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Vekariya GN, Singh S, Neazee S, Jawade S, Gujrathi AR. Klippel-Trenaunay Syndrome: To Be or Not to Be Afraid. Cureus 2024; 16:e52361. [PMID: 38361716 PMCID: PMC10868153 DOI: 10.7759/cureus.52361] [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: 03/27/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Klippel-Trenaunay syndrome (KTS) is a rare genetic syndrome comprising an abnormal development of soft tissues and the lymphovascular system with bony overgrowth, venous malformation, and port wine stains. We present an interesting case of a three-year-old child brought to our hospital with a swollen limb and raised skin lesions associated with bleeding from minor trauma. Most of the clinical characteristics of KTS were seen in our patient, including arteriovenous, soft tissue, capillary, and lymphatic abnormalities. The diagnosis of KTS is based on clinical examinations and imaging investigations. He had gross hypertrophy of the left lower limb with measurable lengthening compared to the opposite limb. Ultrasonography of the left limb revealed soft tissue hypertrophy with abnormal venous communication. The management of KTS is mainly symptomatic and should be approached conservatively if the patient has functional limbs without edema, bleeding, ulceration, or pain.
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Affiliation(s)
- Gautam N Vekariya
- Dermatology, Venereology, and Leprosy, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Sudhir Singh
- Dermatology, Venereology, and Leprosy, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Sabha Neazee
- Dermatology, Venereology, and Leprosy, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Sugat Jawade
- Dermatology, Venereology, and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amey R Gujrathi
- Dermatology, Venereology, and Leprosy, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
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2
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Mehawej C, Chouery E, Al Hage Chehade G, Bejaoui Y, Mahfoud D, Gerges M, Delague V, El Hajj N, Megarbane A. Report on a Case with Moreno-Nishimura-Schmidt Overgrowth Syndrome: A Clinically Delineated Disease Yet of an Unknown Origin! Mol Syndromol 2023; 14:219-224. [PMID: 37323196 PMCID: PMC10267562 DOI: 10.1159/000527215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2023] Open
Abstract
Introduction Overgrowth syndromes are a heterogeneous group of genetic disorders characterized by excessive growth, often accompanied by additional clinical features, such as facial dysmorphism, hormonal imbalances, cognitive impairment, and increased risk for neoplasia. Moreno-Nishimura-Schmidt (M-N-S) overgrowth syndrome is a very rare overgrowth syndrome characterized by severe pre- and postnatal overgrowth, dysmorphic facial features, kyphoscoliosis, large hands and feet, inguinal hernia, and distinctive skeletal features. The clinical and radiological features of the disorder have been well delineated, yet its molecular pathogenesis remains unclear. Case Presentation We report on a Lebanese boy with M-N-S syndrome, whose clinical manifestations were compared with those of previously reported 5 affected individuals. Whole-exome sequencing combined with comparative genome hybridization analysis failed to delineate the molecular basis of the phenotype. However, epigenetic studies revealed a different methylation status of several CpG sites between him and healthy controls, with methyltransferase activity showing the most significant enrichment. Conclusion An additional case of M-N-S syndrome recapitulated the clinical and radiological manifestations described in the previous reports. The data in the epigenetic studies implicated that abnormal methylations might play an essential role in development of the disease phenotype. However, additional studies in a clinically homogeneous cohort of patients are crucial to confirm this hypothesis.
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Affiliation(s)
- Cybel Mehawej
- Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Eliane Chouery
- Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Ghada Al Hage Chehade
- Pediatric Endocrinology and Diabetology, Pediatrics Department, Hammoud Hospital University Medical Center, Saida, Lebanon
- Pediatric Endocrinology and Diabetology, Pediatric Division, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Yosra Bejaoui
- College of Health and Life Sciences, Qatar Foundation, Education City, Hamad Bin Khalifa University, Doha, Qatar
| | - Daniel Mahfoud
- Department of Radiology, Gilbert and Rose-Marie Ghagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Maya Gerges
- Genetic Laboratory, American University of Science and Technology, Beirut, Lebanon
| | - Valérie Delague
- Inserm, MMG, U 1251, Institut Marseille Maladies Rares (MarMaRa), Aix Marseille University, Marseille, France
| | - Nady El Hajj
- College of Health and Life Sciences, Qatar Foundation, Education City, Hamad Bin Khalifa University, Doha, Qatar
| | - Andre Megarbane
- Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Institut Jérôme Lejeune, Paris, France
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3
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Okello DA, Mutio J, Masiga MA, Guthua S, Kariuki N, Mutinda C, Sarna K, Wanjohi R. A Rare Case of an Asymmetric Overgrowth Syndrome in a Kenyan African Child: A Case Report and Review of Literature. Cureus 2022; 14:e29761. [DOI: 10.7759/cureus.29761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
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4
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Mussa A, Carli D, Cardaropoli S, Ferrero GB, Resta N. Lateralized and Segmental Overgrowth in Children. Cancers (Basel) 2021; 13:cancers13246166. [PMID: 34944785 PMCID: PMC8699773 DOI: 10.3390/cancers13246166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 01/19/2023] Open
Abstract
Congenital disorders of lateralized or segmental overgrowth (LO) are heterogeneous conditions with increased tissue growth in a body region. LO can affect every region, be localized or extensive, involve one or several embryonic tissues, showing variable severity, from mild forms with minor body asymmetry to severe ones with progressive tissue growth and related relevant complications. Recently, next-generation sequencing approaches have increased the knowledge on the molecular defects in LO, allowing classifying them based on the deranged cellular signaling pathway. LO is caused by either genetic or epigenetic somatic anomalies affecting cell proliferation. Most LOs are classifiable in the Beckwith-Wiedemann spectrum (BWSp), PI3KCA/AKT-related overgrowth spectrum (PROS/AROS), mosaic RASopathies, PTEN Hamartoma Tumor Syndrome, mosaic activating variants in angiogenesis pathways, and isolated LO (ILO). These disorders overlap over common phenotypes, making their appraisal and distinction challenging. The latter is crucial, as specific management strategies are key: some LO is associated with increased cancer risk making imperative tumor screening since childhood. Interestingly, some LO shares molecular mechanisms with cancer: recent advances in tumor biological pathway druggability and growth downregulation offer new avenues for the treatment of the most severe and complicated LO.
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Affiliation(s)
- Alessandro Mussa
- Department of Public Health and Pediatric Sciences, University of Torino, 10126 Torino, Italy; (D.C.); (S.C.)
- Pediatric Clinical Genetics Unit, Regina Margherita Children’s Hospital, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
- Correspondence: ; Tel.: +39-0113135372
| | - Diana Carli
- Department of Public Health and Pediatric Sciences, University of Torino, 10126 Torino, Italy; (D.C.); (S.C.)
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cell Therapy Division, Regina Margherita Children’s Hospital, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Simona Cardaropoli
- Department of Public Health and Pediatric Sciences, University of Torino, 10126 Torino, Italy; (D.C.); (S.C.)
| | | | - Nicoletta Resta
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari “Aldo Moro”, 70121 Bari, Italy;
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5
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Arafa OM, Alzuhair AR, Alharbi SK, Alromaih NI. Surgical correction of foot equino-cavocarus deformity in Klippel-Trénaunay-Weber syndrome: a case report. J Surg Case Rep 2021; 2021:rjab434. [PMID: 34650788 PMCID: PMC8510640 DOI: 10.1093/jscr/rjab434] [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: 07/14/2021] [Revised: 09/06/2021] [Accepted: 09/12/2021] [Indexed: 01/19/2023] Open
Abstract
Klippel-Trénaunay-Weber syndrome (KTWS) is a rare condition characterized by a classic clinical triad. However, it can also have other features, such as cavocarus foot deformity, which is a rare presentation in a patient with KTWS. In this case report, we present our surgical technique of correcting such a complex deformity. Also, there are no other similar cases reported in the literature. An 18-year-old girl who is a known case of KTWS with a complaint of progressive unilateral left foot deformity. Her examination, revealed a rigid pes cavus with an equinus deformity in the left foot. Radiography of the left foot revealed marked cavus as well as hindfoot and forefoot varus. A successful surgical correction of the deformity was described in a stepwise fashion. The management of foot cavocarus deformity in KTWS patients is associated with high intra- and post-operative risk due to its complexity. Therefore, the management requires a multidisciplinary team approach.
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Affiliation(s)
- Orfan M Arafa
- Orthopaedic Surgery Consultant, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abduljabar R Alzuhair
- Assistant Consultant of Orthopaedic Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Sultan K Alharbi
- Orthopaedic Surgery Resident, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Norah I Alromaih
- Medical Intern, King Saud University Medical City, Riyadh, Saudi Arabia
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6
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Sikakulya FK, Egesa WI, Kiyaka SM, Anyama P. A neonate with Klippel-Trénaunay syndrome: a case report. J Med Case Rep 2021; 15:447. [PMID: 34488883 PMCID: PMC8422675 DOI: 10.1186/s13256-021-03029-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/26/2021] [Indexed: 01/19/2023] Open
Abstract
Background Klippel–Trénaunay syndrome is a rare congenital capillary–lymphatic–venous condition characterized by the clinical triad of capillary malformations (port wine stains), varicose veins with or without venous malformations, and bony and/or soft-tissue hypertrophy. It has a very low incidence of about 1:100,000. Case presentation We report the case of 21-day-old neonate Black African female (born in Uganda) with Klippel–Trénaunay syndrome who presented with macrodactyly and ectrodactyly on the left foot, as well as numerous port wine stains on the left thoracoabdominal region and anteroposterior left lower limb. Color Doppler ultrasound examination of the left lower limb and abdomen revealed varicose veins without signs of arteriovenous fistula. Conclusion The report presents the case of a neonate with a rare congenital vascular disorder type Klippel–Trénaunay syndrome.
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Affiliation(s)
- Franck Katembo Sikakulya
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda. .,Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo.
| | - Walufu Ivan Egesa
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Bushenyi, Uganda
| | - Sonye Magugu Kiyaka
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Philip Anyama
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda.,Department of Surgery, Jinja Regional Referral Hospital, Jinja, Uganda
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7
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Snee IA, Mazzola CA, Sikorskyj T. Chiari I malformation with Klippel-Trenaunay syndrome: case report and review of the literature. Childs Nerv Syst 2021; 37:2369-2373. [PMID: 33492467 PMCID: PMC8263457 DOI: 10.1007/s00381-020-04992-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/30/2020] [Indexed: 01/19/2023]
Abstract
We present a rare case of an 8-year-old male with Klippel-Trenaunay syndrome (KTS) and a Chiari I malformation (CIM). Magnetic resonance imaging (MRI) to investigate facial asymmetry and speech delay at age two revealed CIM with cerebellar tonsils 1.3 cm below the foramen magnum without syringomyelia. The patient underwent a craniectomy and posterior fossa decompression with C1 laminectomy. While gene sequencing determined the patient was negative for the PIK3CA gene mutation, the patient's clinical history strongly suggests KTS. He has hemihypertrophy, leg length discrepancy, hemangiomas and pigmentary mosaicism along the upper and lower extremities, heart murmur, chronic low heart rate, recurrent hip pain, and mild scoliosis. Neurodevelopmental concerns include difficulty reading, attention deficit hyperactivity disorder (ADHD), anxiety, and difficulty running and going downstairs. His most recent MRI shows good decompression at the cervicomedullary junction, global cerebrospinal fluid (CSF) flow, and less peg-like cerebellar tonsils. Also noted were two intravertebral hemangiomas at T5 and T6. While the patient's speech has improved, there is still difficulty with the expressive language. He still has mild delays, runs slowly, and does not alternate feet when climbing stairs. The patient is being followed by multiple specialists including neurology, hematology-oncology, genetics, orthopedic surgery, and developmental pediatrics.
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Affiliation(s)
- Isabel A. Snee
- The University of Notre Dame, Notre Dame, IN USA ,The New Jersey Pediatric Neuroscience Institute, Morristown, NJ USA
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8
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Klippel-Trenaunay Syndrome Involving Upper Limb and Chest Wall: A Case Report and Review of the Literature. ACTA MEDICA BULGARICA 2020. [DOI: 10.2478/amb-2020-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Abstract
The group of congenital limb overgrowth syndromes associated with vascular malformations include various disorders, often with variable clinical expression. Klippel-Trenaunay syndrome is the most common syndrome in this group, compared to other similar disorders such as Proteus, Parkes-Weber, Sturge-Weber, Cobb, Maffucii and CLOVES syndromes. We present a case of a 55-year-old male who presented with swelling, pain, heaviness, numbness and increased local temperature, involving the right upper extremity and the right side of the chest wall and associated with a livid erythema. The patient had several comorbidities including arterial hypertension and ischemic heart disease. He also had a family history of diabetes mellitus. A multidisciplinary team-based treatment approach, including physicians with expertise in various medical and surgical specialties was applied with the patient being “the unifying focus” of all these experts and their efforts. A personal approach tailored to the patient’s preferences was the key to a successful treatment.
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9
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Ivanitskaya O, Andreeva E, Odegova N. Prenatal diagnosis of Klippel-Trenaunay syndrome: Series of four cases and review of the literature. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2020; 28:91-102. [PMID: 32528545 DOI: 10.1177/1742271x19880327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 09/08/2019] [Indexed: 01/19/2023]
Abstract
Klippel-Trenaunay syndrome is a rare disease with a classic triad of port wine stains, varicose veins, and bony and soft tissue hypertrophy of an extremity. The quality of life in these patients is significantly affected, making the prenatal diagnosis of Klippel-Trenaunay syndrome important. We present four prenatally diagnosed cases of this anomaly with a unique case of ectrodactyly of the hand in foetus with Klippel-Trenaunay syndrome. Such a combination has not been previously reported prenatally. A review of the literature for similar cases is also presented.
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Affiliation(s)
- Olga Ivanitskaya
- Medical Genetic Department, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russian Federation
| | - Elena Andreeva
- Medical Genetic Department, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russian Federation
| | - Natalia Odegova
- Medical Genetic Department, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russian Federation
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10
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Zhai J, Zhong ME, Shen J, Tan H, Li Z. Kyphoscoliosis with Klippel-Trenaunay syndrome: a case report and literature review. BMC Musculoskelet Disord 2019; 20:10. [PMID: 30611239 PMCID: PMC6320630 DOI: 10.1186/s12891-018-2393-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/21/2018] [Indexed: 01/19/2023] Open
Abstract
Background Klippel-Trenaunay syndrome (KTS) is a rare congenital syndrome characterized by the triad of venous varicosities, capillary malformations and limb hypertrophy. However, KTS may rarely occur in combination with kyphoscoliosis. Case presentation We presented an 18-year-old female with KTS and kyphoscoliosis. Hypertrophy of bone and soft tissue affected her left face, trunk and lower limb. Moreover, the patient is associated with subacute thyroiditis, vitamin D deficiency and iron deficiency anemia, high level of D-dimer, swollen tonsil, kyphoscoliosis and Chiari-I-malformation without syringomyelia. A posterior correction and spinal fusion from T10 to L5 levels were performed for this patient. The lumbar curve was corrected from 105° to 60° and the kyphosis improved from 58° to 26°. The distance of trunk shift decreased from 10 cm to 1.4 cm. There were no thrombotic events occurred. At the 8th month follow-up, there was no significantly change of the curve in the coronal and sagittal radiographs. During the 31-month follow-up, the patient did not experience any discomfort. And her general appearance did not have any change until the last follow-up. However, she refused to take radiograph for worrying about radiation. Conclusions KTS is a rare disease with classic clinical triad. However, it can also have other different features, including kyphoscoliosis, elevated D-Dimer, vitamin D deficiency and iron-deficiency anemia. These issues should be taken into consideration when planning treatment for kyphoscoliosis in KTS patients.
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Affiliation(s)
- Jiliang Zhai
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Min-Er Zhong
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jianxiong Shen
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| | - Haining Tan
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Zheng Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
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11
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Pallister-Hall syndrome with orofacial narrowing and tethered cord: a case report. J Med Case Rep 2018; 12:354. [PMID: 30486853 PMCID: PMC6262955 DOI: 10.1186/s13256-018-1868-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 10/03/2018] [Indexed: 11/14/2022] Open
Abstract
Background Pallister–Hall syndrome is a rare, autosomal dominant, genetic disorder characterized by different congenital abnormalities: hypothalamic hamartoblastoma, bifid or shortened epiglottis, polydactyly, renal anomalies, and imperforate anus. Case presentation In this case report, we describe the case of a 13-year-old Lebanese-Armenian boy born with Pallister–Hall syndrome showing newly associated manifestations (orofacial narrowing and tethered cord), and currently showing a spontaneous puberty with normal growth pattern following management with growth hormones. Conclusions This case report shows a practical approach to this very rare syndrome, mainly with testosterone and growth hormones, and its follow-up in the long term. Being familiar with such cases may allow improvement of our knowledge for better management in the future.
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12
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Chenbhanich J, Leelayuwatanakul N, Phowthongkum P. Klippel-Trenaunay-Weber syndrome as a cause of chronic thromboembolic pulmonary hypertension. BMJ Case Rep 2018; 2018:bcr-2018-224621. [PMID: 29572375 DOI: 10.1136/bcr-2018-224621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Jirat Chenbhanich
- Department of Internal Medicine, Metrowest Medical Center, Framingham, Massachusetts, USA
| | - Nophol Leelayuwatanakul
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Prasit Phowthongkum
- Division of Medical Genetics and Genomics, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Adult Cardiovascular Genetic Clinic, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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13
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Mehta V, Bhatia K, Dave AM, Depew ZS. A 39-Year-Old Pregnant Woman with Pulmonary Emboli on Long Term Anticoagulation. Cureus 2017; 9:e1356. [PMID: 28721324 PMCID: PMC5510980 DOI: 10.7759/cureus.1356] [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] [Indexed: 01/19/2023] Open
Abstract
We present the case of a 39-year-old pregnant woman with Klippel-Trenaunay syndrome (KTS). We demonstrate the risks of multiple, co-existing pro-thrombotic states (pregnancy, KTS), discuss complications of KTS (deep venous thromboembolisms and pulmonary emboli) and highlight general and disease-specific preventive measures against venous thromboembolic events (VTE). KTS is a rare condition and it's co-existence with pregnancy and VTEs is rarer still.
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Affiliation(s)
| | | | - Amanda M Dave
- School of Medicine, Creighton University Medical Center
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14
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Arts FA, Chand D, Pecquet C, Velghe AI, Constantinescu S, Hallberg B, Demoulin JB. PDGFRB mutants found in patients with familial infantile myofibromatosis or overgrowth syndrome are oncogenic and sensitive to imatinib. Oncogene 2015; 35:3239-48. [PMID: 26455322 DOI: 10.1038/onc.2015.383] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/27/2015] [Accepted: 09/04/2015] [Indexed: 12/26/2022]
Abstract
Recently, germline and somatic heterozygous mutations in the platelet-derived growth factor receptor β (PDGFRB) have been associated with familial infantile myofibromatosis (IM), which is characterized by soft tissue tumors, and overgrowth syndrome, a disease that predisposes to cancer. These mutations have not been functionally characterized. In the present study, the activity of three PDGFRB mutants associated with familial IM (R561C, P660T and N666K) and one PDGFRB mutant found in patients with overgrowth syndrome (P584R) was tested in various models. The P660T mutant showed no difference with the wild-type receptor, suggesting that it might represent a polymorphic variant unrelated to the disease. By contrast, the three other mutants were constitutively active and able to transform NIH3T3 and Ba/F3 cells to different extents. In particular, the germline mutant identified in overgrowth syndrome, P584R, was a stronger oncogene than the germline R561C mutant associated with myofibromatosis. The distinct phenotypes associated with these two mutations could be related to this difference of potency. Importantly, all activated mutants were sensitive to tyrosine kinase inhibitors such as imatinib, nilotinib and ponatinib. In conclusion, the PDGFRB mutations previously identified in familial IM and overgrowth syndrome activate the receptor in the absence of ligand, supporting the hypothesis that these mutations cause the diseases. Moreover, imatinib seems to be a promising treatment for patients carrying these mutations. To our knowledge, these are the first confirmed gain-of-function point mutations of PDGFRB in human cancer.
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Affiliation(s)
- F A Arts
- De Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - D Chand
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Molecular Biology, Umeå University, Umeå, Sweden
| | - C Pecquet
- De Duve Institute, Université Catholique de Louvain, Brussels, Belgium.,Ludwig Institute for Cancer Research, Brussels, Belgium
| | - A I Velghe
- De Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - S Constantinescu
- De Duve Institute, Université Catholique de Louvain, Brussels, Belgium.,Ludwig Institute for Cancer Research, Brussels, Belgium
| | - B Hallberg
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - J-B Demoulin
- De Duve Institute, Université Catholique de Louvain, Brussels, Belgium
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15
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Ophthalmic Alterations in the Sturge-Weber Syndrome, Klippel-Trenaunay Syndrome, and the Phakomatosis Pigmentovascularis: An Independent Group of Conditions? BIOMED RESEARCH INTERNATIONAL 2015; 2015:786519. [PMID: 26451379 PMCID: PMC4588354 DOI: 10.1155/2015/786519] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/27/2015] [Indexed: 01/19/2023]
Abstract
The phakomatoses have been traditionally defined as a group of hereditary diseases with variable expressivity characterized by multisystem tumors with possible malignant transformation. The Sturge-Weber syndrome, Klippel-Trenaunay syndrome, and the phakomatosis pigmentovascularis have the facial port-wine stain in common. Numerous pathophysiogenetic mechanisms have been suggested such as venous dysplasia of the emissary veins in the intracranial circulation, neural crest alterations leading to alterations of autonomic perivascular nerves, mutation of the GNAO gene in the Sturge-Weber syndrome, PIK3CA mutation in malformative/overgrowth syndromes such as the Klippel-Trenaunay syndrome, and the twin-spotting phenomenon in phakomatosis pigmentovascularis. Other features linked to the port-wine stain and typical to all of the three conditions are glaucoma and choroidal alterations. Glaucoma can be due to malformations of the anterior chamber or high episcleral venous pressure and in phakomatosis pigmentovascularis it can also be associated with angle hyperpigmentation. The choroid can be thickened in all diseases. Furthermore, choroidal melanocytosis in the phakomatosis pigmentovascularis can lead to malignant transformation. Although the multiple pathophysiological mechanisms still require clarification, similarities in ophthalmic manifestations make it reasonable to classify these diseases in an independent group.
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Edmondson AC, Kalish JM. Overgrowth Syndromes. J Pediatr Genet 2015; 4:136-43. [PMID: 27617124 PMCID: PMC4918719 DOI: 10.1055/s-0035-1564440] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 05/20/2015] [Indexed: 01/19/2023]
Abstract
Numerous multiple malformation syndromes associated with pathologic overgrowth have been described and, for many, their molecular bases elucidated. This review describes the characteristic features of these overgrowth syndromes, as well as the current understanding of their molecular bases, intellectual outcomes, and cancer predispositions. We review syndromes such as Sotos, Malan, Marshall-Smith, Weaver, Simpson-Golabi-Behmel, Perlman, Bannayan-Riley-Ruvalcaba, PI3K-related, Proteus, Beckwith-Wiedemann, fibrous dysplasia, Klippel-Trenaunay-Weber, and Maffucci.
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Affiliation(s)
- Andrew C. Edmondson
- Division of Human Genetics, Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jennifer M. Kalish
- Division of Human Genetics, Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
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