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Madadi S, Alami K, Kaneda Y, Sediqi P. From seizures to cognitive dysfunction: A case report of Fahr syndrome in an Afghan patient. Medicine (Baltimore) 2024; 103:e38542. [PMID: 38905413 PMCID: PMC11192003 DOI: 10.1097/md.0000000000038542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/21/2024] [Indexed: 06/23/2024] Open
Abstract
RATIONALE Fahr syndrome is a rare, degenerative neurological condition characterized by bilateral idiopathic calcification of the periventricular region, especially the basal ganglia. This condition is often misdiagnosed as other neurological or psychiatric disorders due to its rarity and overlapping symptoms. PATIENT CONCERNS A 34-year-old man had been experiencing seizures and cognitive dysfunction for few years, which were further compounded by slurred speech and motor difficulties as acute conditions. DIAGNOSIS After investigations, severe hypocalcemia, and hypoparathyroidism were detected and his brain computed tomography showed extensive bilateral calcifications in basal ganglia, thalamus, dentate nuclei, and some parts of subcortical white matter, suggestive of Fahr syndrome. Although, the patient was initially misdiagnosed due to a lack of information and the rarity of this disease. INTERVENTION The patient was treated with intravenous calcium gluconate, vitamin D3, l-ornithine l-aspartate syrup, and levetiracetam, replacing carbamazepine. OUTCOME His symptoms, including slurred speech, muscle pain, and stiffness improved, serum calcium normalized, and he was discharged with medications for memory deficit and depression. LESSONS This case underscores the importance of raising awareness among physicians, especially in areas with limited medical resources, about the significance of prompt diagnosis and appropriate symptomatic treatment in enhancing patient prognosis and quality of life.
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Affiliation(s)
- Shekiba Madadi
- Neuropsychiatry Department, Ariana Medical Complex, Kabul, Afghanistan
| | - Kawsar Alami
- Neuropsychiatry Department, Ariana Medical Complex, Kabul, Afghanistan
- Department of cognitive neuroscience, Neuroscience Research Center, Kavosh Nonprofit Educational-Research Institute, Kabul, Afghanistan
| | - Yudai Kaneda
- School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Pazhman Sediqi
- Neuropsychiatry Department, Ariana Medical Complex, Kabul, Afghanistan
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Horton A, Fostier W, Winship I, Rajan N. Facial Features of Hereditary Cancer Predisposition. JCO Oncol Pract 2024:OP2300610. [PMID: 38713892 DOI: 10.1200/op.23.00610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/07/2024] [Accepted: 03/26/2024] [Indexed: 05/09/2024] Open
Abstract
In the age of telehealth medicine, an individual's facial features may provide the only physical clues signaling the presence of a heritable cancer predisposition syndrome. These syndromes include APC-associated polyposis, Birt-Hogg-Dubé syndrome, CYLD cutaneous syndrome, hereditary leiomyomatosis and renal cell cancer, multiple endocrine neoplasia, neurofibromatosis type 1, Peutz-Jeghers syndrome, PTEN hamartoma tumor syndrome, and tuberous sclerosis complex 1 and 2, among others. Correctly identifying characteristic features is important for genetic and nongenetic specialists as early detection can enable prompt intervention, improving patient outcomes. Advancements in the availability of genetic testing allow patients and their relatives to have more information about their genetic risk profile than before. These changes in clinical pathways, combined with improvements in screening and risk-reducing treatment, highlight the need to outline the cutaneous and morphologic features of high-risk cancer syndromes for clinicians. In this review, we describe the important facial features of hereditary cancer predisposition, with emphasis on diagnosis, cutaneous and extracutaneous manifestations, and screening.
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Affiliation(s)
- Ari Horton
- Genomic Medicine and Parkville Familial Cancer Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - William Fostier
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ingrid Winship
- Genomic Medicine and Parkville Familial Cancer Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Neil Rajan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
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Almuqbil M, Aldoohan W, Alhinti S, Almahmoud N, Abdulmajeed I, Alkhodair R, Kashgari A, Baarmah D, Altwaijri W, Alrumayyan A. Review of the spectrum of tuberous sclerosis complex: The Saudi Arabian Experience. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2024; 29:113-121. [PMID: 38740395 PMCID: PMC11305360 DOI: 10.17712/nsj.2024.2.20230061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/28/2023] [Indexed: 05/16/2024]
Abstract
OBJECTIVES To determine the prevalence of tuberous sclerosis complex (TSC) in the paediatric Saudi population and to characterise the range of clinical symptoms, neurocutaneous findings, neuroimaging results, and complications of the disease. METHODS A total of 61 genetically confirmed TSC patients from the National Guard Health Affairs (NGHA) in Saudi Arabia were the subject of this retrospective descriptive analysis. The data were presented using descriptive measures. RESULTS The mean age at diagnosis was found to be 4.9 years. Subependymal nodules (86.9%), numerous cortical tubers and/or radial migration lines (63.9%), and hypomelanotic macules (63.9%) were the 3 most common significant criteria. The vast majority (86.9%) of those diagnosed had epilepsy, of which 50% were considered medically intractable. Nearly half of our subjects underwent genetic testing, which revealed that TSC2 predominated over TSC1. Symptoms of Tuberous Sclerosis Complex-Associated Neuropsychiatric Disorders (TAND) were present in 66.7% of TSC1 patients and 73.9% of TSC2 patients. CONCLUSION The findings of this study demonstrate that the clinical spectrum of TSC among Saudi children is consistent with the body of existing literature. The TSC2 was more prevalent than TSC1. The most frequent signs were cutaneous and neurological. Monitoring TSC patients regularly is crucial to identify any issues as soon as possible.
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Affiliation(s)
- Mohammed Almuqbil
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Waad Aldoohan
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Sara Alhinti
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Nora Almahmoud
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Imad Abdulmajeed
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Rayan Alkhodair
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Amna Kashgari
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Duaa Baarmah
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Waleed Altwaijri
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad Alrumayyan
- From the College of Medicine (Almuqbil, Aldoohan, Alhinti, Alkhodair, Kashgari, Altwaijri, Alrumayyan), King Saud bin Abdulaziz University for Health Sciences, from King Abdullah International Medical Research Center (Almuqbil, Alkhodair), Ministry of National Guard, from the Division of Pediatric Neurology (Almuqbil Altwaijri, Alrumayyan), Department of Pediatrics, King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, from the Department of Family Medicine and Primary Health Care (Abdulmajeed), King Abdulaziz Medical City, from the Division of Pediatric Dermatology (Alkhodair), Department of Pediatrics, King Abdullah Specialized Children’s Hospital (KASCH), National Guard Health Affairs, and from Department of Pediatric (Baarmah), King Abdullah Bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
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Dulamea AO, Arbune AA, Anghel D, Boscaiu V, Andronesi A, Ismail G. Neurological and Dermatological Manifestations of Tuberous Sclerosis Complex: Report from a Romanian Tertiary Hospital Cohort. J Clin Med 2023; 12:6550. [PMID: 37892688 PMCID: PMC10607726 DOI: 10.3390/jcm12206550] [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: 09/23/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Tuberous sclerosis complex is a rare multisystem genetic disorder characterized by multiorgan involvement, frequently associated with intellectual impairment and epilepsy. The aim of our study was to describe the neurological and dermatological manifestations of TSC in 32 adult patients (of whom 19 were females) who attended the Neurology and Nephrology Clinics of Fundeni Clinical Institute in Romania from 2015 to 2020. Seventeen patients were diagnosed with epilepsy, nine patients had intellectual impairment, and complete neuroimaging was available for twenty-two patients. As expected, the most frequent dermatological lesions were cutaneous angiofibromas in 20 patients, but with a lower frequency than described in the current literature. Statistical analysis was performed considering the small number of patients. Cortical tubers in neuroimaging seemed to be associated with the diagnosis of epilepsy, while subependymal nodules represented a risk factor for intellectual impairment. Males showed a larger number of dermatological types of lesions, especially café -au-lait patches. Interestingly, we found a statistically significant positive association between epilepsy and the presence of cutaneous angiofibromas, as well as total dermatological involvement. Females had significantly higher Charlson comorbidity index scores, indicating a higher burden of disease. Everolimus seemed to be a well-tolerated treatment and showed promising results in controlling epileptic seizures alone in two patients. More studies, with the inclusion of a larger number of patients, are needed to confirm these results.
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Affiliation(s)
- Adriana Octaviana Dulamea
- Neurology Clinic, Fundeni Clinical Institute, 022328 Bucharest, Romania; (A.O.D.); (D.A.)
- Department III, Dental Medicine Faculty, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Anca Adriana Arbune
- Neurology Clinic, Fundeni Clinical Institute, 022328 Bucharest, Romania; (A.O.D.); (D.A.)
| | - Daniela Anghel
- Neurology Clinic, Fundeni Clinical Institute, 022328 Bucharest, Romania; (A.O.D.); (D.A.)
- Department III, Dental Medicine Faculty, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Voicu Boscaiu
- Institute of Mathematical Statistics and Applied Mathematics “Gheorghe Mihoc-Caius Iacob”, 050711 Bucharest, Romania
| | - Andreea Andronesi
- Nephrology Clinic, Fundeni Clinical Institute, 022328 Bucharest, Romania; (A.A.); (G.I.)
- Department 3, Medicine Faculty, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Gener Ismail
- Nephrology Clinic, Fundeni Clinical Institute, 022328 Bucharest, Romania; (A.A.); (G.I.)
- Department 3, Medicine Faculty, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Prashanth RR, Nair S, Haribalakrishna A, Thakkar H. How early is too early? Diagnosis of tuberous sclerosis complex in a neonate. J Postgrad Med 2023; 69:243-244. [PMID: 37675664 PMCID: PMC10846816 DOI: 10.4103/jpgm.jpgm_326_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/01/2023] [Accepted: 05/29/2023] [Indexed: 09/08/2023] Open
Affiliation(s)
- RR Prashanth
- Department of Neonatology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - S Nair
- Department of Neonatology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - A Haribalakrishna
- Department of Neonatology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - H Thakkar
- Department of Radiology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
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6
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Koufopoulos N, Pateras IS, Koratzanis C, Gouloumis AR, Ieronimaki AI, Fotiou A, Panayiotides IG, Vrachnis N. Uterine collision tumor (PEComa and endometrioid carcinoma) in a tuberous sclerosis patient: a case report. Front Oncol 2023; 13:1244261. [PMID: 37621679 PMCID: PMC10445650 DOI: 10.3389/fonc.2023.1244261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
Perivascular epithelioid cell tumors are very rare mesenchymal neoplasms arising in various locations, such as the female genital tract, kidney, lung, prostate, bladder, pancreas, soft tissues, and bone. They possess a unique immunophenotype, co-expressing myogenic and melanocytic markers; molecular findings include mutations of tuberous sclerosis complex and translocations of transcription factor E3, a member of the microphthalmia transcription factor gene family. We herewith report a uterine collision tumor consisting of a perivascular epithelioid cell tumor and a moderately differentiated endometrial endometrioid carcinoma in a patient with genetically proven tuberous sclerosis; two leiomyomas were also found in contact with the tumor. Although two such cases one with a benign and another with a malignant perivascular epithelioid cell tumor have previously been reported, ours is, to our knowledge, the first reported in a tuberous sclerosis patient.
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Affiliation(s)
- Nektarios Koufopoulos
- Second Department of Pathology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
| | - Ioannis S. Pateras
- Second Department of Pathology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
| | - Christos Koratzanis
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
| | - Alina-Roxani Gouloumis
- Second Department of Pathology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
| | - Argyro-Ioanna Ieronimaki
- Second Department of Pathology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
| | - Alexandros Fotiou
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
| | - Ioannis G. Panayiotides
- Second Department of Pathology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
| | - Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens School of Medicine, “Attikon” University Hospital, Haidari, Greece
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Park L, Reyes-Hadsall S, Dhillon R, Frauenfelder A, Graneiro A, Fayiga FF, Lange C, Duarte AM. Concerning Newborn Rashes and Developmental Abnormalities: Part II: Congenital Infections, Ichthyosis, Neurocutaneous Disorders, Vascular Malformations, and Midline Lesions. Pediatr Rev 2023; 44:447-465. [PMID: 37525307 DOI: 10.1542/pir.2022-005640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Affiliation(s)
- Lily Park
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
- Nova Southwestern University, Fort Lauderdale, FL
| | - Sophia Reyes-Hadsall
- University of Miami Miller School of Medicine, Miami, FL
- Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
| | - Rummit Dhillon
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
- Nova Southwestern University, Fort Lauderdale, FL
| | | | - Ana Graneiro
- Department of Allergy and Immunology, Nicklaus Children's Hospital, Miami, FL
| | - Folasade F Fayiga
- University of Miami Miller School of Medicine, Miami, FL
- Wright State University Boonshoft School of Medicine, Fairborn, OH
- Children's Skin Center, Miami, FL
| | - Carlos Lange
- Children's Skin Center, Miami, FL
- Florida International University, Miami, FL
| | - Ana M Duarte
- University of Miami Miller School of Medicine, Miami, FL
- Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
- Children's Skin Center, Miami, FL
- Florida International University, Miami, FL
- Nova Southwestern University, Fort Lauderdale, FL
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8
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Domínguez-Valdez LF, Hernández-Utrera JE, Chávez-Sánchez IN, Peralta-Amaro AL, Talin-Bosquez MJ, García-Pedraza LA, Hernández-Jiménez CA, Delgado-Carmona DK, Gracia-Ramos AE. Late diagnosis of tuberous sclerosis: a case report. Oxf Med Case Reports 2023; 2023:omad029. [PMID: 37091681 PMCID: PMC10120429 DOI: 10.1093/omcr/omad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/01/2023] [Accepted: 03/06/2023] [Indexed: 04/25/2023] Open
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder characterized by the formation of hamartomas in organ systems such as the brain, skin, kidneys and lungs. Patients with TSC are usually diagnosed early in life. However, in some cases, the diagnosis is delayed until adulthood because various manifestations occur at various times throughout an individual's life. In this regard, we present the case of a female patient diagnosed at the beginning of the seventh decade of life. The patient had a history of seizures and showed clinical findings on the skin (facial angiofibromas, ungual fibromas, 'Confetti-like' skin lesions, shagreen patch), brain (cortical tubers), heart (cardiac rhabdomyomas), kidneys (angiomyolipomas) and a positive genetic test for mutations in TSC2, fulfilling the diagnostic criteria. We compared the differences between manifestations in patients diagnosed during childhood and adulthood. Knowledge of the clinical spectrum of TSC allows early identification.
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Affiliation(s)
- Luis F Domínguez-Valdez
- Departamento de Medicina Interna, UMAE Hospital de Especialidades ‘Dr. Antonio Fraga Mouret’, Centro Médico Nacional ‘La Raza’, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Jaime E Hernández-Utrera
- Departamento de Medicina Interna, UMAE Hospital de Especialidades ‘Dr. Antonio Fraga Mouret’, Centro Médico Nacional ‘La Raza’, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Iliana N Chávez-Sánchez
- Departamento de Medicina Interna, UMAE Hospital de Especialidades ‘Dr. Antonio Fraga Mouret’, Centro Médico Nacional ‘La Raza’, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ana L Peralta-Amaro
- Departamento de Medicina Interna, UMAE Hospital de Especialidades ‘Dr. Antonio Fraga Mouret’, Centro Médico Nacional ‘La Raza’, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Melina J Talin-Bosquez
- Departamento de Cardiología, UMAE Hospital de Especialidades ‘Dr. Antonio Fraga Mouret’, Centro Médico Nacional ‘La Raza’, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Luis A García-Pedraza
- Departamento de Medicina Interna, UMAE Hospital de Especialidades ‘Dr. Antonio Fraga Mouret’, Centro Médico Nacional ‘La Raza’, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Carlos A Hernández-Jiménez
- Departamento de Medicina Interna, UMAE Hospital de Especialidades ‘Dr. Antonio Fraga Mouret’, Centro Médico Nacional ‘La Raza’, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Diana K Delgado-Carmona
- Departamento de Medicina Interna, UMAE Hospital de Especialidades ‘Dr. Antonio Fraga Mouret’, Centro Médico Nacional ‘La Raza’, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Abraham E Gracia-Ramos
- Correspondence address. Departamento de Medicina Interna, UMAE Hospital General ‘Dr. Gaudencio González Garza’, Centro Médico Nacional ‘La Raza’, Instituto Mexicano del Seguro Social. Av. Jacaranda S/N, Col. La Raza, Alcaldía Azcapotzalco, C.P. 02990, Mexico City, Mexico. Tel: (+52)5557245900). E-mail:
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Olvera-Rodríguez V, Barrera Garibay AC, Domínguez-Cherit J. Giant Koenen Tumors as the Presenting and Only Clinical Sign of Tuberous Sclerosis Complex in a 56-Year-Old Man and Its Surgical Management. Skin Appendage Disord 2022; 8:492-496. [PMID: 36407640 PMCID: PMC9672865 DOI: 10.1159/000524858] [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: 02/16/2022] [Accepted: 04/27/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Tuberous sclerosis complex (TSC) is a genetic multisystem disorder with prominent skin involvement. Multiple ungual fibromas, also known as Koenen tumors (KTs), are one of the major diagnostic criteria and occur approximately in 50% of patients with TSC. They are disfiguring, painful, and challenging to treat as they frequently recur. There are 2 previous cases in the literature of KTs as the only clinical sign of TSC. Case Presentation A 56-year-old male patient with intellectual disability presented with a history of ungual growths that had gradually increased in size and number for 20 years. The diagnosis of KTs was established on clinical grounds, without the requirement of histological confirmation. No additional clinical evidence of TSC was found. Complete surgical excision of the tumors located in the proximal nail matrix, periungual folds, and nail bed of each toe was successfully performed. Discussion The association between KTs and intellectual disability with TSC supported the clinical diagnosis. To date, there is no standard first-line treatment for KTs. Complete surgical excision up to the proximal base of the tumor offers satisfactory results in terms of functionally and esthetic appearance and could be considered the preferred therapeutic modality for patients with severe functional and cosmetic impairment. Prompt recognition of the many signs and symptoms associated with TSC is important to achieve early diagnosis, preventing further complications.
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Affiliation(s)
- Valeria Olvera-Rodríguez
- Escuela de Medicina y Ciencias de la Salud, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | - Andrea C. Barrera Garibay
- Escuela de Medicina y Ciencias de la Salud, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Judith Domínguez-Cherit
- Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico
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Deng S, Shi W, Cai Y, Tang Y, Liu W, Yin P, Chen C, Meng L, Dong H, Huang J, Liu Y. Tuberous sclerosis complex with skin lesions as the initial presentation: A case report and multidisciplinary discussion. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:973-980. [PMID: 36039596 PMCID: PMC10930287 DOI: 10.11817/j.issn.1672-7347.2022.210452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Indexed: 06/15/2023]
Abstract
We reported a case of tuberous sclerosis complex with facial angiofibroma as the initial presentation and conducted a multidisciplinary discussion. The patient, a young female, was admitted to the Department of Dermatology for cosmetic purpose. After the examination, she was found to have multiple system involvement, including a large renal angiomyolipoma pressing on the liver. She never had any subjective symptom. After consultation by the multidisciplinary team of tuberous sclerosis complex, the patient was treated with everolimus orally and followed up regularly. It is suggested that dermatologists should pay attention to the systemic involvement of patients with tuberous sclerosis complex. Early intervention can prolong the life of patients and improve their life quality. Multidisciplinary collaboration for lifelong disease management is the key to enhance the diagnosis and treatment for tuberous sclerosis complex and enhance the prognosis of patients.
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Affiliation(s)
- Sihan Deng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008.
| | - Wei Shi
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008.
| | - Yi Cai
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008
| | - Yongjun Tang
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha 410008
| | - Weiping Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008
| | - Ping Yin
- Department of Stomatology, Xiangya Hospital, Central South University, Changsha 410008
| | - Chen Chen
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha 410008
| | - Li Meng
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008
| | - Huixi Dong
- Mental Health Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jundong Huang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008
| | - Yu Liu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008
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Wang X, Wang W, Zhao Y, Wang Z, Zhang Y. Analysis of Clinical Features and Next-Generation Sequencing of 12 Tuberous Sclerosis Families in China. Front Med (Lausanne) 2022; 9:840709. [PMID: 35712104 PMCID: PMC9197381 DOI: 10.3389/fmed.2022.840709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disease with systemic organ involvement. So far, only a few TSC families in China have been reported. Therefore, more data on the clinical and genetic features of TSC families are required. Materials and Methods We retrospectively analyzed 12 TSC family probands and their family members. Next-generation sequencing (NGS) has been applied to confirm the type of TSC mutation along with a detailed physical examination. Results In this study, twenty-seven patients in 12 TSC families were reported, including 12 male and 15 female patients, aged 8-67 years. Skin lesions were detected among all patients with TSC, including 25 cases of facial angiofibromas, 18 cases of hypomelanotic macules, 15 cases of ungual fibromas, and 13 cases of shagreen patch. Other clinical features were also revealed: 14 cases of renal angiomyolipoma, 6 cases of subependymal nodules (SENs), and 3 cases of lymphangioleiomyomatosis. All twenty-seven patients with TSC were tested by NGS. Totally, TSC2 mutations were reported in 19 cases (7 frameshift mutations, 10 nonsense mutations, and 2 missense mutations), TSC1 mutations were reported in 4 cases (4 nonsense mutations), and 4 cases were genetically negative. The novel causal mutations (TSC2: c.208dup, c.1874C > G, c.1852del) identified in three families were first reported in TSC. Conclusion Our findings expand the mutation spectrum of patients with TSC in China. The clinical characteristics can vary among patients with TSC with the same pathogenic mutation. The genetic results and summary of clinical features of 12 TSC families contribute to a more accurate diagnosis and further genetic counseling.
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Affiliation(s)
- Xu Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenda Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Zhao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhan Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Barzegar M, Poorshiri B, Yousefi L, Raeisi S, Bakhtiary H, Eftekhari Milani A, Ebadi Z. The clinical and paraclinical manifestations of tuberous sclerosis complex in children. Acta Neurol Belg 2022; 122:385-390. [PMID: 33738777 DOI: 10.1007/s13760-021-01635-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal-dominant, multi-system, neurocutaneous disorder characterized by hamartomas in multiple organs. This study aimed to evaluate the clinical and paraclinical manifestations of children with TSC. The clinical and paraclinical characteristics of 79 children with TSC were evaluated and the possible correlations between the factors were calculated. Among the studied children which composed of 41 females (51.9%) and 38 males (48.1%), skin manifestations as hypopigmented macules as well as the brain involvement as cortical tubers in all (100%) cases, seizure in 74 (93.7%), and sub-ependymal nodules in 73 (92.4%) patients were the most common findings. The renal angiomyolipoma was diagnosed in 36 (70.6%) out of 51 patients. Subependymal giant cell astrocytoma in 25 (3/54%) out of 46 patients, retinal hamartoma in 15 (42.9%) out of 35 patients, and cardiac rhabdomyoma in 17 (41.3%) out of 46 patients were diagnosed. Furthermore, 50 (63.3%) out of 79 patients had psychological disorders that had a significant correlation with the prevalence of seizures (p = 0.002). Given the multi-systemic involvement of TSC, it is necessary that all organs of the patients even without any related clinical symptom or sign be examined regularly for proper therapeutic intervention and prevent disease progression. The growth of hamartomas in the brain and kidneys can be life-threatening; therefore, these organs have more importance to be regularly followed up and examined.
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Affiliation(s)
- Mohammad Barzegar
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Bita Poorshiri
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Yousefi
- Medical Radiation Sciences Research Group, Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Raeisi
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Bakhtiary
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Eftekhari Milani
- Department of Ophthalmology, Nikookary Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zakiyeh Ebadi
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Alshoabi SA, Hamid AM, Alhazmi FH, Qurashi AA, Abdulaal OM, Aloufi KM, Daqqaq TS. Diagnostic features of tuberous sclerosis complex: case report and literature review. Quant Imaging Med Surg 2022; 12:846-861. [PMID: 34993123 DOI: 10.21037/qims-21-412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/06/2021] [Indexed: 01/09/2023]
Abstract
Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic syndrome that is caused by mutations in the tumour suppressor genes TSC1 or TSC2 which causes multiorgan growths. TSC presents at any age as a wide range of clinical and phenotypic manifestations with varying severity. The main goal of this article was to state two cases of TSC and review the most commonly reported major and minor diagnostic clinical features and the most common features that led to an investigation of possible TSC diagnosis. Herein, we report two cases of TSC, which both presented with seizures during the first 6 months of life. Case 1 presented with multiple types of seizures from 6 months of age and was diagnosed by multiple calcified subependymal nodules (SENs) detected by computed tomography and magnetic resonance imaging (MRI). Case 2 presented with seizures from 3 months of age and was diagnosed prenatally when a tumour was seen in her heart during antenatal ultrasonography. In conclusion, the literature review revealed that neurological manifestations (mainly seizures) were the main feature that led to investigation and diagnosis of TSC followed by abdominal manifestations (mainly renal features) and antenatal follow-up imaging. Other manifestations in skin, chest, eyes, teeth and heart rarely led to TSC diagnosis. In some cases, TSC was incidentally discovered by medical imaging. The cortical tubers, SENs, and subependymal giant cell astrocytomas brain lesions were the most commonly reported major features. Skin features including angiofibromas, ungual fibromas and shagreen patch were the second most common major features reported in the literature. However, skin manifestations were not a common led to investigation and diagnosis of TSC. Renal features, mainly angiomyolipomas (AMLs), were the third most common major feature reported. Medical imaging plays an essential role in diagnosis of TSC, and clinical features are important clues that lead to investigation for the disease.
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Affiliation(s)
- Sultan Abdulwadoud Alshoabi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, Kingdom of Saudi Arabia
| | | | - Fahad H Alhazmi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, Kingdom of Saudi Arabia
| | - Abdulaziz A Qurashi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, Kingdom of Saudi Arabia
| | - Osamah M Abdulaal
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, Kingdom of Saudi Arabia
| | - Khaled M Aloufi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, Kingdom of Saudi Arabia
| | - Tareef S Daqqaq
- Radiology Department, Faculty of Medicine, Taibah University, Almadinah Almunawwarah, Kingdom of Saudi Arabia
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Albaghdadi M, Thibodeau ML, Lara-Corrales I. Updated Approach to Patients with Multiple Café au Lait Macules. Dermatol Clin 2021; 40:9-23. [PMID: 34799039 DOI: 10.1016/j.det.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Café au lait macules (CALMs) are a normal and frequent finding in the general population, but multiple CALMs raise the possibility of an underlying neurocutaneous disease like neurofibromatosis type I. Certain features of CALMs like number, size, shape, and distribution are important in identifying children at higher risk of having a neurocutaneous disorder or another genetic disorder. Genetic testing can be especially helpful in establishing a diagnosis in atypical presentations, or when the child is young and other features of the disease aside from CALMs have not manifested.
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Affiliation(s)
| | - My Linh Thibodeau
- Division of Clinical and Metabolic Genetics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Irene Lara-Corrales
- Pediatric Dermatology, Division of Dermatology, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G1X8, Canada.
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15
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Quartier J, Lapteva M, Boulaguiem Y, Guerrier S, Kalia YN. Polymeric micelle formulations for the cutaneous delivery of sirolimus: A new approach for the treatment of facial angiofibromas in tuberous sclerosis complex. Int J Pharm 2021; 604:120736. [PMID: 34048926 DOI: 10.1016/j.ijpharm.2021.120736] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/13/2022]
Abstract
Facial angiofibromas are benign tumors characteristic of tuberous sclerosis complex. The disease involves the mTOR pathway and the cutaneous manifestation responds to topical treatment with sirolimus (SIR). However, there are no approved topical SIR products and extemporaneous formulations have been sub-optimal. The aims of this study were (i) to develop aqueous formulations of SIR loaded in polymeric micelles prepared using D-α-tocopherol polyethylene glycol 1000 succinate (TPGS) and (ii) to use the cutaneous biodistribution method, in conjunction with a new statistical approach, to investigate the feasibility of SIR delivery to the viable epidermis. Optimized micelle solutions and hydrogels (0.2%) were developed and stable at 4 °C for at least 6 and 3 months, respectively. Cutaneous delivery experiments (infinite and finite dose) using porcine skin demonstrated that both formulations increased SIR cutaneous bioavailability as compared to the control (ointment 0.2%). Moreover, studies with the micellar hydrogel 0.2% demonstrated SIR deposition in the viable epidermis with no transdermal permeation. These encouraging results confirmed that polymeric micelles enabled development of aqueous SIR formulations capable of targeted epidermal delivery. Furthermore, the cutaneous biodistribution provided a detailed insight into drug bioavailability in the different skin compartments that could complement/explain clinical observations of formulation efficacy.
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Affiliation(s)
- Julie Quartier
- School of Pharmaceutical Sciences, University of Geneva, CMU-1 rue Michel Servet, 1211 Genève 4, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU-1 rue Michel Servet, 1211 Genève 4, Switzerland
| | - Maria Lapteva
- School of Pharmaceutical Sciences, University of Geneva, CMU-1 rue Michel Servet, 1211 Genève 4, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU-1 rue Michel Servet, 1211 Genève 4, Switzerland
| | - Younes Boulaguiem
- Geneva School of Economics and Management, University of Geneva, 40 Boulevard du Pont d'Arve, 1204 Genève, Switzerland
| | - Stéphane Guerrier
- School of Pharmaceutical Sciences, University of Geneva, CMU-1 rue Michel Servet, 1211 Genève 4, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU-1 rue Michel Servet, 1211 Genève 4, Switzerland; Geneva School of Economics and Management, University of Geneva, 40 Boulevard du Pont d'Arve, 1204 Genève, Switzerland
| | - Yogeshvar N Kalia
- School of Pharmaceutical Sciences, University of Geneva, CMU-1 rue Michel Servet, 1211 Genève 4, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU-1 rue Michel Servet, 1211 Genève 4, Switzerland.
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Oba MÇ, Uzunçakmak TK, Sar M, Serdaroğlu S. Dermoscopic findings in a case of multiple subungual fibromas. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2021. [DOI: 10.15570/actaapa.2021.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Hamroun A, Lenain R, Provôt F, Maanaoui M, Lionet A. An unusual case of multiple bilateral kidney tumors. J Nephrol 2020; 34:1783-1784. [PMID: 33113122 DOI: 10.1007/s40620-020-00891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Aghilès Hamroun
- Nephrology, Dialysis, and Kidney Transplantation Department, Lille University, Regional and University Hospital Center of Lille, 59000, Lille, France. .,Center for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, National Institute of Health and Medical Research, Villejuif, France.
| | - Rémi Lenain
- Nephrology, Dialysis, and Kidney Transplantation Department, Lille University, Regional and University Hospital Center of Lille, 59000, Lille, France
| | - François Provôt
- Nephrology, Dialysis, and Kidney Transplantation Department, Lille University, Regional and University Hospital Center of Lille, 59000, Lille, France
| | - Mehdi Maanaoui
- Nephrology, Dialysis, and Kidney Transplantation Department, Lille University, Regional and University Hospital Center of Lille, 59000, Lille, France.,INSERM U1190, Translational Research for Diabetes, Lille, France
| | - Arnaud Lionet
- Nephrology, Dialysis, and Kidney Transplantation Department, Lille University, Regional and University Hospital Center of Lille, 59000, Lille, France
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Acne in the first three decades of life: An update of a disorder with profound implications for all decades of life. Dis Mon 2020; 67:101103. [PMID: 33041056 DOI: 10.1016/j.disamonth.2020.101103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acne vulgaris is a chronic, inflammatory, skin condition that involves the pilosebaceous follicles and is influenced by a variety of factors including genetics, androgen-stimulation of sebaceous glands with abnormal keratinization, colonization with Cutibacterium acnes (previously called Propionibacterium acnes), and pathological immune response to inflammation. Acne can occur at all ages and this discussion focuses on the first three decades of life. Conditions that are part of the differential diagnosis and/or are co-morbid with acne vulgaris are also considered. Acne in the first year of life includes neonatal acne (acne neonatorum) that presents in the first four weeks of life and infantile acne that usually presents between 3 and 6 months of the first year of life with a range of 3 to 16 months after birth. Acne rosacea is a chronic, inflammatory, skin condition that is distinct from acne vulgaris, typically presents in adults, and has four main types: erythemato-telangiectatic, papulopustular, phymatous and ocular. Treatment options for acne vulgaris include topical retinoids, topical benzoyl peroxide, antibiotics (topical, oral), oral contraceptive pills, isotretinoin, and others. Management must consider the increasing impact of antibiotic resistance in the 21st century. Psychological impact of acne can be quite severe and treatment of acne includes awareness of the potential emotional toll this disease may bring to the person with acne as well as assiduous attention to known side effects of various anti-acne medications (topical and systemic). Efforts should be directed at preventing acne-caused scars and depigmentation on the skin as well as emotional scars within the person suffering from acne.
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Abstract
The hereditary nature of some forms of cancer was recognized long ago. Over time, recognition of associated findings led to the delineation of numerous hereditary cancer syndromes. Many of these syndromes also have cutaneous manifestations, the recognition of which can lead to their early identification. Recognition of these syndromes allows vigilant surveillance and preemptive treatment, which can dramatically impact the risks of morbidity and mortality for affected patients. The rise of rapid and accurate genetic testing now allows the early identification of asymptomatic at risk family members so that monitoring can be initiated as early as possible. The dermatologist plays a critical role in early identification of these syndromes and, in many cases, their treatment. This review summarizes many known hereditary cancer syndromes with cutaneous findings, their etiology, identification, evaluation, and management. Importantly, this is an ever evolving topic and new findings and syndromes will continue to be recognized. The dermatologist must be always alert to ensure they are detected.
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Affiliation(s)
- Ryan Ladd
- Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Matthew Davis
- Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Jonathan A Dyer
- Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri, USA.
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Gao Z, Hua B, Ge X, Liu J, Xue L, Zhen F, Luo J. Comparison Between Size and Stage of Preoperative Tumor Defined by Preoperative Magnetic Resonance Imaging and Postoperative Specimens After Radical Resection of Esophageal Cancer. Technol Cancer Res Treat 2020; 18:1533033819876263. [PMID: 31551000 PMCID: PMC6763937 DOI: 10.1177/1533033819876263] [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] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Our objective is to explore the accuracy of magnetic resonance imaging in determining the preoperative T and N staging, pathological stage, and the length of esophageal tumor in patients with esophageal cancer. METHODS This retrospective analysis included 57 patients admitted to the Department of Thoracic Surgery of The First Affiliated Hospital of Nanjing Medical University between January 2015 and December 2016. Postoperative pathological results were used as the reference to verify the accuracy of magnetic resonance imaging in evaluating tumor T and N staging, pathological stage, and tumor length. The correlation between tumor lengths-measured using magnetic resonance imaging and the surgical specimen measurements-was evaluated. RESULTS The mean age of the patients was 64.6 ± 7.2 years, with a range of 47 to 77 years. The overall accuracy rate of magnetic resonance imaging in T staging of esophageal cancer was 63.2%; magnetic resonance imaging was generally consistent in the N staging of esophageal cancer. Magnetic resonance imaging and surgical evaluation of tumor length were in excellent agreement (κ = .82, P < .001), while that of gastroscopy and postoperative pathology was moderate (κ = .63, P < .001). CONCLUSION Magnetic resonance imaging is highly accurate in determining the preoperative T and N staging, pathologic stage, and tumor length in patients with esophageal cancer, which is important in deciding the choice of preoperative treatment and the surgical approach.
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Affiliation(s)
- Zhenzhen Gao
- Department of Clinical Oncology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Beibei Hua
- Department of Radiation Oncology, Yili Friendship Hospital, Xinjiang, China
| | - Xiaolin Ge
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jinyuan Liu
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Xue
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fuxi Zhen
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jinhua Luo
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Mundhe B, Warpe B, Joshi-Warpe S, Kulkarni A. Cutaneous angiofibroma: A clinching evidence for diagnostic workup of tuberous sclerosis complex. INDIAN JOURNAL OF DERMATOPATHOLOGY AND DIAGNOSTIC DERMATOLOGY 2020. [DOI: 10.4103/ijdpdd.ijdpdd_54_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Furuya M, Hasumi H, Yao M, Nagashima Y. Birt-Hogg-Dubé syndrome-associated renal cell carcinoma: Histopathological features and diagnostic conundrum. Cancer Sci 2019; 111:15-22. [PMID: 31777168 PMCID: PMC6942440 DOI: 10.1111/cas.14255] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022] Open
Abstract
Birt‐Hogg‐Dubé (BHD) syndrome is associated with the development of hereditary renal cell carcinoma (RCC) and is caused by a germline mutation in the folliculin gene. Most cases of BHD syndrome‐associated RCC (BHD‐RCC) are less aggressive than sporadic clear cell RCC and multifocal. Therefore, it is critical to distinguish BHD‐RCC from its sporadic counterparts to identify and monitor affected families and to preserve renal function for as long as possible. The World Health Organization/International Society of Urological Pathology consensus classification defined distinct entities for certain hereditary RCC; however, BHD‐RCC was not included in this classification. Although the clinical features and molecular mechanisms of BHD‐RCC have been investigated intensively over the last two decades, pathologists and urologists occasionally face difficulties in the diagnosis of BHD‐RCC that require genetic testing. Affected patients usually have miscellaneous benign disorders that often precede renal carcinogenesis. In the present review, we summarize the current understanding of the histopathological features of BHD‐RCC based on our epidemiological studies of Japanese families and a literature review. Pathological diagnostic clues and differential diagnosis of BHD‐RCC from other hereditary RCC are also briefly discussed.
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Affiliation(s)
- Mitsuko Furuya
- Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hisashi Hasumi
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
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Abstract
The discoveries of new genes underlying genetic skin diseases have occurred at a rapid pace, supported by advances in DNA sequencing technologies. These discoveries have translated to an improved understanding of disease mechanisms at a molecular level and identified new therapeutic options based on molecular targets. This article highlights just a few of these recent discoveries for a diverse group of skin diseases, including tuberous sclerosis complex, ichthyoses, overgrowth syndromes, interferonopathies, and basal cell nevus syndrome, and how this has translated into novel targeted therapies and improved patient care.
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Auvin S, Bissler JJ, Cottin V, Fujimoto A, Hofbauer GFL, Jansen AC, Jóźwiak S, Kerecuk L, Kingswood JC, Moavero R, Torra R, Villanueva V. A step-wise approach for establishing a multidisciplinary team for the management of tuberous sclerosis complex: a Delphi consensus report. Orphanet J Rare Dis 2019; 14:91. [PMID: 31039793 PMCID: PMC6492321 DOI: 10.1186/s13023-019-1072-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/17/2019] [Indexed: 12/13/2022] Open
Abstract
Background Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder associated with mutations in TSC1 and TSC2 genes, upregulation of mammalian target of rapamycin signaling, and subsequent tumor formation in various organs. Due to the many manifestations of TSC and their potential complications, management requires the expertise of multiple medical disciplines. A multidisciplinary care approach is recommended by consensus guidelines. Use of multidisciplinary teams (MDTs) has been shown to be beneficial in treating other complex diseases, such as cancer. In a lifelong disease such as TSC, an MDT may facilitate the transition from pediatric to adult care. However, little guidance exists in the literature regarding how to organize an MDT in TSC. Methods To discuss the best approach to assembling an MDT, this project was initiated in October 2017 with a meeting of 12 physicians from various specialties and various countries. Following this first meeting, the experts generated statements on the most important aspects to implement in establishing an MDT for TSC by 3 rounds of selection using a Delphi process via electronic correspondence. Finally, TSC patient advocates reviewed the findings and provided additional insights from a patient perspective. Results A 3-step roadmap was recommended, starting with identifying a single individual to begin organizing care (Step 1), then establishing a small core team (Step 2), and finally, establishing a larger multi-disciplinary team (Step 3). Because of the multisystemic nature of TSC, the MDT should include specialists such as a neurologist, a neurosurgeon, a nephrologist, a urologist, a pulmonologist, an ophthalmologist, a cardiologist, a dermatologist, a geneticist, and a psychiatrist/psychologist. The MDT should recommend a care plan for each patient based on the individual’s needs and in consultation with him/her or his/her family. Some of the most important aspects of an MDT that were agreed upon included identifying a case manager to help coordinate care, providing access to health care professionals of varying specialties, and including a lead physician who takes medical responsibility for patients’ overall care. Conclusions The results of our consensus provide guidance to support the initiation of an MDT in TSC.
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Affiliation(s)
- Stéphane Auvin
- Service de Neurologie Pédiatrique et des Maladies Métaboliques, APHP, Robert-Debré Children's Hospital, 48 Boulevard Serurier, 75019, 19, Paris Cedex, France. .,INSERM U1141, Paris, France.
| | - John J Bissler
- St. Jude Children's Research Hospital and Le Bonheur Children's Hospital, 848 Adams Ave, Memphis, TN, 38103, USA
| | - Vincent Cottin
- Claude Bernard University of Lyon 1, Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, UMR754, 69677, Lyon, Cedex, France
| | - Ayataka Fujimoto
- Seirei Hamamatsu General Hospital, 2 Chome-12-12 Sumiyoshi, Naka Ward, Hamamatsu, Japan
| | | | - Anna C Jansen
- UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Sergiusz Jóźwiak
- Department of Child Neurology, Warsaw Medical University, Banacha 1, 02-097, Warsaw, Poland.,Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Larissa Kerecuk
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B15 2TG, UK
| | | | - Romina Moavero
- Tor Vergata University Hospital, Via Columbia, 2, 00133, Rome, Italy.,Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Roser Torra
- Fundació Puigvert, Universitat Autónoma Barcelona, REDINREN, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain
| | - Vicente Villanueva
- Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
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Singh S, Sahni K, Arava S. Speckled Acral Hypopigmentation: A New Pigmentary Disorder or an Unknown Presentation of a Known Disorder? Indian Dermatol Online J 2019; 10:182-183. [PMID: 30984599 PMCID: PMC6434748 DOI: 10.4103/idoj.idoj_139_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sanjay Singh
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanika Sahni
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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McEneaney LJ, Tee AR. Finding a cure for tuberous sclerosis complex: From genetics through to targeted drug therapies. ADVANCES IN GENETICS 2018; 103:91-118. [PMID: 30904097 DOI: 10.1016/bs.adgen.2018.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Tuberous sclerosis complex (TSC) is a rare, autosomal dominant genetic condition caused by a mutation in either the TSC1 or TSC2 gene. Phenotypically, this leads to aberrant cell growth and the formation of benign tumors called hamartomas in multiple organs. Understanding the mechanisms of pathology that are caused through the presence of disease causing mutations is a real hurdle for many rare genetic disorders; a limiting factor that restricts knowledge of the disease and any hope of a future cure. Through the discovery of the TSC1 and TSC2 genes and the signaling pathways responsible for the pathology of TSC, a new drug target called mechanistic target of rapamycin complex 1 (mTORC1) was discovered. Rapamycin, an mTORC1 inhibitor, is now the only pharmacological therapy approved for the treatment of TSC. This chapter summarizes the success story of TSC and explores the future possibilities of finding a cure.
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Affiliation(s)
- Lauren J McEneaney
- Division of Cancer and Genetics, Cardiff University, Cardiff, United Kingdom
| | - Andrew R Tee
- Division of Cancer and Genetics, Cardiff University, Cardiff, United Kingdom.
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27
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Okhlopkov VA, Zykova EA, Pravdina OV. Tuberous sclerosis syndrome: a typical case of a rare disease. VESTNIK DERMATOLOGII I VENEROLOGII 2018. [DOI: 10.25208/0042-4609-2018-94-4-49-54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article is devoted to a rare hereditary disease from the group of phak omatoses with an autosomal dominant type of inheritance — Pringle — Burnevill disease. The questions of the prevalence of the disease, the variability of the clinical picture, the timeliness of the clinical diagnosis are considered. Particular attention is paid to skin manifestations and their differential diagnosis. A clinical case of this disease is described.
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28
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Reimer A, He Y, Has C. Update on Genetic Conditions Affecting the Skin and the Kidneys. Front Pediatr 2018; 6:43. [PMID: 29552546 PMCID: PMC5840143 DOI: 10.3389/fped.2018.00043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/14/2018] [Indexed: 01/01/2023] Open
Abstract
Genetic conditions affecting the skin and kidney are clinically and genetically heterogeneous, and target molecular components present in both organs. The molecular pathology involves defects of cell-matrix adhesion, metabolic or signaling pathways, as well as tumor suppressor genes. This article gives a clinically oriented overview of this group of disorders, highlighting entities which have been recently described, as well as the progress made in understanding well-known entities. The genetic bases as well as molecular cell biological mechanisms are described, with therapeutic applications.
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Affiliation(s)
- Antonia Reimer
- Department of Dermatology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.,Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Yinghong He
- Department of Dermatology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Cristina Has
- Department of Dermatology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
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Mao S, Long Q, Lin H, Liu J. Rapamycin therapy for neonatal tuberous sclerosis complex with cardiac rhabdomyomas: A case report and review. Exp Ther Med 2017; 14:6159-6163. [PMID: 29285173 PMCID: PMC5740740 DOI: 10.3892/etm.2017.5335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 07/11/2017] [Indexed: 11/19/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disease that varies greatly in its expression. The current study reports a novel case of TSC caused by a TSC2 mutation (TSC2c.1642_1643insA or TSC2p.K549fsX589), in which multiple cardiac rhabdomyomas were detected by fetal echocardiography in week 31 of pregnancy. The infant was delivered successfully; however, seizures began 16 days following birth. Subsequent genetic tests confirmed a diagnosis of TSC. Rapamycin treatment resulted in regression of cardiac rhabdomyomas and controlled seizures. The current study demonstrates the value of fetal echocardiography in the diagnosis of TSC and suggests that inhibition of the mammalian target of the rapamycin (mTOR) signaling pathway may be considered as a potential antiepileptogenic therapy for neonatal TSC. In addition, it was demonstrated that rapamycin treatment was therapeutically beneficial for preventing disorders caused by abnormal mTOR signaling, such as cancer. According to the literature, cardiac rhabdomyomas, seizures and skin lesions are well established markers for TSC in neonates. MRI scans of the brain and genetic screening of TSC1 and TSC2 genes may facilitate an early diagnosis of TSC.
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Affiliation(s)
- Shanshan Mao
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310052, P.R. China
| | - Qi Long
- Department of Clinical Nutrition, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310052, P.R. China
| | - Huijia Lin
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310052, P.R. China
| | - Jinling Liu
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310052, P.R. China
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