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Guedes F, Llorian E, Henriques VM, Torrão-Junior FJL. Brachial plexus peripheral nerve sheath tumors (PNSTs): clinical and surgical management in the pediatric population. Childs Nerv Syst 2024:10.1007/s00381-024-06509-2. [PMID: 38940956 DOI: 10.1007/s00381-024-06509-2] [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] [Received: 05/10/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Peripheral nerve sheath tumors (PNSTs) are rare in pediatric patients, especially in the brachial plexus. Research on PNSTs is lacking. This article presents a retrospective cohort study of pediatric patients diagnosed and treated with PNSTs, specifically brachial plexus tumors. METHODS All pediatric patients intervened in a single center between 2007 and 2023 with brachial plexus tumors were systemically analyzed. RESULTS Eleven pediatric patients with 14 brachial plexus PNSTs were studied. The gender distribution was 64% female and 36% male, with an average age of 10.7 years. Ninety-one percent had a previous NF-1 diagnosis. Right brachial plexus presented a higher prevalence (64%). Pain, Tinel's sign, and stiffness masses were common during diagnosis. Motor deficits were noted in 43% of the patients. Surgery was indicated for symptoms, particularly pain and rapid growth, increasing malignancy risk. Due to suspected malignancy, an en bloc resection with safety margins was performed. Among the patients, 57% received a histopathological diagnosis of MPNST (malignant peripheral nerve sheath tumor). Treatment included radiotherapy and chemotherapy. Clinical follow-up was conducted for all cases, involving clinical and oncological evaluations for all MPNSTs. CONCLUSIONS This article present a series of pediatric brachial plexus tumors, especially in NF-1, and emphasizes the importance of thorough evaluation for this group. Swift diagnosis is crucial in pediatrics, enabling successful surgery for small lesions with limited neurological symptoms, improving long-term outcomes. Prompt referral to specialized services is urged for suspected masses, irrespective of neurological symptoms. Benign tumor postsurgical progression shows better outcomes than MPNSTs, with complete resection as the primary goal. Needle-guided biopsy is not recommended.
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Affiliation(s)
- Fernando Guedes
- Department of Surgery, School of Medicine, Division of Neurosurgery, Gaffrée and Guinle University Hospital, Federal University of Rio de Janeiro State (UNIRIO), 775 Mariz E Barros Street, Rio de Janeiro, RJ, Brazil.
| | - Evelina Llorian
- Department of Surgery, School of Medicine, Division of Neurosurgery, Gaffrée and Guinle University Hospital, Federal University of Rio de Janeiro State (UNIRIO), 775 Mariz E Barros Street, Rio de Janeiro, RJ, Brazil
| | - Vinícius M Henriques
- Department of Surgery, School of Medicine, Division of Neurosurgery, Gaffrée and Guinle University Hospital, Federal University of Rio de Janeiro State (UNIRIO), 775 Mariz E Barros Street, Rio de Janeiro, RJ, Brazil
| | - Francisco José Lourenço Torrão-Junior
- Department of Surgery, School of Medicine, Division of Neurosurgery, Gaffrée and Guinle University Hospital, Federal University of Rio de Janeiro State (UNIRIO), 775 Mariz E Barros Street, Rio de Janeiro, RJ, Brazil
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2
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Tonouchi E, Morita KI, Harazono Y, Hoshino K, Yoda T. NF1 with 47,XYY mosaicism diagnosed by mandibular neurofibromas. Hum Genome Var 2024; 11:22. [PMID: 38755192 PMCID: PMC11099053 DOI: 10.1038/s41439-024-00279-8] [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: 02/09/2024] [Revised: 03/20/2024] [Accepted: 03/29/2024] [Indexed: 05/18/2024] Open
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant nevus disease characterized by multiple manifestations, primarily café-au-lait macules and neurofibromas. Here, we present the case of an NF1 patient with 47,XYY mosaicism whose diagnosis was prompted by café-au-lait macules on the skin and mandibular neurofibromas. Targeted next-generation sequencing of the patient's blood sample revealed a novel frameshift mutation in NF1 (NM_000267.3:c.6832dupA:p.Thr2278Asnfs*8) that is considered a pathogenic variant.
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Affiliation(s)
- Erina Tonouchi
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kei-Ichi Morita
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
- Bioresource Research Center, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yosuke Harazono
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyoko Hoshino
- Segawa Memorial Neurological Clinic for Children, Tokyo, Japan
| | - Tetsuya Yoda
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Pourirahim M, Houshmand G, Abdolkarimi L, Maleki M, Kalayinia S. Whole-exome sequencing revealed a likely pathogenic variant in NF1 causing neurofibromatosis type I and Arrhythmogenic Cardiomyopathy. BMC Cardiovasc Disord 2024; 24:220. [PMID: 38654147 PMCID: PMC11036766 DOI: 10.1186/s12872-024-03878-z] [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: 12/25/2023] [Accepted: 04/05/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Neurofibromatosis type I (NF1) is a genetic disorder characterized by the tumor's development in nerve tissue. Complications of NF1 can include pigmented lesions, skin neurofibromas, and heart problems such as cardiomyopathy. In this study, we performed whole-exome sequencing (WES) on an Iranian patient with NF1 to identify the genetic cause of the disease. METHODS Following clinical assessment, WES was used to identify genetic variants in a family with a son suffering from NF1. No symptomatic manifestations were observed in other family members. In the studied family, in silico and segregation analysis were applied to survey candidate variants. RESULTS Clinical manifestations were consistent with arrhythmogenic cardiomyopathy (ACM). WES detected a likely pathogenic heterozygous missense variant, c.3277G > A:p.Val1093Met, in the NF1 gene, confirmed by PCR and Sanger sequencing. The patient's parents and brother had a normal sequence at this locus. CONCLUSIONS Although there is no cure for NF1, genetic tests, such as WES, can detect at-risk asymptomatic family members. Furthermore, cardiac evaluation could also help these patients before heart disease development.
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Affiliation(s)
- Maryam Pourirahim
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Golnaz Houshmand
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Leyla Abdolkarimi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Kalayinia
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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4
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Giraud JS, Bièche I, Pasmant É, Tlemsani C. NF1 alterations in cancers: therapeutic implications in precision medicine. Expert Opin Investig Drugs 2023; 32:941-957. [PMID: 37747491 DOI: 10.1080/13543784.2023.2263836] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/24/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION NF1 is a tumor suppressor gene encoding neurofibromin, an inhibitor of the RAS/MAPK and PI3K-AKT-mTOR signaling pathways. NF1 germline pathogenic variants cause the tumor predisposition syndrome neurofibromatosis type 1. Targeted therapies (MEK inhibitors) have been approved for benign nerve sheath tumors in neurofibromatosis type 1 patients. NF1 somatic alterations are present in ~5% of all human sporadic cancers. In melanomas, acute myeloid leukemias and lung adenocarcinomas, the NF1 somatic alteration frequency is higher (~15%). However, to date, the therapeutic impact of NF1 somatic alterations is poorly investigated. AREAS COVERED This review presents a comprehensive overview of targeted therapies and immunotherapies currently developed and evaluated in vitro and in vivo for NF1-altered cancer treatment. A PubMed database literature review was performed to select relevant original articles. Active clinical trials were researched in ClinicalTrials.gov database in August 2022. TCGA and HGMD® databases were consulted. EXPERT OPINION This review highlights the need to better understand the molecular mechanisms of NF1-altered tumors and the development of innovative strategies to effectively target NF1-loss in human cancers. One of the current major challenges in cancer management is the targeting of tumor suppressor genes such as NF1 gene. Currently, most studies are focusing on inhibitors of the RAS/MAPK and PI3K-AKT-mTOR pathways and immunotherapies.
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Affiliation(s)
- Jean-Stéphane Giraud
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université Paris Cité, CARPEM, Paris, France
| | - Ivan Bièche
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université Paris Cité, CARPEM, Paris, France
- Genetic Department, Curie Institute, Paris, France
| | - Éric Pasmant
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université Paris Cité, CARPEM, Paris, France
- Genetic Department, Hôpital Cochin, AP-HP.Centre-Université Paris Cité, Paris, France
| | - Camille Tlemsani
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université Paris Cité, CARPEM, Paris, France
- Oncology Department, Hôpital Cochin, AP-HP.Centre-Université Paris Cité, Paris, France
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Cohen-Barak E, Toledano-Alhadef H, Danial-Farran N, Livneh I, Mwassi B, Hriesh M, Zagairy F, Gafni-Amsalem C, Bashir H, Khayat M, Warrour N, Sher O, Marom D, Postovsky S, Dujovny T, Ziv M, Shalev SA. Concomitant variants in NF1, LZTR1 and GNAZ genes probably contribute to the aggressiveness of plexiform neurofibroma and warrant treatment with MEK inhibitor. Exp Dermatol 2021; 31:775-780. [PMID: 34913528 DOI: 10.1111/exd.14514] [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] [Received: 06/22/2021] [Revised: 11/17/2021] [Accepted: 12/12/2021] [Indexed: 12/25/2022]
Abstract
Neurofibromatosis 1 (NF1) is caused by germline mutations in the NF1 gene and manifests as proliferation of various tissues, including plexiform neurofibromas. The plexiform neurofibroma phenotype varies from indolent to locally aggressive, suggesting contributions of other modifiers in addition to somatic loss of NF1. In this study, we investigated a life-threatening plexiform neurofibroma in a 9-month-old female infant with NF1. Germline mutations in two RASopathy-associated genes were identified using whole-exome sequencing-a de novo pathogenic variant in the NF1 gene, and a known pathogenic variant in the LZTR1 gene. Somatic analysis of the plexiform neurofibroma revealed NF1 loss of heterozygosity and a variant in GNAZ, a gene encoding a G protein-coupled receptor. Cells expressing mutant GNAZ exhibited increased ERK 1/2 activation compared to those expressing wild-type GNAZ. Taken together, we suggest the variants in NF1, LZRT1 and GNAZ act synergistically in our patient, leading to MAPK pathway activation and contributing to the severity of the patient's plexiform neurofibromatosis. After treatment with the MEK inhibitor, trametinib, a prominent clinical improvement was observed in this patient. This case study contributes to the knowledge of germline and somatic non-NF1 variants affecting the NF1 clinical phenotype and supports use of personalized, targeted therapy.
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Affiliation(s)
- Eran Cohen-Barak
- Department of Dermatology, "Emek" Medical Center, Afula, Israel.,Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Hagit Toledano-Alhadef
- Pediatric Neurology and Child Development Center, Gilbert Israeli and International Neurofibromatosis Center, Dana-Dwek Children Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ido Livneh
- Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Banan Mwassi
- Department of Dermatology, "Emek" Medical Center, Afula, Israel.,Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Maysa Hriesh
- Department of Dermatology, "Emek" Medical Center, Afula, Israel
| | - Fadia Zagairy
- Department of Dermatology, "Emek" Medical Center, Afula, Israel
| | | | - Husam Bashir
- The Genetic Institute, "Emek" Medical Center, Afula, Israel
| | - Morad Khayat
- The Genetic Institute, "Emek" Medical Center, Afula, Israel
| | - Nassim Warrour
- The Genetic Institute, "Emek" Medical Center, Afula, Israel
| | - Osnat Sher
- Bone&Soft Tissue Pathology Service, Department of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Daphna Marom
- Human Genetics Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sergey Postovsky
- Department of Pediatric Oncology, "Emek" Medical Center, Afula, Israel
| | - Tal Dujovny
- Department of Pediatric Oncology, "Emek" Medical Center, Afula, Israel
| | - Michael Ziv
- Department of Dermatology, "Emek" Medical Center, Afula, Israel
| | - Stavit A Shalev
- Bruce and Ruth Rappaport Faculty of Medicine, Technion, Haifa, Israel.,The Genetic Institute, "Emek" Medical Center, Afula, Israel
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6
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National Multi-Center Treatment Collaboration Group For Neurofibromatosis Type, National Multi-Center Research Platform For Plastic And Reconstructive Surgery. [Expert consensus on diagnosis and management of neurofibromatosis type 1 (2021 edition)]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1384-1395. [PMID: 34779163 DOI: 10.7507/1002-1892.202108065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant neoplastic disease caused by mutations in the NF1 gene and one of the most challenging diseases to treat. Patients have a characteristic phenotype with neurofibromas as the main features in different forms, including numerous cutaneous neurofibromas, plexiform neurofibromas involving the primary nerves, or malignant peripheral nerve sheath tumors with a very short survival period after malignant transformation. NF1 patients also suffer from multi-system involvement, with a high rate of deformity and disability, making complete surgical resection more difficult. Currently, there is no consensus on the diagnosis and treatment of NF1 in China, and different disciplines have different understandings of NF1. Multidisciplinary systematic evaluations and cooperative treatments are the keys to improve the treatment, quality of life, and prognosis of NF1 patients. In 2020, the Department of Plastic Surgery of the Ninth People's Hospital of Shanghai Jiaotong University School of Medicine led the establishment of the first multi-center collaboration group for NF1 in China. Furthermore, the group had worked with renowned experts from the various departments including surgical oncology, medical oncology, dermatology, reproductive medicine, et al. in China to formulate the "Expert consensus on diagnosis and management of neurofibromatosis type 1 (2021 edition)", aiming to promote standardized and homogeneous treatment covering the whole life cycle of NF1 patients and improve the treatment level and outcome of NF1 patients in China.
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7
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Calligaris L, Cortellazzo Wiel L, Sartor E, Berti I, Bruno I, Barbi E, Magnolato A. Juvenile xanthogranuloma: A possible diagnostic criterion for Neurofibromatosis type 1 in young children. Am J Med Genet A 2021; 185:3895-3896. [PMID: 34250743 DOI: 10.1002/ajmg.a.62420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/09/2021] [Accepted: 06/18/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Lorenzo Calligaris
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Luisa Cortellazzo Wiel
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Emma Sartor
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Irene Berti
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Irene Bruno
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Andrea Magnolato
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
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8
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Scala M, Schiavetti I, Madia F, Chelleri C, Piccolo G, Accogli A, Riva A, Salpietro V, Bocciardi R, Morcaldi G, Di Duca M, Caroli F, Verrico A, Milanaccio C, Viglizzo G, Traverso M, Baldassari S, Scudieri P, Iacomino M, Piatelli G, Minetti C, Striano P, Garrè ML, De Marco P, Diana MC, Capra V, Pavanello M, Zara F. Genotype-Phenotype Correlations in Neurofibromatosis Type 1: A Single-Center Cohort Study. Cancers (Basel) 2021; 13:cancers13081879. [PMID: 33919865 PMCID: PMC8070780 DOI: 10.3390/cancers13081879] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Neurofibromatosis type 1 (NF1) is a complex disorder characterized by a multisystem involvement and cancer predisposition. It is caused by genetic variants in NF1, a large tumor suppressor gene encoding a cytoplasmatic protein (neurofibromin) with a regulatory role in essential cellular processes. Genotype–phenotype correlations in NF1 patients are so far elusive. We retrospectively reviewed clinical, radiological, and genetic data of 583 individuals with at least 1 National Institutes of Health (NIH) criterion for NF1 diagnosis, including 365 subjects fulfilling criteria for the diagnosis. Novel genotype–phenotype correlations were identified through uni- and multivariate statistical analysis. Missense variants negatively correlated with neurofibromas. Skeletal abnormalities were associated with frameshift variants and whole gene deletions. The c.3721C>T; p.(R1241*) variant positively correlated with structural brain alterations, whereas the c.6855C>A; p.(Y2285*) variant was associated with a higher prevalence of Lisch nodules and endocrinological disorders. These novel NF1 genotype–phenotype correlations may have a relevant role in the implementation of patients’ care. Abstract Neurofibromatosis type 1 (NF1) is a proteiform genetic condition caused by pathogenic variants in NF1 and characterized by a heterogeneous phenotypic presentation. Relevant genotype–phenotype correlations have recently emerged, but only few pertinent studies are available. We retrospectively reviewed clinical, instrumental, and genetic data from a cohort of 583 individuals meeting at least 1 diagnostic National Institutes of Health (NIH) criterion for NF1. Of these, 365 subjects fulfilled ≥2 NIH criteria, including 235 pediatric patients. Genetic testing was performed through cDNA-based sequencing, Next Generation Sequencing (NGS), and Multiplex Ligation-dependent Probe Amplification (MLPA). Uni- and multivariate statistical analysis was used to investigate genotype–phenotype correlations. Among patients fulfilling ≥ 2 NIH criteria, causative single nucleotide variants (SNVs) and copy number variations (CNVs) were detected in 267/365 (73.2%) and 20/365 (5.5%) cases. Missense variants negatively correlated with neurofibromas (p = 0.005). Skeletal abnormalities were associated with whole gene deletions (p = 0.05) and frameshift variants (p = 0.006). The c.3721C>T; p.(R1241*) variant positively correlated with structural brain alterations (p = 0.031), whereas Lisch nodules (p = 0.05) and endocrinological disorders (p = 0.043) were associated with the c.6855C>A; p.(Y2285*) variant. We identified novel NF1 genotype–phenotype correlations and provided an overview of known associations, supporting their potential relevance in the implementation of patient management.
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Affiliation(s)
- Marcello Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, 16132 Genoa, Italy;
| | - Francesca Madia
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Cristina Chelleri
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Gianluca Piccolo
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Andrea Accogli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
| | - Antonella Riva
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Vincenzo Salpietro
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Renata Bocciardi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Guido Morcaldi
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Marco Di Duca
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Francesco Caroli
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Antonio Verrico
- Neuro-Oncology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.V.); (C.M.); (M.L.G.)
| | - Claudia Milanaccio
- Neuro-Oncology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.V.); (C.M.); (M.L.G.)
| | | | - Monica Traverso
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Simona Baldassari
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Paolo Scudieri
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Michele Iacomino
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Gianluca Piatelli
- Neurosurgery Department, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy;
| | - Carlo Minetti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Maria Luisa Garrè
- Neuro-Oncology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.V.); (C.M.); (M.L.G.)
| | - Patrizia De Marco
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Maria Cristina Diana
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (G.P.); (G.M.); (M.T.); (M.C.D.)
| | - Valeria Capra
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
| | - Marco Pavanello
- Neurosurgery Department, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy;
- Correspondence:
| | - Federico Zara
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (M.S.); (C.C.); (A.A.); (A.R.); (V.S.); (R.B.); (P.S.); (C.M.); (P.S.); (F.Z.)
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (F.M.); (M.D.D.); (F.C.); (S.B.); (M.I.); (P.D.M.); (V.C.)
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Quirk B, Olasz E, Kumar S, Basel D, Whelan H. Photodynamic Therapy for Benign Cutaneous Neurofibromas Using Aminolevulinic Acid Topical Application and 633 nm Red Light Illumination. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2021; 39:411-417. [PMID: 33470897 PMCID: PMC8219184 DOI: 10.1089/photob.2020.4957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Neurofibromatosis type 1 (NF1) has no current effective treatments beyond surgery. Topical photodynamic therapy (PDT) has the potential to provide a less invasive treatment modality. Objective: Based on murine data, we hypothesized PDT could be used for the treatment of cutaneous neurofibromas (cNF). Methods and results: We conducted a phase I trial to examine absorption and conversion of topical aminolevulinic acid (ALA) in cNF and determine safety in a dose escalation study. ALA or control vehicle was applied to neurofibromas through microneedle-assisted delivery (n = 4) and excised specimens were examined 24 h later for protoporphyrin IX fluorescence. Fluorescence was detected in the tumors at 304 ± 94 U/μm2, while adjacent paralesional normal skin and vehicle-treated tumors showed no fluorescence (p < 0.0001). Subsequently, neurofibromas (n = 27) were treated with ALA and irradiated with 633 nm red light 18 h later, at escalating dosages of 50 and 100 mJ/cm2. Maximum tolerable dose was established at 100 mJ/cm2. Light microscopy study of tumors biopsied 48 h after PDT (ALA n = 14 and vehicle n = 4) showed mixed inflammatory infiltrate in the ALA, but not in the vehicle-treated tumors or perilesional normal skin. TUNEL evaluation showed 42.5 ± 19.9 apoptotic cells per visual field for ALA-treated and 1.1 ± 1.4 for vehicle-treated tumors (p = 0.002). Conclusions: In the first reported clinical trial of PDT for NF1, PDT targeted neurofibromas specifically, and may offer a normal tissue-sparing treatment modality in the future. This study is registered at Clintrials.gov (NCT01682811).
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Affiliation(s)
- Brendan Quirk
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Edit Olasz
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Suresh Kumar
- Department of Pathology & Laboratory Medicine, and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Donald Basel
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Harry Whelan
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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10
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Steele L, Shipman AR. Neuroimaging in infants and children in select neurocutaneous disorders. Clin Exp Dermatol 2020; 46:438-443. [PMID: 33180972 DOI: 10.1111/ced.14471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
The role of neuroimaging in neurocutaneous disorders is an evolving field. Research can be inconsistent and inconclusive, leading to divergent practice for some disorders. This study provides an overview of the current role of magnetic resonance imaging (MRI) of the brain in select neurocutaneous disorders, namely Sturge-Weber syndrome, congenital melanocytic naevus syndrome, neurofibromatosis type 1, tuberous sclerosis complex, incontinentia pigmenti and basal cell naevus syndrome. Future research assessing new targeted treatments and novel MRI techniques may change current practice.
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Affiliation(s)
- L Steele
- Department of Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - A R Shipman
- Department of Dermatology, St Mary's Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
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11
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Schneider KW, Cost NG, Schultz KAP, Svihovec S, Suttman A. Germline predisposition to genitourinary rhabdomyosarcoma. Transl Androl Urol 2020; 9:2430-2440. [PMID: 33209717 PMCID: PMC7658107 DOI: 10.21037/tau-20-76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Multiple genetic conditions predispose to the development of rhabdomyosarcoma. Much of the literature on rhabdomyosarcoma in genetic syndromes does not sub-divide the location or the pathology of the sarcomas. Therefore, there are limited data on genitourinary specific associations with certain genetic syndromes. We summarize, here, the primary differential considerations for rhabdomyosarcoma of the genitourinary system. Primary considerations include DICER1 pathogenic variation, Li-Fraumeni syndrome, constitutional mismatch repair deficiency, mosaic variegated aneuploidy, neurofibromatosis type 1, Noonan syndrome, other RASopathies, Costello syndrome, and Beckwith-Wiedemann syndrome. Some conditions may present with specific pathological, clinical and/or family history features, but for others, the genitourinary tumor may be the only presenting sign at the time of diagnosis. Genetic evaluation with counseling and/or testing may help identify an underlying tumor predisposition. This manuscript serves as an introduction to germline considerations for children with genitourinary rhabdomyosarcoma.
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Affiliation(s)
- Kami Wolfe Schneider
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplantation, University of Colorado, Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA
| | - Nicholas G Cost
- Department of Surgery, Division of Urology, University of Colorado, Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA
| | - Kris Ann P Schultz
- International Pleuropulmonary Blastoma (PPB)/DICER1 Registry, Cancer and Blood Disorders Program, Children's Minnesota, Minneapolis, MN, USA
| | - Shayna Svihovec
- Department of Pediatrics, Division of Genetics, University of Colorado, Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA
| | - Alexandra Suttman
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplantation, University of Colorado, Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA
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12
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Neurofibromatosis type 1: New developments in genetics and treatment. J Am Acad Dermatol 2020; 84:1667-1676. [PMID: 32771543 DOI: 10.1016/j.jaad.2020.07.105] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022]
Abstract
Neurofibromatosis type 1 is the most common neurocutaneous syndrome, with a frequency of 1 in 2500 persons. Diagnosis is paramount in the pretumor stage to provide proper anticipatory guidance for a number of neoplasms, both benign and malignant. Loss-of-function mutations in the NF1 gene result in truncated and nonfunctional production of neurofibromin, a tumor suppressor protein involved in downregulating the RAS signaling pathway. New therapeutic and preventive options include tyrosine kinase inhibitors, mTOR inhibitors, interferons, and radiofrequency therapy. This review summarizes recent updates in genetics, mutation analysis assays, and treatment options targeting aberrant genetic pathways. We also propose modified diagnostic criteria and provide an algorithm for surveillance of patients with neurofibromatosis type 1.
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Selumetinib in the Treatment of Symptomatic Intractable Plexiform Neurofibromas in Neurofibromatosis Type 1: A Prospective Case Series with Emphasis on Side Effects. Paediatr Drugs 2020; 22:417-423. [PMID: 32533336 DOI: 10.1007/s40272-020-00399-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Plexiform neurofibromas (PN) are congenital tumors that affect up to 50% of individuals with neurofibromatosis type 1. Despite their benign nature, they can grow rapidly and cause severe morbidities. Selumetinib, an inhibitor of mitogen-activated protein kinase (MEK) 1 and 2, was reported to induce a clinical response in pediatric subjects with inoperable PN. OBJECTIVE The aim of this paper is to describe a prospective case series of patients treated with selumetinib with emphasis on drug adverse events. PATIENTS AND METHODS All the subjects who received selumetinib at the Pediatric Department of Scientific Research Institute and Hospital "Burlo Garofolo", from November 2017 to January 2020, were progressively included. We monitored the patients with a follow-up visit every 3 months. MRI or CT scans to monitor the growth of the tumor were performed after 3 months of treatment, and then every 6-9 months. RESULTS Selumetinib was prescribed to nine children, with a total of 17 inoperable PN. The mean follow-up period was 12 months. During the follow-up, one patient experienced an ischemic stroke, unrelated to the treatment. Only minor adverse events were observed: six individuals developed gastrointestinal side effects, seven patients presented a mild form of acne, six had paronychia, four developed irritability, and two showed a mild increase in creatine kinase. None of the patients stopped the treatment. Tumor reduction > 20% was recorded in 16 out of 17 PN (94%). One PN remained stable. No tumor growth was recorded during the treatment. CONCLUSIONS In this case series, selumetinib appears to be effective and safe for the pediatric population.
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Razmara E, Azimi H, Bitaraf A, Daneshmand MA, Galehdari M, Dokhanchi M, Esmaeilzadeh‐Gharehdaghi E, Garshasbi M. Whole-exome sequencing identified a novel variant in an Iranian patient affected by pycnodysostosis. Mol Genet Genomic Med 2020; 8:e1118. [PMID: 31944631 PMCID: PMC7057126 DOI: 10.1002/mgg3.1118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/15/2019] [Accepted: 12/23/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Whole-exome sequencing (WES) has emerged as a successful diagnostic tool in molecular genetics laboratories worldwide. In this study, we aimed to find the potential genetic cause of skeletal disease, a heterogeneous disease, revealing the obvious short stature phenotype. In an Iranian family, we used solo-WES in a suspected patient to decipher the potential genetic cause(s). METHODS A comprehensive clinical and genotyping examination was applied to suspect the disease of the patient. The solo clinical WES was exploited, and the derived data were filtered according to the standard pipelines. In order to validate the WES finding, the region harboring the candidate variant in the CTSK gene was amplified from genomic DNA and sequenced directly by Sanger sequencing. RESULTS Sequence analysis revealed a rare novel nonsense variant, p.(Trp320*); c.905G>A, in the CTSK gene (NM_000396.3). In silico analysis shed light on the contribution of the variant to the pathogenicity of pycnodysostosis. This variant was confirmed by Sanger sequencing and further clinical examinations of the patient confirmed the disease. CONCLUSION The present study shows a rare variant of the CTSK gene, which inherited as autosomal recessive, in an Iranian male patient with pycnodysostosis. Taken together, the novel nonsense CTSK variant meets the criteria of being likely pathogenic according to the American College of Medical Genetics and Genomics-the Association for Molecular Pathology (ACMG-AMP) variant interpretation guidelines.
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Affiliation(s)
- Ehsan Razmara
- Australian Regenerative Medicine InstituteMonash UniversityClaytonVICAustralia
| | | | - Amirreza Bitaraf
- Department of Molecular GeneticsFaculty of Biological SciencesTarbiat Modares UniversityTehranIran
| | | | - Mohammad Galehdari
- Department of BiologyFaculty of SciencesNorth Tehran BranchIslamic Azad UniversityTehranIran
| | - Maryam Dokhanchi
- Department of Biology, Science and Research BranchIslamic Azad UniversityTehranIran
| | | | - Masoud Garshasbi
- Department of Medical GeneticsFaculty of Medical SciencesTarbiat Modares UniversityTehranIran
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Abstract
Phakomatoses present with characteristic findings on the skin, central or peripheral nervous system, and tumors. Neurofibromatosis type 1 is the most common syndrome and is characterized by Café-au-lait macules, intertriginous freckling, Lisch nodules, and tumors including neurofibromas, malignant peripheral nerve sheath tumors, and gliomas. Tuberous Sclerosis Complex is characterized by benign hamartomas presenting with hypomelanotic macules, shagreen patches, angiofibromas, confetti lesions and tumors including cortical tubers, subependymal nodules, subependymal giant cell astrocytomas and tumors of the kidney, lung, and heart. Managing these disorders requires disease specific supportive care, tumor monitoring, surveillance for selected cancers, and treatment of comorbid conditions.
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Affiliation(s)
- Benjamin Becker
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
| | - Roy E Strowd
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA; Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest Baptist Health, Winston Salem, NC 27157, USA; Translational Science Institute, Wake Forest Baptist Health, Winston Salem, NC 27157, USA
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16
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Zipfel J, Al-Hariri M, Gugel I, Haas-Lude K, Grimm A, Warmann S, Krimmel M, Mautner VF, Tatagiba M, Schuhmann MU. Surgical management of peripheral nerve sheath tumours in children, with special consideration of neurofibromatoses. Childs Nerv Syst 2020; 36:2433-2442. [PMID: 32506255 PMCID: PMC8272701 DOI: 10.1007/s00381-020-04703-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/25/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Peripheral nerve sheath tumours in children are a rare and heterogeneous group, consisting mostly of benign tumours as well as malignant neoplasms. Especially in the paediatric population, diagnostics and indication for therapy pose relevant challenges for neurosurgeons and paediatric neurologists alike. Most paediatric cases that need surgical intervention are associated to neurofibromatosis type 1 (NF1). METHODS We retrospectively reviewed all paediatric cases treated at the Department of Neurosurgery in Tübingen between 2006 and 2017 for peripheral nerve sheath tumours. We analysed clinical signs, symptoms, histology, association to an underlying phacomatosis and sensory/motor function. RESULTS Of the 82 identified patients, the majority had NF1 (76.8%). Nine children bore a sporadic tumour without underlying phacomatosis (11%), 8 had NF2 (9.8%) and 2 schwannomatosis (2.4%), A total of 168 surgical interventions were performed, and 206 tumours were removed. Indication for surgery was in most instances significant tumour growth (45.2%) followed by pain (33.9%). New deficits led to surgery in 12.5% of interventions; malignancy was suspected in 8.3%. Histopathology revealed mostly neurofibromas (82.5%), divided into cutaneous neurofibromas (10.7%), infiltrating plexiform neurofibromas (25.7%) and peripheral nerve-born neurofibromas (46.1%). 12.1% of tumours were schwannomas, 2.9% MPNST, 1.5% ganglioneuroma (n = 3) and 1 hybrid-neurofibroma and perineurinoma each. Leading symptoms, such as pain and motor and sensory deficits, improved after 125/166 interventions (74.4%), remained unchanged following 39 interventions (23.2%) and worsened in 4 occasions (2.4%). CONCLUSION Surgery is safe and effective for (neurofibromatosis associated) peripheral nerve sheath tumours in the paediatric population; however, management needs a multidisciplinary setting. We propose early surgical resection in paediatric patients with peripheral nerve sheath tumours with significant growth, or pain, or motor deficit, or suspected malignancy.
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Affiliation(s)
- Julian Zipfel
- Division of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany. .,Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany. .,Centre for Neurofibromatosis at the Centre of Rare Diseases, University Hospital and University of Tübingen, Tübingen, Germany.
| | - Meizer Al-Hariri
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - Isabel Gugel
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany ,Centre for Neurofibromatosis at the Centre of Rare Diseases, University Hospital and University of Tübingen, Tübingen, Germany
| | - Karin Haas-Lude
- Centre for Neurofibromatosis at the Centre of Rare Diseases, University Hospital and University of Tübingen, Tübingen, Germany ,Department of Paediatric Neurology, University Children’s Hospital Tübingen, Tübingen, Germany
| | - Alexander Grimm
- Department of Neurology, University Hospital Tübingen, Tübingen, Germany
| | - Steven Warmann
- Department of Paediatric Surgery, University Children’s Hospital Tübingen, Tübingen, Germany
| | - Michael Krimmel
- Department of Maxillofacial Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Victor-Felix Mautner
- Neurofibromatosis Centre Hamburg, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcos Tatagiba
- Division of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany ,Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany ,Centre for Neurofibromatosis at the Centre of Rare Diseases, University Hospital and University of Tübingen, Tübingen, Germany
| | - Martin U. Schuhmann
- Division of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany ,Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany ,Centre for Neurofibromatosis at the Centre of Rare Diseases, University Hospital and University of Tübingen, Tübingen, Germany
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Yao R, Yu T, Xu Y, Yu L, Wang J, Wang X, Wang J, Shen Y. Clinical Presentation and Novel Pathogenic Variants among 68 Chinese Neurofibromatosis 1 Children. Genes (Basel) 2019; 10:genes10110847. [PMID: 31717729 PMCID: PMC6896037 DOI: 10.3390/genes10110847] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/08/2019] [Accepted: 10/23/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Neurofibromatosis 1 (NF1) is one of the most common dominantly inherited genetic disorders worldwide, with an age-dependent phenotypic expression. Exploring the mutational spectrum and clinical presentation of NF1 patients at different ages from a diverse population will aid the understanding of genotype–phenotype correlations. Methods: In this study, 95 Chinese children with clinical suspicion of NF1 mainly due to the presence of multiple café-au-lait macules (CALMs) were subjected to medical exome-sequencing analysis and Sanger confirmation of pathogenic variants. Clinical presentations were evaluated regarding dermatological, ocular, neurological, and behavioral features. Results: Pathogenic or likely pathogenic NF1 variants were detected in 71.6% (68/95) of patients; 20 pathogenic variants were not previously reported, indicating that Chinese NF1 patients are still understudied. Parental Sanger sequencing confirmation revealed 77.9% of de novo variants, a percentage that was much higher than expected. The presence of a higher number of NF1-related features at young ages was correlated with positive diagnostic findings. In addition to CALMs, neurological and behavioral features had a high expression among Chinese NF1 children. We attempted to correlate short stature with the locations of the pathogenic variants across the NF1 gene. It is interesting to notice that variants detected in the C-terminal region of the NF1 gene were less likely to be associated with short stature among the NF1 patients, whereas variants at the N-terminal were highly penetrant for the short stature phenotype. Conclusion: Novel NF1 pathogenic variants are yet to be uncovered in under-studied NF1 patient populations; their identification will help to reveal novel genotype–phenotype correlations.
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Affiliation(s)
- Ruen Yao
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children’s Medical Center—Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; (R.Y.); (T.Y.); (Y.X.); (L.Y.); (J.W.)
| | - Tingting Yu
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children’s Medical Center—Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; (R.Y.); (T.Y.); (Y.X.); (L.Y.); (J.W.)
| | - Yufei Xu
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children’s Medical Center—Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; (R.Y.); (T.Y.); (Y.X.); (L.Y.); (J.W.)
| | - Li Yu
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children’s Medical Center—Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; (R.Y.); (T.Y.); (Y.X.); (L.Y.); (J.W.)
| | - Jiwen Wang
- Department of Pediatrics, Shanghai Children’s Medical Center—Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; (J.W.); (X.W.)
| | - Xiumin Wang
- Department of Pediatrics, Shanghai Children’s Medical Center—Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; (J.W.); (X.W.)
| | - Jian Wang
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children’s Medical Center—Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; (R.Y.); (T.Y.); (Y.X.); (L.Y.); (J.W.)
| | - Yiping Shen
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children’s Medical Center—Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; (R.Y.); (T.Y.); (Y.X.); (L.Y.); (J.W.)
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
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Muller CO, Mille E, Virzi A, Marret JB, Peyrot Q, Delmonte A, Berteloot L, Gori P, Blanc T, Grevent D, Boddaert N, Bloch I, Sarnacki S. Integrating tractography in pelvic surgery: a proof of concept. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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19
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Kokkinou E, Roka K, Alexopoulos A, Tsina E, Nikas I, Krallis P, Thanopoulou I, Nasi L, Makrygianni E, Tsoutsou E, Kosma K, Tsipi M, Tzetis M, Frysira H, Kattamis A, Pons R. Development of a multidisciplinary clinic of neurofibromatosis type 1 and other neurocutaneous disorders in Greece. A 3-year experience. Postgrad Med 2019; 131:445-452. [PMID: 31443616 DOI: 10.1080/00325481.2019.1659708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Given the complexity of neurocutaneous syndromes, a multidisciplinary approach has been advocated in order to provide optimum care. Subjects and Methods: Retrospective analysis of a cohort of 157 patients during a 3-year period, seen at a newly developed neurocutaneous clinic in a pediatric tertiary care hospital in Athens (Greece); and systematic chart review of the patients diagnosed with neurofibromatosis type 1 during this time period. Results: The most frequent neurocutaneous syndromes were neurofibromatosis type 1 (NF1) in 89 patients and tuberous sclerosis complex in 17. In 20.38% of patients a neurocutaneous syndrome was not confirmed. Approximately 2/3 of the NF1 patients underwent genetic analysis, and for 76.67% of them, a pathogenic mutation on the NF1 gene was revealed. Eighty-one patients manifested with generalized NF1 and eight with mosaic NF1. Dermatological manifestations included café-au-lait macules in all patients, followed by axillary and/or inguinal freckling (n = 57), external plexiform neurofibromas (n = 17), and cutaneous and subcutaneous neurofibromas (n = 11). Approximately half of patients had learning disabilities and attention deficit hyperactivity disorder, followed by mental retardation (n = 9), autistic spectrum disorders (n = 4), headaches (n = 3) and seizures (n = 2). Neuroimaging showed characteristic areas of hyperintensity on T2-weighted images in 74.07% of patients and optic pathway glioma in 19.75%. Two patients developed malignant peripheral sheath nerve tumor. Conclusions: Neurocutaneous syndromes are clinically heterogeneous and the surveillance of potential clinical complications is challenging. The availability of genetic diagnosis and novel imaging methods in this group of disorders is likely to further expand their clinical spectrum. Guidelines for assessment and management will need to be modified based on new available data.
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Affiliation(s)
- Eleftheria Kokkinou
- Special Unit of Pediatric Neurology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Agia Sofia Children's Hospital , Athens , Greece
| | - Kleoniki Roka
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Agia Sofia Children's Hospital , Athens , Greece
| | - Alexis Alexopoulos
- Special Unit of Dermatology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Agia Sofia Children's Hospital , Athens , Greece
| | - Efthymia Tsina
- Department of Ophthalmology, Agia Sofia Children's Hospital , Athens , Greece
| | - Ioannis Nikas
- Department of Radiology, Agia Sofia Children's Hospital , Athens , Greece
| | - Panagiotis Krallis
- Department of Orthopaedics, Agia Sofia Children's Hospital , Athens , Greece
| | - Ioanna Thanopoulou
- Special Unit of Dermatology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Agia Sofia Children's Hospital , Athens , Greece
| | - Lambrini Nasi
- Special Unit of Dermatology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Agia Sofia Children's Hospital , Athens , Greece
| | - Evanthia Makrygianni
- Special Unit of Pediatric Neurology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Agia Sofia Children's Hospital , Athens , Greece
| | - Eirini Tsoutsou
- Department of Medical Genetics, Choremio Research Laboratory, National and Kapodistrian University of Athens Medical School, Agia Sofia Children's Hospital , Athens , Greece
| | - Konstantina Kosma
- Department of Medical Genetics, Choremio Research Laboratory, National and Kapodistrian University of Athens Medical School, Agia Sofia Children's Hospital , Athens , Greece
| | - Maria Tsipi
- Department of Medical Genetics, Choremio Research Laboratory, National and Kapodistrian University of Athens Medical School, Agia Sofia Children's Hospital , Athens , Greece
| | - Maria Tzetis
- Department of Medical Genetics, Choremio Research Laboratory, National and Kapodistrian University of Athens Medical School, Agia Sofia Children's Hospital , Athens , Greece
| | - Helen Frysira
- Department of Medical Genetics, Choremio Research Laboratory, National and Kapodistrian University of Athens Medical School, Agia Sofia Children's Hospital , Athens , Greece
| | - Antonis Kattamis
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Agia Sofia Children's Hospital , Athens , Greece
| | - Roser Pons
- Special Unit of Pediatric Neurology, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Agia Sofia Children's Hospital , Athens , Greece
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Rüegger AD, Coleman L, Hansford JR, McLean N, Dabscheck G. Spinal Cord Hyperintensities in Neurofibromatosis Type 1: Are They the Cord Equivalent of Unidentified Bright Objects in the Brain? Pediatr Neurol 2018; 86:63-65. [PMID: 30174245 DOI: 10.1016/j.pediatrneurol.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Focal areas of T2 hyperintensity are seen on magnetic resonance imaging (MRI) in patients with neurofibromatosis type 1 (NF1). These lesions are commonly known as "unidentified bright objects" of the brain. We have seen similar lesions in the spinal cord of the same patient population. Our aim was to determine the prevalence and characterize the imaging features of these T2 hyperintense spinal cord lesions in children with NF1. METHODS A search of our hospital's medical imaging database yielded all children with NF1 and MRI of the brain and/or spine between February 2014 and April 2017. Medical imaging was reviewed for T2 hyperintense signal changes and medical records were reviewed of those children with T2 hyperintense spinal cord lesions. RESULTS During the study period 155 children underwent a brain MRI and 72 had a spine MRI. One hundred twenty-three (79%) showed multiple cerebral T2 hyperintense lesions and six (8%) had non-contrast enhancing spinal cord T2 hyperintensities with five children having had a follow-up scan. The one child without follow-up imaging was not further pursued. Interval scanning showed stable appearance of the spinal cord lesions in four children and signal reduction in one child. All five children with T2 hyperintense changes in the spinal cord had an MRI brain and all (100%) also exhibited cerebral T2 hyperintensities. CONCLUSIONS Focal areas of signal hyperintensity in the spinal cord are the corollary of the better described cerebral T2 hyperintensities in individuals with NF1.
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Affiliation(s)
- Andrea D Rüegger
- Department of Neurology, The Royal Children's Hospital, Parkville, Victoria, Australia.
| | - Lee Coleman
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Medical Imaging, The Royal Children's Hospital, Parkville, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia
| | - Jordan R Hansford
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Department of Pediatrics, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Natalie McLean
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Victorian Clinical Genetics Services, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Gabriel Dabscheck
- Department of Neurology, The Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Uehara M, Nakamura Y, Takahashi J, Kamimura M, Isobe F, Yamaguchi T, Kosho T, Uchiyama S, Suzuki T, Kato H. Efficacy of denosumab therapy for neurofibromatosis type 1 with osteoporosis and history of fractures: a case report. Ther Clin Risk Manag 2018; 14:1243-1246. [PMID: 30038498 PMCID: PMC6052922 DOI: 10.2147/tcrm.s159668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The natural history and pathogenesis of the skeletal abnormalities found in neurofibromatosis type 1 (NF1) are poorly understood, and the therapeutic options for these manifestations remain limited. This report first describes the clinical outcomes of denosumab treatment for a patient with NF1 suffering from osteoporosis. Methods We enrolled a patient with NF1 under denosumab treatment for osteoporosis, prior fractures, and no improvement in bone mineral density (BMD) over 3 years of alendronate therapy. BMD was monitored by dual-energy X-ray absorptiometry. Tested laboratory data included bone-specific alkaline phosphatase, urinary type I collagen amino-terminal telopeptide, tartrate-resistant acid phosphatase 5b, 1-alpha, 25-dihydroxyvitamin D3, and parathyroid hormone. BMD and laboratory data were evaluated before, between 2 and 4 months, and at 6, 12, 18, and 24 months of treatment. Case presentation During 2 years of denosumab therapy for osteoporosis in a 58-year-old female NF1 patient with prior fractures, BMD increased by 6.5% in the lumbar spine and 10.6% in the total hips, and bone turnover markers were notably improved. No fractures occurred during the latter half of treatment. Conclusion Denosumab represents an effective treatment option for osteoporosis in NF1 patients.
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Affiliation(s)
- Masashi Uehara
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan,
| | - Yukio Nakamura
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan,
| | - Jun Takahashi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan,
| | - Mikio Kamimura
- Center for Osteoporosis and Spinal Disorders, Kamimura Orthopedic Clinic, Kotobuki, Matsumoto, Japan
| | - Fumihiro Isobe
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan,
| | - Tomomi Yamaguchi
- Department of Medical Genetics, Shinshu University School of Medicine, Asahi, Matsumoto, Japan.,Center for Medical Genetics, Shinshu University Hospital, Asahi, Matsumoto, Japan
| | - Tomoki Kosho
- Department of Medical Genetics, Shinshu University School of Medicine, Asahi, Matsumoto, Japan.,Center for Medical Genetics, Shinshu University Hospital, Asahi, Matsumoto, Japan
| | - Shigeharu Uchiyama
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan, .,Department of Orthopedic Surgery, Okaya City Hospital, Honmachi, Okaya, Japan
| | - Takako Suzuki
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan,
| | - Hiroyuki Kato
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan,
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22
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Abstract
Short stature is a common and heterogeneous condition that is often genetic in etiology. For most children with genetic short stature, the specific molecular causes remain unknown; but with advances in exome/genome sequencing and bioinformatics approaches, new genetic causes of growth disorders have been identified, contributing to the understanding of the underlying molecular mechanisms of longitudinal bone growth and growth failure. Identifying new genetic causes of growth disorders has the potential to improve diagnosis, prognostic accuracy, and individualized management, and help avoid unnecessary testing for endocrine and other disorders.
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Affiliation(s)
- Youn Hee Jee
- Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, CRC, Room 1-3330, 10 Center Drive MSC 1103, Bethesda, MD 20892-1103, USA.
| | - Anenisia C Andrade
- Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Solnavägen 1, Solna 171 77, Sweden
| | - Jeffrey Baron
- Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, CRC, Room 1-3330, 10 Center Drive MSC 1103, Bethesda, MD 20892-1103, USA
| | - Ola Nilsson
- Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Solnavägen 1, Solna 171 77, Sweden; University Hospital, Örebro University, Södra Grev Rosengatan, Örebro 701 85, Sweden
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