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Koslow M, Lynch DA, Cool CD, Groshong SD, Downey GP. Lymphangioleiomyomatosis and Other Cystic Lung Diseases. Immunol Allergy Clin North Am 2023; 43:359-377. [PMID: 37055093 PMCID: PMC10863428 DOI: 10.1016/j.iac.2023.01.003] [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] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Cysts and cavities in the lung are commonly encountered on chest imaging. It is necessary to distinguish thin-walled lung cysts (≤2 mm) from cavities and characterize their distribution as focal or multifocal versus diffuse. Focal cavitary lesions are often caused by inflammatory, infectious, or neoplastic processes in contrast to diffuse cystic lung diseases. An algorithmic approach to diffuse cystic lung disease can help narrow the differential diagnosis, and additional testing such as skin biopsy, serum biomarkers, and genetic testing can be confirmatory. An accurate diagnosis is essential for the management and disease surveillance of extrapulmonary complications.
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Affiliation(s)
- Matthew Koslow
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA; Department of Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA.
| | - David A Lynch
- Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA
| | - Carlyne D Cool
- Department of Pathology, University of Colorado School of Medicine Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA; Division of Pathology, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Steve D Groshong
- Department of Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA
| | - Gregory P Downey
- Department of Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA; Department of Pediatrics, National Jewish Health; Department of Immunology and Genomic Medicine, National Jewish Health
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Kim D, Murvelashvili N, Hamidi O, Jia L. Adrenal Cortical Carcinoma and Additional Rare Pathologic Findings in Multi-Organs in a Birt-Hogg-Dubé Syndrome Patient: With an Emphasis on the Molecular Characteristics of Adrenal Cortical Carcinoma. Int J Surg Pathol 2022:10668969221117246. [PMID: 35946080 DOI: 10.1177/10668969221117246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Birt-Hogg-Dubé (BHD) syndrome is a rare autosomal dominant disorder caused by germline alterations in the FLCN gene. We report a 38-year-old man with BHD syndrome presenting with multiple rare pathologic findings involving various organs, including adrenal cortical carcinoma (ACC). Initially, he presented with severe cholestatic jaundice and was found to have a 25 cm left adrenal mass with radiologic evidence of lung metastases, which was diagnosed as ACC on resection. Concurrently, pigmented, bile-stained granular casts were present within the kidney and diffuse cholestasis of the liver consistent with Stauffer syndrome was identified. Subsequent staging workup detected a 1.2 cm tubulovillous adenoma in the distal ascending colon and an incidental 1.2 cm thyroid nodule. Germline genetic testing revealed a pathogenic FLCN c.1285dup. Targeted DNA next generation sequencing of ACC revealed FLCN c.1285dup, IDH2 c.5332C>T, PRKAR1A c.1074del, and PDGFRB c.3282C>A and concurrent transcriptomic analysis demonstrated VEGFA overexpression. Fourteen months after resection, follow-up computerized tomography (CT) identified the progression of lung metastases and chemotherapy with etoposide doxorubicin and cisplatin was initiated. Here, we report the first ACC with the molecular characteristics in a BHD syndrome patient, although 5 adrenal lesions, including ACC, adenomas or neoplasm with malignant potential due to higher Ki67 labelling index, have been reported in the literature and no somatic analysis in these tumors were performed. Despite the rarity, our case potentially expands the tumor spectrum of BHD patients, helps to solidify possible association with adrenal cortical tumors and reiterates the value of genetic counseling in patients with ACC.
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Affiliation(s)
- David Kim
- Department of Pathology, 89063UT Southwestern Medical Center, Dallas, TX, USA
| | - Natia Murvelashvili
- Division of Endocrinology and Metabolism, Department of Internal Medicine, 89063UT Southwestern Medical Center, Dallas, TX, USA
| | - Oksana Hamidi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, 89063UT Southwestern Medical Center, Dallas, TX, USA
| | - Liwei Jia
- Department of Pathology, 89063UT Southwestern Medical Center, Dallas, TX, USA
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3
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Daccord C, Good JM, Morren MA, Bonny O, Hohl D, Lazor R. Birt-Hogg-Dubé syndrome. Eur Respir Rev 2020; 29:29/157/200042. [PMID: 32943413 PMCID: PMC9489184 DOI: 10.1183/16000617.0042-2020] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/22/2020] [Indexed: 12/22/2022] Open
Abstract
Birt–Hogg–Dubé syndrome (BHD) is a rare inherited autosomal dominant disorder caused by germline mutations in the tumour suppressor gene FLCN, encoding the protein folliculin. Its clinical expression typically includes multiple pulmonary cysts, recurrent spontaneous pneumothoraces, cutaneous fibrofolliculomas and renal tumours of various histological types. BHD has no sex predilection and tends to manifest in the third or fourth decade of life. Multiple bilateral pulmonary cysts are found on chest computed tomography in >80% of patients and more than half experience one or more episodes of pneumothorax. A family history of pneumothorax is an important clue, which suggests the diagnosis of BHD. Unlike other cystic lung diseases such as lymphangioleiomyomatosis and pulmonary Langerhans cell histiocytosis, BHD does not lead to progressive loss of lung function and chronic respiratory insufficiency. Renal tumours affect about 30% of patients during their lifetime, and can be multiple and recurrent. The diagnosis of BHD is based on a combination of genetic, clinical and/or skin histopathological criteria. Management mainly consists of early pleurodesis in the case of pneumothorax, periodic renal imaging for tumour detection, and diagnostic work-up in search of BHD in relatives of the index patient. Birt–Hogg–Dubé syndrome is a rare genetic disorder characterised by multiple lung cysts, recurrent pneumothoraces, skin lesions and kidney tumours. As the presenting symptoms may be respiratory, chest physicians should be able to identify this disease.https://bit.ly/2xsOTuk
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Affiliation(s)
- Cécile Daccord
- Respiratory Medicine Dept, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Marc Good
- Division of Genetic Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie-Anne Morren
- Pediatric Dermatology Unit, Dept of Pediatrics and Dermatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Bonny
- Service of Nephrology, Dept of Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Dept of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Daniel Hohl
- Dermatology Dept, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Romain Lazor
- Respiratory Medicine Dept, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Nowsheen S, Hand JL, Gibson LE, El-Azhary RA. Melanoma in a patient with previously unrecognized Birt-Hogg-Dubé syndrome. JAAD Case Rep 2019; 5:947-952. [PMID: 31687461 PMCID: PMC6820253 DOI: 10.1016/j.jdcr.2019.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Somaira Nowsheen
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota
| | - Jennifer L Hand
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.,Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota
| | - Lawrence E Gibson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Sattler EC, Ertl-Wagner B, Pellegrini C, Peris K, Reithmair M, Schädle N, Ruzicka T, Steinlein OK. Cutaneous melanoma in Birt-Hogg-Dubé syndrome: part of the clinical spectrum? Br J Dermatol 2018; 178:e132-e133. [PMID: 28869776 DOI: 10.1111/bjd.15937] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E C Sattler
- Department of Dermatology and Allergology, Ludwig-Maximilian University of Munich, Frauenlobstraße 9-11, D-80337, Munich, Germany
| | - B Ertl-Wagner
- Department of Radiology, Ludwig-Maximilian University of Munich, Frauenlobstraße 9-11, D-80337, Munich, Germany
| | - C Pellegrini
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - K Peris
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - M Reithmair
- Institute of Human Genetics, University Hospital, Ludwig-Maximilian University of Munich, Frauenlobstraße 9-11, D-80337, Munich, Germany
| | - N Schädle
- Department of Dermatology and Allergology, Ludwig-Maximilian University of Munich, Frauenlobstraße 9-11, D-80337, Munich, Germany
| | - T Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University of Munich, Frauenlobstraße 9-11, D-80337, Munich, Germany
| | - O K Steinlein
- Institute of Human Genetics, University Hospital, Ludwig-Maximilian University of Munich, Frauenlobstraße 9-11, D-80337, Munich, Germany
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Lattouf JB, Pautler SE, Reaume MN, Kim RH, Care M, Green J, So A, Violette PD, Saliba I, Major P, Silver S, Leicht R, Basiuk J, Tanguay S, Jewett MAS, Drachenberg D. Structured assessment and followup for patients with hereditary kidney tumour syndromes. Can Urol Assoc J 2016; 10:E214-E222. [PMID: 28255411 DOI: 10.5489/cuaj.3798] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Optimal clinical assessment and subsequent followup of patients with or suspected of having a hereditary renal cell carcinoma syndrome (hRCC) is not standardized and practice varies widely. We propose protocols to optimize these processes in patients with hRCC to encourage a more uniform approach to management that can then be evaluated. METHODS A review of the literature, including existing guidelines, was carried out for the years 1985-2015. Expert consensus was used to define recommendations for initial assessment and followup. RESULTS Recommendations for newly diagnosed patients' assessment and optimal ages to initiate followup protocols for von Hippel Lindau disease (VHL), hereditary papillary renal cancer (HPRC), hereditary leiomyomatosis with renal cell carcinoma (HLRCC), Birt-Hogg-Dubé syndrome (BHD), familial paraganglioma-pheochromocytoma syndromes (PGL-PCC), and tuberous sclerosis (TSC) are proposed. CONCLUSIONS Our proposed consensus for structured assessment and followup is intended as a roadmap for the care of patients with hRCC to guide healthcare providers. Although the list of syndromes included is not exhaustive, the document serves as a starting point for future updates.
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Affiliation(s)
- Jean-Baptiste Lattouf
- Division of Urology, Department of Surgery, University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Stephen E Pautler
- Divisions of Urology and Surgical Oncology, Departments of Surgery and Oncology, Western University, London, ON, Canada
| | - M Neil Reaume
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Raymond H Kim
- Division of Medical Oncology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Melanie Care
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network & Mount Sinai Hospital, Toronto, ON, Canada
| | - Jane Green
- Disciplines of Genetics and Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Alan So
- Department of Urologic Sciences, Faculty of Medicine, Vancouver General Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Philippe D Violette
- Division of Urology, Department of Surgery, Woodstock General Hospital, Woodstock, ON, Canada
| | - Issam Saliba
- Division of ENT, Department of Surgery, University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Philippe Major
- CHU Sainte-Justine, Department of Neurosciences, University of Montreal, Montreal, QC, Canada
| | - Shane Silver
- Faculty of Medicine and the Division of Dermatology, University of Manitoba, Winnipeg, MB, Canada
| | - Richard Leicht
- Department of Ophthalmology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Joan Basiuk
- Kidney Cancer Research Network of Canada, Toronto, ON, Canada
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC, Canada
| | - Michael A S Jewett
- Division of Urology, Departments of Surgical Oncology and Surgery, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Darrel Drachenberg
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
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Abstract
OBJECTIVES Identify and discuss the nursing implications of personalized and precision oncology care. DATA SOURCES PubMed, CINAHL. CONCLUSION The implications in personalized and precision cancer nursing care include interpretation and clinical use of novel and personalized information including genetic testing; patient advocacy and support throughout testing, anticipation of results and treatment; ongoing chronic monitoring; and support for patient decision-making. Attention must also be given to the family and ethical implications of a personalized approach to care. IMPLICATIONS FOR NURSING PRACTICE Nurses face increasing challenges and opportunities in communication, support, and advocacy for patients given the availability of advanced testing, care and treatment in personalized and precision medicine. Nursing education and continuing education, clinical decision support, and health systems changes will be necessary to provide personalized multidisciplinary care to patients, in which nurses play a key role.
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Birt-Hogg-Dubé syndrome. State-of-the-art review with emphasis on pulmonary involvement. Respir Med 2014; 109:289-96. [PMID: 25519092 DOI: 10.1016/j.rmed.2014.11.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/21/2014] [Accepted: 11/20/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Birt-Hogg-Dubé syndrome (BHDS) is a rare, inherited autosomal-dominant disorder characterized by the development of cutaneous lesions, renal tumors, pulmonary cysts, and spontaneous pneumothorax. The gene responsible for BHDS is located on the short arm of chromosome 17 (17p11.2) and codes for the protein folliculin, which is believed to be an oncogene suppressor protein. METHODS We reviewed currently published literature on the main characteristics of BHDS. RESULTS Pulmonary cysts and spontaneous pneumothorax are often the presenting manifestations that lead to a final diagnosis in family members affected by the syndrome. CONCLUSIONS Certain imaging characteristics of pulmonary cysts, including size and location, can suggest the diagnosis of BHDS based on chest computed tomography alone. The main concern in patients with BHDS is the increased risk of renal carcinoma. The aim of this review is to describe the main pathological, clinical, and imaging aspects of BHDS, ranging from its genetic basis to treatment, with emphasis on pulmonary involvement.
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