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Alanazi AI, Alanezi T, Aljofan ZF, Alarabi A, Elwatidy S. Lhermitte-Duclos disease: A systematic review. Surg Neurol Int 2023; 14:351. [PMID: 37810307 PMCID: PMC10559389 DOI: 10.25259/sni_555_2023] [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: 07/01/2023] [Accepted: 09/02/2023] [Indexed: 10/10/2023] Open
Abstract
Background Lhermitte-Duclos disease (LDD) is a rare tumor, with only about 300 reported cases. It often shows comorbidity with Cowden syndrome (CS); however, it can occur by itself. Radiologically, the "tiger-stripe" appearance is considered pathognomonic. Surgical resection remains the mainstay of treatment. This report aims to describe the clinical and radiological characteristics of LDD and its relationship with CS according to age group. Methods PubMed electronic databases were searched in August 2022. The search terms included "Lhermitte- Duclos disease" and "dysplastic gangliocytoma," which yielded 297 and 103 research articles, respectively. The articles were collected and reviewed by three researchers. Results Out of 400 identified articles, we analyzed 302 reported cases. The mean age at presentation was 33.6 ± 16 years; 171 patients (56.6%) were female, and 123 (40.7%) were male. The most commonly reported symptom was headache (174 patients, 57.6%), followed by ataxia (109, 36.1%). In addition, 99 cases (32.8%) were associated with CS, and 60 (19.9%) had a confirmed phosphatase and tensin homolog (PTEN) mutation. A tiger-stripe appearance was observed in 208 cases (58.7%); surgical resection was performed in 64.2% of the cases. Mortality and recurrence rates were 4.3% and 8.6%, respectively. No statistically significant difference was found between adult- and pediatric-onset LDD for the association with CS (P = 0.128). Conclusion Our findings suggest that adult and pediatric LDD have major commonalities; however, further prospective studies are warranted.
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Affiliation(s)
- Aued Iaed Alanazi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Tariq Alanezi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ziyad Fahad Aljofan
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alwaleed Alarabi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sherif Elwatidy
- Department of Neurosurgery, King Saud University, Riyadh, Saudi Arabia
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Pregúntegui-Loayza I, Apaza-Tintaya A, Ramírez-Espinoza A, Mayo-Simón N, Toledo-Aguirre M. Lhermitte-Duclos Disease in Pediatric Population: Report of 2 Cases. Pediatr Neurosurg 2021; 56:279-285. [PMID: 33780960 DOI: 10.1159/000514335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Lhermitte-Duclos disease (LDD), also known as dysplastic cerebellar gangliocytoma, is an uncommon disorder in children, characterized by being a slow-growing lesion of the posterior fossa, which mainly affects the granular cell layer of the cerebellar parenchyma and may be associated with other multiple hereditary hamartomas and neoplasms. CASE PRESENTATION We report 2 cases of LDD in pediatric patients and describe clinical symptoms and radiological and histopathological characteristics. In addition, we analyzed the relation to Cowden Syndrome based on the International Cowden Syndrome Consortium Operational Criteria and the most updated guidelines by the National Comprehensive Cancer Network (NCCN Guidelines Version 1.2020). CONCLUSION LDD is a very rare disease in childhood but should be considered in the differential diagnosis of posterior fossa lesions. LDD can mimic low-grade glial tumors or infectious diseases. Patients develop late clinical manifestations due to the slow-growing pattern, and conservative treatment with outpatient follow-up may be an option in asymptomatic children.
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Affiliation(s)
| | | | | | - Nancy Mayo-Simón
- Diagnostic Support Unit, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
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Cheng CS, Ou CH, Chen JS, Lui CC, Yeh LR. Lhermitte-Duclos disease: A case report with radiologic-pathologic correlation. Radiol Case Rep 2019; 14:734-739. [PMID: 30988866 PMCID: PMC6447731 DOI: 10.1016/j.radcr.2019.03.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/14/2019] [Accepted: 03/17/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Lhermitte-Duclos disease (LDD) stems from the development of a rare benign lesion of uncertain pathogenesis that distorts the normal cerebellar laminar cytoarchitecture. We explored the lesion's appearance on conventional magnetic resonance imaging (MRI) combined with susceptibility-weighted imaging, diffusion-weighted imaging, perfusion imaging, or arterial spin labeling. Although many cases of LDD have been previously reported in the literature, the radiologic-pathologic correlation has been described in only a few of these cases. To the best of our knowledge, this is the first case report to provide detailed information about the radiologic-pathologic correlation of LDD. Case Report: A 48-year-old woman presented with left facial tics, occipital headache, and dizziness for 1 month. MRI revealed a left cerebellar lesion with hypointensity on T1-weighted images. On T2-weighted images, the mass was hyperintense with tigroid appearance due to alternating high and normal signal intensities. High signal intensity was noted on fluid-attenuated inversion recovery images. Magnetic resonance spectroscopy indicated decreased level of choline (Cho), N-acetyl aspartate, and myoinositol with elevated level of lactate on the affected side. The lesion showed a bright signal on diffusion-weighted images, whereas apparent diffusion coefficient mapping revealed no disturbance of diffusion. The pathology of the excised lesion was consistent with LDD. Conclusion: MRI with advanced techniques can provide not only preoperative diagnosis but also better pathologic correlation.
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Key Words
- ASL, arterial spin labeling
- CS, Cowden syndrome
- CT, computed tomography
- Cho, choline
- DWI, diffusion-weighted imaging
- EMA, epithelial membrane antigen
- FLAIR, fluid-attenuated inversion recovery images
- GFAP, glial fibrillary acidic protein
- LDD, Lhermitte-Duclos disease
- Lhermitte-Duclos disease
- MI, myoinositol
- MR, magnetic resonance
- MRI
- MRI, magnetic resonance image
- MRS, magnetic resonance spectroscopy
- NAA, N-acetyl aspartate
- NCV, nerve conduction velocity
- PTEN, phosphatase and tensin homologue
- Radiologic-pathologic correlation
- SWI, susceptibility-weighted imaging
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Affiliation(s)
- Chiu-Shih Cheng
- Department of Medical Imaging, E-Da Hospital, I-Shou University, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan
| | - Chang-Hsien Ou
- Division of Neuroradiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Jui-Sheng Chen
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Chun-Chung Lui
- Division of Medical Imaging, E-Da Cancer Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Lee-Ren Yeh
- Department of Medical Imaging, E-Da Hospital, I-Shou University, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan
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Affiliation(s)
- Aashim Bhatia
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Sumit Pruthi
- Department of Radiology and Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN; Department of Pediatric Neuroradiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN; Department of Pediatric Radiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
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Otheman Y, Aalouane R, Aarab C, Rammouz I. A case report of Lhermitte-Duclos disease revealed by psychiatric disturbances. Ann Gen Psychiatry 2017; 16:24. [PMID: 28572832 PMCID: PMC5450341 DOI: 10.1186/s12991-017-0147-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lhermitte-Duclos disease (LDD) is a rare cerebellar lesion characterized by a hamartomatous lesion in the posterior fossa. Mainly diagnosed by MRI, the clinical presentation is usually made of neurological symptoms. CASE PRESENTATION We present here a rare case of a woman who developed depressive symptoms that inaugurated the clinical presentation of LDD. CONCLUSION Psychiatric symptoms may occur in all brain lesions, delaying the diagnosis and causing therapeutic escalation. More attention should be given by practitioners to psychiatric aspects of LDD.
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Affiliation(s)
- Yassine Otheman
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Rachid Aalouane
- Psychiatry Department, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Chadia Aarab
- Psychiatry Department, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Ismail Rammouz
- Psychiatry Department, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
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Meulepas JM, Ronckers CM, Merks J, Weijerman ME, Lubin JH, Hauptmann M. Confounding of the association between radiation exposure from CT scans and risk of leukemia and brain tumors by cancer susceptibility syndromes. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2016; 36:953-974. [PMID: 27893452 DOI: 10.1088/0952-4746/36/4/953] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Recent studies linking radiation exposure from pediatric computed tomography (CT) to increased risks of leukemia and brain tumors lacked data to control for cancer susceptibility syndromes (CSS). These syndromes might be confounders because they are associated with an increased cancer risk and may increase the likelihood of pediatric CT scans. We identify CSS predisposing to leukemia and brain tumors through a systematic literature search and summarize prevalence and risk. Since empirical evidence is lacking in published literature on patterns of CT use for most types of CSS, we estimate confounding bias of relative risks (RR) for categories of radiation exposure based on expert opinion about patterns of CT scans among CSS patients. We estimate that radiation-related RRs for leukemia are not meaningfully confounded by Down syndrome, Noonan syndrome and other CSS. Moreover, tuberous sclerosis complex, von Hippel-Lindau disease, neurofibromatosis type 1 and other CSS do not meaningfully confound RRs for brain tumors. Empirical data on the use of CT scans among CSS patients is urgently needed. Our assessment indicates that associations with radiation exposure from pediatric CT scans and leukemia or brain tumors reported in previous studies are unlikely to be substantially confounded by unmeasured CSS.
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Affiliation(s)
- Johanna M Meulepas
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Puri A, Garg A, Mishra N, Gaikwad S, Mehta V. Bilateral Cerebellar Dysplastic Gangliocytomas (Lhermitte Duclos Disease) with Cerebellar Ectopia and Presyrinx Cord Changes. Neuroradiol J 2016; 19:717-21. [DOI: 10.1177/197140090601900605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 12/18/2006] [Indexed: 11/16/2022] Open
Abstract
Lhermitte-Duclos disease (LDD) is a rare cerebellar lesion with features of both malformation and benign neoplasm. However, the fundamental nature of the entity, its pathogenesis, and the exact genetic alterations remain unknown. We describe a rare case of bilateral LDD with cerebellar ectopia and presyrinx spinal cord changes. Bilaterality of lesions should argue against a neoplastic origin and support a hamartomatous origin.
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Affiliation(s)
- A.S. Puri
- All India Institute of Medical Sciences; New Delhi, India
| | - A. Garg
- All India Institute of Medical Sciences; New Delhi, India
| | - N.K. Mishra
- All India Institute of Medical Sciences; New Delhi, India
| | - S.B. Gaikwad
- All India Institute of Medical Sciences; New Delhi, India
| | - V.S. Mehta
- All India Institute of Medical Sciences; New Delhi, India
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8
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Meulepas JM, Ronckers CM, Merks J, Weijerman ME, Lubin JH, Hauptmann M. Confounding of the Association between Radiation Exposure from CT Scans and Risk of Leukemia and Brain Tumors by Cancer Susceptibility Syndromes. Cancer Epidemiol Biomarkers Prev 2015; 25:114-26. [DOI: 10.1158/1055-9965.epi-15-0636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022] Open
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Prabhu SS, Aldape KD, Bruner JM, Weinberg JS. Cowden Disease with Lhermitte-Duclos Disease: Case Report. Can J Neurol Sci 2014; 31:542-9. [PMID: 15595264 DOI: 10.1017/s0317167100003784] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background:We report a case and review the recent literature describing 36 patients with both Lhermitte-Duclos disease (LDD) and Cowden disease (CD). Lhermitte-Duclos disease, or dysplastic gangliocytoma, is a benign hamartomatous condition involving the cerebellum. The presenting symptoms are usually headaches, gait ataxia, and symptoms of lower cranial nerve involvement. Cowden disease is a rare autosomal dominant disease that usually presents with multiple mucocutaneous lesions. Patients with CD are prone to multiple systemic malignancies, the most common of which is breast cancer. Recent studies have demonstrated an association between LDD and CD.Methods:A 44-year-old woman with a previous history of breast cancer, multiple benign skin lesions, Hashimoto's thyroiditis, and chronic headaches presented with exacerbation of her headaches during the previous year. Magnetic resonance imaging of the brain revealed a right cerebellar nonenhancing mass and an acquired tonsillar herniation.Results:The patient underwent resection of the right cerebellar mass, posterior fossa decompression, C1 and C2 laminectomies, and a duraplasty. Pathologic examination confirmed LDD. The patient recovered well after surgery, with immediate improvement of her headaches.Conclusion:The association between LDD and CD has been under-recognized and under-reported. Recognition of this association has direct clinical relevance, because diligent monitoring of individuals with LDD and CD may lead to the early detection of systemic malignancies.
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Affiliation(s)
- Sujit S Prabhu
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, The Brain Tumor Center, Houston, Texas, USA
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10
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Affiliation(s)
- Kamal K Sen
- Department of Radiology and Imaging, P. S. G. Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamilnadu, India
| | - Kannan Gunasekaran
- Department of Radiology and Imaging, P. S. G. Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamilnadu, India
| | - Vikrant Kanagaraj
- Department of Radiology and Imaging, P. S. G. Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamilnadu, India
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11
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Cognitive characteristics of PTEN hamartoma tumor syndromes. Genet Med 2013; 15:548-53. [PMID: 23470840 DOI: 10.1038/gim.2013.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 01/08/2013] [Indexed: 01/02/2023] Open
Abstract
PURPOSE We sought to characterize cognition in individuals with germline PTEN mutations (n = 23) as well as in PTEN mutation-negative individuals with classic Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome (n = 2). METHODS Twenty-five individuals completed a comprehensive neuropsychological evaluation. One sample t-tests and effect sizes were used to examine differences in participant test scores compared with normal controls. Composite scores were created for each patient within each of the cognitive domains assessed and classified as above average, average, or below average according to normative standards. χ(2) analyses compared these classifications to expected proportions in normal control samples. RESULTS The mean intelligence quotient was in the average range, and the range of intellectual functioning was very wide (from extremely low to very superior). However, in a large subset of patients, scores were lower than expected on measures of motor functioning, executive functioning, and memory recall, suggesting disruption of frontal circuits in these participants. CONCLUSION This is the first study to characterize cognition in individuals with PTEN mutations and associated syndromes using a comprehensive neuropsychological battery. Contrary to previous reports suggesting an association with intellectual disability, the mean intelligence quotient was average, and there was a broad range of intellectual abilities. Specific evidence of disruption of frontal circuits may have implications for treatment compliance and cancer surveillance, and further investigation is warranted.
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12
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Hariri OR, Khachekian A, Muilli D, Amin J, Minassian T, Berman B, Ritter Y, Siddiqi J. Acute-Onset Cerebellar Symptoms in Lhermitte–Duclos Disease: Case Report. THE CEREBELLUM 2012; 12:127-30. [DOI: 10.1007/s12311-012-0394-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Yağcı-Küpeli B, Oguz KK, Bilen MA, Yalçın B, Akalan N, Büyükpamukçu M. An unusual cause of posterior fossa mass: Lhermitte-Duclos disease. J Neurol Sci 2010; 290:138-41. [DOI: 10.1016/j.jns.2009.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 10/23/2009] [Accepted: 12/08/2009] [Indexed: 11/25/2022]
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14
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Boonpipattanapong T, Phuenpathom N, Mitarnun W. Cowden's syndrome with Lhermitte–Duclos disease. Br J Neurosurg 2009; 19:361-5. [PMID: 16455548 DOI: 10.1080/02688690500305431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cowden's syndrome (CS) is a rare autosomal dominant condition featuring multiple hamartomas, often with mucocutaneous lesions, goitre, breast cancer, gastrointestinal polyps or even Lhermitte-Duclos disease (LDD). In this article we report the case of a 34-year-old man who was diagnosed with LDD. Subsequent examinations also revealed manifestations of CS, i.e. macrocephaly, thyroid nodules and gastrointestinal polyps.
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Affiliation(s)
- T Boonpipattanapong
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand.
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15
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Shinagare AB, Patil NK, Sorte SZ. Case 144: Dysplastic cerebellar gangliocytoma (Lhermitte-Duclos disease). Radiology 2009; 251:298-303. [PMID: 19332858 DOI: 10.1148/radiol.2511071390] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Atul B Shinagare
- Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India.
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16
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Zhou L, Luo L, Hui X, You C, Yang Y, Xu J. Three adolescents with Lhermitte-Duclos disease. J Clin Neurosci 2009; 16:124-7. [DOI: 10.1016/j.jocn.2008.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Revised: 02/21/2008] [Accepted: 02/24/2008] [Indexed: 11/27/2022]
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17
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Farhadi MR, Rittierodt M, Stan A, Capelle HH, Tham-Mücke B, Krauss JK. Intramedullary ependymoma associated with Lhermitte–Duclos disease and Cowden syndrome. Clin Neurol Neurosurg 2007; 109:692-7. [PMID: 17544575 DOI: 10.1016/j.clineuro.2007.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2007] [Revised: 04/16/2007] [Accepted: 04/19/2007] [Indexed: 10/23/2022]
Abstract
The authors describe the case of a 45-year-old man with progressive gait ataxia and sensorimotor deficits of the upper and lower extremities. The patient had been diagnosed earlier with Lhermitte-Duclos disease (LDD) in the left cerebellar hemisphere and Cowden syndrome (CS). MR imaging studies revealed an intraspinal tumor at C6-C7. Microsurgical gross total resection of the tumor was achieved. Histolopathological examination revealed an intramedullary ependymoma. Postoperatively, neurological deficits gradually improved. This is the first reported case of ependymoma in a patient with LDD and CD. Coexistence of an intraspinal ependymoma with cerebellar LDD and CS appears to be rare, but can lead to treatment failure if missed.
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Affiliation(s)
- Mohammad R Farhadi
- Department of Neurosurgery, Medical School Hannover, MHH, Carl-Neuberg street 1, 30625 Hannover, Germany
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18
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Tan TC, Ho LC. Lhermitte-Duclos disease associated with Cowden syndrome. J Clin Neurosci 2007; 14:801-5. [PMID: 17485210 DOI: 10.1016/j.jocn.2006.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Revised: 06/14/2006] [Accepted: 06/28/2006] [Indexed: 10/23/2022]
Abstract
Lhermitte-Duclos disease or dysplastic gangliocytoma of the cerebellum, is a rare cerebellar lesion, which can cause mass effects in the posterior fossa. It may occur sporadically, or in association with Cowden syndrome. Cowden syndrome or multiple hamartoma-neoplasia syndrome, is an uncommon autosomal dominant condition characterized by mucocutaneous lesions and systemic malignancies. We report two patients with Lhermitte-Duclos disease and associated Cowden syndrome. The clinical, radiological and histopathological features and management strategies of this rare disease complex are discussed.
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Affiliation(s)
- Tze-Ching Tan
- Department of Neurosurgery, Queen Elizabeth Hospital, Kowloon, Hong Kong.
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Abstract
BACKGROUND Lhermitte-Duclos disease (LDD; dysplastic gangliocytoma of the cerebellum) is a rare hamartoma of the cerebellum. It was first described by Lhermitte and Duclos in 1920 as "Sur un ganglioneurome diffus du cortex du cervelet" (Lhermitte and Duclos [Bull Assoc Fr Etude Cancer 9:99-107, 1920]). Since then, due to its rarity and the variability of its presentation, the diagnosis is often missed. It is not only important for the neurosurgeon and the pathologist to be aware of this entity so as to differentiate from malignant lesions but also to distinguish it from other cerebellar malformations, which may be hypoplastic or dysplastic, focal or diffuse in nature, with brain stem and cerebral involvement, and varied natural course. ILLUSTRATIVE CASE We report a case of LDD in a 16-year-old boy. This case exemplifies the rarity of the disease leading to lack of awareness with which the diagnosis was easily missed. We also take this opportunity to discuss the clinical presentation, neuroradiological appearance, and a brief summary of histopathological findings, pathogenetic considerations, and neurogenetical aspects.
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Affiliation(s)
- Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, U.P., India.
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20
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Peltier J, Lok C, Fichten A, Bruniau A, Lefranc M, Toussaint P, Desenclos C, Le Gars D. Lhermitte-Duclos disease and Cowden's syndrome. Neurochirurgie 2006; 52:407-14. [PMID: 17185946 DOI: 10.1016/s0028-3770(06)71239-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE AND IMPORTANCE Lhermitte-Duclos disease, or dysplastic cerebellar gangliocytoma is a rare entity characterized by a hamartomatous lesion in the posterior fossa. Cowden's syndrome, or hamartoma-neoplasia syndrome is a rare underdiagnosed autosomal dominant genodermatosis with high incidence of malignant tumors. Several recent reports suggest that Lhermitte-Duclos disease may be a component of Cowden's syndrome. CLINICAL PRESENTATION We report two cases of Lhermitte-Duclos and Cowden disease occurring in adult patients. A 40-year-old woman had symptoms of raised intracranial pressure and macrocephaly. She displayed the stigmata of fibrocystic breast disease, thyroid goitre. Clinical examination showed mucocutaneous lesions. Her mother, brother and uncle had manifestations of Cowden's disease. An asymptomatic 38-year-old male had bilateral optic nerve drusen related to a cerebellar neoplasm. He exhibited manifestations of Cowden's syndrome and his familial history confirmed this hypothesis. INTERVENTION The first patient was operated on for Lhermitte-Duclos disease. A conservative strategy was performed for the second patient and the clinical and imaging follow-ups were uneventful over 5 years. CONCLUSION We stress the possibility that Lhermitte-Duclos and Cowden disease might be a peculiar form of phakomatosis. A conservative strategy can be chosen without neurological signs because of slow tumor growth. However, these patients should be carefully examined and followed up because of the risk of future malignancy.
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Affiliation(s)
- J Peltier
- Department of Neurosurgery, Centre Hospitalier Universitaire d'Amiens, Place Victor-Pauchet, 80054 Amiens Cedex 1.
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21
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Prestor B. Dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease). J Clin Neurosci 2006; 13:877-81. [PMID: 16934474 DOI: 10.1016/j.jocn.2005.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Accepted: 07/26/2005] [Indexed: 10/24/2022]
Abstract
Dysplastic gangliocytoma of the cerebellum is a rare disorder requiring surgical resection. During surgical exploration, the margin with normal cerebellar tissue is often not distinct. We present here a case in which we surgically treated a patient with Lhermitte-Duclos disease, and discuss radical resection of the tumour. The patient was first admitted at the age of 34 years. A MRI scan revealed a large left cerebellar mass typical of dysplastic gangliocytoma. Postoperatively the patient developed severe cerebellar syndrome with only partial recovery after 4 years. MRI revealed no impairment of cerebrospinal fluid circulation; the mass in the left cerebellum had been removed, and no recurrent disease was visible. Clinical problems after gross total or complete removal of Lhermitte-Duclos lesions have not been reported in the literature, but herein we stress the importance of extreme caution in removing these lesions in cerebellar areas that have no distinct border between the tumour and normal tissue.
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Affiliation(s)
- Borut Prestor
- Department of Neurosurgery, University Hospital Center, Zaloska 7, Ljubljana, Slovenia.
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Leão JC, Batista V, Guimarães PB, Belo J, Porter SR. Cowden's syndrome affecting the mouth, gastrointestinal, and central nervous system: a case report and review of the literature. ACTA ACUST UNITED AC 2006; 99:569-72. [PMID: 15829879 DOI: 10.1016/j.tripleo.2004.08.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cowden's syndrome (CS) is a rare genodermatosis, of autosomal dominant inheritance and variable phenotype, principally characterized by the formation of hamartomas in various organs, including skin, thyroid, breast, brain, and gastrointestinal tract and by the increased risk for the development of malignancy. The present report details the features of a very rare presentation of Cowden's syndrome affecting not only the mouth and gastrointestinal mucosa but also the central nervous system.
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Affiliation(s)
- Jair C Leão
- Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, Brazil.
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Affiliation(s)
- Anders Merg
- Roswell Park Cancer Institute, Buffalo, New York, USA
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Lok C, Viseux V, Avril MF, Richard MA, Gondry-Jouet C, Deramond H, Desfossez-Tribout C, Courtade S, Delaunay M, Piette F, Legars D, Dreno B, Saïag P, Longy M, Lorette G, Laroche L, Caux F. Brain magnetic resonance imaging in patients with Cowden syndrome. Medicine (Baltimore) 2005; 84:129-136. [PMID: 15758842 DOI: 10.1097/01.md.0000158792.24888.d2] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cowden syndrome (CS) is a rare autosomal dominant genodermatosis, characterized by multiple hamartomas, particularly of the skin, associated with high frequencies of breast, thyroid, and genitourinary malignancies. Although Lhermitte-Duclos disease (LDD) or dysplastic gangliocytoma of the cerebellum, a slowly progressive unilateral tumor, is a major criterion of CS, its frequency in patients with CS is unknown. Other cerebral abnormalities, especially meningioma and vascular malformations, have also been described, albeit rarely, in these patients. The aim of the current study was to use cerebral magnetic resonance imaging (MRI) to evaluate LDD frequency and to investigate other brain abnormalities in CS patients recruited by dermatologists. A multicenter study was conducted in 8 hospital dermatology departments between January 2000 and December 2003. Twenty patients with CS were included; specific cerebral MRI abnormalities were found in 35% (7/20) of them. Cerebral MRI revealed LDD in 3 patients, a meningioma in 1, and numerous vascular malformations in 6 patients. Five patients had venous angiomas (3 associated with LDD) and 2 patients had cavernous angiomas (1 associated with LDD and a venous angioma). The discovery of asymptomatic LDD in 3 patients and a cavernous angioma in another prompted us to perform neurologic examinations regularly and MRI to estimate the size and the extension of the tumor, and to assess the need for surgery. CS similarities with Bannayan-Riley-Ruvalcaba (BRR) are discussed because some patients could also have the BRR phenotype (for example, genital lentigines, macrocephaly, multiple lipomas) and because BRR seems to have more central nervous system vascular anomalies. Because CS signs can involve numerous systems, all physicians who might encounter this disease should be aware of its neurologic manifestations. Our findings confirm the contribution of brain MRI to detecting asymptomatic LDD, vascular malformations, and meningiomas in patients with CS.
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Affiliation(s)
- Catherine Lok
- From Department of Dermatology (CL, VV, CD-T, SC), CHU Sud, Amiens; Department of Dermatology (MFA), Institut Gustave-Roussy, Villejuif; Department of Dermatology (MAR), CHU Sainte-Marguerite, Marseille; Department of Radiology A (CG-J, HD), Department of Neurosurgery (DL), CHU Nord, Amiens; Department of Dermatology (MD), CHU Saint-André, Bordeaux; Department of Dermatology (FP), CHU de Lille, Lille; Department of Dermatology (BD), CHU de Nantes, Nantes; Department of Dermatology (PS), CHU Ambroise-Paré, Boulogne-Billancourt; Molecular Genetics Laboratory (ML), Bergonié Institute, Bordeaux; Department of Dermatology (GL), CHU Tours, Tours; Department of Dermatology (LL, FC), CHU Avicenne, Bobigny, France
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Derrey S, Proust F, Debono B, Langlois O, Layet A, Layet V, Longy M, Fréger P, Laquerrière A. Association between Cowden syndrome and Lhermitte-Duclos disease. ACTA ACUST UNITED AC 2004; 61:447-54; discussion 454. [PMID: 15120218 DOI: 10.1016/s0090-3019(03)00576-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2002] [Accepted: 06/30/2003] [Indexed: 11/22/2022]
Abstract
BACKGROUND The authors describe 2 cases of dysplasic gangliocytoma of the cerebellum or Lhermitte-Duclos disease revealing Cowden disease or multiple hamartoma neoplasia syndrome. Cowden disease is a rare autosomal dominant disorder, now considered as a phakomatosis. Nevertheless, relationships between both conditions still remain unclear, since Lhermitte-Duclos disease can also be sporadic. CASE REPORTS Two patients, 25 and 27 years old, were admitted to the emergency department for an acute intracranial hypertension. In both cases, magnetic resonance imaging (MRI) scan showed a mass in the cerebellar hemisphere. Pathological examination of surgical resection specimens concluded Lhermitte-Duclos disease. Because of the patients' previous personal and familial medical history, Cowden disease was suspected and confirmed by mutational analysis of the phosphatase and tensin homolog (PTEN) gene. In the first case, a nonsense punctual mutation in exon 8 was found. In the second one, a mutation was revealed in the exon 5, a mutational hot spot encoding the phosphatase catalytic core motif. CONCLUSION Lhermitte-Duclos disease and Cowden disease can be associated. Germline mutations of PTEN gene are known to be implicated in Cowden disease. This gene, located at chromosome 10q23-3, is a tumor suppressor gene that encodes a protein with phosphatase activity. To date, more than 80 mutations have been reported in Cowden disease. When the diagnosis of either one of these two disorders is established, it is imperative to search for the other one to detect early malignant lesions that occur in Cowden disease. Finally, a long-term follow up of the patient is required and a thorough familial screening is necessary.
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Affiliation(s)
- Stéphane Derrey
- Department of Neurosurgery, Rouen University Hospital, Rouen Cedex, France
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Abstract
Juvenile polyps are hamartomatous polyps found primarily in infants and children, and in association with juvenile polyposis (JP; OMIM #174900), Cowden syndrome (CS; OMIM #158350), and Bannayan-Riley-Ruvalcaba syndrome (BRRS; OMIM# 153480). Although solitary juvenile polyps are benign lesions, when present in JP patients they may lead to gastrointestinal cancers. Germline mutations in MADH4 and BMPR1A predispose to JP, and both genes are involved in TGF-beta superfamily signaling pathways. In CS and BRRS, juvenile polyps are a less consistent feature, and CS patients are at risk for breast and thyroid cancers. Mutations of the tumor suppressor gene PTEN have been found in the germline of both CS and BRRS patients. Despite different underlying genetic mechanisms, these and other syndromes share the same phenotypic feature of juvenile polyps.
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Affiliation(s)
- Anders Merg
- Surgical Oncology and Endocrine Surgery, Department of Surgery, Roy J. and Lucille A. Carver Iowa College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
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27
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Zhou XP, Marsh DJ, Morrison CD, Chaudhury AR, Maxwell M, Reifenberger G, Eng C. Germline inactivation of PTEN and dysregulation of the phosphoinositol-3-kinase/Akt pathway cause human Lhermitte-Duclos disease in adults. Am J Hum Genet 2003; 73:1191-8. [PMID: 14566704 PMCID: PMC1180498 DOI: 10.1086/379382] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Accepted: 08/29/2003] [Indexed: 01/17/2023] Open
Abstract
Lhermitte-Duclos disease (LDD), or dysplastic gangliocytoma of the cerebellum, is an unusual hamartomatous overgrowth disorder. LDD can be familial or, more commonly, sporadic. It has been only recently recognized that LDD may be associated with Cowden syndrome (CS). Over 80% of patients with CS carry germline mutations in PTEN. It remains unclear whether all cases of LDD, even without features of CS, are caused by germline PTEN mutation and whether somatic PTEN mutation occurs in sporadic LDD. We obtained paraffin-embedded LDD lesions from 18 unselected, unrelated patients and performed mutational analysis of PTEN. Overall, 15 (83%) of 18 samples were found to carry a PTEN mutation. All individuals with mutations were adult-onset patients, but the three without mutations were diagnosed at the ages of 1, 3, and 11 years. Germline DNA was available from six adult-onset cases, and all had germline PTEN mutations. Of these six, two had CS features, one did not have CS features, and three were of unknown CS status. Immunohistochemistry revealed that 75% of the LDD samples had complete or partial loss of PTEN expression accompanied by elevated phosphorylated Akt, specifically in the dysplastic gangliocytoma cells. These data suggest that the loss of PTEN function is sufficient to cause LDD. The high frequency and spectrum of germline PTEN mutations in patients ascertaining by LDD alone confirm that LDD is an important defining feature of CS. Individuals with LDD, even without apparent CS features, should be counseled as in CS.
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Affiliation(s)
- Xiao-Ping Zhou
- Clinical Cancer Genetics and Human Cancer Genetics Programs, Comprehensive Cancer Center, Division of Human Cancer Genetics, Department of Molecular Virology, Immunology, and Medical Genetics, and the Division of Human Genetics, Department of Internal Medicine, and Department of Pathology, The Ohio State University, Columbus; Translational Research Laboratory, Department of Adult Oncology, Charles A. Dana Human Cancer Genetics Unit, Dana-Farber Cancer Institute, Boston; Neurosurgical Service, Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston; Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, and the Department of Molecular Medicine, University of Sydney, Sydney, Australia; Institut für Neuropathologie, Heinrich Heine Universität Düsseldorf, Düsseldorf; and Cancer Research UK, Human Cancer Genetics Research Group, University of Cambridge, Cambridge
| | - Deborah J. Marsh
- Clinical Cancer Genetics and Human Cancer Genetics Programs, Comprehensive Cancer Center, Division of Human Cancer Genetics, Department of Molecular Virology, Immunology, and Medical Genetics, and the Division of Human Genetics, Department of Internal Medicine, and Department of Pathology, The Ohio State University, Columbus; Translational Research Laboratory, Department of Adult Oncology, Charles A. Dana Human Cancer Genetics Unit, Dana-Farber Cancer Institute, Boston; Neurosurgical Service, Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston; Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, and the Department of Molecular Medicine, University of Sydney, Sydney, Australia; Institut für Neuropathologie, Heinrich Heine Universität Düsseldorf, Düsseldorf; and Cancer Research UK, Human Cancer Genetics Research Group, University of Cambridge, Cambridge
| | - Carl D. Morrison
- Clinical Cancer Genetics and Human Cancer Genetics Programs, Comprehensive Cancer Center, Division of Human Cancer Genetics, Department of Molecular Virology, Immunology, and Medical Genetics, and the Division of Human Genetics, Department of Internal Medicine, and Department of Pathology, The Ohio State University, Columbus; Translational Research Laboratory, Department of Adult Oncology, Charles A. Dana Human Cancer Genetics Unit, Dana-Farber Cancer Institute, Boston; Neurosurgical Service, Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston; Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, and the Department of Molecular Medicine, University of Sydney, Sydney, Australia; Institut für Neuropathologie, Heinrich Heine Universität Düsseldorf, Düsseldorf; and Cancer Research UK, Human Cancer Genetics Research Group, University of Cambridge, Cambridge
| | - Abhik R. Chaudhury
- Clinical Cancer Genetics and Human Cancer Genetics Programs, Comprehensive Cancer Center, Division of Human Cancer Genetics, Department of Molecular Virology, Immunology, and Medical Genetics, and the Division of Human Genetics, Department of Internal Medicine, and Department of Pathology, The Ohio State University, Columbus; Translational Research Laboratory, Department of Adult Oncology, Charles A. Dana Human Cancer Genetics Unit, Dana-Farber Cancer Institute, Boston; Neurosurgical Service, Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston; Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, and the Department of Molecular Medicine, University of Sydney, Sydney, Australia; Institut für Neuropathologie, Heinrich Heine Universität Düsseldorf, Düsseldorf; and Cancer Research UK, Human Cancer Genetics Research Group, University of Cambridge, Cambridge
| | - Marius Maxwell
- Clinical Cancer Genetics and Human Cancer Genetics Programs, Comprehensive Cancer Center, Division of Human Cancer Genetics, Department of Molecular Virology, Immunology, and Medical Genetics, and the Division of Human Genetics, Department of Internal Medicine, and Department of Pathology, The Ohio State University, Columbus; Translational Research Laboratory, Department of Adult Oncology, Charles A. Dana Human Cancer Genetics Unit, Dana-Farber Cancer Institute, Boston; Neurosurgical Service, Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston; Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, and the Department of Molecular Medicine, University of Sydney, Sydney, Australia; Institut für Neuropathologie, Heinrich Heine Universität Düsseldorf, Düsseldorf; and Cancer Research UK, Human Cancer Genetics Research Group, University of Cambridge, Cambridge
| | - Guido Reifenberger
- Clinical Cancer Genetics and Human Cancer Genetics Programs, Comprehensive Cancer Center, Division of Human Cancer Genetics, Department of Molecular Virology, Immunology, and Medical Genetics, and the Division of Human Genetics, Department of Internal Medicine, and Department of Pathology, The Ohio State University, Columbus; Translational Research Laboratory, Department of Adult Oncology, Charles A. Dana Human Cancer Genetics Unit, Dana-Farber Cancer Institute, Boston; Neurosurgical Service, Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston; Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, and the Department of Molecular Medicine, University of Sydney, Sydney, Australia; Institut für Neuropathologie, Heinrich Heine Universität Düsseldorf, Düsseldorf; and Cancer Research UK, Human Cancer Genetics Research Group, University of Cambridge, Cambridge
| | - Charis Eng
- Clinical Cancer Genetics and Human Cancer Genetics Programs, Comprehensive Cancer Center, Division of Human Cancer Genetics, Department of Molecular Virology, Immunology, and Medical Genetics, and the Division of Human Genetics, Department of Internal Medicine, and Department of Pathology, The Ohio State University, Columbus; Translational Research Laboratory, Department of Adult Oncology, Charles A. Dana Human Cancer Genetics Unit, Dana-Farber Cancer Institute, Boston; Neurosurgical Service, Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston; Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, and the Department of Molecular Medicine, University of Sydney, Sydney, Australia; Institut für Neuropathologie, Heinrich Heine Universität Düsseldorf, Düsseldorf; and Cancer Research UK, Human Cancer Genetics Research Group, University of Cambridge, Cambridge
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Abstract
The PTEN tumor suppressor gene is a lipid phosphatase that negatively regulates cell survival mediated by the phosphatidyl inositol 3' kinase-protein kinase B/Akt signaling pathway. Recent in vivo studies have revealed a novel role for PTEN in the size control of neurons. Dysregulation of cell growth control by PTEN is associated with the neurological disorder Lhermitte-Duclos disease. PTEN may regulate cell size through effects on protein translation.
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Affiliation(s)
- Stéphanie Backman
- Department of Medical Biophysics, University of Toronto and Ontario Cancer Institute, 610 University Avenue, Toronto, Canada.
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Papageorgiou T, Stratakis CA. Ovarian tumors associated with multiple endocrine neoplasias and related syndromes (Carney complex, Peutz-Jeghers syndrome, von Hippel-Lindau disease, Cowden's disease). Int J Gynecol Cancer 2002; 12:337-47. [PMID: 12144681 DOI: 10.1046/j.1525-1438.2002.01147.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Despite the relatively high prevalence of ovarian cancer (1% of American women will develop this disease in their lifetime) and recent developments in its molecular genetic understanding (several proto-oncogenes, such as AKT2 and cKRAS, and tumor suppressor genes, such as BRCA1 and BRCA2, have been implicated), little is known about the presence of ovarian tumors and cancer in women already diagnosed with other familial multiple tumor syndromes. In this review, we focus on the possible association of ovarian tumors with multiple endocrine neoplasias (MENs) and their related syndromes, such as Carney complex (CNC), Peutz-Jeghers syndrome (PJS), von Hippel-Lindau disease (VHLD), and Cowden's disease (CD). These conditions recently have been molecularly elucidated, and some of the genes responsible for them (including STK11/LKB1 and PTEN, the genes responsible for PJS and CD, respectively) have already been investigated in series of sporadic ovarian lesions, mostly carcinomas. A brief description of each disease is followed by a literature search for affected patients with ovarian tumors; we review our own experience with CNC patients and ovarian tumors. An association between PJS and CNC and ovarian neoplasms seems likely; carcinoids of the ovary may occur in patients with MEN 1. Only few patients with CD and VHLD have any ovarian pathology, but PTEN, the CD gene has been investigated in sporadic ovarian tumors. The aim of the present report is to alert clinicians who care for patients with MENs, CNC, PJS, VHLD, CD, and other syndromes for possible associations between various types of ovarian tumors and these conditions.
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Affiliation(s)
- T Papageorgiou
- Unit on Genetics & Endocrinology (UGEN), Developmental Endocrinology Branch (DEB), National Institute of Child Health and Human Development (NICHD)/NIH, Building 10, Room 10 N262, 10 Center Drive MSC 1862, Bethesda, MD 20892, USA
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30
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Nowak DA, Trost HA. Lhermitte-Duclos disease (dysplastic cerebellar gangliocytoma): a malformation, hamartoma or neoplasm? Acta Neurol Scand 2002; 105:137-45. [PMID: 11886354 DOI: 10.1034/j.1600-0404.2002.1r127.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Dysplastic gangliocytoma (Lhermitte-Duclos disease) is a rare disorder, characterized by a slowly progressive unilateral tumour mass of the cerebellar cortex. The fundamental nature of this apparently benign entity and in particular its pathogenesis remain unknown. The debate, whether it represents a neoplastic, malformative or hamartomatous lesion, is still in progress. Lhermitte-Duclos disease was recently encountered to be part of a multiple hamartoma-neoplasia complex (Cowden's syndrome). METHODS The present account gives a review of the pertinent literature with emphasize on clinical presentation, radiological findings, surgical procedures, histopathological features and pathogenetic considerations of dysplastic cerebellar gangliocytoma. RESULTS Dysplastic cerebellar gangliocytoma clusters within the third to fourth decades of life. Cranial nerve palsies, unsteadiness of gait, ataxia and sudden neurological deterioration as a result of occlusive hydrocephalus are frequent signs and symptoms. Associations with other congenital malformations, such as megalencephaly, polydactylia, multiple haemangioma and skull abnormalities are common. Magnetic resonance imaging (MRI) is the diagnostic modality of choice and reveals characteristic non-enhancing gyriform patterns with enlargement of cerebellar folia. Surgery is the therapeutic procedure generally performed and complete resection was attempted in the majority of cases. The histopathological findings of Lhermitte-Duclos disease include widening of the molecular layer, which is occupied by abnormal ganglion cells, absence of the Purkinje cell layer and hypertrophy of the granule cell layer. CONCLUSIONS Dysplastic gangliocytoma of the cerebellum is of benign behaviour and its incidence is extremely rare. The disease should be considered when confronted with a young adult presenting with clinical signs of progressive mass effect in the posterior fossa. The lesion is hypointense on T1- and hyperintense on T2-weighted magnetic resonance images. Recognition of the disease is of particular importance, as the frequent but under-reported coexistence with Cowden syndrome, should prompt thorough clinical and apparative investigation to detect or exclude concomitant malignancies.
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Affiliation(s)
- D A Nowak
- Department of Neurology, Academic Hospital München - Bogenhausen, Technical University of Munich, Munich, Germany.
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31
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Mcheik JN, Vabres P, Bonneau D, Longy M, Levard G. [Cowden's disease in an adolescent]. ANNALES DE CHIRURGIE 2002; 127:138-41. [PMID: 11885374 DOI: 10.1016/s0003-3944(01)00690-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cowden's disease is an autosomal dominantly inherited syndrome characterized by mucocutaneous lesions and multiple hamartomas. We report here a 12 years-old boy case with craniomegally, intestinal polyps, epilepsy and multiadenomatous goiter. All the lesions were beginnings. The predisposing genetic defect has been assignated to chromosomal 10 (PTEN-gene mutation). A long term follow-up is necessary because of the risk of malignancies.
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Affiliation(s)
- J N Mcheik
- Service de chirurgie pédiatrique, centre hospitalier universitaire de Poitiers, 350, avenue Jacques-Caeur, BP 577, 86021 Poitiers, France.
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Backman SA, Stambolic V, Suzuki A, Haight J, Elia A, Pretorius J, Tsao MS, Shannon P, Bolon B, Ivy GO, Mak TW. Deletion of Pten in mouse brain causes seizures, ataxia and defects in soma size resembling Lhermitte-Duclos disease. Nat Genet 2001; 29:396-403. [PMID: 11726926 DOI: 10.1038/ng782] [Citation(s) in RCA: 362] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Initially identified in high-grade gliomas, mutations in the PTEN tumor-suppressor are also found in many sporadic cancers and a few related autosomal dominant hamartoma syndromes. PTEN is a 3'-specific phosphatidylinositol-3,4,5-trisphosphate (PI(3,4,5)P3) phosphatase and functions as a negative regulator of PI3K signaling. We generated a tissue-specific deletion of the mouse homolog Pten to address its role in brain function. Mice homozygous for this deletion (PtenloxP/loxP;Gfap-cre), developed seizures and ataxia by 9 wk and died by 29 wk. Histological analysis showed brain enlargement in PtenloxP/loxP;Gfap-cre mice as a consequence of primary granule-cell dysplasia in the cerebellum and dentate gyrus. Pten mutant cells showed a cell-autonomous increase in soma size and elevated phosphorylation of Akt. These data represent the first evidence for the role of Pten and Akt in cell size regulation in mammals and provide an animal model for a human phakomatosis condition, Lhermitte-Duclos disease (LDD).
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Affiliation(s)
- S A Backman
- Department of Medical Biophysics, University of Toronto and Ontario Cancer Institute, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
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Kwon CH, Zhu X, Zhang J, Knoop LL, Tharp R, Smeyne RJ, Eberhart CG, Burger PC, Baker SJ. Pten regulates neuronal soma size: a mouse model of Lhermitte-Duclos disease. Nat Genet 2001; 29:404-11. [PMID: 11726927 DOI: 10.1038/ng781] [Citation(s) in RCA: 345] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Somatic inactivation of PTEN occurs in different human tumors including glioblastoma, endometrial carcinoma and prostate carcinoma. Germline mutations in PTEN result in a range of phenotypic abnormalities that occur with variable penetrance, including neurological features such as macrocephaly, seizures, ataxia and Lhermitte-Duclos disease (also described as dysplastic gangliocytoma of the cerebellum). Homozygous deletion of Pten causes embryonic lethality in mice. To investigate function in the brain, we used Cre-loxP technology to selectively inactivate Pten in specific mouse neuronal populations. Loss of Pten resulted in progressive macrocephaly and seizures. Neurons lacking Pten expressed high levels of phosphorylated Akt and showed a progressive increase in soma size without evidence of abnormal proliferation. Cerebellar abnormalities closely resembled the histopathology of human Lhermitte-Duclos disease. These results indicate that Pten regulates neuronal size in vivo in a cell-autonomous manner and provide new insights into the etiology of Lhermitte-Duclos disease.
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Affiliation(s)
- C H Kwon
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, 332 North Lauderdale, Memphis, Tennessee 38105, USA
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Koeller KK, Henry JM. From the archives of the AFIP: superficial gliomas: radiologic-pathologic correlation. Armed Forces Institute of Pathology. Radiographics 2001; 21:1533-56. [PMID: 11706224 DOI: 10.1148/radiographics.21.6.g01nv051533] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Glial neoplasms that are peripherally located and involve the cortical gray matter are noteworthy because of their predilection to serve as a seizure locus, their amenability to surgical resection, their generally favorable prognosis, and their characteristic imaging features, which facilitate diagnosis before surgery. The smaller lesions include ganglioglioma and dysembryoplastic neuroepithelial tumor. Gangliogliomas contain both neuronal and glial components and occur most commonly in the temporal lobe. Variant forms of gangliogliomas may occur and are related to the different compositions of the underlying cellular population. Gangliocytomas lack glial cells and are located both in the cerebral hemispheres and the cerebellum. Lhermitte-Duclos disease represents a specific type of cerebellar gangliocytoma with dysplastic features and is characterized by a laminar pattern at imaging. Dysembryoplastic neuroepithelial tumors occur predominantly in children and young adults with partial seizures and most commonly arise in the temporal lobe, frequently in combination with cortical dysplasia. Surrounding vasogenic edema is conspicuously absent in both gangliogliomas and dysembryoplastic neuroepithelial tumors. The larger masses in this group include desmoplastic infantile ganglioglioma and pleomorphic xanthoastrocytoma and tend to involve the leptomeninges and cortical territory. Both invoke an intense desmoplastic reaction, which appears as an enhancing soft-tissue component at imaging.
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Affiliation(s)
- K K Koeller
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, Bldg 54, Rm M-121, 14th St at Alaska Ave, Washington, DC 20306-6000, USA.
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Vantomme N, Van Calenbergh F, Goffin J, Sciot R, Demaerel P, Plets C. Lhermitte-Duclos disease is a clinical manifestation of Cowden's syndrome. SURGICAL NEUROLOGY 2001; 56:201-4; discussion 204-5. [PMID: 11597654 DOI: 10.1016/s0090-3019(01)00552-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lhermitte-Duclos disease (LDD) is a hamartomatous overgrowth of cerebellar ganglion cells, which replace granular cells and Purkinje cells. In recent years several cases involving the association between LDD and Cowden's syndrome (CS), an autosomal dominant condition characterized by multiple hamartomas and neoplastic lesions in skin and internal organs, have been reported. METHODS We reviewed the medical records and imaging studies of six patients with LDD who were treated at our institution, and we looked at other possible symptoms of CS. RESULTS Other clinical findings suggestive of CS were apparent in five patients: These included mucocutaneous lesions, acral keratosis, thyroid adenoma, fibrocystic disease, ovarian cyst, intestinal polyposis, and arteriovenous malformation. Only in the youngest patient, a 5-year-old boy, were no cutaneous or other signs found, despite extensive clinical and ultrasound examination. CONCLUSION Our observations strengthen the hypothesis that LDD is a neurological manifestation of CS. Patients with LDD should receive a thorough dermatological and systemic screening, because some of the lesions (breast, etc...) can develop into malignant tumors.
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Affiliation(s)
- N Vantomme
- Department of Neurosurgery, University Hospital Gasthuisberg, Leuven, Belgium
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36
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Murray C, Shipman P, Khangure M, Chakera T, Robbins P, McAuliffe W, Davis S. Lhermitte-Duclos disease associated with Cowden's syndrome: case report and literature review. AUSTRALASIAN RADIOLOGY 2001; 45:343-6. [PMID: 11531761 DOI: 10.1046/j.1440-1673.2001.00933.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lhermitte-Duclos disease (LDD) is a rare entity that may occur in the setting of Cowden's syndrome (CS). Accurate preoperative diagnosis can be made on the characteristic CT and MR appearances, thereby obviating the need for biopsy. It is important to be aware of the link between LDD and CS so that appropriate genetic counselling and tumour surveillance can be undertaken.
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Affiliation(s)
- C Murray
- Department of Diagnostic Imaging, Royal Perth Hospital, Perth, Western Australia, Australia.
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Nowak DA, Trost HA, Porr A, Stölzle A, Lumenta CB. Lhermitte-Duclos disease (Dysplastic gangliocytoma of the cerebellum). Clin Neurol Neurosurg 2001; 103:105-10. [PMID: 11516554 DOI: 10.1016/s0303-8467(01)00124-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease) is a rare hamartomatous lesion of the cerebellar cortex. The pathogenesis of the disease is still poorly understood. Lhermitte-Duclos disease was recently considered to be part of a multiple hamartoma-neoplasia syndrome (Cowden disease). We add two further cases to this rare entity. PATIENTS A 24-year old woman presented with occipital headaches, blurred vision, diplopia and ataxia of gait. Physical examination revealed turricephaly. The second patient was a 37-year old woman, who presented with progressive occipital headache with nausea and vomiting. Physical examination revealed congenital facial asymmetry. Computed tomography and NMR-imaging, respectively demonstrated a space occupying mass of a cerebellar hemisphere in both cases. RESULTS Suboccipital craniotomy and complete removal of the infratentorial tumour were performed in both patients. Histopathological findings clinched the diagnosis of Lhermitte-Duclos disease. Postoperative course was uneventful in the first and complicated by progressive occlusive hydrocephalus in the second patient, necessitating permanent surgical shunt drainage. Both patients were discharged free of complaints. CONCLUSIONS Dysplastic cerebellar gangliocytoma is commonly associated with progressive mass effects in the posterior fossa and typically presents with headaches, cerebellar dysfunction, occlusive hydrocephalus and cranial nerve palsies. The disease usually manifests in young adults, but the age at presentation ranges from birth to the sixth decade. There is no sex predilection. NMR-imaging became a useful clue to the diagnosis within the last decade. Therapy consists of decompression of the posterior fossa by total surgical removal of the tumour mass.
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Affiliation(s)
- D A Nowak
- Department of Neurosurgery, Academic Hospital München-Bogenhausen, Technical University of Munich, Englschalkingerstrasse 77, D-81925 München, Germany.
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Chaudhry SI, Shirlaw PJ, Morgan PR, Challacombe SJ. Cowden's syndrome (multiple hamartoma and neoplasia syndrome): diagnostic dilemmas in three cases. Oral Dis 2000; 6:248-52. [PMID: 10918563 DOI: 10.1111/j.1601-0825.2000.tb00121.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cowden's syndrome is a multisystem disease inherited as an autosomal dominant trait with incomplete penetrance and variable expression. The disease has typical oral manifestations which often precede more systemic involvement, and the dental professional is therefore well placed to institute a regime of regular checks to ensure early treatment of any neoplasms which may occur. However, since not all of the classical signs are present in all patients, diagnosis may be difficult. The case report of a patient with most of the features of Cowden's syndrome is presented and features compared with two other possible cases.
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Affiliation(s)
- S I Chaudhry
- Department of Oral Medicine & Pathology, GKT Dental Institute, Guy's Hospital, London SE1 9RT, UK
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Robinson S, Cohen AR. Cowden disease and Lhermitte-Duclos disease: characterization of a new phakomatosis. Neurosurgery 2000; 46:371-83. [PMID: 10690726 DOI: 10.1097/00006123-200002000-00021] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Lhermitte-Duclos disease, or dysplastic gangliocytoma of the cerebellum, is an unusual hamartomatous lesion that can cause progressive mass effects in the posterior fossa. Cowden disease, or multiple hamartoma-neoplasia syndrome, is a rare autosomal dominant disorder characterized by mucocutaneous hamartomas and high incidences of systemic malignancies. We recently treated a patient with manifestations of both Lhermitte-Duclos disease and Cowden disease, and we were intrigued by the occurrence of these two rare disorders in the same patient. The purpose of the present study was to examine the nature of the association between Lhermitte-Duclos disease and Cowden disease. METHODS The records for all patients who had been diagnosed at our institution as having Lhermitte-Duclos disease were reviewed, to determine whether these patients also exhibited manifestations of Cowden disease. Data were obtained from multiple sources, including patient interviews, correspondence with treating physicians, and chart reviews. RESULTS During the past 40 years, five patients were diagnosed at Case Western Reserve University as having Lhermitte-Duclos disease. All five patients exhibited manifestations of Cowden disease. Before this review, Cowden disease had not been diagnosed for three of the patients. In our most recent case, the diagnoses of both disorders were established preoperatively. That patient was observed to have a deletion in the critical portion of Exon 5 of the PTEN gene, the gene associated with Cowden disease. CONCLUSION Inclusion of Lhermitte-Duclos disease in the Cowden disease spectrum suggests that Cowden disease is a true phakomatosis, with hamartomas arising from cutaneous and neural ectoderm. Recent advances in molecular genetics may help to refine the current descriptive classification of the phakomatoses. The association between Lhermitte-Duclos disease and Cowden disease has been under-recognized and under-reported. Recognition of this association has direct clinical relevance, because diligent long-term follow-up monitoring of individuals with Lhermitte-Duclos disease and Cowden disease may lead to the early detection of malignancy.
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Affiliation(s)
- S Robinson
- Division of Pediatric Neurological Surgery, Rainbow Babies and Childrens Hospital, and Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA
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Sanson M, Zhou XP, Brault JL, Hoang-Xuan K, Hamelin R. A novel germline mutation of the PTEN/MMAC1 gene in a patient with Cowden disease. Acta Oncol 1999; 38:973-5. [PMID: 10606430 DOI: 10.1080/028418699432699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Marsh DJ, Kum JB, Lunetta KL, Bennett MJ, Gorlin RJ, Ahmed SF, Bodurtha J, Crowe C, Curtis MA, Dasouki M, Dunn T, Feit H, Geraghty MT, Graham JM, Hodgson SV, Hunter A, Korf BR, Manchester D, Miesfeldt S, Murday VA, Nathanson KL, Parisi M, Pober B, Romano C, Eng C. PTEN mutation spectrum and genotype-phenotype correlations in Bannayan-Riley-Ruvalcaba syndrome suggest a single entity with Cowden syndrome. Hum Mol Genet 1999; 8:1461-72. [PMID: 10400993 DOI: 10.1093/hmg/8.8.1461] [Citation(s) in RCA: 361] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Germline mutations in the tumour suppressor gene PTEN have been implicated in two hamartoma syndromes that exhibit some clinical overlap, Cowden syndrome (CS) and Bannayan-Riley-Ruvalcaba syndrome (BRR). PTEN maps to 10q23 and encodes a dual specificity phosphatase, a substrate of which is phosphatidylinositol 3,4,5-triphosphate, a phospholipid in the phosphatidylinositol 3-kinase pathway. CS is characterized by multiple hamartomas and an increased risk of benign and malignant disease of the breast, thyroid and central nervous system, whilst the presence of cancer has not been formally documented in BRR. The partial clinical overlap in these two syndromes is exemplified by the hallmark features of BRR: macrocephaly and multiple lipomas, the latter of which occur in a minority of individuals with CS. Additional features observed in BRR, which may also occur in a minority of CS patients, include Hashimoto's thyroiditis, vascular malformations and mental retardation. Pigmented macules of the glans penis, delayed motor development and neonatal or infant onset are noted only in BRR. In this study, constitutive DNA samples from 43 BRR individuals comprising 16 sporadic and 27 familial cases, 11 of which were families with both CS and BRR, were screened for PTEN mutations. Mutations were identified in 26 of 43 (60%) BRR cases. Genotype-phenotype analyses within the BRR group suggested a number of correlations, including the association of PTEN mutation and cancer or breast fibroadenoma in any given CS, BRR or BRR/CS overlap family ( P = 0.014), and, in particular, truncating mutations were associated with the presence of cancer and breast fibroadenoma in a given family ( P = 0.024). Additionally, the presence of lipomas was correlated with the presence of PTEN mutation in BRR patients ( P = 0.028). In contrast to a prior report, no significant difference in mutation status was found in familial versus sporadic cases of BRR ( P = 0.113). Comparisons between BRR and a previously studied group of 37 CS families suggested an increased likelihood of identifying a germline PTEN mutation in families with either CS alone or both CS and BRR when compared with BRR alone ( P = 0.002). Among CS, BRR and BRR/CS overlap families that are PTEN mutation positive, the mutation spectra appear similar. Thus, PTEN mutation-positive CS and BRR may be different presentations of a single syndrome and, hence, both should receive equal attention with respect to cancer surveillance.
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Affiliation(s)
- D J Marsh
- Clinical Cancer Genetics and Human Cancer Genetics Programs, Ohio State University Comprehensive Cancer Center, 690C Medical Research Facility, 420 West 12th Avenue, Columbus, OH 43210, USA
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Lobo CJ, Mehan R, Murugasu E, Laitt RD. Tinnitus as the presenting symptom in a case of Lhermitte-Duclos disease. J Laryngol Otol 1999; 113:464-5. [PMID: 10505163 DOI: 10.1017/s0022215100144226] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dysplastic gangliocytoma or Lhermitte-Duclos disease (LDD) is a hamartomatous malformation of the cerebellar hemisphere that usually presents with signs of increased intracranial pressure or symptoms of cerebellar dysfunction. In this paper, we report a case of LDD presenting with tinnitus, and postulate a probable mechanism for this unusual presentation.
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Affiliation(s)
- C J Lobo
- University Department of Otolaryngology, Manchester Royal Infirmary, UK
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Koch R, Scholz M, Nelen MR, Schwechheimer K, Epplen JT, Harders AG. Lhermitte-Duclos disease as a component of Cowden's syndrome. Case report and review of the literature. J Neurosurg 1999; 90:776-9. [PMID: 10193626 DOI: 10.3171/jns.1999.90.4.0776] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In recent years, 16 cases involving the association between Lhermitte-Duclos disease (LDD), which is a hamartomatous overgrowth of cerebellar tissue, and Cowden's syndrome (CS), an autosomal-dominant condition characterized by multiple hamartomas and neoplasias, have been reported. LDD may be one of the manifestations of CS. Recently, mutations of the PTEN/MMAC 1 gene, a tumor suppressor gene, have been found in families with CS, including four patients in whom LDD was diagnosed. The authors present a case of LDD in a 53-year-old woman who also had the typical mucocutaneous lesions found in CS, as well as goiter and intestinal polyposis. In this case, CS had never been suspected until the diagnosis of LDD was made. The mutation detected in the PTEN/MMAC 1 gene as well as neuropathological results are described.
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Affiliation(s)
- R Koch
- Department of Neurosurgery, Ruhr University Bochum, Germany
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Murata J, Tada M, Sawamura Y, Mitsumori K, Abe H, Nagashima K. Dysplastic gangliocytoma (Lhermitte-Duclos disease) associated with Cowden disease: report of a case and review of the literature for the genetic relationship between the two diseases. J Neurooncol 1999; 41:129-36. [PMID: 10222433 DOI: 10.1023/a:1006167421100] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report a case of dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease, LDD). The patient also had cutaneous and mucosal hamartomas, adenomatous goiter, bilateral breast tumors, and gastrointestinal polyposis, indicating the diagnosis of Cowden disease (CD), the familial hamartoma syndrome. This was a rare sporadic case without any family history of CD, though CD is considered to be an autosomal dominant hereditary disease. Based on a thorough review of the previously reported cases, it is reasonable to consider that CD is inherited in autosomal dominant fashion through a CD gene (PTEN) containing a germline mutation, and that the occurrence of LDD is predicted on an additional somatic hit on the remaining normal CD allele or another unknown gene.
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Affiliation(s)
- J Murata
- Department of Neurosurgery, Hokkaido University School of Medicine, Sapporo, Japan
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Chapman MS, Perry AE, Baughman RD. Cowden's syndrome, Lhermitte-Duclos disease, and sclerotic fibroma. Am J Dermatopathol 1998; 20:413-6. [PMID: 9700384 DOI: 10.1097/00000372-199808000-00017] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The authors report a case of Lhermitte-Duclos disease, or dysplastic cerebellar gangliocytoma, in which a cutaneous sclerotic fibroma was found incidentally during the second resection of a recurrent cerebellar hamartoma. The association of Lhermitte-Duclos disease and sclerotic fibroma with Cowden's syndrome led to a dermatologic examination and confirmation of the diagnosis of Cowden's syndrome. The combination of both Lhermitte-Duclos disease and sclerotic fibroma with Cowden's syndrome has not previously been reported. A review of the 15 cases of Lhermitte-Duclos disease associated with Cowden's syndrome shows no significant gender predilection. Sclerotic fibromas, once thought to be specific for Cowden's syndrome, also are reviewed.
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Affiliation(s)
- M S Chapman
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA
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Tsuchiya KD, Wiesner G, Cassidy SB, Limwongse C, Boyle JT, Schwartz S. Deletion 10q23.2-q23.33 in a patient with gastrointestinal juvenile polyposis and other features of a Cowden-like syndrome. Genes Chromosomes Cancer 1998; 21:113-8. [PMID: 9491322 DOI: 10.1002/(sici)1098-2264(199802)21:2<113::aid-gcc6>3.0.co;2-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A cytogenetically visible interstitial deletion of chromosome band 10q23 was found in a 6-year-old boy with mental retardation, dysmorphic features, and juvenile polyposis coli. In order to map this patient's deletion physically, we performed fluorescence in situ hybridization by using yeast artificial chromosomes (YACs) in the vicinity of the deletion. Five YACs that span an 11-15 cM region within the deletion were identified. This patient's deletion contains the putative locus for Cowden syndrome and a recently discovered candidate tumor suppressor gene (MMAC1 or PTEN) that has been implicated in the progression of a variety of human malignancies. Furthermore, the deletion is near and possibly overlaps a locus associated with juvenile polyposis. The findings in this patient with a constitutional 10q23 deletion raise the issue of whether there are separate genes in this region that are involved in Cowden syndrome, Bannayan-Riley-Ruvalcaba syndrome, juvenile polyposis, and tumor progression, or whether all of these entities could be due to a single gene.
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Affiliation(s)
- K D Tsuchiya
- Department of Genetics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Amagasa M, Yuda F, Tsunoda T, Sato S. Lhermitte-Duclos disease associated with Cowden disease. Brain Tumor Pathol 1998; 14:63-9. [PMID: 9384805 DOI: 10.1007/bf02478871] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We encountered a patient with Lhermitte-Duclos disease accompanied by Cowden disease, the second reported in Japan. The histological findings are described in detail. It is important to suspect Cowden disease in patients with Lhermitte-Duclos disease. Although Cowden disease is little known, making the diagnosis is very important, because cancer frequently occurs in the patient's family and genetic counseling is necessary.
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Affiliation(s)
- M Amagasa
- Department of Neurosurgery, Yamagata City Hospital Saiseikan, Japan.
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Arch EM, Goodman BK, Wesep RV, Liaw D, Clarke K, Parsons R, McKusick VA, Geraghty MT. Deletion ofPTEN in a patient with Bannayan-Riley-Ruvalcaba syndrome suggests allelism with Cowden disease. ACTA ACUST UNITED AC 1997. [DOI: 10.1002/(sici)1096-8628(19970905)71:4<489::aid-ajmg24>3.0.co;2-b] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Tuli S, Provias JP, Bernstein M. Lhermitte-Duclos disease: literature review and novel treatment strategy. Neurol Sci 1997; 24:155-60. [PMID: 9164695 DOI: 10.1017/s031716710002151x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lhermitte-Duclos disease (LDD) is a rare pathologic entity involving the cerebellum. The fundamental nature of the entity and its pathogenesis remain unknown, and considerable debate has centered on whether it represents a neoplastic, malformative or hamartomatous lesion. The cell or cells of origin remain incompletely defined. Previous reports of cases in the English literature have dealt predominantly with the clinical and pathological aspects yet few address issues of treatment. METHODS A case of Lhermitte-Duclos disease (LDD) in a 54-year-old female leading to local compressive symptoms and obstructive hydrocephalus is presented. A craniectomy, in addition to a C1 laminectomy followed by a decompressive duroplasty (using autologous fascia lata graft) was performed. RESULTS The patient clinically improved and follow-up MRI 11 months post-operatively revealed improvement in hydrocephalus. CONCLUSION The histological and immunohistochemical features of the lesion are described, emphasizing the role of an abnormal dysplastic granule cell layer. The evidence in favor of each of the major theories of pathogenesis, malformative and neoplastic is discussed. Based on these facts a form of surgical intervention involving decompressive duroplasty is proposed.
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Affiliation(s)
- S Tuli
- Division of Neurosurgery, Toronto Hospital, University of Toronto, Ontario
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Abstract
Five to ten percent of breast cancer is attributable to the autosomal dominant inheritance of a high-risk susceptibility gene. There are a number of known inherited cancer syndromes that confer a higher risk of breast cancer. Recently, the BRCA1 gene, which is responsible for 45% of hereditary early-onset breast cancer and for the majority of co-inheritance of breast and ovarian cancer, has been cloned. Another gene that confers an increased risk of breast cancer is the BRCA2 gene, which maps to the long arm of chromosome 13 by linkage analysis. Mutations in BRCA2 account for approximately 40% of hereditary early-onset breast cancer. In addition, at least 7% of breast cancer may occur in women who are heterozygous for mutations in a gene for ataxia-telangiectasia, an autosomal recessive chromosome instability syndrome. Predictive testing for some predisposing conditions is possible through indirect or direct mutation testing. In this article, the genetics of breast cancer are reviewed, and practical concerns for the surgeon in counseling high-risk patients are addressed.
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Affiliation(s)
- D M Radford
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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