polyostotic non-ossifying fibroma (NOF). This case explores FD as a possible new clinical feature of CFC syndrome, and when linked to the historical case of OES, explores whether the KRAS(NM_004985.5):c.57G>C; p.Leu19Phe mutation may potentially contribute to the development of dysplastic bone lesions in patients with this particular mutation.
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Affiliation(s)
- Xiaoao Dong
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Nicholas C Y Png
- Department of Diagnostic and Interventional Radiology, KK Women's and Children's Hospital, Singapore
| | - Marielle V Fortier
- Department of Diagnostic and Interventional Radiology, KK Women's and Children's Hospital, Singapore
| | - Jiin Ying Lim
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,SingHealth Duke-NUS Genomic Medicine Centre, Singapore
| | - Kenneth P L Wong
- Department of Paediatric Orthopaedics, KK Women's and Children's Hospital, Singapore
| | - Jonathan T L Choo
- Department of Cardiology, KK Women's and Children's Hospital, Singapore
| | - Ene Choo Tan
- KK Research Centre, KK Women's and Children's Hospital, Singapore
| | - Saumya Shekhar Jamuar
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Department of Diagnostic and Interventional Radiology, KK Women's and Children's Hospital, Singapore
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11
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Yang K, Wang J, Kanwar N, Villani A, Ajani O, Fleming A, Patil V, Mamatjan Y, Wei Q, Malkin D, Shlien A, Zadeh G, Provias J. A primary DICER1-sarcoma with KRAS and TP53 mutations in a child with suspected ECCL. Brain Tumor Pathol 2022; 39:225-231. [PMID: 35668302 DOI: 10.1007/s10014-022-00437-2] [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: 04/06/2022] [Accepted: 05/16/2022] [Indexed: 11/02/2022]
Abstract
A child had been followed since infancy by our multi-disciplinary neuro-oncology clinic with annual magnetic resonance imaging (MRI) under the presumed diagnosis of encephalocraniocutaneous lipomatosis (ECCL), with clinical features including nevus psiloliparus, scalp lipoma, nodular skin tag on and coloboma of the eyelid, cortical atrophy and meningeal angiomatosis. At the age of 4, she was found to have a large temporoparietal lesion causing elevated intracranial pressure requiring surgical resection. Histopathological exam of the tumor was suggestive of an intracranial sarcoma. Sequencing analysis of the tumor revealed mutations in DICER1, KRAS and TP53. Subsequent germline testing confirmed DICER1 syndrome and revealed an insignificant FGFR1 variant at a low frequency. Methylation profile of the tumor showed the tumor clustered most closely with sarcoma (rhabdomyosarcoma-like), confirming this tumor to be a primary DICER1-sarcoma. Compared to the previously reported cases, our unique case of primary DICER1-sarcoma also demonstrated neurofilament and chromogranin positivity, and genomic instability with loss of chromosome 4p, 4q, 8p, 11p, and 19p, as well as gains in chromosome 7p, 9p, 9q, 13q, and 15q on copy variant analysis. The detailed sequencing and methylation information discovered in this unique case of DICER1-sarcoma will hopefully help further our understanding of this rare and emerging entity.
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Affiliation(s)
- Kaiyun Yang
- Department of Neurosurgery, University of Toronto, Toronto, ON, Canada.
| | - Justin Wang
- Department of Neurosurgery, University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Center, MacFeeters-Hamilton Center for Neuro-Oncology Research, University of Toronto, Toronto, ON, Canada
| | - Nisha Kanwar
- Genome Diagnostics, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Anita Villani
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Olufemi Ajani
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Adam Fleming
- Division of Hematology/Oncology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Vikas Patil
- Princess Margaret Cancer Center, MacFeeters-Hamilton Center for Neuro-Oncology Research, University of Toronto, Toronto, ON, Canada
| | - Yasin Mamatjan
- Princess Margaret Cancer Center, MacFeeters-Hamilton Center for Neuro-Oncology Research, University of Toronto, Toronto, ON, Canada.,Department of Engineering, Thompson Rivers University, Kamloops, BC, Canada
| | - Qingxia Wei
- Princess Margaret Cancer Center, MacFeeters-Hamilton Center for Neuro-Oncology Research, University of Toronto, Toronto, ON, Canada
| | - David Malkin
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adam Shlien
- Department of Laboratory Medicine and Pathobiology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gelareh Zadeh
- Department of Neurosurgery, University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Center, MacFeeters-Hamilton Center for Neuro-Oncology Research, University of Toronto, Toronto, ON, Canada
| | - John Provias
- Neuropathology Section, Department of Pathology and Molecular Medicine/Neuropathology, Hamilton General Hospital, McMaster University, 237 Barton Street, Hamilton, ON, L8L 2X2, Canada.
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Ververi A, Laidou S, Chatzidimitriou A, Gidaris D, Mataftsi A, Kozeis N, Fidani L, Zafeiriou DI. Patient with recurrent mosaic KRAS variant: Rare oculoectodermal syndrome with severe neurologic phenotype. J Dermatol 2022; 49:e381-e382. [PMID: 35593416 DOI: 10.1111/1346-8138.16440] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 04/21/2022] [Accepted: 05/02/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Athina Ververi
- Genetic Unit, 1st Department of Obstetrics & Gynaecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Stamatia Laidou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | | | - Dimos Gidaris
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Asimina Mataftsi
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nikolaos Kozeis
- Ophthalmica Institute of Ophthalmology and Microsurgery, Thessaloniki, Greece
| | - Liana Fidani
- 2nd Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.,Department of Medical Biology Genetics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Ioannis Zafeiriou
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital Thessaloniki, Greece
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13
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Lehalle D, Bruel AL, Vitobello A, Denommé-Pichon AS, Duffourd Y, Assoum M, Amiel J, Baujat G, Bessieres B, Bigoni S, Burglen L, Captier G, Dard R, Edery P, Fortunato F, Geneviève D, Goldenberg A, Guibaud L, Héron D, Holder-Espinasse M, Lederer D, Lopez Grondona F, Grotto S, Marlin S, Nadeau G, Picard A, Rossi M, Roume J, Sanlaville D, Saugier-Veber P, Triau S, Valenzuela Palafoll MI, Vanlerberghe C, Van Maldergem L, Vezain M, Vincent-Delorme C, Zivi E, Thevenon J, Vabres P, Thauvin-Robinet C, Callier P, Faivre L. Toward clinical and molecular dissection of frontonasal dysplasia with facial skin polyps: From Pai syndrome to differential diagnosis through a series of 27 patients. Am J Med Genet A 2022; 188:2036-2047. [PMID: 35445792 DOI: 10.1002/ajmg.a.62739] [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: 04/30/2021] [Revised: 10/20/2021] [Accepted: 11/02/2021] [Indexed: 11/07/2022]
Abstract
Unique or multiple congenital facial skin polyps are features of several rare syndromes, from the most well-known Pai syndrome (PS), to the less recognized oculoauriculofrontonasal syndrome (OAFNS), encephalocraniocutaneous lipomatosis (ECCL), or Sakoda complex (SC). We set up a research project aiming to identify the molecular bases of PS. We reviewed 27 individuals presenting with a syndromic frontonasal polyp and initially referred for PS. Based on strict clinical classification criteria, we could confirm only nine (33%) typical and two (7%) atypical PS individuals. The remaining ones were either OAFNS (11/27-41%) or presenting with an overlapping syndrome (5/27-19%). Because of the phenotypic overlap between these entities, OAFNS, ECCL, and SC can be either considered as differential diagnosis of PS or part of the same spectrum. Exome and/or genome sequencing from blood DNA in 12 patients and from affected tissue in one patient failed to identify any replication in candidate genes. Taken together, our data suggest that conventional approaches routinely utilized for the identification of molecular etiologies responsible for Mendelian disorders are inconclusive. Future studies on affected tissues and multiomics studies will thus be required in order to address either the contribution of mosaic or noncoding variation in these diseases.
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Affiliation(s)
- Daphné Lehalle
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Interrégion Est, FHU TRANSLAD, Centre Hospitalier Universitaire Dijon, Dijon, France
- Equipe GAD, INSERM LNC UMR 1231, FHU TRANSLAD, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
- Unité Fonctionnelle d'Innovation diagnostique des maladies rares, Pôle de Biologie, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
- Département de Génétique, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Ange-Line Bruel
- Equipe GAD, INSERM LNC UMR 1231, FHU TRANSLAD, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
- Unité Fonctionnelle d'Innovation diagnostique des maladies rares, Pôle de Biologie, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Antonio Vitobello
- Equipe GAD, INSERM LNC UMR 1231, FHU TRANSLAD, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
- Unité Fonctionnelle d'Innovation diagnostique des maladies rares, Pôle de Biologie, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Anne-Sophie Denommé-Pichon
- Equipe GAD, INSERM LNC UMR 1231, FHU TRANSLAD, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
- Unité Fonctionnelle d'Innovation diagnostique des maladies rares, Pôle de Biologie, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Yannis Duffourd
- Equipe GAD, INSERM LNC UMR 1231, FHU TRANSLAD, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
- Unité Fonctionnelle d'Innovation diagnostique des maladies rares, Pôle de Biologie, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Mirna Assoum
- Equipe GAD, INSERM LNC UMR 1231, FHU TRANSLAD, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
| | - Jeanne Amiel
- Service de Génétique, INSERM U781, Hôpital Necker-Enfants Malades, Institut Imagine, University Sorbonne-Paris-Cité, Paris, France
| | - Geneviève Baujat
- Service de Génétique, INSERM U781, Hôpital Necker-Enfants Malades, Institut Imagine, University Sorbonne-Paris-Cité, Paris, France
| | - Bettina Bessieres
- Unite d'embryofoetopathologie, Service d'Histologie-Embryologie-Cytogénétique, Hôpital Necker-Enfants Malades APHP, Paris, France
| | - Stefania Bigoni
- UOL of Medical Genetics, Ferrara Hospital University, Ferrara, Italy
| | - Lydie Burglen
- Département de Génétique et Centre de Référence "malformations et maladies congénitales du cervelet," AP-HP, Hôpital Trousseau, Paris, France
| | - Guillaume Captier
- Service de chirurgie orthopédique et plastique pédiatrique, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Rodolphe Dard
- Service de Cytogénétique, Centre Hospitalier Intercommunal de Poissy Saint-Germain-en-Laye, Poissy, France
| | - Patrick Edery
- Service de génétique et Centre de Référence des Anomalies du développement de la région Auvergne-Rhône-Alpes, CHU de Lyon, Lyon, France
- Centre de Recherche en Neurosciences de Lyon, INSERM U1028 CNRS UMR 5292, UCB Lyon 1, Villeurbanne, France
| | | | - David Geneviève
- Genetic Department for Rare Disease and Personalised Medicine, Clinical Division, Montpellier University, Inserm U1183, Montpellier, France
| | - Alice Goldenberg
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | - Laurent Guibaud
- Centre de Recherche en Neurosciences de Lyon, INSERM U1028 CNRS UMR 5292, UCB Lyon 1, Villeurbanne, France
| | - Delphine Héron
- Department of Genetics, Intellectual Disability and Autism Clinical Research Group, Pierre and Marie Curie University, Pitié-Salpêtrière Hospital, Public Hospital Network of Paris, Paris, France
| | - Muriel Holder-Espinasse
- Department of Clinical Genetics, CHU Lille, Lille, France
- Clinical Genetics Department, Guy's Hospital, London, UK
| | - Damien Lederer
- Center for Human Genetics, Institut de Pathologie et Génétique (I.p.G.), Gosselies, Belgium
| | - Fermina Lopez Grondona
- Àrea de Genètica Clínica i Malalties Minoritàries, Hospital Vall d'Hebron, Barcelona, Spain
| | - Sarah Grotto
- Genetic Department for Rare Disease and Personalised Medicine, Clinical Division, Montpellier University, Inserm U1183, Montpellier, France
| | - Sandrine Marlin
- Laboratory of Embryology and Genetics of Malformations, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Institut Imagine, Université de Paris, Paris, Spain
| | - Gwenaël Nadeau
- Unité fonctionnelle de cytogénétique, CH de Valence, Valence, France
| | - Arnaud Picard
- Service de Chirurgie Maxillofaciale, Hôpital Necker, Paris, France
| | - Massimiliano Rossi
- Service de Cytogénétique, Centre Hospitalier Intercommunal de Poissy Saint-Germain-en-Laye, Poissy, France
- Service de génétique et Centre de Référence des Anomalies du développement de la région Auvergne-Rhône-Alpes, CHU de Lyon, Lyon, France
| | - Joëlle Roume
- Service de chirurgie orthopédique et plastique pédiatrique, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Damien Sanlaville
- Service de Cytogénétique, Centre Hospitalier Intercommunal de Poissy Saint-Germain-en-Laye, Poissy, France
- Service de génétique et Centre de Référence des Anomalies du développement de la région Auvergne-Rhône-Alpes, CHU de Lyon, Lyon, France
| | - Pascale Saugier-Veber
- Department of Genetics, Normandy Centre for Genomic and Personalized Medicine, Normandie Univ, UNIROUEN, Inserm U1245 and Rouen University Hospital, Rouen, France
| | | | | | | | | | - Myriam Vezain
- Department of Genetics, Normandy Centre for Genomic and Personalized Medicine, Normandie Univ, UNIROUEN, Inserm U1245 and Rouen University Hospital, Rouen, France
| | | | - Einat Zivi
- Medical Genetics Institute, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Julien Thevenon
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Interrégion Est, FHU TRANSLAD, Centre Hospitalier Universitaire Dijon, Dijon, France
- Equipe GAD, INSERM LNC UMR 1231, FHU TRANSLAD, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
| | - Pierre Vabres
- Equipe GAD, INSERM LNC UMR 1231, FHU TRANSLAD, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
- Service de Dermatologie, CHU Dijon, Dijon, France
| | - Christel Thauvin-Robinet
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Interrégion Est, FHU TRANSLAD, Centre Hospitalier Universitaire Dijon, Dijon, France
- Equipe GAD, INSERM LNC UMR 1231, FHU TRANSLAD, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
- Unité Fonctionnelle d'Innovation diagnostique des maladies rares, Pôle de Biologie, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Patrick Callier
- Equipe GAD, INSERM LNC UMR 1231, FHU TRANSLAD, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
| | - Laurence Faivre
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Interrégion Est, FHU TRANSLAD, Centre Hospitalier Universitaire Dijon, Dijon, France
- Equipe GAD, INSERM LNC UMR 1231, FHU TRANSLAD, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
- Unité Fonctionnelle d'Innovation diagnostique des maladies rares, Pôle de Biologie, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
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14
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Beyens A, Dequeker L, Brems H, Janssens S, Syryn H, D’Hooghe A, De Paepe P, Vanwalleghem L, Stockman A, Vankwikelberge E, De Schepper S, Goeteyn M, Delbeke P, Callewaert B. Identification of Codon 146 KRAS Variants in Isolated Epidermal Nevus and Multiple Lesions in Oculoectodermal Syndrome: Confirmation of the Phenotypic Continuum of Mosaic RASopathies. Int J Mol Sci 2022; 23:ijms23074036. [PMID: 35409398 PMCID: PMC8999796 DOI: 10.3390/ijms23074036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 01/31/2023] Open
Abstract
Mosaic RASopathies are a molecularly heterogeneous group of (neuro)cutaneous syndromes with high phenotypical variability. Postzygotic variants in KRAS have been described in oculoectodermal syndrome (OES), encephalocraniocutaneous lipomatosis (ECCL) and epidermal nevus syndrome (ENS). This study confirms the continuum of mosaic neurocutaneous RASopathies showing codon 146 KRAS variants in an individual with OES and, for the first time, in an individual with (isolated) epidermal nevus. The presence of a nevus psiloliparus in individuals with OES indicates that this finding is not specific for ECCL and highlights the phenotypical overlap between ECCL and OES. The presence of the somatic KRAS variant in the nevus psiloliparus resolves the underlying molecular etiology of this fatty-tissue nevus. In addition, this finding refutes the theory of non-allelic twin-spotting as an underlying hypothesis to explain the concurrent presence of two different mosaicisms in one individual. The identification of codon 146 KRAS variants in isolated epidermal nevus introduces a new hot spot for this condition, which is useful for increasing molecular genetic testing using targeted gene sequencing panels.
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Affiliation(s)
- Aude Beyens
- Center for Medical Genetics Ghent, Ghent University Hospital, 9000 Ghent, Belgium; (A.B.); (S.J.); (H.S.)
- Department of Biomolecular Medicine, Ghent University Hospital, 9000 Ghent, Belgium
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium; (E.V.); (S.D.S.)
| | - Laure Dequeker
- Department of Ophthalmology, General Hospital Sint-Jan Brugge-Oostende, 8000 Bruges, Belgium; (L.D.); (P.D.)
- Department of Ophthalmology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Hilde Brems
- Department of Human Genetics, University Hospital Leuven, 3000 Leuven, Belgium;
| | - Sandra Janssens
- Center for Medical Genetics Ghent, Ghent University Hospital, 9000 Ghent, Belgium; (A.B.); (S.J.); (H.S.)
- Department of Biomolecular Medicine, Ghent University Hospital, 9000 Ghent, Belgium
| | - Hannes Syryn
- Center for Medical Genetics Ghent, Ghent University Hospital, 9000 Ghent, Belgium; (A.B.); (S.J.); (H.S.)
- Department of Biomolecular Medicine, Ghent University Hospital, 9000 Ghent, Belgium
| | - Anne D’Hooghe
- Department of Pediatrics, General Hospital Sint-Jan Brugge-Oostende, 8000 Bruges, Belgium
| | - Pascale De Paepe
- Department of Pathology, General Hospital Sint-Jan Brugge-Oostende, 8000 Bruges, Belgium; (P.D.P.); (L.V.)
| | - Lieve Vanwalleghem
- Department of Pathology, General Hospital Sint-Jan Brugge-Oostende, 8000 Bruges, Belgium; (P.D.P.); (L.V.)
| | - Annelies Stockman
- Department of Dermatology, General Hospital Delta Roeselare-Menen-Torhout, 8820 Torhout, Belgium;
| | - Elena Vankwikelberge
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium; (E.V.); (S.D.S.)
| | - Sofie De Schepper
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium; (E.V.); (S.D.S.)
| | - Marleen Goeteyn
- Department of Dermatology, General Hospital Sint-Jan Brugge-Oostende, 8000 Bruges, Belgium;
| | - Patricia Delbeke
- Department of Ophthalmology, General Hospital Sint-Jan Brugge-Oostende, 8000 Bruges, Belgium; (L.D.); (P.D.)
| | - Bert Callewaert
- Center for Medical Genetics Ghent, Ghent University Hospital, 9000 Ghent, Belgium; (A.B.); (S.J.); (H.S.)
- Department of Biomolecular Medicine, Ghent University Hospital, 9000 Ghent, Belgium
- Correspondence:
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15
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Johnson C, Burkhart DL, Haigis KM. Classification of KRAS-Activating Mutations and the Implications for Therapeutic Intervention. Cancer Discov 2022; 12:913-923. [PMID: 35373279 PMCID: PMC8988514 DOI: 10.1158/2159-8290.cd-22-0035] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 12/12/2022]
Abstract
Members of the family of RAS proto-oncogenes, discovered just over 40 years ago, were among the first cancer-initiating genes to be discovered. Of the three RAS family members, KRAS is the most frequently mutated in human cancers. Despite intensive biological and biochemical study of RAS proteins over the past four decades, we are only now starting to devise therapeutic strategies to target their oncogenic properties. Here, we highlight the distinct biochemical properties of common and rare KRAS alleles, enabling their classification into functional subtypes. We also discuss the implications of this functional classification for potential therapeutic avenues targeting mutant subtypes. SIGNIFICANCE Efforts in the recent past to inhibit KRAS oncogenicity have focused on kinases that function in downstream signal transduction cascades, although preclinical successes have not translated to patients with KRAS-mutant cancer. Recently, clinically effective covalent inhibitors of KRASG12C have been developed, establishing two principles that form a foundation for future efforts. First, KRAS is druggable. Second, each mutant form of KRAS is likely to have properties that make it uniquely druggable.
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Affiliation(s)
- Christian Johnson
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Deborah L Burkhart
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kevin M Haigis
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts
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16
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Cattin J, Formet J, Sartelet H, Lenoir M, Riethmuller D, Collardeau-Frachon S. Expending the Phenotypic Spectrum of Encephalocraniocutaneous Lipomatosis: About a Prenatal Case With Complete Autopsy. Pediatr Dev Pathol 2022; 25:180-185. [PMID: 34547955 DOI: 10.1177/10935266211040802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Encephalocraniocutaneous lipomatosis (ECCL) or Haberland syndrome (MIM #613001) is a rare congenital neurocutaneous disorder. It is characterized by unilateral ocular, cutaneous and central nervous system anomalies. Key clinical features include hairless fatty tissue nevus of the scalp, choristoma of the eye and intraspinal and intracerebral lipomas. We report one of the first cases diagnosed after termination of pregnancy at 35 WG, including antenatal and post-mortem imaging, complete autopsy and genetic analysis. Prenatal ultrasound and MRI of the third trimester showed multifocal spinal lesions and left lateral cerebral ventriculomegaly with cerebral atrophy. Diagnosis of ECCL was suggested at complete autopsy which revealed nevus psiloliparus of the scalp, facial hamartomas and intracranial and spinal lipomas. In addition, our case also exhibited a cardiac rhabdomyoma and a multicystic dysplastic kidney, both never reported to date in this syndrome. ECCL was confirmed by the identification of a postzygotic FGFR1 mutation. We reviewed the literature and discuss the pathogenesis of this syndrome.
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Affiliation(s)
- Julie Cattin
- Obstetrics and Gynecology Department, University Medical Center, Besançon, France
| | - Justine Formet
- Obstetrics and Gynecology Department, University Medical Center, Besançon, France
| | - Hervé Sartelet
- Institute of Biology and Pathology, Department of Pathology, University Medical Center, Grenoble, France
| | - Marion Lenoir
- Radiology Department, University Medical Center, Besançon, France
| | - Didier Riethmuller
- Obstetrics and Gynecology Department, University Medical Center, Besançon, France
| | - Sophie Collardeau-Frachon
- Institute of Pathology, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France.,SOFFOET, Société Française de Foetopathologie Paris, France
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17
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Kalavar M, Echegaray JJ, Ashkenazy N, McKeown C, Berrocal AM. Choroidal calcifications in two cases of aplasia cutis congenita and oculoectodermal syndrome. Ophthalmic Genet 2021; 43:258-261. [PMID: 34895016 DOI: 10.1080/13816810.2021.1998552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe choroidal calcifications as an ophthalmic feature in aplasia cutis congenita (ACC) with oculoectodermal syndrome (OES). OBSERVATIONS Two cases of ACC/OES with characteristic echographic evidence of choroidal calcifications are described. CONCLUSIONS AND IMPORTANCE The ophthalmic manifestations of ACC/OES may be expanded to include choroidal calcifications. The presence of a choroidal calcification with B-scan ultrasound in a case suspicious for ACC/OES may facilitate a more timely diagnosis and inform future follow-up regimens to monitor ophthalmic and systemic manifestations of this disease.
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Affiliation(s)
- Meghana Kalavar
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jose J Echegaray
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Noy Ashkenazy
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Craig McKeown
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Audina M Berrocal
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, USA
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18
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Mussa A, Carli D, Cardaropoli S, Ferrero GB, Resta N. Lateralized and Segmental Overgrowth in Children. Cancers (Basel) 2021; 13:cancers13246166. [PMID: 34944785 PMCID: PMC8699773 DOI: 10.3390/cancers13246166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 01/19/2023] Open
Abstract
Congenital disorders of lateralized or segmental overgrowth (LO) are heterogeneous conditions with increased tissue growth in a body region. LO can affect every region, be localized or extensive, involve one or several embryonic tissues, showing variable severity, from mild forms with minor body asymmetry to severe ones with progressive tissue growth and related relevant complications. Recently, next-generation sequencing approaches have increased the knowledge on the molecular defects in LO, allowing classifying them based on the deranged cellular signaling pathway. LO is caused by either genetic or epigenetic somatic anomalies affecting cell proliferation. Most LOs are classifiable in the Beckwith-Wiedemann spectrum (BWSp), PI3KCA/AKT-related overgrowth spectrum (PROS/AROS), mosaic RASopathies, PTEN Hamartoma Tumor Syndrome, mosaic activating variants in angiogenesis pathways, and isolated LO (ILO). These disorders overlap over common phenotypes, making their appraisal and distinction challenging. The latter is crucial, as specific management strategies are key: some LO is associated with increased cancer risk making imperative tumor screening since childhood. Interestingly, some LO shares molecular mechanisms with cancer: recent advances in tumor biological pathway druggability and growth downregulation offer new avenues for the treatment of the most severe and complicated LO.
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Affiliation(s)
- Alessandro Mussa
- Department of Public Health and Pediatric Sciences, University of Torino, 10126 Torino, Italy; (D.C.); (S.C.)
- Pediatric Clinical Genetics Unit, Regina Margherita Children’s Hospital, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
- Correspondence: ; Tel.: +39-0113135372
| | - Diana Carli
- Department of Public Health and Pediatric Sciences, University of Torino, 10126 Torino, Italy; (D.C.); (S.C.)
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cell Therapy Division, Regina Margherita Children’s Hospital, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Simona Cardaropoli
- Department of Public Health and Pediatric Sciences, University of Torino, 10126 Torino, Italy; (D.C.); (S.C.)
| | | | - Nicoletta Resta
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari “Aldo Moro”, 70121 Bari, Italy;
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Schreuder WH, van der Wal JE, de Lange J, van den Berg H. Multiple versus solitary giant cell lesions of the jaw: Similar or distinct entities? Bone 2021; 149:115935. [PMID: 33771761 DOI: 10.1016/j.bone.2021.115935] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/27/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023]
Abstract
The majority of giant cell lesions of the jaw present as a solitary focus of disease in bones of the maxillofacial skeleton. Less frequently they occur as multifocal lesions. This raises the clinical dilemma if these should be considered distinct entities and therefore each need a specific therapeutic approach. Solitary giant cell lesions of the jaw present with a great diversity of symptoms. Recent molecular analysis revealed that these are associated with somatic gain-of-function mutations in KRAS, FGFR1 or TRPV4 in a large component of the mononuclear stromal cells which all act on the RAS/MAPK pathway. For multifocal lesions, a small group of neoplastic multifocal giant cell lesions of the jaw remain after ruling out hyperparathyroidism. Strikingly, most of these patients are diagnosed with jaw lesions before the age of 20 years, thus before the completion of dental and jaw development. These multifocal lesions are often accompanied by a diagnosis or strong clinical suspicion of a syndrome. Many of the frequently reported syndromes belong to the so-called RASopathies, with germline or mosaic mutations leading to downstream upregulation of the RAS/MAPK pathway. The other frequently reported syndrome is cherubism, with gain-of-function mutations in the SH3BP2 gene leading through assumed and unknown signaling to an autoinflammatory bone disorder with hyperactive osteoclasts and defective osteoblastogenesis. Based on this extensive literature review, a RAS/MAPK pathway activation is hypothesized in all giant cell lesions of the jaw. The different interaction between and contribution of deregulated signaling in individual cell lineages and crosstalk with other pathways among the different germline- and non-germline-based alterations causing giant cell lesions of the jaw can be explanatory for the characteristic clinical features. As such, this might also aid in the understanding of the age-dependent symptomatology of syndrome associated giant cell lesions of the jaw; hopefully guiding ideal timing when installing treatment strategies in the future.
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Affiliation(s)
- Willem H Schreuder
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands; Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek / Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Jacqueline E van der Wal
- Department of Pathology, Antoni van Leeuwenhoek / Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Henk van den Berg
- Department of Pediatrics / Oncology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
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20
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Kapoor S, Scanga HL, Reyes-Múgica M, Nischal KK. Somatic KRAS mutation affecting codon 146 in linear sebaceous nevus syndrome. Am J Med Genet A 2021; 185:3825-3830. [PMID: 34254724 DOI: 10.1002/ajmg.a.62422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/04/2021] [Accepted: 06/11/2021] [Indexed: 01/04/2023]
Abstract
Linear Sebaceous Nevus Syndrome is a rare disorder that presents with nevus sebaceus in association with corneal dermoids, colobomas, choroidal osteomas, and arachnoid cysts. It is thought to represent a mosaic RASopathy. These are disorders characterized by postzygotic somatic mutation in genes involved in RAS/MAPK signaling pathway. In this report we describe two patients with linear sebaceous nevus syndrome found to have mutations in codon 146 of KRAS with evidence of mosaicism. This specific mutation has previously been reported in Oculoectodermal Syndrome and Encephalocraniocutaneous Lipomatosis, two other mosaic RASopathies with predominantly cerebrooculocutaneous manifestations. These findings suggest that, while initially classified as different syndromes, these disorders should be evaluated and managed as a spectrum of related disorders.
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Affiliation(s)
- Saloni Kapoor
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hannah L Scanga
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Ken K Nischal
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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21
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Chang CA, Perrier R, Kurek KC, Estrada-Veras J, Lehman A, Yip S, Hendson G, Diamond C, Pinchot JW, Tran JM, Arkin LM, Drolet BA, Napier MP, O'Neill SA, Balci TB, Keppler-Noreuil KM. Novel findings and expansion of phenotype in a mosaic RASopathy caused by somatic KRAS variants. Am J Med Genet A 2021; 185:2829-2845. [PMID: 34056834 DOI: 10.1002/ajmg.a.62356] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/16/2021] [Accepted: 05/04/2021] [Indexed: 11/11/2022]
Abstract
Mosaic KRAS variants and other RASopathy genes cause oculoectodermal, encephalo-cranio-cutaneous lipomatosis, and Schimmelpenning-Feuerstein-Mims syndromes, and a spectrum of vascular malformations, overgrowth and other associated anomalies, the latter of which are only recently being characterized. We describe eight individuals in total (six unreported cases and two previously reported cases) with somatic KRAS variants and variably associated features. Given the findings of somatic overgrowth (in seven individuals) and vascular or lymphatic malformations (in eight individuals), we suggest mosaic RASopathies (mosaic KRAS variants) be considered in the differential diagnosis for individuals presenting with asymmetric overgrowth and lymphatic or vascular anomalies. We expand the association with embryonal tumors, including the third report of embryonal rhabdomyosarcoma, as well as novel findings of Wilms tumor and nephroblastomatosis in two individuals. Rare or novel findings in our series include the presence of epilepsy, polycystic kidneys, and T-cell deficiency in one individual, and multifocal lytic bone lesions in two individuals. Finally, we describe the first use of targeted therapy with a MEK inhibitor for an individual with a mosaic KRAS variant. The purposes of this report are to expand the phenotypic spectrum of mosaic KRAS-related disorders, and to propose possible mechanisms of pathogenesis, and surveillance of its associated findings.
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Affiliation(s)
- Caitlin A Chang
- Department of Medical Genetics, BC Women and Children's Hospital, Vancouver, British Columbia, Canada
| | - Renee Perrier
- Department of Medical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kyle C Kurek
- Department of Pathology, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Juvianee Estrada-Veras
- Medical Genetics Service, Walter Reed National Military Medical Center, Henry M. Jackson Foundation for the Advancement of Military Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Anna Lehman
- Department of Medical Genetics, BC Women and Children's Hospital, Vancouver, British Columbia, Canada
| | - Stephen Yip
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Glenda Hendson
- Department of Pathology, BC Women and Children's Hospital, Vancouver, British Columbia, Canada
| | - Carol Diamond
- Department of Hematology-Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jason W Pinchot
- Department of Interventional Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jennifer M Tran
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Beth A Drolet
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Melanie P Napier
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Sarah A O'Neill
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Tugce B Balci
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Kim M Keppler-Noreuil
- Division of Genetics and Metabolism, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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22
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Tiemann‐Boege I, Mair T, Yasari A, Zurovec M. Pathogenic postzygotic mosaicism in the tyrosine receptor kinase pathway: potential unidentified human disease hidden away in a few cells. FEBS J 2021; 288:3108-3119. [PMID: 32810928 PMCID: PMC8247027 DOI: 10.1111/febs.15528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/17/2020] [Accepted: 08/14/2020] [Indexed: 01/19/2023]
Abstract
Mutations occurring during embryonic development affect only a subset of cells resulting in two or more distinct cell populations that are present at different levels, also known as postzygotic mosaicism (PZM). Although PZM is a common biological phenomenon, it is often overlooked as a source of disease due to the challenges associated with its detection and characterization, especially for very low-frequency variants. Moreover, PZM can cause a different phenotype compared to constitutional mutations. Especially, lethal mutations in receptor tyrosine kinase (RTK) pathway genes, which exist only in a mosaic state, can have completely new clinical manifestations and can look very different from the associated monogenic disorder. However, some key questions are still not addressed, such as the level of mosaicism resulting in a pathogenic phenotype and how the clinical outcome changes with the development and age. Addressing these questions is not trivial as we require methods with the sensitivity to capture some of these variants hidden away in very few cells. Recent ultra-accurate deep-sequencing approaches can now identify these low-level mosaics and will be central to understand systemic and local effects of mosaicism in the RTK pathway. The main focus of this review is to highlight the importance of low-level mosaics and the need to include their detection in studies of genomic variation associated with disease.
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Affiliation(s)
| | - Theresa Mair
- Institute of BiophysicsJohannes Kepler UniversityLinzAustria
| | - Atena Yasari
- Institute of BiophysicsJohannes Kepler UniversityLinzAustria
| | - Michal Zurovec
- Biology Centre of the Czech Academy of SciencesInstitute of EntomologyCeske BudejoviceCzech Republic
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23
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Landau Prat D, Katowitz WR, Strong A, Katowitz JA. Ocular manifestations of ectodermal dysplasia. Orphanet J Rare Dis 2021; 16:197. [PMID: 33933124 PMCID: PMC8088613 DOI: 10.1186/s13023-021-01824-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose The ectodermal dysplasias (EDs) constitute a group of disorders characterized by abnormalities in two or more ectodermal derivatives, including skin, hair, teeth, and sweat glands. The purpose of the current study was to evaluate ocular manifestations in pediatric patients with ED. Methods Retrospective case series including consecutive ED subjects who were treated in the ophthalmology department at the Children’s Hospital of Philadelphia over a 12-year period (2009–2020). Main Outcome Measures were ocular and ocular adnexal abnormalities. Results Thirty subjects were included: 20 males (67%), mean age of 4.5 years (range 0.3–18). Patients with different subtypes were included, with the hypohidrotic ED and ectrodactyly-ectodermal dysplasia-clefting variants being most prevalent. Most common findings were: lacrimal drainage obstruction in 12 (40%) including punctal agenesis in 10 (33%), refractive errors in 13 (43%) and amblyopia in 6 (20%). A new finding of eyelid ptosis or eyelash ptosis was demonstrated in 11 subjects (37%), mostly associated with TP63 or EDA1 genes variants. Conclusion Ectodermal dysplasias are associated with various ocular pathologies and amblyopia in the pediatric population. We report a possible genetic association between lash ptosis and EDA1 gene, and eyelid ptosis and TP63 or EDA1 genes variants.
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Affiliation(s)
- Daphna Landau Prat
- Division of Ophthalmology, The Children's Hospital of Philadelphia, 34Th and Civic Center Boulevard, Philadelphia, PA, 19104, USA.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - William R Katowitz
- Division of Ophthalmology, The Children's Hospital of Philadelphia, 34Th and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Alanna Strong
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - James A Katowitz
- Division of Ophthalmology, The Children's Hospital of Philadelphia, 34Th and Civic Center Boulevard, Philadelphia, PA, 19104, USA
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24
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De Vito A, Taranath A, Dahmoush H, Ganapathy SS, Sudhakar S, Mankad K. Neuroimaging manifestations of epidermal nevus syndrome. Quant Imaging Med Surg 2021; 11:415-422. [PMID: 33392041 DOI: 10.21037/qims-20-634] [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] [Indexed: 11/06/2022]
Abstract
Epidermal nevus syndrome (ENS) represents a diverse group of rare neurocutaneous diseases associated with the presence of characteristic epidermal nevi (EN) in the skin and extracutaneous manifestations in the eyes, skeletal, urogenital and central nervous systems. We present a case series of 7 children with ENS, with specific attention to the neuroradiological characteristics of this entity.
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Affiliation(s)
- Andrea De Vito
- Department of Neuroradiology, H. S. Gerardo Monza, Monza, Italy
| | - Ajay Taranath
- Department of Radiology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Hisham Dahmoush
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Sniya Sudhakar
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, London, UK
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25
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Dovigi E, Stull CM, Hernandez C. Alopecia, ocular, and cranial abnormalities in a newborn. Pediatr Dermatol 2021; 38:278-279. [PMID: 33630372 DOI: 10.1111/pde.14433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Edwin Dovigi
- Department of Dermatology, Rush University Medical Center, Chicago, IL, USA
| | - Carolyn M Stull
- Department of Dermatology, Rush University Medical Center, Chicago, IL, USA
| | - Claudia Hernandez
- Department of Dermatology, Rush University Medical Center, Chicago, IL, USA
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27
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Moog U, Felbor U, Has C, Zirn B. Disorders Caused by Genetic Mosaicism. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:119-125. [PMID: 32181732 PMCID: PMC7081367 DOI: 10.3238/arztebl.2020.0119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 04/23/2019] [Accepted: 11/28/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Genetic mosaics arise through new mutations occurring after fertiliza- tion (i.e., postzygotic mutations). Mosaics have been described in recent years as the cause of many different disorders; many of these are neurocutaneous diseases and syndromal developmental disorders, each with a characteristic phenotype. In some of these disorders, there is a genetic predisposition to the development of tumors. This article is intended as an overview of selected mosaic diseases. METHODS This review is based on publications retrieved by a selective search in PubMed, with particular attention to recent articles in high-ranking journals dealing with asymmetric growth disturbances, focal brain malformations, mosaic diseases due to dysregulation of the RAS/RAF signaling pathway (mosaic RASopathies), and vascular malformations. RESULTS The identification of postzygotic mutations has led to the reclassification of traditional disease entities and to a better understanding of their pathogenesis. Diagnosis is aided by modern next-generation sequencing (NGS) techniques that allow the detection even of low-grade mosaics. Many mosaic mutations are not detectable in blood, but only in the affected tissue, e.g., the skin. Genetic mosaic diseases often manifest themselves in the skin and brain, and by facial dysmorphism, asymmetrical growth disturbances, and vascular malformations. CONCLUSION The possibility of a mosaic disease should be kept in mind in the diag- nostic evaluation of patients with asymmetrical growth disturbances, focal neuronal migration disturbances, vascular malformations, and linear skin abnormalities. The demonstration of a postzygotic mutation often affords relief to the parents of an affected child, since this means that there is no increased risk for recurrence of the same disorder in future children. Correct classification is important, as molecular available for certain mosaic diseases, e.g., PIK3CA-related overgrowth spectrum (PROS) disorder.
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Affiliation(s)
- Ute Moog
- Institute of Human Genetics. University Hospital Heidelberg, Heidelberg
| | - Ute Felbor
- Institute of Human Genetics, University of Greifswald and Interfaculty Institute for Genetics and Functional Genomics, Greifswald University, Greifswald
| | - Cristina Has
- Department of Dermatology and Venereology, University Medical Center Freiburg, Albert-Ludwigs-Universität Freiburg, Freiburg
| | - Birgit Zirn
- genetikum, Genetische Beratung und Diagnostik, Stuttgart
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28
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Moog U, Dobyns WB. An update on oculocerebrocutaneous (Delleman-Oorthuys) syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 178:414-422. [PMID: 30580480 DOI: 10.1002/ajmg.c.31667] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 11/07/2022]
Abstract
Oculocerebrocutaneous syndrome (OCCS) is a rare disorder characterized primarily by congenital skin, eye, and brain anomalies. The most distinctive findings are hypoplastic or aplastic skin defects; pedunculated, typically hamartomatous, or nodular skin appendages; cystic microphthalmia; and a combination of forebrain anomalies and a specific mid-hindbrain malformation. Based on a review of 40 patients with OCCS, existing clinical criteria have been revised. Because of the asymmetric and patchy distribution of features, lack of recurrence in families, male preponderance and completely skewed X-inactivation in one female, OCCS is hypothesized to result from postzygotic mosaic variants in an X-linked gene. Whole exome and genome sequencing on blood DNA in two patients failed to identify pathogenic variants so far. In view of the overlapping features, in particular of the brain, of OCCS and Aicardi syndrome, both may be pathogenetically related or even result from different variants in the same gene. For the elucidation of the cause of OCCS, exome or genome sequencing on multiple lesional tissues is the primary goal.
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Affiliation(s)
- Ute Moog
- Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - William B Dobyns
- Department of Pediatrics, University of Washington, Seattle, Washington.,Department of Neurology, University of Washington, Seattle, Washington.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
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29
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FGFR1 Mosaic Pathogenic Variant in Encephalocraniocutaneous Lipomatosis with Leptomeningeal Angiomatosis. JOURNAL OF PEDIATRIC NEUROLOGY 2019. [DOI: 10.1055/s-0039-1692985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AbstractEncephalocraniocutaneous lipomatosis (ECCL) is a congenital neurocutaneous disorder. It is characterized by ocular anomalies (epibulbar choristomas), skin lesions (as nevus psiloliparus and subcutaneous lipomas), and central nervous system abnormalities (mostly arachnoid cysts, brain anomalies, vascular defects, and intracranial and spinal lipomas). Mutations in KRAS and fibroblast growth factor receptor gene-1 (FGFR1) are related to ECCL, explaining additional manifestations such as jaw tumors or gliomas. We report a pediatric patient with clinical, radiological, and histological findings consistent with ECCL and a mosaic pathogenic variant in FGFR1 found in the DNA from a non-cultured biopsy of the nevus psiloliparus and absent in blood and DNA from buccal mucosa.
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30
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Kordacka J, Zakrzewski K, Gruszka R, Witusik-Perkowska M, Taha J, Sikorska B, Liberski PP, Zakrzewska M. Sensitive detection of FGFR1 N546K mosaic mutation in patient with encephalocraniocutaneous lipomatosis and pilocytic astrocytoma. Am J Med Genet A 2019; 179:1622-1627. [PMID: 31173478 DOI: 10.1002/ajmg.a.61256] [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: 01/18/2019] [Revised: 03/28/2019] [Accepted: 05/21/2019] [Indexed: 11/12/2022]
Abstract
Encephalocraniocutaneous lipomatosis (ECCL) is a rare neurocutaneous disorder, with only about 100 cases reported worldwide. It is characterized by congenital lesions of the eye, skin, and central nervous system. Only recently, potential causative FGFR1 point mutations have been identified in brain tumors and cultured skin biopsies from patients with this condition. Here, we analyzed the molecular status of a patient with ECCL and a coexisting pilocytic astrocytoma with detected FGFR1 N546K mutation. The presence of the alteration in both affected and unaffected tissues has been evaluated using Sanger sequencing and droplet digital polymerase chain reaction (ddPCR) technique. The ddPCR analysis showed differential distribution of the alteration in all specimens, including unaffected and untreated samples. Therefore, we confirm that FGFR1 N546K is a plausible causative mutation of ECCL patients and could be associated with a risk of brain tumor development. We also show the usefulness of sensitive ddPCR method for detection of low levels of autosomal mosaic mutation in blood or swabs. We suggest that utilization of this method may improve the diagnostic process, especially when targeted therapies are considered.
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Affiliation(s)
- Joanna Kordacka
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Krzysztof Zakrzewski
- Department of Neurosurgery, Polish Mother Memorial Hospital Research Institute in Lodz, Lodz, Poland
| | - Renata Gruszka
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | | | - Joanna Taha
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Beata Sikorska
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Paweł P Liberski
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Magdalena Zakrzewska
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
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Chacon‐Camacho OF, Lopez‐Moreno D, Morales‐Sanchez MA, Hofmann E, Pacheco‐Quito M, Wieland I, Cortes‐Gonzalez V, Villanueva‐Mendoza C, Zenker M, Zenteno JC. Expansion of the phenotypic spectrum and description of molecular findings in a cohort of patients with oculocutaneous mosaic RASopathies. Mol Genet Genomic Med 2019; 7:e625. [PMID: 30891959 PMCID: PMC6503218 DOI: 10.1002/mgg3.625] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Postzygotic KRAS, HRAS, NRAS, and FGFR1 mutations result in a group of mosaic RASopathies characterized by related developmental anomalies in eye, skin, heart, and brain. These oculocutaneous disorders include oculoectodermal syndrome (OES) encephalo-cranio-cutaneous lipomatosis (ECCL), and Schimmelpenning-Feuerstein-Mims syndrome (SFMS). Here, we report the results of the clinical and molecular characterization of a novel cohort of patients with oculocutaneous mosaic RASopathies. METHODS Two OES, two ECCL, and two SFMS patients were ascertained in the study. In addition, two subjects with unilateral isolated epibulbar dermoids were also enrolled. Molecular analysis included PCR amplification and Sanger sequencing of KRAS, HRAS, NRAS, and FGFR1 genes in DNA obtained from biopsies (skin/epibulbar dermoids), buccal mucosa, and blood leukocytes. Massive parallel sequencing was employed in two cases with low-level mosaicism. RESULTS In DNA from biopsies, mosaicism for pathogenic variants, including KRAS p.Ala146Thr in two OES subjects, FGFR1 p.Asn546Lys and KRAS p.Ala146Val in ECCL patients, and KRAS p.Gly12Asp in both SFMS patients, was demonstrated. No mutations were shown in DNA from conjunctival lesions in two subjects with isolated epibubar dermoids. CONCLUSION Our study allowed the expansion of the clinical spectrum of mosaic RASopathies and supports that mosaicism for recurrent mutations in KRAS and FGFR1 is a commonly involved mechanism in these rare oculocutaneous anomalies.
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Affiliation(s)
| | - Daniel Lopez‐Moreno
- Department of GeneticsInstitute of Ophthalmology “Conde de Valenciana”Mexico CityMexico
| | | | - Enriqueta Hofmann
- Department of GlaucomaInstitute of Ophthalmology “Conde de Valenciana”Mexico CityMexico
| | | | - Ilse Wieland
- Institute of Human Genetics, University HospitalMagdeburgGermany
| | - Vianney Cortes‐Gonzalez
- Department of GeneticsHospital "Dr. Luis Sanchez Bulnes", Asociación para Evitar la Ceguera en MéxicoMexico CityMexico
| | - Cristina Villanueva‐Mendoza
- Department of GeneticsHospital "Dr. Luis Sanchez Bulnes", Asociación para Evitar la Ceguera en MéxicoMexico CityMexico
| | - Martin Zenker
- Institute of Human Genetics, University HospitalMagdeburgGermany
| | - Juan Carlos Zenteno
- Department of GeneticsInstitute of Ophthalmology “Conde de Valenciana”Mexico CityMexico
- Department of Biochemistry, Faculty of MedicineUNAMMexico CityMexico
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32
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Kumar I, Aggarwal P, Rai T, Gupta V. Posterior quadrantic dysplasia with localized hemimegalencephaly in a patient with giant congenital melanocytic nevus: First case report. Neuroradiol J 2019; 32:210-214. [PMID: 30794039 DOI: 10.1177/1971400919832474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Giant congenital melanocytic nevus (GCMN) is associated with neurocutaneous melanocytosis and various other neurological complications. Its association with migrational anomalies of the brain is extremely rare. Herein, we document the first case of GCMN in a one-day-old baby associated with localized hemimegalencephaly (HME) of the brain with extensive malformation of cortical development including polymicrogyria, pachygyria and sublobar dysplasia, limited to an enlarged quadrant of the brain. HME and GCMN are considered embryological anomalies of cell migration and proliferation. We discuss the unusual magnetic resonance imaging findings along with a brief review of the literature. To the best of our knowledge, our case is the first to report the association of GCMN with localized HME.
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Affiliation(s)
- Ishan Kumar
- 1 Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, India
| | - Priyanka Aggarwal
- 2 Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, India
| | - Tulika Rai
- 3 Department of Dermatology, Institute of Medical Sciences, Banaras Hindu University, India
| | - Vineeta Gupta
- 2 Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, India
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33
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Baskaran A, Britto T. Encephalocraniocutaneous lipomatosis: A rare neurocutaneous disorder. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2019. [DOI: 10.4103/tjosr.tjosr_38_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ulrich M, Tinschert S, Siebert E, Franke I, Tüting T, Ulrich J, Schanze D, Wieland I, Zenker M. Detection of a multilineage mosaic NRAS mutation c.181C>A (p.Gln61Lys) in an individual with a complex congenital nevus syndrome. Pigment Cell Melanoma Res 2018; 32:470-473. [DOI: 10.1111/pcmr.12761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Maximilian Ulrich
- Institute of Human Genetics University Hospital Otto‐von‐Guericke‐University Magdeburg Germany
| | - Sigrid Tinschert
- Medical Faculty Carl Gustav Carus Technical University of Dresden Dresden Germany
- Division of Human Genetics Medical University of Innsbruck Innsbruck Austria
| | | | - Ingolf Franke
- Department of Dermatology University Hospital Magdeburg Magdeburg Germany
| | - Thomas Tüting
- Department of Dermatology University Hospital Magdeburg Magdeburg Germany
| | - Jens Ulrich
- Klinik für Dermatologie und Venerologie Harzklinikum Dorothea Christiane Erxleben Quedlinburg Germany
| | - Denny Schanze
- Institute of Human Genetics University Hospital Otto‐von‐Guericke‐University Magdeburg Germany
| | - Ilse Wieland
- Institute of Human Genetics University Hospital Otto‐von‐Guericke‐University Magdeburg Germany
| | - Martin Zenker
- Institute of Human Genetics University Hospital Otto‐von‐Guericke‐University Magdeburg Germany
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Lehalle D, Altunoglu U, Bruel AL, Assoum M, Duffourd Y, Masurel A, Baujat G, Bessieres B, Captier G, Edery P, Elçioğlu NH, Geneviève D, Goldenberg A, Héron D, Grotto S, Marlin S, Putoux A, Rossi M, Saugier-Veber P, Triau S, Cabrol C, Vézain M, Vincent-Delorme C, Thauvin-Robinet C, Thevenon J, Vabres P, Callier P, Kayserili H, Faivre L. The oculoauriculofrontonasal syndrome: Further clinical characterization and additional evidence suggesting a nontraditional mode of inheritance. Am J Med Genet A 2018; 176:2740-2750. [PMID: 30548201 DOI: 10.1002/ajmg.a.40662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/01/2018] [Accepted: 08/23/2018] [Indexed: 12/22/2022]
Abstract
The oculoauriculofrontonasal syndrome (OAFNS) is a rare disorder characterized by the association of frontonasal dysplasia (widely spaced eyes, facial cleft, and nose abnormalities) and oculo-auriculo-vertebral spectrum (OAVS)-associated features, such as preauricular ear tags, ear dysplasia, mandibular asymmetry, epibulbar dermoids, eyelid coloboma, and costovertebral anomalies. The etiology is unknown so far. This work aimed to identify molecular bases for the OAFNS. Among a cohort of 130 patients with frontonasal dysplasia, accurate phenotyping identified 18 individuals with OAFNS. We describe their clinical spectrum, including the report of new features (micro/anophtalmia, cataract, thyroid agenesis, polymicrogyria, olfactory bulb hypoplasia, and mandibular cleft), and emphasize the high frequency of nasal polyps in OAFNS (56%). We report the negative results of ALX1, ALX3, and ALX4 genes sequencing and next-generation sequencing strategy performed on blood-derived DNA from respectively, four and four individuals. Exome sequencing was performed in four individuals, genome sequencing in one patient with negative exome sequencing result. Based on the data from this series and the literature, diverse hypotheses can be raised regarding the etiology of OAFNS: mosaic mutation, epigenetic anomaly, oligogenism, or nongenetic cause. In conclusion, this series represents further clinical delineation work of the rare OAFNS, and paves the way toward the identification of the causing mechanism.
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Affiliation(s)
- Daphné Lehalle
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Interrégion Est, Centre Hospitalier Universitaire Dijon, Dijon, France.,Equipe GAD, INSERM LNC UMR 1231, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France.,Unité fonctionnelle de Génétique Clinique, Centre Hospitalier Intercommunal de Créteil, Dijon, France
| | - Umut Altunoglu
- Medical Genetics Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ange-Line Bruel
- Equipe GAD, INSERM LNC UMR 1231, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
| | - Mirna Assoum
- Equipe GAD, INSERM LNC UMR 1231, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
| | - Yannis Duffourd
- Equipe GAD, INSERM LNC UMR 1231, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
| | - Alice Masurel
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Interrégion Est, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - Geneviève Baujat
- Service de Génétique, INSERM U781, Hôpital Necker-Enfants Malades, Institut Imagine, University Sorbonne-Paris-Cité, Paris, France
| | - Bettina Bessieres
- Unite d'embryofoetopathologie, Service d'Histologie-Embryologie-Cytogénétique, Hôpital Necker - Enfants Malades, APHP, Paris, France
| | - Guillaume Captier
- Service de chirurgie orthopédique et plastique pédiatrique, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Patrick Edery
- Service de génétique et Centre de Référence des Anomalies du développement de la région Auvergne-Rhône-Alpes, CHU de Lyon, Lyon, France.,Centre de Recherche en Neurosciences de Lyon, INSERM U1028 CNRS UMR 5292, UCB Lyon 1, Lyon, France
| | - Nursel H Elçioğlu
- Department of Pediatric Genetics, Marmara University Medical School, Istanbul, Turkey.,Eastern Mediterranean University Medical School, Mersin, Turkey
| | - David Geneviève
- Genetic Department for Rare Disease and Personalised Medicine, Clinical Division, Montpellier University, Inserm U1183, Montpellier, France.,Centre de référence des anomalies du développement et syndromes malformatifs, Sud-Ouest Occitanie, France
| | - Alice Goldenberg
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | - Delphine Héron
- AP-HP, Hôpital de la Pitié-Salpêtrière, Département de Génétique, Paris, France.,Centre de Référence "déficiences intellectuelles de causes rares", Paris, France.,Groupe de Recherche Clinique (GRC) "déficience intellectuelle et autisme" UPMC, Paris, France.,INSERM, U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Paris, France.,Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Sarah Grotto
- Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | - Sandrine Marlin
- Service de Génétique, INSERM U781, Hôpital Necker-Enfants Malades, Institut Imagine, University Sorbonne-Paris-Cité, Paris, France
| | - Audrey Putoux
- Service de génétique et Centre de Référence des Anomalies du développement de la région Auvergne-Rhône-Alpes, CHU de Lyon, Lyon, France.,Centre de Recherche en Neurosciences de Lyon, INSERM U1028 CNRS UMR 5292, UCB Lyon 1, Lyon, France
| | - Massimiliano Rossi
- Service de génétique et Centre de Référence des Anomalies du développement de la région Auvergne-Rhône-Alpes, CHU de Lyon, Lyon, France.,Centre de Recherche en Neurosciences de Lyon, INSERM U1028 CNRS UMR 5292, UCB Lyon 1, Lyon, France
| | - Pascale Saugier-Veber
- Normandie Univ, UNIROUEN, Inserm U1245 and Rouen University Hospital, Department of Genetics, Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | | | | | - Myriam Vézain
- Normandie Univ, UNIROUEN, Inserm U1245 and Rouen University Hospital, Department of Genetics, Normandy Centre for Genomic and Personalized Medicine, Rouen, France
| | | | - Christel Thauvin-Robinet
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Interrégion Est, Centre Hospitalier Universitaire Dijon, Dijon, France.,Equipe GAD, INSERM LNC UMR 1231, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
| | - Julien Thevenon
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Interrégion Est, Centre Hospitalier Universitaire Dijon, Dijon, France.,Equipe GAD, INSERM LNC UMR 1231, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
| | - Pierre Vabres
- Equipe GAD, INSERM LNC UMR 1231, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France.,Service de Dermatologie, CHU Dijon, Dijon, France
| | - Patrick Callier
- Equipe GAD, INSERM LNC UMR 1231, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
| | - Hulya Kayserili
- Medical Genetics Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.,Koç University School of Medicine (KUSoM) Medical Genetics Department, İstanbul, Turkey
| | - Laurence Faivre
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Interrégion Est, Centre Hospitalier Universitaire Dijon, Dijon, France.,Equipe GAD, INSERM LNC UMR 1231, Faculté de Médecine, Université de Bourgogne Franche-Comté, Dijon, France
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Barros FS, Marussi VHR, Amaral LLF, da Rocha AJ, Campos CMS, Freitas LF, Huisman TAGM, Soares BP. The Rare Neurocutaneous Disorders: Update on Clinical, Molecular, and Neuroimaging Features. Top Magn Reson Imaging 2018; 27:433-462. [PMID: 30516694 DOI: 10.1097/rmr.0000000000000185] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Phakomatoses, also known as neurocutaneous disorders, comprise a vast number of entities that predominantly affect structures originated from the ectoderm such as the central nervous system and the skin, but also the mesoderm, particularly the vascular system. Extensive literature exists about the most common phakomatoses, namely neurofibromatosis, tuberous sclerosis, von Hippel-Lindau and Sturge-Weber syndrome. However, recent developments in the understanding of the molecular underpinnings of less common phakomatoses have sparked interest in these disorders. In this article, we review the clinical features, current pathogenesis, and modern neuroimaging findings of melanophakomatoses, vascular phakomatoses, and other rare neurocutaneous syndromes that may also include tissue overgrowth or neoplastic predisposition.
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Affiliation(s)
- Felipe S Barros
- Division of Neuroradiology, BP Medicina Diagnóstica, Hospital da Beneficência Portuguesa de São Paulo
| | - Victor Hugo R Marussi
- Division of Neuroradiology, BP Medicina Diagnóstica, Hospital da Beneficência Portuguesa de São Paulo
| | - Lázaro L F Amaral
- Division of Neuroradiology, BP Medicina Diagnóstica, Hospital da Beneficência Portuguesa de São Paulo
| | - Antônio José da Rocha
- Division of Neuroradiology, Department of Radiology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Christiane M S Campos
- Division of Neuroradiology, BP Medicina Diagnóstica, Hospital da Beneficência Portuguesa de São Paulo
| | - Leonardo F Freitas
- Division of Neuroradiology, BP Medicina Diagnóstica, Hospital da Beneficência Portuguesa de São Paulo
| | - Thierry A G M Huisman
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bruno P Soares
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
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Nagatsuma M, Takasawa K, Yamauchi T, Nakagawa R, Mizuno T, Tanaka E, Yamamoto K, Uemura N, Kashimada K, Morio T. A postzygotic KRAS mutation in a patient with Schimmelpenning syndrome presenting with lipomatosis, renovascular hypertension, and diabetes mellitus. J Hum Genet 2018; 64:177-181. [DOI: 10.1038/s10038-018-0539-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/30/2018] [Accepted: 11/02/2018] [Indexed: 01/17/2023]
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McDonell LM, Leung GKC, Daoud H, Ip J, Chim S, Luk HM, Lan L, Boycott KM, Chung BHY. Mosaic KRAS
mutation in a patient with encephalocraniocutaneous lipomatosis and renovascular hypertension. Am J Med Genet A 2018; 176:2523-2527. [DOI: 10.1002/ajmg.a.40349] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Laura M. McDonell
- Children's Hospital of Eastern Ontario Research Institute; University of Ottawa; Ottawa ON Canada
| | - Gordon Ka-Chun Leung
- Department of Paediatrics and Adolescent Medicine; LKS Faculty of Medicine, The University of Hong Kong; Hong Kong
| | - Hussein Daoud
- Department of Genetics, Children's Hospital of Eastern Ontario; Ottawa ON Canada
| | - Janice Ip
- Department of Radiology; Queen Mary Hospital; Hong Kong
| | - Stella Chim
- Department of Paediatrics and Adolescent Medicine; LKS Faculty of Medicine, The University of Hong Kong; Hong Kong
| | - Ho Ming Luk
- Department of Health; Clinical Genetic Service; Hong Kong
| | - Lawrence Lan
- Division of Paediatric Surgery, Department of Surgery; The University of Hong Kong; Hong Kong
| | - Kym M. Boycott
- Children's Hospital of Eastern Ontario Research Institute; University of Ottawa; Ottawa ON Canada
| | - Brian Hon-Yin Chung
- Department of Paediatrics and Adolescent Medicine; LKS Faculty of Medicine, The University of Hong Kong; Hong Kong
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39
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Epibulbar Mass With Upper Eyelid Cleft and Focal Scalp Alopecia in a Neonate: A New Case of Oculoectodermal Syndrome. Ophthalmic Plast Reconstr Surg 2018; 34:e133-e136. [DOI: 10.1097/iop.0000000000001151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Al-Olabi L, Polubothu S, Dowsett K, Andrews KA, Stadnik P, Joseph AP, Knox R, Pittman A, Clark G, Baird W, Bulstrode N, Glover M, Gordon K, Hargrave D, Huson SM, Jacques TS, James G, Kondolf H, Kangesu L, Keppler-Noreuil KM, Khan A, Lindhurst MJ, Lipson M, Mansour S, O'Hara J, Mahon C, Mosica A, Moss C, Murthy A, Ong J, Parker VE, Rivière JB, Sapp JC, Sebire NJ, Shah R, Sivakumar B, Thomas A, Virasami A, Waelchli R, Zeng Z, Biesecker LG, Barnacle A, Topf M, Semple RK, Patton EE, Kinsler VA. Mosaic RAS/MAPK variants cause sporadic vascular malformations which respond to targeted therapy. J Clin Invest 2018; 128:1496-1508. [PMID: 29461977 PMCID: PMC5873857 DOI: 10.1172/jci98589] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/30/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND. Sporadic vascular malformations (VMs) are complex congenital anomalies of blood vessels that lead to stroke, life-threatening bleeds, disfigurement, overgrowth, and/or pain. Therapeutic options are severely limited, and multidisciplinary management remains challenging, particularly for high-flow arteriovenous malformations (AVM). METHODS. To investigate the pathogenesis of sporadic intracranial and extracranial VMs in 160 children in which known genetic causes had been excluded, we sequenced DNA from affected tissue and optimized analysis for detection of low mutant allele frequency. RESULTS. We discovered multiple mosaic-activating variants in 4 genes of the RAS/MAPK pathway, KRAS, NRAS, BRAF, and MAP2K1, a pathway commonly activated in cancer and responsible for the germline RAS-opathies. These variants were more frequent in high-flow than low-flow VMs. In vitro characterization and 2 transgenic zebrafish AVM models that recapitulated the human phenotype validated the pathogenesis of the mutant alleles. Importantly, treatment of AVM-BRAF mutant zebrafish with the BRAF inhibitor vemurafinib restored blood flow in AVM. CONCLUSION. Our findings uncover a major cause of sporadic VMs of different clinical types and thereby offer the potential of personalized medical treatment by repurposing existing licensed cancer therapies. FUNDING. This work was funded or supported by grants from the AVM Butterfly Charity, the Wellcome Trust (UK), the Medical Research Council (UK), the UK National Institute for Health Research, the L’Oreal-Melanoma Research Alliance, the European Research Council, and the National Human Genome Research Institute (US).
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Affiliation(s)
- Lara Al-Olabi
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Satyamaanasa Polubothu
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom.,Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Katherine Dowsett
- MRC Human Genetics Unit and Cancer Research UK (CRUK) Edinburgh Centre, Medical Research Council (MRC) Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
| | - Katrina A Andrews
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.,The National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Paulina Stadnik
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Agnel P Joseph
- Department of Biological Sciences, Birkbeck, University of London, London, United Kingdom
| | - Rachel Knox
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.,The National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Alan Pittman
- Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Graeme Clark
- Department of Medical Genetics, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - William Baird
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Neil Bulstrode
- Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Mary Glover
- Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Kristiana Gordon
- Dermatology and Lymphovascular Medicine, St. George's Hospital NHS Trust, London, United Kingdom
| | - Darren Hargrave
- Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Susan M Huson
- Manchester Centre for Genomic Medicine, St. Mary's Hospital, Manchester, United Kingdom
| | - Thomas S Jacques
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health and Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Gregory James
- Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Hannah Kondolf
- National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - Loshan Kangesu
- Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | | | - Amjad Khan
- Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | | | - Mark Lipson
- Paediatrics and Clinical Genetics, Kaiser Permanente Medical Center, Sacramento, California, USA
| | - Sahar Mansour
- Clinical Genetics, St. George's Hospital NHS Trust, London, United Kingdom
| | - Justine O'Hara
- Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Caroline Mahon
- Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Anda Mosica
- Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Celia Moss
- Paediatric Dermatology, Birmingham Women's and Children's NHS Foundation Trust Birmingham and University of Birmingham, Birmingham, United Kingdom
| | - Aditi Murthy
- Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Juling Ong
- Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Victoria E Parker
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.,The National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | | | - Julie C Sapp
- National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - Neil J Sebire
- Paediatric Pathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Rahul Shah
- Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Branavan Sivakumar
- Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Anna Thomas
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Alex Virasami
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health and Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Regula Waelchli
- Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Zhiqiang Zeng
- MRC Human Genetics Unit and Cancer Research UK (CRUK) Edinburgh Centre, Medical Research Council (MRC) Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
| | | | - Alex Barnacle
- Interventional Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Maya Topf
- Department of Biological Sciences, Birkbeck, University of London, London, United Kingdom
| | - Robert K Semple
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.,The National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, United Kingdom.,University of Edinburgh Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - E Elizabeth Patton
- MRC Human Genetics Unit and Cancer Research UK (CRUK) Edinburgh Centre, Medical Research Council (MRC) Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
| | - Veronica A Kinsler
- Genetics and Genomic Medicine, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom.,Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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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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42
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Abstract
In this article we discuss the occurrence of myeloid neoplasms in patients with a range of syndromes that are due to germline defects of the RAS signaling pathway and in patients with trisomy 21. Both RAS mutations and trisomy 21 are common somatic events contributing to leukemogenis. Thus, the increased leukemia risk observed in children affected by these conditions is biologically highly plausible. Children with myeloid neoplasms in the context of these syndromes require different treatments than children with sporadic myeloid neoplasms and provide an opportunity to study the role of trisomy 21 and RAS signaling during leukemogenesis and development.
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Affiliation(s)
- Christian P Kratz
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany.
| | - Shai Izraeli
- The Genes, Development and Environment Institute for Pediatric Research, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Human Molecular Genetics and Biochemistry, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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43
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Villani A, Greer MLC, Kalish JM, Nakagawara A, Nathanson KL, Pajtler KW, Pfister SM, Walsh MF, Wasserman JD, Zelley K, Kratz CP. Recommendations for Cancer Surveillance in Individuals with RASopathies and Other Rare Genetic Conditions with Increased Cancer Risk. Clin Cancer Res 2017; 23:e83-e90. [DOI: 10.1158/1078-0432.ccr-17-0631] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 11/16/2022]
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44
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Abstract
RAS mutations are among the most common genetic alterations found in cancerous tumors but rational criteria or strategies for targeting RAS-dependent tumors are only recently emerging. Clinical and laboratory data suggest that patient selection based on specific RAS mutations will be an essential component of these strategies. A thorough understanding of the biochemical and structural properties of mutant RAS proteins form the theoretical basis for these approaches. Direct inhibition of KRAS G12C by covalent inhibitors is a notable recent example of the RAS mutation-tailored approach that establishes a paradigm for other RAS mutation-centered strategies.
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Affiliation(s)
- Steven K Montalvo
- School of Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Lianbo Li
- Departments of Biochemistry & Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Kenneth D Westover
- Departments of Biochemistry & Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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