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Abstract
The authors present a case of Muir-Torre syndrome, the « sporadic » form, with a review of the literature. The importance of the close scrutiny of these patients and their relatives is stressed.
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Affiliation(s)
- M Bisceglia
- Department of Anatomic Pathology, Casa Sollievo della Sofferenza Hospital, S. Giovanni Rotondo Foggia, Italy
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PERIS K, ONORATI M, KELLER G, MAGRINI F, DONATI P, MUSCARDIN L, HÖFLER H, CHIMENTI S. Widespread microsatellite instability in sebaceous tumours of patients with the Muir-Torre syndrome. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1997.18491942.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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4
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Abstract
Muir-Torre syndrome is an autosomal-dominant skin condition of genetic origin, characterised by tumours of the sebaceous gland or keratoacanthoma that are associated with visceral malignant diseases. The cutaneous characteristics of Muir-Torre syndrome are sebaceous adenoma, epithelioma, carcinoma, or multiple keratoacanthomas, whereas visceral malignant diseases include colorectal, endometrial, urological, and upper gastrointestinal tumours. Although Muir-Torre syndrome has a striking familial association and features of autosomal-dominant transmission, it can arise in individuals without a family history or any known mutations. Clinical and biomolecular evidence has suggested that there are two types of Muir-Torre syndrome. The most common is a variant of hereditary non-polyposis colorectal cancer, which is characterised by defects in mismatch repair genes and early-onset tumours. The second type does not show deficiency in mismatch repair and its pathogenesis remains undefined. Diagnosis of these rare sebaceous lesions warrants the search for associated internal malignant diseases: the peculiarity of skin lesions and their biomolecular characterisation with microsatellite instability analysis and immunohistochemistry could be used to identify familial Muir-Torre syndrome, allowing clinicians to tailor a personalised programme to screen for skin and visceral malignant diseases in high-risk individuals.
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Affiliation(s)
- Giovanni Ponti
- Department of Internal Medicine, Division of Internal Medicine, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100 Modena, Italy
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Ponti G, Ponz de Leon M, Losi L, Di Gregorio C, Benatti P, Pedroni M, Scarselli A, Riegler G, Lembo L, Pellacani G, Seidenari S, Rossi G, Roncucci L. Different phenotypes in Muir-Torre syndrome: clinical and biomolecular characterization in two Italian families. Br J Dermatol 2005; 152:1335-8. [PMID: 15949004 DOI: 10.1111/j.1365-2133.2005.06506.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Muir-Torre syndrome (MTS) is an autosomal dominant genodermatosis characterized by the presence of sebaceous gland tumours, with or without keratoacanthomas, associated with visceral malignancies. We describe and characterize two families in which the ample phenotypic variability of MTS was evident. After clinical evaluation, the skin and visceral tumours of one member of a family with 'classic' MTS and one member of a family with a 'peculiar' MTS phenotype without sebaceous lesions, but with only multiple keratoacanthomas, were analysed for microsatellite instability (MSI) and by immunohistochemistry. Tumours of both individuals showed MSI, with a concomitant lack of MSH2 immunostaining in all evaluated skin and visceral lesions; moreover, in the proband of family 2 a constitutional mutation (C-->T substitution leading to a stop codon) in the MSH2 gene was identified. We conclude that the diagnosis of MTS, which is mainly clinical, should take into account an ample phenotypic variability, which includes both cases with typical cancer aggregation in families and cases characterized by the association of visceral malignancies with multiple keratoacanthomas (without sebaceous lesions), without an apparent family history of cancer.
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Affiliation(s)
- G Ponti
- Division of Internal Medicine, Department of Medicine, University of Modena and Reggio Emilia, Via del Pozzo 71, Policlinico, 41100 Modena, Italy
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Ponti G, Losi L, Di Gregorio C, Roncucci L, Pedroni M, Scarselli A, Benatti P, Seidenari S, Pellacani G, Lembo L, Rossi G, Marino M, Lucci-Cordisco E, Ponz de Leon M. Identification of Muir-Torre syndrome among patients with sebaceous tumors and keratoacanthomas. Cancer 2005; 103:1018-25. [PMID: 15662714 DOI: 10.1002/cncr.20873] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Muir-Torre syndrome (MTS) is an autosomal-dominant genodermatosis characterized by the presence of sebaceous gland tumors, with or without keratoacanthomas, associated with visceral malignancies. A subset of patients with MTS is considered a variant of the hereditary nonpolyposis colorectal carcinoma, which is caused by mutations in mismatch-repair genes. The objective of the current study was to evaluate whether a combined clinical, immunohistochemical, and biomolecular approach could be useful for the identification of Muir-Torre syndrome among patients with a diagnosis of sebaceous tumors and keratoacanthomas. METHODS The authors collected sebaceous skin lesions and keratoacanthomas recorded in the files of the Pathology Department of the University of Modena during the period 1986-2000. Through interviews and examination of clinical charts, family trees were drawn for 120 patients who were affected by these skin lesions. RESULTS Seven patients also were affected by gastrointestinal tumors, thus meeting the clinical criteria for the diagnosis of MTS. In the MTS families, a wide phenotypic variability was evident, both in the spectrum of visceral tumors and in the type of skin lesions. Microsatellite instability was found in five MTS patients: These patients showed concordance with immunohistochemical analysis; moreover, a constitutional mutation in the MSH2 gene was found in 1 patient. Lack of expression of MSH2/MSH6 or MLH1 proteins was evident in the skin lesions and in the associated internal malignancies of 3 patients and 2 patients with MTS, respectively. CONCLUSIONS The clinical, biomolecular, and immunohistochemical characterization of sebaceous skin lesions and keratoacanthomas may be used as screening for the identification of families at risk of MTS, a disease that is difficult to recognize and diagnose.
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Affiliation(s)
- Giovanni Ponti
- Division of Internal Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Tran TA, Ross JS, Sheehan CE, Carlson JA. Comparison of oncostatin M expression in keratoacanthoma and squamous cell carcinoma. Mod Pathol 2000; 13:427-32. [PMID: 10786810 DOI: 10.1038/modpathol.3880073] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oncostatin M (OSM) is a 28-kDa glycoprotein, produced by stimulated macrophages and T lymphocytes, that inhibits the proliferation and induces differentiation of a number of different cell lines derived from solid tumors. To determine whether keratoacanthoma (KA) is unique or a variant of squamous cell carcinoma (SCC), we compared the immunohistochemical expression of OSM in the tumor cells and peri- and intratumoral macrophages of 21 mature KAs, 7 regressing KAs, and 27 SCCs. An inverse correlation was identified between OSM tumor labeling and the density of OSM-labeled tumor-associated macrophages for KAs (r = -.4; P = .09). OSM tumor expression was significantly more frequent and more intense in KAs than in SCCs (95% versus 63%; P < .01). In contrast, the density of OSM-labeled macrophages was significantly higher in SCCs compared with mature KAs (7/3 high power fields versus 4/3 high power fields; P = .02). These OSM-positive macrophages were predominantly located at the advancing, infiltrative margins of both neoplasms. Regressing KAs demonstrated a decreased level of OSM tumor expression compared with mature KAs (53% versus 95%; P = .001), but there was no difference in density of OSM-labeled macrophages. Both the above differences and the overlapping patterns of OSM expression suggest that KAs are a variant of SCC where OSM, possibly as an autocrine factor, may mediate KA's overwhelming but not absolute tendency to involute.
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Affiliation(s)
- T A Tran
- Department of Pathology and Laboratory Medicine, Albany Medical College, New York 12208, USA
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Tran TA, Ross JS, Boehm JR, Carlson JA. Comparison of mitotic cyclins and cyclin-dependent kinase expression in keratoacanthoma and squamous cell carcinoma. J Cutan Pathol 1999; 26:391-7. [PMID: 10551411 DOI: 10.1111/j.1600-0560.1999.tb01863.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Disruption of the cell-cycle regulation through over-expression or mutation of cyclins and cyclin-dependent kinases has been implicated in carcinogenesis. In order to determine whether keratoacanthoma (KA) is unique or a variant of squamous cell carcinoma (SCC) and whether expression of mitosis-related antigens are associated with KAs' tendency to regress, we compared the immunohistochemical expression of mitotic cyclins (cyclins A and B) and their cyclin-dependent kinase p34(cdc2) in 21 KAs, 8 regressing KAs, and 28 conventional squamous cell carcinomas. KAs showed both overlap and significant differences in expression of these mitosis-related antigens compared to SCCs. Basal and parabasal pattern of expression of cyclins A and B significantly predominated in KAs in contrast to SCCs which exhibited diffuse pattern (cyclin A 86%/cyclin B 64% vs. 25%/36%, p < 0.01). However, no differences in the highest mean level of expression in 'hot spot' loci of cyclins A and B were identified comparing KAs to SCCs (19%/12% vs. 25%/13%, p > 0.05). For the cyclin-dependent kinase p34(cdc2), no differences in pattern, distribution or mean levels of expression were found. For cyclins A and B, regressing KA showed significantly more regional tumor labeling (88%/88% vs. 57%/33%, p = 0.03) and a lower mean level of immunoreactivity (5%/4% vs. 19%/12%, p = 0.001) compared to mature KAs. These findings indicate a role for mitotic cyclins in the evolution of both SCC and KA. The overlapping patterns of expression for these mitosis-related antigens suggest that KAs represent a variant of SCC that exhibit an overwhelming but not absolute tendency to involute.
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Affiliation(s)
- T A Tran
- Department of Pathology and Laboratory Medicine, Albany Medical College, New York 12208, USA
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PERIS K, ONORATI M, KELLER G, MAGRINI F, DONATI P, MUSCARDIN L, HÖFLER H, CHIMENTI S. Widespread microsatellite instability in sebaceous tumours of patients with the Muir-Torre syndrome. Br J Dermatol 1997. [DOI: 10.1111/j.1365-2133.1997.tb03738.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Romiti R, Belda W, Rivitti E. Multiple keratoacanthomas treated with oral retinoids. J DERMATOL TREAT 1996. [DOI: 10.3109/09546639609089561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- R Romiti
- Department of Dermatology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Säo Paulo, Brazil
| | - W Belda
- Department of Dermatology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Säo Paulo, Brazil
| | - E Rivitti
- Department of Dermatology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Säo Paulo, Brazil
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11
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Abstract
The Torre or Muir-Torre syndrome consists of certain types of sebaceous neoplasms of the skin, with or without keratoacanthomas, and one or more low-grade visceral malignancies in the absence of other predisposing factors. The sebaceous tumors are relatively uncommon or rare: sebaceous adenoma, sebaceous epithelioma, basal cell epithelioma with sebaceous differentiation, and sebaceous carcinoma. Sebaceous hyperplasia and hamartomas such as nevus sebaceus of Jadassohn, with or without a sebaceous epithelioma within it, are not a defining part of this syndrome. Sebaceous hyperplasia is common in elderly light-complexioned people with or without this syndrome. Nevus sebaceus of Jadassohn is not rare and is predisposed to the development of other neoplasms within it, including occasionally a sebaceous epithelioma. Colonic polyps are frequently present. Muir-Torre syndrome requires recognition because affected patients are at risk of multiple primary malignancies. The skin lesions may be the first sign of this syndrome, although more often its cutaneous signs follow the diagnosis of at least the first visceral malignancy. The Muir-Torre syndrome portends the greater possibility of a favorable prognosis than might be anticipated otherwise because the visceral cancers are usually low-grade malignancies. However, they are often multiple, so identifying such patients will affect their management in a few ways. Because these indolent visceral malignancies tend to permit prolonged survival, even metastatic disease may respond well to aggressive surgical treatment. The sebaceous cancers in this syndrome, like the visceral malignancies, are less aggressive than their counterparts unassociated with this syndrome. Because this syndrome is inherited in an autosomal dominant manner, identifying one patient means delineating an entire family, which should be investigated. This syndrome may be caused by a defective mismatch DNA repair gene.
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Affiliation(s)
- R A Schwartz
- UMD New Jersey Medical School, Newark, NJ 07103-2714, USA
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Abstract
The keratoacanthoma is a common cutaneous neoplasm that most often occurs on sun-exposed sites in light-skinned persons of middle age or older. It is considered the prototype of cutaneous pseudo-malignancies because it is a rapidly growing tumor with a histologic pattern resembling squamous cell carcinoma. It may be best viewed as an aborted malignancy that only rarely progresses into an invasive squamous cell carcinoma. It is most likely derived from hair follicle cells. The common type of keratoacanthoma and its many variants are discussed with emphasis on clinical and histologic features, biologic behavior, and response to therapy.
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Abstract
This article reviews the cutaneous manifestations of gastrointestinal tract diseases. In part I, the gastrointestinal tract polyposis syndromes and gastrointestinal tract malignancies will be discussed. The cutaneous manifestations of inflammatory bowel disorders, vascular disorders of the gastrointestinal tract, celiac disease and bowel-associated dermatosis-arthritis syndrome will be discussed in part II. For each entity, a brief summary of the gastrointestinal tract (and other extracutaneous) manifestations is given. This is followed by a detailed discussion of the cutaneous signs. Current guidelines for the investigation and management of these diseases are presented.
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Affiliation(s)
- B Gregory
- Division of Dermatology, University of British Columbia, Vancouver, Canada
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Caccialanza M, Sopelana N. Radiation therapy of keratoacanthomas: results in 55 patients. Int J Radiat Oncol Biol Phys 1989; 16:475-7. [PMID: 2921150 DOI: 10.1016/0360-3016(89)90345-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The radiation therapy of keratoacanthomas in fifty-five patients treated between 1976 and 1986 using orthovoltage X rays (contact and soft X ray therapy) is reported. The total dose delivered was 40 Gy by means of twice weekly fractions of 4 Gy each in 52 cases, and 60 Gy by twice weekly fractions of 5 Gy each in 3 cases with notable cellular atypia. In all cases we obtained complete regression of the lesions irradiated within 1 month after the termination of radiotherapy. So far we have not had any recurrences. The cosmetic result was always satisfactory. We should like to point out the association between keratoacanthomas and a second malignancy in two cases. The role of radiotherapy in the treatment of keratoacanthomas is discussed and re-confirmed, in relation to the literature data.
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Affiliation(s)
- M Caccialanza
- Department of Dermatologic Radiotherapy, Ospedale Maggiore, University of Milano, Italia
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Abstract
Three cases of Torre-Muir syndrome are described in which isolated sebaceous carcinomas were associated with internal malignancy. The first was a 66-year-old woman who had a sebaceous carcinoma in association with carcinoma of the uterus, two adenocarcinomas of colon, carcinoma of renal pelvis and bladder, and a squamous cell carcinoma of the skin. The second was a 78-year-old woman who had a sebaceous carcinoma associated with carcinomas of the colon, ovary, and pancreas. The third patient had a sebaceous carcinoma associated with breast cancer. The subject is discussed and the previously reported cases reviewed.
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Abstract
The association of multiple tumors of the sebaceous glands with primary visceral carcinomas was described for the first time by Torre in 1967. Another 26 cases with similar features have been subsequently reported in the literature. In 12 of these patients isolated or multiple keratoacanthomas and in 8 intestinal polyps were also found. The authors add the report of a personal case. The patient is a 54-year-old man who, during a period of 8 years, has shown multiple sebaceous tumors, 1 keratoacanthoma, and 3 primary adenocarcinomas of the colon. The outline and nosologic position of this pathologic conditions are discussed.
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Banse-Kupin L, Morales A, Barlow M. Torre's syndrome: report of two cases and review of the literature. J Am Acad Dermatol 1984; 10:803-17. [PMID: 6373856 DOI: 10.1016/s0190-9622(84)70096-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Two patients with multiple sebaceous adenomas associated with visceral carcinoma (Torre's syndrome) are described, and reported cases in the literature are summarized. Certain aspects of Torre's syndrome are emphasized: that the presence of multiple sebaceous adenomas is a cutaneous marker for visceral carcinomas, that the associated carcinomas are of comparatively low-grade malignancy, and that it is a genetic condition probably related to the Cancer Family syndrome. In addition, three morphologic patterns of the sebaceous adenoma are described: solid, cystic, and "keratoacanthoma-like"; then, the potential pitfalls in the histopathologic interpretation of this tumor are discussed.
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Abstract
Muir-Torre syndrome patients have multiple internal malignancies along with cutaneous sebaceous proliferations and keratoacanthomas. We describe a 62-year-old male with nine primarily internal malignancies who survived eight years after his initial tumor was identified. His sebaceous lesions ranged from innocuous adenomas to an anaplastic carcinoma of the chin which recurred and spread locally to involve the mandible and the right parotid region.
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Sullivan JJ, Donoghue MF, Kynaston B, McCaffrey JF. Multiple keratoacanthomas: report of four cases. Australas J Dermatol 1980; 21:16-24. [PMID: 7406786 DOI: 10.1111/j.1440-0960.1980.tb00134.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Abstract
Three inherited types of large bowel cancer not associated with polyposis were previously proposed. A fourth should also be added to the list, namely, Torre's or Muir's syndrome. This report summarizes the clinical and genetic features of that syndrome in one family. The principle features of the syndrome comprise multiple skin tumors, i.e., sebaceous adenomas, keratoacanthomas, and basal and squamous cell carcinomas occurring with polyps and adenocarcinomas, mainly of the large bowel and also of the small intestine and stomach. Other malignancies occurring with the multiple skin tumors, with or without the involvement of intestinal malignancies, included adenocarcinoma of the uterus, transitional cell carcinoma of the bladder or ureter, squamous cell carcinoma of the larynx, esophagus, or vulva, and cancer of the breast. The syndrome followed a dominant mode of inheritance with high penetrance and variable expressivity, perhaps more variable in females than in males.
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Tschang TP, Poulos E, Ho CK, Kuo TT. Multiple sebaceous adenomas and internal malignant disease: a case report with chromosomal analysis. Hum Pathol 1976; 7:589-94. [PMID: 964982 DOI: 10.1016/s0046-8177(76)80104-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A case of multiple sebaceous adenomas associated with internal malignant disease is further documented. Thirteen similar cases reported in the literature are also reviewed. We support the thesis that this association represents a unique syndrome. It can be seen in both sexes and usually is manifested during the fifth and sixth decades. A family history of malignant disease was revealed among seven of the nine cases mentioned. Of the other skin lesions, keratoacanthoma is also frequently seen. The internal malignant tumors most commonly afflict the gastrointestinal tract, especially the large intestine. With proper treatment the internal tumors appear to be of a low degree of malignancy. However, these patients have a propensity to develop muliple visceral tumors and require periodic follow-up. Some patients develop skin tumors prior to the discovery of internal malignant disease, an event that offers some prognostic value. Chromosomal study of the cultured blood lymphocytes by the Giemsa banding technique failed to reveal any abnormality.
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