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Abdolrahimzadeh S, Pugi DM, Manni P, Iodice CM, Di Tizio F, Persechino F, Scuderi G. An update on ophthalmological perspectives in oculodermal melanocytosis (Nevus of Ota). Graefes Arch Clin Exp Ophthalmol 2023; 261:291-301. [PMID: 35851619 PMCID: PMC9837000 DOI: 10.1007/s00417-022-05743-1] [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: 03/16/2022] [Revised: 06/07/2022] [Accepted: 06/29/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To provide a review of the literature on oculodermal melanocytosis (ODM) with a focus on the diagnostic and therapeutic implications of multimodal imaging techniques in the management of ophthalmic complications. METHODS The authors carried out a literature search on PubMed, Medline, and Scopus of English language articles published on ODM through August 2021. This review presents traditional and novel diagnostic methods in the diagnosis and follow-up of patients with particular emphasis on addressing the role of imaging in the management of the ophthalmic complications of the condition towards improving current practice patterns. RESULTS ODM is a rare, prevalently unilateral, congenital condition that presents with brown or blue/gray flat asymptomatic lesions of the skin, mucosae, episclera/sclera, and uvea localized within the territory of distribution of the ophthalmic and mandibular branches of the trigeminal nerve. Glaucoma and predisposition to uveal melanoma are the main ophthalmic complications. Diagnosis and management are through comprehensive opthalmological examination and traditional imaging methods such as ultrasonography and fluorescein/indocyanine green angiography as pigmentation of the fundus can conceal subtle retinal and choroidal alterations. Anterior segment optical coherence tomography and ultrasound biomicroscopy are used to evaluate the anterior segment and the ciliary body in the presence of glaucoma or melanoma of the anterior uveal tract. Fundus autofluorescence and retinal pigment epithelium (RPE) alterations are of aid in the differential diagnosis between choroidal nevi and melanoma. Enhanced depth imaging spectral domain optical coherence tomography offers outstanding in vivo evaluation of the dimensions and details of tumors or nevi and surrounding choroidal tissues and small choroidal melanomas may show distortions of the retinal and sub-retinal profile, presence of intra and sub-retinal fluid, abnormalities of the RPE, and compression of the choriocapillaris. CONCLUSIONS Novel multimodal imaging techniques are significant in the diagnosis and management of the ophthalmic complications of ODM. Fundus autofluorescence and enhanced depth spectral domain optical coherence tomography have adjunctive value in the detection of early-stage melanoma and differential diagnosis between nevi and melanoma. Awareness of current and emerging imaging techniques can propagate improved standardized definition and assessment of the complications of ODM.
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Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, Mental Health, Neurosciences, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy ,St. Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy
| | - Damiano Maria Pugi
- Ophthalmology Unit, Mental Health, Neurosciences, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Priscilla Manni
- Ophthalmology Unit, Mental Health, Neurosciences, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Clemente Maria Iodice
- Multidisciplinary Department of Medical Surgical and Dental Sciences, Eye Clinic, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Federico Di Tizio
- St. Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy
| | - Flavia Persechino
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Gianluca Scuderi
- Ophthalmology Unit, Mental Health, Neurosciences, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy ,St. Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy
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Venkatesh R, Agrawal S, Reddy NG, Mangla R, Yadav NK, Chhablani J. Choroidal Melanocytic Hamartoma. J Clin Med 2022; 11:5983. [PMID: 36294307 PMCID: PMC9604492 DOI: 10.3390/jcm11205983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 09/18/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2024] Open
Abstract
We report on a case series that revealed flat, choroidal lesions on optical coherence tomography (OCT) and on enface MultiColor® (MCI) imaging of the fundus but were not noticeable on clinical examination or conventional color fundus images. This observational study included 12 eyes from 11 patients who had distinct, orange-colored lesions on MCI. Retinal imaging was conducted using conventional color fundus photography and OCT. On the color fundus images and the blue and green reflectance channels of MCI, each of the lesions was difficult to distinguish. On the infrared channel, the lesion was identified as bright white in color and bright orange on the multicolor image. The lesion was identified on OCT as a flat, homogeneous hyperreflective lesion involving the choroid, with an intact overlying retinal pigment epithelium and retinal layers. A comparison of the clinical and imaging features with other known entities led to the conclusion that the lesion was a distinct clinical entity. The presence of melanin in the lesion was confirmed based on the retinal imaging findings and the light absorption properties of melanin. As a result, the lesion was named as 'choroidal melanocytic hamartoma'. A longer follow-up is required to confirm the benign nature of this clinical entity.
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Affiliation(s)
- Ramesh Venkatesh
- Narayana Nethralaya, Department of Retina and Vitreous, #121/C, Chord Road, 1st R Block Rajaji Nagar, Bangalore 560010, India
| | - Sameeksha Agrawal
- Narayana Nethralaya, Department of Retina and Vitreous, #121/C, Chord Road, 1st R Block Rajaji Nagar, Bangalore 560010, India
| | - Nikitha Gurram Reddy
- Narayana Nethralaya, Department of Retina and Vitreous, #121/C, Chord Road, 1st R Block Rajaji Nagar, Bangalore 560010, India
| | - Rubble Mangla
- Narayana Nethralaya, Department of Retina and Vitreous, #121/C, Chord Road, 1st R Block Rajaji Nagar, Bangalore 560010, India
| | - Naresh Kumar Yadav
- Narayana Nethralaya, Department of Retina and Vitreous, #121/C, Chord Road, 1st R Block Rajaji Nagar, Bangalore 560010, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA 15213, USA
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Abdolrahimzadeh S, Formisano M, Marani C, Rahimi S. An update on the ophthalmic features in hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). Int Ophthalmol 2022; 42:1987-1995. [PMID: 35034241 PMCID: PMC9156511 DOI: 10.1007/s10792-021-02197-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/18/2021] [Indexed: 11/29/2022]
Abstract
Hereditary haemorrhagic telangiectasia (HHT) or Osler-Rendu-Weber syndrome is a rare autosomal dominant disease, characterised by systemic angiodysplasia. Dysfunction of the signalling pathway of β transforming growth factor is the main cause of HHT principally owing to mutations of the genes encoding for endoglin (ENG) and activin A receptor type II-like 1 (ACVRL1). Clinical manifestations can range from mucocutaneous telangiectasia to organ arterio-venous malformations and recurrent epistaxis. The early clinical manifestations may sometimes be subtle, and diagnosis may be delayed. The main ophthalmic manifestations historically reported in HHT are haemorrhagic epiphora, and conjunctival telangiectasia present in 45-65% of cases, however, imaging with wide-field fluorescein angiography has recently shown peripheral retinal telangiectasia in 83% of patients. Optimal management of HHT requires both understanding of the clinical presentations and detection of early signs of disease. Advances in imaging methods in ophthalmology such as wide-field fluorescein angiography, spectral domain optical coherence tomography, and near infrared reflectance promise further insight into the ophthalmic signs of HHT towards improved diagnosis and early management of possible severe complications.
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Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, Neurosciences, Mental Health and Sense Organs (NESMOS) Department, University of Rome Sapienza, Rome, Italy. .,Faculty of Medicine and Psychology, St. Andrea Hospital, Via di Grottarossa 1035/1039, 00189, Rome, Italy.
| | - Martina Formisano
- Department of Sense Organs, Ophthalmology Unit, University of Rome Sapienza, Azienda Policlinico Umberto I, viale del Policlinico 155, 00161, Rome, Italy
| | - Carla Marani
- San Carlo Hospital, Via Aurelia 275, 00165, Rome, Italy
| | - Siavash Rahimi
- Istituto Dermopatico dell'Immacolata (IDI-IRCCS) Department of Histopathology, Via Monti di Creta 104, 00167, Rome, Italy
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Abdolrahimzadeh S, Ciancimino C, Grassi F, Sordi E, Fragiotta S, Scuderi G. Near-Infrared Reflectance Imaging in Retinal Diseases Affecting Young Patients. J Ophthalmol 2021; 2021:5581851. [PMID: 34373789 PMCID: PMC8349282 DOI: 10.1155/2021/5581851] [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: 01/05/2021] [Revised: 06/04/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Abstract
Near-infrared reflectance (NIR) is a noninvasive, contactless, and rapid in vivo imaging technique for visualizing subretinal alterations in the photoreceptor layer, retinal pigment epithelium, and choroid. The present report describes the application of this imaging method in retinal and choroidal pathologies affecting young patients where scarce cooperation, poor fixation, and intense glare sensation can result in a challenging clinical examination. A literature search of the MEDLINE database was performed using the terms "near-infrared reflectance" and "spectral-domain optical coherence tomography." Articles were selected if they described the diagnostic use of NIR in children or young adults. Of 700 publications, 42 manuscripts published between 2005 and 2020 were inherent to children or young adults and were considered in this narrative literature review. The first disease category is the phakomatoses where NIR is essential in visualizing choroidal alterations recognized as cardinal biomarkers in neurofibromatosis type 1, microvascular retinal alterations, and retinal astrocytic hamartomas. Another diagnostic application is the accurate visualization of crystals of various nature, including the glistening crystals that characterize Bietti crystalline dystrophy. Acute macular neuropathy and paracentral acute middle maculopathy represent a further disease category with young adulthood onset where NIR is not only diagnostic but also essential to monitor disease progression. A further interesting clinical application is to facilitate the detection of laser-induced maculopathy where funduscopic examination can be normal or subnormal. In conclusion, NIR imaging has a noninterchangeable role in diagnosing certain retinal diseases, especially in children and young adults where there is scarce collaboration and a lack of evident clinical findings. Moreover, this technique can reveal unique retinal and choroidal biomarkers highly specific to rare conditions.
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Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Chiara Ciancimino
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Flaminia Grassi
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Edoardo Sordi
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Serena Fragiotta
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
| | - Gianluca Scuderi
- Ophthalmology Unit, “Sapienza” University of Rome, NESMOS Department, St. Andrea Hospital, Via di Grottarossa 1035/1039, Rome, Italy
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Gonca Kaçar A, Kılınc Oktay B, Çınar Özel S, Ocak S, Güneş N, Uludağ Alkaya D, Tüysüz B, Apak H, Tiraje Celkan T. Neurofibromatosis Type 1 in Children: A Single-Center Experience. Turk Arch Pediatr 2021; 56:339-343. [PMID: 35005728 PMCID: PMC8655961 DOI: 10.5152/turkarchpediatr.2021.20165] [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: 08/04/2020] [Accepted: 10/22/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Neurofibromatosis (NF) is the most common autosomal dominantly inherited neurocutaneous syndrome. The characteristic features of NF type 1 (NF-1) are café au lait spots, axillary and inguinal freckling, peripheral neurofibromas, optic pathway glioma, and Lisch nodules. The present study aimed to analyze the clinical features of children with NF-1. MATERIALS AND METHODS In this study, the children with NF-1 diagnosed and followed-up in our center between 2000 and 2020 were retrospectively evaluated. Demographic and clinical features of patients were defined. RESULTS The study group consisted of 52 patients. Of those, 25 were boys and 27 were girls. The children's median age at diagnosis was 5.9 years (1-15.8). Café au lait (CAL) spots and axillary/inguinal freckling were observed in 50 and 24 patients, respectively. Neurofibroma was present in 22 cases. Ten of the cohort had optic gliomas, and 39 of them had cranial hamartomas. Orthopedic complications such as scoliosis, tibial pseudoarthrosis, and osteoporosis were observed in 13 patients. Eleven children had neurocognitive disorders. CONCLUSIONS Early diagnosis is important in neurofibromatosis to prevent the complications of the disease. Also, neurological development and secondary malignancy follow-up should be done carefully in this group of patients.
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Affiliation(s)
- Ayşe Gonca Kaçar
- Department of Pediatric Hematology and Oncology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Burcu Kılınc Oktay
- Department of Genetics, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Simge Çınar Özel
- Department of Pediatric Hematology and Oncology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Süheyla Ocak
- Department of Pediatric Hematology and Oncology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Nilay Güneş
- Department of Genetics, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Dilek Uludağ Alkaya
- Department of Genetics, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Beyhan Tüysüz
- Department of Genetics, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Hilmi Apak
- Department of Pediatric Hematology and Oncology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Tülin Tiraje Celkan
- Department of Pediatric Hematology and Oncology, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
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Formisano M, di Pippo MC, Scuderi L, Abdolrahimzadeh S. Current concepts on diffuse choroidal hemangioma in Sturge Weber syndrome. Ophthalmic Genet 2021; 42:375-382. [PMID: 33843430 DOI: 10.1080/13816810.2021.1910963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Diffuse choroidal hemangioma (DCH) is a benign vascular tumor that is characteristically found in the Sturge-Weber syndrome (SWS). Recent genetic discoveries demonstrate that DCH occurs sporadically from an activating mutation in GNAQ at codon R183. Mutations in GNAQ or GNA11 result in dysregulation of the mitogen-activated protein kinase, which influences gene transcription and results in cellular proliferation. DCH may not always be readily detected on routine ophthalmological examination, consequently diagnosis and multidisciplinary referral are often delayed.Purpose: A literature search was performed through April 2020 without a lower date limit. This review will summarize the pathogenesis, diagnosis and management of DCH.Discussion: Multimodal imaging facilitates early detection of the condition. In particular, enhanced depth imaging spectral domain optical coherence tomography enables non-invasive, high-resolution visualization of the choroid to even detect mild choroidal thickening. Management of symptomatic DCH is generally difficult and results in poor visual outcome, thus, treatment is generally unwarranted, unless the hemangioma complicated by serous retinal detachment. The main treatment method is radiation therapy with external beam radiation therapy, proton beam therapy, plaque brachytherapy, and gamma knife surgery where low doses of radiation entail fewer complications. One method of alternative management is with photodynamic therapy that, although less invasive with a lower rate of complications, is not always feasible or effective in cases with extensive exudative retinal detachment.Conclusions: Multimodal ophthalmological imaging facilitates diagnosis of DCH and lifelong surveillance is essential in patients.
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Affiliation(s)
- Martina Formisano
- Ophthalmology Unit, Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Maria Chiara di Pippo
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, St. Andrea Hospital, Rome, Italy
| | - Luca Scuderi
- Ophthalmology Unit, Department of Sense Organs, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Solmaz Abdolrahimzadeh
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, St. Andrea Hospital, Rome, Italy
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Marani C, Akaev I, Yeoh CC, Walsh E, Rahimi S. Cervical malignant mixed mesonephric tumour: A case report with local recurrence after six-years and next-generation sequencing analysis with particular reference to the ataxia telangiectasia mutated gene. Exp Ther Med 2021; 21:394. [PMID: 33680116 PMCID: PMC7918045 DOI: 10.3892/etm.2021.9825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 11/05/2020] [Indexed: 12/16/2022] Open
Abstract
Malignant mixed mesonephric tumours (MMMsT) of the female genital tract are extremely rare, and the majority are located in the wall of the cervix uteri. At present, there are no reports of the molecular characterisation of MMMsT of the female genital tract. Herein, we report the morphological, immunohistochemical and molecular features of this rare malignancy using next-generation sequencing (NGS) analysis. A 58-year-old woman presented with vaginal bleeding. In 2013, she had been diagnosed with a cervical carcinosarcoma of probable mesonephric origin and International Federation of Gynaecology and Obstetrics (FIGO) stage IB that had been treated by total hysterosalpingo-oopherectomy without adjuvant chemo-radiotherapy. Ultrasonography showed a vaginal mass measuring 25 mm in the maximum dimension. Biopsy was performed and showed a biphasic neoplasm composed of adenocarcinoma and sarcoma. Immunohistochemistry showed positive staining for epithelial membrane antigen (EMA), pancytokeratin (MNF116), paired box 8 (PAX-8), β-catenin, cytokeratin 7, cyclin D1, GATA3 and CD10. Androgen receptor positivity was detected in very limited areas. Cytokeratin 20, carcinoembryonic antigen (CEA), oestrogen receptor (ER), progesterone receptor (PR), transcription termination factor 1 (TTF1), Wilm's tumour antigen-1 (WT-1), calretinin and p16 were negative. The immunohistochemical profile was consistent with mesonephric origin. NGS analysis identified a variant of the ataxia-telangiectasia mutated (ATM) gene (p.Phe858Leu; c.2572 T>C; COSM21826). The number of detected allele frequency reads of ATM mutation following clinical relapse was higher, compared to its baseline: 65 vs. 96%. The differential diagnosis of MMMsT includes mesonephric hyperplasia, malignant mixed Mullerian tumour (carcinosarcoma), endometrioid adenocarcinoma and endometrial stromal sarcoma. The clinical significance of the observed ATM variant in the case reported herein is unknown. The present findings need further verification, as the mutation in ATM may result in chemotherapy resistance or conversely, may be exploited for targeted therapies.
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Affiliation(s)
- Carla Marani
- Histopathology Division, San Carlo di Nancy Hospital, Rome 00165, Italy
| | - Iolia Akaev
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2UP, UK
| | - Chit Cheng Yeoh
- Department of Oncology, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
| | - Elizabeth Walsh
- Frontier Pathology, Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Brighton BN2 5BE, UK
| | - Siavash Rahimi
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2UP, UK
- Frontier Pathology, Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Brighton BN2 5BE, UK
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de Paula A, Abdolrahimzadeh S, Fragiotta S, Di Pippo M, Scuderi G. Current concepts on ocular vascular abnormalities in the phakomatoses. Semin Ophthalmol 2021; 36:549-560. [PMID: 33755531 DOI: 10.1080/08820538.2021.1900284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neurofibromatosis, Von Hippel Lindau disease, and tuberous sclerosis complex are classified under the term phakomatoses. They are characterized by ocular vascular abnormalities such as vascular tortuosity, corkscrew retinal vessel configuration, moyamoya-like aspect, microaneurysms, hemangioblastomas, and focal sheathing of retinal arteries, possibly due to abnormal formation, migration, and differentiation of neural crest cells. These alterations can be the first sign or the hallmark of disease and can be related to vasoproliferative tumors. PURPOSE Novel imaging technologies in ophthalmology, such as near-infrared reflectances and spectral domain optical coherence tomography, have improved our knowledge in the diagnosis of these pathologies. Previously undetected macular vascular alterations have been reported in phakomatoses using optical coherence tomography angiography. This review will summarize the ophthalmic vascular abnormalities and novel imaging methods in the phakomatoses. CONCLUSION Active research is being led into the ophthalmic management of these conditions and their complications, and owing to elevated vascular endothelial growth factor production from hemangioblastoma, hamartoma, and retinal vascular proliferative tumors, increasing interest in this line of therapy has been conducted although research is still ongoing in this area.
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Affiliation(s)
- Alessandro de Paula
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Solmaz Abdolrahimzadeh
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Serena Fragiotta
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Mariachiara Di Pippo
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Gianluca Scuderi
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
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Abdolrahimzadeh S, Formisano M, Scuderi L, Rahimi S. Long-term follow-up of adult patient with neurofibromatosis type 1 with retinal astrocytic hamartoma using spectral-domain optical coherence tomography: a review of the literature and a report of a case. Ophthalmic Genet 2020; 42:209-215. [PMID: 33203322 DOI: 10.1080/13816810.2020.1849315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Background: Retinal astrocytic hamartoma (RAH) is a tumor that can be sporadic or in the context of tuberous sclerosis complex (TSC) and has been reported to be associated with neurofibromatosis type 1 (NF1) in a few cases.Patient and methods: A 65-year-old male patient with NF1 was referred for ophthalmological evaluation. Comprehensive examination, near-infrared reflectance (NIR), spectral-domain optical coherence tomography (SDOCT), fluorescein angiography (FFA), and indocyanine green angiography (ICGA) were carried out. The follow-up of the patient was at 4 and 7 years.Results: Best-corrected visual acuity (BCVA) was 20/20 in both eyes. Anterior segment examination revealed bilateral Lisch nodules. Fundus examination was unremarkable but at NIR and SDOCT the patient presented choroidal hamartoma, microvascular retinal alterations, and enlarged choroidal vessels in both eyes. NIR also revealed an unusual area of peripapillary hyporeflectivity in the right eye. On SDOCT, this corresponded to an elevated peripapillary mass characterized by intralesional optically empty cavities in the retinal nerve fiber layer (RNFL) and ganglion cell layer-inner plexiform layer (GCL-IPL), diagnosed as a RAH. Four years later, BCVA was 20/25 with a retinal schisis departing from the lesion to the macula. At 7 years, BCVA was stable at 20/25, the lesion was smaller, and there was a slight reduction of the schisis.Conclusion: RAH is a rare finding in NF1 and the translucent type has not been previously reported. RAH in NF1 has a peripapillary location and demonstrates clinically unpredictable behavior; thus, close monitoring with multimodal imaging is advisable.
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Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, NESMOS Department, University of Rome Sapienza, St.Andrea Hospital, Rome, Italy
| | - Martina Formisano
- Ophthalmology Unit, Department of Sense Organs, University of Rome Sapienza, Azienda Policlinico Umberto I, Rome, Italy
| | - Luca Scuderi
- Ophthalmology Unit, Department of Sense Organs, University of Rome Sapienza, Azienda Policlinico Umberto I, Rome, Italy
| | - Siavash Rahimi
- Histopathology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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Bouvarel H, Rodier-Bonifas C, Burillon C. Cataracte congénitale et sclérose tubéreuse de Bourneville : à propos de deux cas. J Fr Ophtalmol 2020; 43:e337-e339. [DOI: 10.1016/j.jfo.2019.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/24/2019] [Accepted: 12/10/2019] [Indexed: 10/23/2022]
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Venkatesh R, Jain K, Pereira A, Jain SD, Aseem A, Mahendradas P, Yadav NK. Retinal cafe-au-lait macules: A rare retinal finding in a patient with neurofibromatosis type 1. Indian J Ophthalmol 2020; 67:2101-2103. [PMID: 31755475 PMCID: PMC6896559 DOI: 10.4103/ijo.ijo_925_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report the retinal and choroidal manifestations using multimodal imaging in a patient with Neurofibromatosis type 1 (NF-1). In this report, we describe the occurrence of a new retinal finding which we label as retinal café-au-lait macules. Also, we describe the superiority of multicolour imaging in comparison to colour fundus photography for identifying the retinal manifestations in NF-1.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina-Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Kushagra Jain
- Department of Retina-Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Arpitha Pereira
- Department of Retina-Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Shreya Dass Jain
- Department of Retina and Vitreous, Narayana Nethralaya, All Skin Clinic, Indore, Madhya Pradesh, India
| | - Aditya Aseem
- Department of Retina-Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | | | - Naresh Kumar Yadav
- Department of Retina-Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
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Abdolrahimzadeh S, Formisano M, Guglielmelli F, Amodeo S, Costa MC, Scuderi G. Unusual Case of Indolent Choroidal Alterations Mimicking Neurofibromatosis Type 1. Case Rep Ophthalmol 2020; 11:167-173. [PMID: 32508623 PMCID: PMC7250382 DOI: 10.1159/000507428] [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: 12/18/2019] [Accepted: 03/23/2020] [Indexed: 11/19/2022] Open
Abstract
Indolent, non-progressive choroidal alterations can be strongly suggestive of neurofibromatosis type 1 (NF1) but are also rarely of unknown aetiology. A 63-year-old man presented for a routine examination. Comprehensive ophthalmological examination and retinal imaging was performed. Visual acuity was 20/20. The anterior segment and fundus were unremarkable. Near-infrared reflectance (NIR) with spectral-domain optical coherence tomography showed unilateral hyperreflective areas in the left posterior pole, corresponding to choroidal nodules on enhanced depth imaging and hypofluorescent areas on indocyanine green angiography. Dermatological evaluation and genetic testing for NF1 were negative. Chest computed tomography, liver function, HLA-A29, and angiotensin-converting enzyme level were negative. The patient has remained in good health and the choroidal alterations have remained non-progressive for 3 years. Choroidal alterations observed with NIR could be a manifestation of somatic mosaicism or a variation of a new unclassified correlated condition that may be better elucidated in the future, given the use of novel imaging techniques that are currently available in ophthalmology.
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Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, Neurosciences, Mental Health and Sensory Organs (NESMOS) Department, Sapienza University of Rome, St. Andrea Hospital, Rome, Italy
- *Solmaz Abdolrahimzadeh, MD, PhD, Ophthalmology Unit, NESMOS Department, Sapienza University of Rome, St. Andrea Hospital, Via di Grottarossa 1035–1039, IT–00189 Rome (Italy),
| | - Martina Formisano
- Ophthalmology Unit, Sapienza University of Rome, Department of Sense Organs, Policlinico Umberto I, Rome, Italy
| | - Fabio Guglielmelli
- Ophthalmology Unit, Neurosciences, Mental Health and Sensory Organs (NESMOS) Department, Sapienza University of Rome, St. Andrea Hospital, Rome, Italy
| | - Stefano Amodeo
- Ophthalmology Unit, Neurosciences, Mental Health and Sensory Organs (NESMOS) Department, Sapienza University of Rome, St. Andrea Hospital, Rome, Italy
| | | | - Gianluca Scuderi
- Ophthalmology Unit, Neurosciences, Mental Health and Sensory Organs (NESMOS) Department, Sapienza University of Rome, St. Andrea Hospital, Rome, Italy
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OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY PARAMETERS IN PATIENTS WITH PHACOMATOSIS. Retina 2020; 41:366-372. [PMID: 32355124 DOI: 10.1097/iae.0000000000002840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the retinal vasculature characteristics between eyes of patients with and without phacomatosis. METHODS Case-control observational study with retinal vasculature evaluation by optical coherence tomography and optical coherence tomography angiography of the macula and disk. RESULTS The study included 80 eyes. Neurofibromatosis Type 1 patients presented with a higher central macular thickness (P = 0.007), a lower optical disk nervous fiber layer (P = 0.006), a lower perimeter, area, and circularity of the foveal avascular zone (P < 0.05), a higher vascular density of macular avascular layer (AMVD) (P = 0.004), and a lower papillary vascular density of superficial capillary plexus (SPVD) (P = 0.048). Patients with tuberous sclerosis presented with an increase in central macular thickness (P = 0.024) and in vascular densities (P < 0.05) [except for macular vascular density of deep capillary plexus (PMVD), AMVD, and SPVD]. Patients with Sturge-Weber syndrome showed a decrease in optical disk nervous fiber layer (P < 0.001), subfoveal choroid thickness (P = 0.011), macular vascular density of superficial capillary plexus (SMVD) (P = 0.036), and SPVD (P < 0.001). CONCLUSION Phacomatosis patients showed statistically significant differences of retinal vasculature characteristics, compared to eyes without pathology. Further studies are needed to determine when and if these parameters change with the course of the disease and if they can be used as biomarkers for disease severity or progression.
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DI Staso F, Ciancaglini M, Abdolrahimzadeh S, D'Apolito F, Scuderi G. Optical Coherence Tomography of Choroid in Common Neurological Diseases. In Vivo 2020; 33:1403-1409. [PMID: 31471385 DOI: 10.21873/invivo.11617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/07/2019] [Accepted: 07/12/2019] [Indexed: 01/13/2023]
Abstract
The choroid is involved directly and indirectly in many pathological conditions such as age-related macular degeneration, myopia-related chorioretinal atrophy and central serous chorioretinopathy. Optical coherence tomography (OCT) has gradually become a fundamental part of modern resources in the hands of ophthalmologists. The enhanced depth imaging technique and swept-source OCT make a great contribution to conventional in vivo choroid assessment. This review focuses on the most common neurological conditions in which choroid assessment by OCT may provide help in early diagnosis and be used as an interdisciplinary follow-up tool. In order to avoid evaluation biases and misdiagnosis, the main and most common physiological and para-physiological conditions in which the choroid may show alterations are also reviewed.
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Affiliation(s)
- Federico DI Staso
- Ophthalmology Unit, NESMOS Department, St. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Ciancaglini
- Eye Clinic, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Solmaz Abdolrahimzadeh
- Ophthalmology Unit, NESMOS Department, St. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Fabian D'Apolito
- Ophthalmology Unit, NESMOS Department, St. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Scuderi
- Ophthalmology Unit, NESMOS Department, St. Andrea Hospital, Sapienza University of Rome, Rome, Italy
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15
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Wan MJ, Chan KL, Jastrzembski BG, Ali A. Neuro-ophthalmological manifestations of tuberous sclerosis: current perspectives. Eye Brain 2019; 11:13-23. [PMID: 31417327 PMCID: PMC6592065 DOI: 10.2147/eb.s186306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/24/2019] [Indexed: 12/11/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a complex, multi-system disorder with a well-described underlying genetic etiology. While retinal findings are common in TSC and important in establishing the diagnosis, TSC also has many potential neuro-ophthalmology manifestations. The neuro-ophthalmology manifestations of TSC can have a significant impact on visual function and are sometimes a sign of serious neurological disease. The purpose of this review is to describe the neuro-ophthalmological manifestations of TSC. These manifestations include optic nerve hamartomas, elevated intracranial pressure, cranial nerve palsies, cortical visual impairment, visual field deficits, and ocular toxicity from vigabatrin treatment of infantile spasms. It is important to be aware of potential neuro-ophthalmological manifestations in these patients in order to detect signs of vision- or life-threatening disease and to optimize visual function and quality-of-life.
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Affiliation(s)
- Michael J Wan
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ka Lo Chan
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,School of Medicine, Griffith University, Brisbane, QLD, Australia
| | - Benjamin G Jastrzembski
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Asim Ali
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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16
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Zhang H, Hudson FZ, Xu Z, Tritz R, Rojas M, Patel C, Haigh SB, Bordán Z, Ingram DA, Fulton DJ, Weintraub NL, Caldwell RB, Stansfield BK. Neurofibromin Deficiency Induces Endothelial Cell Proliferation and Retinal Neovascularization. Invest Ophthalmol Vis Sci 2019; 59:2520-2528. [PMID: 29847659 PMCID: PMC5963003 DOI: 10.1167/iovs.17-22588] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose Neurofibromatosis type 1 (NF1) is the result of inherited mutations in the NF1 tumor suppressor gene, which encodes the protein neurofibromin. Eye manifestations are common in NF1 with recent reports describing a vascular dysplasia in the retina and choroid. Common features of NF1 retinopathy include tortuous and dilated feeder vessels that terminate in capillary tufts, increased endothelial permeability, and neovascularization. Given the retinal vascular phenotype observed in persons with NF1, we hypothesize that preserving neurofibromin may be a novel strategy to control pathologic retinal neovascularization. Methods Nf1 expression in human endothelial cells (EC) was reduced using small hairpin (sh) RNA and EC proliferation, migration, and capacity to form vessel-like networks were assessed in response to VEGF and hypoxia. Wild-type (WT), Nf1 heterozygous (Nf1+/−), and Nf1flox/+;Tie2cre pups were subjected to hyperoxia/hypoxia using the oxygen-induced retinopathy model. Retinas were analyzed quantitatively for extent of retinal vessel dropout, neovascularization, and capillary branching. Results Neurofibromin expression was suppressed in response to VEGF, which corresponded with activation of Mek-Erk and PI3-K-Akt signaling. Neurofibromin-deficient EC exhibited enhanced proliferation and network formation in response to VEGF and hypoxia via an Akt-dependent mechanism. In response to hyperoxia/hypoxia, Nf1+/− retinas exhibited increased vessel dropout and neovascularization when compared with WT retinas. Neovascularization was similar between Nf1+/− and Nf1flox/+;Tie2cre retinas, but capillary drop out in Nf1flox/+;Tie2cre retinas was significantly reduced when compared with Nf1+/− retinas. Conclusions These data suggest that neurofibromin expression is essential for controlling endothelial cell proliferation and retinal neovascularization and therapies targeting neurofibromin-deficient EC may be beneficial.
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Affiliation(s)
- Hanfang Zhang
- Department of Pediatrics and Neonatal-Perinatal Medicine, Augusta University, Augusta, Georgia, United States.,Vascular Biology Center, Augusta University, Augusta, Georgia, United States
| | - Farlyn Z Hudson
- Department of Pediatrics and Neonatal-Perinatal Medicine, Augusta University, Augusta, Georgia, United States.,Vascular Biology Center, Augusta University, Augusta, Georgia, United States
| | - Zhimin Xu
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States
| | - Rebekah Tritz
- Department of Pediatrics and Neonatal-Perinatal Medicine, Augusta University, Augusta, Georgia, United States.,Vascular Biology Center, Augusta University, Augusta, Georgia, United States
| | - Modesto Rojas
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States.,Department of Pharmacology and Toxicology, Augusta University, Augusta, Georgia, United States
| | - Chintan Patel
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States
| | - Stephen B Haigh
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States
| | - Zsuzsanna Bordán
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States
| | - David A Ingram
- Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States.,Department of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - David J Fulton
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States.,Department of Pharmacology and Toxicology, Augusta University, Augusta, Georgia, United States
| | - Neal L Weintraub
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States.,Department of Cardiology, Augusta University, Augusta, Georgia, United States
| | - Ruth B Caldwell
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States.,Vision Discovery Institute, Augusta University, Augusta, Georgia, United States.,Department of Cellular Biology and Anatomy, Augusta University, Augusta, Georgia, United States.,Charlie Norwood VA Medical Center, Augusta, Georgia, United States
| | - Brian K Stansfield
- Department of Pediatrics and Neonatal-Perinatal Medicine, Augusta University, Augusta, Georgia, United States.,Vascular Biology Center, Augusta University, Augusta, Georgia, United States.,Vision Discovery Institute, Augusta University, Augusta, Georgia, United States
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Affiliation(s)
- Eli Kisilevsky
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Edward Margolin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
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Słowińska M, Jóźwiak S, Peron A, Borkowska J, Chmielewski D, Sadowski K, Jurkiewicz E, Vignoli A, La Briola F, Canevini MP, Kotulska-Jóźwiak K. Early diagnosis of tuberous sclerosis complex: a race against time. How to make the diagnosis before seizures? Orphanet J Rare Dis 2018; 13:25. [PMID: 29378663 PMCID: PMC5789613 DOI: 10.1186/s13023-018-0764-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is a genetic disorder with an incidence of 1:6000 live births and associated with the development of benign tumors in several organs. It is also characterized by high rates of neurological and neuropsychiatric abnormalities, including epilepsy affecting 70-90% of patients and being one of the major risk factors of intellectual disability. The first seizures in TSC patients appear usually between the 4th and the 6th months of life. Recent studies have shown the beneficial role of preventative antiepileptic treatment in TSC patients, with the possibility for improvement of cognitive outcome. Moreover, European recommendations suggest early introduction of Vigabatrin if ictal discharges occur on EEG recordings, with or without clinical manifestation. The aim of this study was to define the most useful approach to make the diagnosis of TSC before seizure onset (before age 4th months), in order to start early EEG monitoring with possible preventative treatment intervention. METHODS We performed a retrospective review of children who were suspected of having TSC due to single or multiple cardiac tumors as the first sign of the disease. We analyzed the medical records in terms of conducted clinical tests and TSC signs, which were observed until the end of the 4th month of age. Subsequently, we described the different clinical scenarios and recommendations for early diagnosis. RESULTS 82/100 children were diagnosed with TSC within the first 4 months of life. Apart from cardiac tumors, the most frequently observed early TSC signs were subependymal nodules (71/100, 71%), cortical dysplasia (66/100, 66%), and hypomelanotic macules (35/100, 35%). The most useful clinical studies for early TSC diagnosis were brain magnetic resonance imaging (MRI), skin examination and echocardiography. Genetic testing was performed in 49/100 of the patients, but the results were obtained within the first 4 months of life in only 3 children. CONCLUSIONS Early diagnosis of TSC, before seizure onset, is feasible and it is becoming pivotal for epilepsy management and improvement of cognitive outcome. Early TSC diagnosis is mostly based on clinical signs. Brain MRI, echocardiography, skin examination and genetic testing should be performed early in every patient suspected of having TSC.
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Affiliation(s)
- Monika Słowińska
- Department of Neurology and Epileptology, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warszawa, Poland
- Department of Child Neurology, Medical University of Warsaw, Ul. Żwirki I Wigury 63A, 02-091 Warszawa, Poland
| | - Sergiusz Jóźwiak
- Department of Neurology and Epileptology, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warszawa, Poland
- Department of Child Neurology, Medical University of Warsaw, Ul. Żwirki I Wigury 63A, 02-091 Warszawa, Poland
| | - Angela Peron
- Child Neuropsychiatry Unit - Epilepsy Center, San Paolo Hospital, Via Antonio di Rudinì, 8, 20142 Milan, Italy
- Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142 Milan, Italy
- Department of Pediatrics, Division of Medical Genetics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Julita Borkowska
- Department of Neurology and Epileptology, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warszawa, Poland
| | - Dariusz Chmielewski
- Department of Neurology and Epileptology, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warszawa, Poland
| | - Krzysztof Sadowski
- Department of Neurology and Epileptology, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warszawa, Poland
| | - Elżbieta Jurkiewicz
- Department of Radiology, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warszawa, Poland
| | - Aglaia Vignoli
- Child Neuropsychiatry Unit - Epilepsy Center, San Paolo Hospital, Via Antonio di Rudinì, 8, 20142 Milan, Italy
- Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142 Milan, Italy
| | - Francesca La Briola
- Child Neuropsychiatry Unit - Epilepsy Center, San Paolo Hospital, Via Antonio di Rudinì, 8, 20142 Milan, Italy
| | - Maria Paola Canevini
- Child Neuropsychiatry Unit - Epilepsy Center, San Paolo Hospital, Via Antonio di Rudinì, 8, 20142 Milan, Italy
- Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142 Milan, Italy
| | - Katarzyna Kotulska-Jóźwiak
- Department of Neurology and Epileptology, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warszawa, Poland
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Abstract
Tuberous sclerosis complex (TSC) is a neurocutaneous syndrome that can present at any age and can affect multiple organ systems. This disorder is usually identified in infants and children based on characteristic skin lesions, seizures, and cellular overgrowth or hamartomas in the heart, brain, and kidneys. Tuberous sclerosis complex is a genetic disorder caused by a mutation in either the TSC1 or TSC2 gene leading to dysfunction of hamartin or tuberin, respectively. Hamartin and tuberin form a protein complex that helps regulate cellular hyperplasia. Accurate diagnosis is essential in implementing appropriate surveillance and treatment to patients with this disorder. Specific guidelines for diagnosis, surveillance, and management have been proposed by the International Tuberous Sclerosis Complex Consensus Group. Treatment of tuberous sclerosis complex is in part symptomatic; however, for certain clinical manifestations, specific treatments may be indicated. [Pediatr Ann. 2017;46(4):e166-e171.].
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