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Ismail MM, Musa SA, Hassan SS, Abdullah MA. Hypercalcemia as a rare presentation of hyaline fibromatosis syndrome from different Sudanese families: two case reports. J Med Case Rep 2023; 17:244. [PMID: 37264371 DOI: 10.1186/s13256-023-03927-9] [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: 01/03/2023] [Accepted: 04/11/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Hyaline fibromatosis syndrome is a rare progressive autosomal recessive connective tissue disorder caused by a mutation in the ANTXR2/CMG2 gene. According to its severity, patients may present with skin nodules or visceral infiltration, which carries a poor prognosis. Hypercalcemia has not been reported as a presenting feature of this syndrome. Stimulation of osteoclasts by inflammatory factors and immobilization--induced hypercalcemia have played role in the pathophysiology. To our knowledge, this is the first report of hypercalcemia-associated hyaline fibromatosis syndrome. CASE PRESENTATION Here, we describe cases of two Sudanese patients, a boy aged 9 months and a girl aged 3.5 years with hypercalcemia as an associated presenting feature of hyaline fibromatosis syndrome. Other features include gingival hypertrophy, painful joint swellings, and restriction of movement, which was misdiagnosed as juvenile rheumatoid arthritis. Workup showed normal phosphate, normal to mildly elevated parathyroid hormone, low vitamin D 25. Genetic testing confirmed the mutation of the ANTXR2/CMG2 gene. Both patients responded well to medical therapy for hypercalcemia, but one of them with the severe form of juvenile hyaline fibromatosis died due to sepsis, while the other one has maintained normocalcemic status. CONCLUSIONS These cases highlight the rare presentation of this syndrome and reflect the importance of biopsy and genetic testing in reaching the diagnosis, especially when the clinical presentation can mimic other inflammatory bone disorders. Calcium levels should be checked in such cases.
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Affiliation(s)
- Mariam M Ismail
- Pediatric Endocrinology Department, Gaafar Ibn Auf Children's Hospital, Khartoum, Sudan.
| | - Salwa A Musa
- Pediatric Endocrinology Department, Gaafar Ibn Auf Children's Hospital, Khartoum, Sudan
- Department of Paediatrics and Child Health, Faculty of Medicine, Al-Neelain University, Khartoum, Sudan
| | - Samar S Hassan
- Pediatric Endocrinology Department, Gaafar Ibn Auf Children's Hospital, Khartoum, Sudan
| | - Mohamed A Abdullah
- Pediatric Endocrinology Department, Gaafar Ibn Auf Children's Hospital, Khartoum, Sudan
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Zhu Y, Du X, Sun L, Wang H, Wang D, Wu B. Hyaline fibromatosis syndrome with a novel 4.41-kb deletion in ANTXR2 gene: A case report and literature review. Mol Genet Genomic Med 2022; 10:e1993. [PMID: 35726349 PMCID: PMC9356561 DOI: 10.1002/mgg3.1993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/02/2022] [Accepted: 05/13/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Hyaline fibromatosis syndrome is a rare autosomal recessive disorder with ANTXR2 mutations characterised by the accumulation of hyaline substances in tissues. We present a case with the severe form-infantile systemic hyalinosis (ISH)-with long survival and review the literature. METHODS AND RESULTS Trio-exome sequencing revealed compound heterozygous mutations, including a novel 4.41 kb deletion on 4q21.21 and the previously reported c.1294C > T mutation, in the ANTXR2 gene. He was diagnosed with ISH and treated symptomatically. After follow-ups until 4 years of age, his recurrent respiratory infections and diarrhoea improved after one severe diarrhoea attack treated with intravenous gamma globulin. He is now awaiting surgical excision of gingival hypertrophy and joint contractures. CONCLUSION The novel gross deletion in ANTXR2 enriches the genetic mutation spectrum of hyaline fibromatosis syndrome. The manifestation of decreased foetal movement, acute-infection attack or intravenous gamma globulin treatment may be associated with hyaline fibromatosis syndrome. A review of 116 reported cases reveals that missense mutations in the vWA domain are associated with joint symptoms, respiratory tract infection and diarrhoea, while frameshift mutations are associated with facial deformities and speech delays. We have enriched the current knowledge of the clinical manifestations and genetic mutation spectrum of HFS.
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Affiliation(s)
- Yunqian Zhu
- Department of NeonatologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Xiaonan Du
- Department of NeurologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Li Sun
- Department of RheumatismChildren's Hospital of Fudan UniversityShanghaiChina
| | - Huijun Wang
- Clinical Genetic CenterChildren's Hospital of Fudan UniversityShanghaiChina
| | - Dahui Wang
- Department of OrthopedicsChildren's Hospital of Fudan UniversityShanghaiChina
| | - Bingbing Wu
- Clinical Genetic CenterChildren's Hospital of Fudan UniversityShanghaiChina
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Xia L, Hu Y, Zhang C, Wu D, Chen Y. Juvenile hyaline fibromatosis: a rare oral disease case report and literature review. Transl Pediatr 2021; 10:3124-3129. [PMID: 34976780 PMCID: PMC8649598 DOI: 10.21037/tp-21-169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/22/2021] [Indexed: 11/06/2022] Open
Abstract
Juvenile hyaline fibromatosis (JHF) is a rare recessive autosomal hereditary disorder characterized by papulonodular skin, gingival hyperplasia, flexural joint contractures, and osteolytic bone lesions. Worldwide, less than 70 cases have been reported. JHF is thought to be a disorder of collagen metabolism which is caused by genomic sequence variations in the ANTXR2/CMG2 gene and is characterized by homogenous amorphous hyaline material and fibrous tissue. JHF is most commonly diagnosed in infants and in children less than 5 years. We report a 28-month-old child of a consanguineous marriage who presented with severe gingival hyperplasia, multiple facial nodules, posterior occipital tumors, joint contractures, and osteolytic bone lesions. His limbs and fingers cannot be straightened, with a posture of frog pose. The occlusal and incisal surfaces of the teeth were completely covered with the gingival overgrowth. The gingival hypertrophy and facial swellings were surgically removed, with pathological features of monomorphic spindled cell proliferation surrounded by an abundant amorphous hyaline matrix. The genome sequencing was performed that a homozygous nucleotide mutation of ANTXR2/CMG2 gene was found. We outline this particular patient's presentation, followed by a discussion highlighting the characteristics that change with the condition and the treatments of this disease. The treatment of JHF is generally symptomatic treatment and requires multidisciplinary care. Physical rehabilitation has been advocated for a lifetime.
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Affiliation(s)
- Liang Xia
- Department of Oral and Cranio-maxillofacial Surgery, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Chinese Academy of Medical Sciences Oral and Maxillofacial Regenerative Medicine Innovation Unit, Shanghai, China
| | - Yuhua Hu
- Department of Oral Pathology, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Chinese Academy of Medical Sciences Oral and Maxillofacial Regenerative Medicine Innovation Unit, Shanghai, China
| | - Chunye Zhang
- Department of Oral Pathology, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Chinese Academy of Medical Sciences Oral and Maxillofacial Regenerative Medicine Innovation Unit, Shanghai, China
| | - Dandan Wu
- Department of Oral and Cranio-maxillofacial Surgery, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Chinese Academy of Medical Sciences Oral and Maxillofacial Regenerative Medicine Innovation Unit, Shanghai, China
| | - Yang Chen
- Department of Oral and Cranio-maxillofacial Surgery, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Chinese Academy of Medical Sciences Oral and Maxillofacial Regenerative Medicine Innovation Unit, Shanghai, China
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Hamie L, Abbas O, Kurban M, Bhawan J. Osteoclast-Like Giant Cells: Focus on Entities Relevant to Dermatopathology and Underlying Pathogenesis. Am J Dermatopathol 2021; 43:163-173. [PMID: 33595228 DOI: 10.1097/dad.0000000000001769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Osteoclast-like giant cells (OLGCs) resemble osteoclasts with their abundant cytoplasm and well-developed organelles. OLGCs are characteristic features of giant cell tumor of the tendon sheath and giant cell tumor of soft tissue but they have also been described in numerous other cutaneous conditions. The diagnostic and prognostic significance of the presence of OLGCs is unknown. Here, we summarize the clinical entities that can exhibit these cells to avoid a histological overlap, affecting diagnosis and management.
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Affiliation(s)
- Lamiaa Hamie
- Dermatology Resident, Dermatology Department, American University of Beirut, Beirut, Lebanon
| | - Ossama Abbas
- Professor, Dermatology Department, American University of Beirut, Beirut, Lebanon
| | - Mazen Kurban
- Associate Professor, Dermatology Department, American University of Beirut, Beirut, Lebanon ; and
| | - Jag Bhawan
- Professor, Dermatopathology Section, Department of Dermatology, Boston University School of Medicine, Boston, MA
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Yoshikawa M, Shinomura T, Kishimoto K, Uga H. Anesthetic Management of an Adult Patient With Hyaline Fibromatosis Syndrome Undergoing Laparoscopic Colectomy: A Case Report. A A Pract 2020; 14:87-89. [PMID: 31842195 DOI: 10.1213/xaa.0000000000001156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hyaline fibromatosis syndrome (HFS) is a rare autosomal recessive disorder characterized by hyaline fibrous depositions in the skin and internal organs. Contractured joints and gingival hypertrophy make airway management difficult in patients with HFS, while trunk deformities complicate surgical positioning. A 56-year-old woman with HFS underwent laparoscopic colectomy for sigmoid colon cancer. Her airway was secured by awake fiberoptic intubation, and general anesthesia was maintained uneventfully. This report discusses the oldest reported patient with HFS and is the first to describe the management of epidural anesthesia in a patient with HFS.
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Affiliation(s)
- Mizuki Yoshikawa
- From the Department of Anesthesia, Japanese Red Cross Otsu Hospital, Otsu, Japan
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Haidar Z, Temanni R, Chouery E, Jitesh P, Liu W, Al-Ali R, Wang E, Marincola FM, Jalkh N, Haddad S, Haidar W, Chouchane L, Mégarbané A. Diagnosis implications of the whole genome sequencing in a large Lebanese family with hyaline fibromatosis syndrome. BMC Genet 2017; 18:3. [PMID: 28103792 PMCID: PMC5244738 DOI: 10.1186/s12863-017-0471-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hyaline fibromatosis syndrome (HFS) is a recently introduced alternative term for two disorders that were previously known as juvenile hyaline fibromatosis (JHF) and infantile systemic hyalinosis (ISH). These two variants are secondary to mutations in the anthrax toxin receptor 2 gene (ANTXR2) located on chromosome 4q21. The main clinical features of both entities include papular and/or nodular skin lesions, gingival hyperplasia, joint contractures and osteolytic bone lesions that appear in the first few years of life, and the syndrome typically progresses with the appearance of new lesions. METHODS We describe five Lebanese patients from one family, aged between 28 and 58 years, and presenting with nodular and papular skin lesions, gingival hyperplasia, joint contractures and bone lesions. Because of the particular clinical features and the absence of a clinical diagnosis, Whole Genome Sequencing (WGS) was carried out on DNA samples from the proband and his parents. RESULTS A mutation in ANTXR2 (p. Gly116Val) that yielded a diagnosis of HFS was noted. CONCLUSIONS The main goal of this paper is to add to the knowledge related to the clinical and radiographic aspects of HFS in adulthood and to show the importance of Next-Generation Sequencing (NGS) techniques in resolving such puzzling cases.
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Affiliation(s)
- Zahraa Haidar
- Unité de Génétique Médicale, Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
| | - Ramzi Temanni
- Bioinformatics Division, Sidra Medical & Research Center, Doha, Qatar
| | - Eliane Chouery
- Unité de Génétique Médicale, Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
| | - Puthen Jitesh
- Bioinformatics Division, Sidra Medical & Research Center, Doha, Qatar
| | - Wei Liu
- Genomics Core Laboratory, Translational Medicine Division, Sidra Medical & Research Center, Doha, Qatar
| | - Rashid Al-Ali
- Bioinformatics Division, Sidra Medical & Research Center, Doha, Qatar
| | - Ena Wang
- Genomics Core Laboratory, Translational Medicine Division, Sidra Medical & Research Center, Doha, Qatar
| | | | - Nadine Jalkh
- Unité de Génétique Médicale, Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
| | - Soha Haddad
- Department of Radiology, Hotel Dieu de France University hospital–Beirut, Beirut, Lebanon
| | - Wassim Haidar
- Department of General surgery, Dar Al Amal University Hospital-Baalbeck, Baalbeck, Lebanon
| | - Lotfi Chouchane
- Laboratory of Genetic Medicine and Immunology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - André Mégarbané
- Institut Jérôme Lejeune, 37, rue des Volontaires, Paris, 75015 France
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Sibaud V, Vigarios E, Tavitian S, Cougoul P, de Bataille C, Campana F, Fricain JC. [Gingival enlargement: Practical management]. Ann Dermatol Venereol 2016; 143:467-81. [PMID: 27259395 DOI: 10.1016/j.annder.2016.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 03/20/2016] [Accepted: 04/01/2016] [Indexed: 12/27/2022]
Affiliation(s)
- V Sibaud
- Oncodermatologie, consultation pluridisciplinaire de pathologies de la muqueuse buccale, institut Claudius-Regaud, institut universitaire du cancer, Toulouse oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
| | - E Vigarios
- Médecine bucco-dentaire, consultation pluridisciplinaire de pathologies de la muqueuse buccale, institut Claudius-Regaud, institut universitaire du cancer, Toulouse oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France; UFR d'odontologie, 3, rue des Maraîchers, 31062 Toulouse, France
| | - S Tavitian
- Hématologie, institut universitaire du cancer, Toulouse oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - P Cougoul
- Médecine interne, institut universitaire du cancer, Toulouse oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - C de Bataille
- Médecine bucco-dentaire, consultation pluridisciplinaire de pathologies de la muqueuse buccale, institut Claudius-Regaud, institut universitaire du cancer, Toulouse oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France; UFR d'odontologie, 3, rue des Maraîchers, 31062 Toulouse, France
| | - F Campana
- Chirurgie orale, centre Massilien de la face, 24, avenue du Prado, 13006 Marseille, France
| | - J-C Fricain
- Chirurgie orale, consultation pluridisciplinaire de pathologies de la muqueuse buccale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; UFR d'odontologie, 16-20, cours de la Marne, 33082 Bordeaux cedex, France
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Rahvar M, Teng J, Kim J. Systemic Hyalinosis With Heterozygous CMG2 Mutations: A Case Report and Review of Literature. Am J Dermatopathol 2016; 38:e60-3. [PMID: 26885603 DOI: 10.1097/dad.0000000000000467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Juvenile hyaline fibromatosis (JHF) is a rare autosomal recessive disorder characterized by hyalinizing fibrosis of the skin and internal organs. Clinical features include multiple papular skin lesions, gingival hyperplasia, joint contractures, and osteolytic bone lesions. The systemic variant of JHF, known as infantile systemic hyalinosis (ISH), has an early onset and poor prognosis. Histological examination of cutaneous lesions shows bland-appearing fibroblasts within amorphous eosinophilic hyaline depositions. JHF and infantile systemic hyalinosis form a clinical spectrum with higher mortality that is typically observed in systemic cases. Here, the authors present a case of systemic hyalinosis with a heterozygous mutation in CMG2 that resulted in improved survival.
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Affiliation(s)
- Maral Rahvar
- *Department of Pathology, Loma Linda University, Loma Linda, CA; and Departments of †Dermatology, and ‡Pathology, Stanford University, Stanford, CA
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