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Vidal-Millan S, Zatarain-Barrón ZL, Daza-Galicia K, Shveid Gerson D, Pichardo-Rojas P, Salazar-Pigeon A, Wegman-Ostrosky T. Case report: Benign and malignant tumors in adult patients with neurofibromatosis type 1: a comprehensive case series from a large oncologic reference center. Front Oncol 2024; 13:1291286. [PMID: 38260834 PMCID: PMC10800395 DOI: 10.3389/fonc.2023.1291286] [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: 09/08/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose Neurofibromatosis type 1 (NF1) is a complex, multisystem disorder that is characterized, among other features, by a higher risk of developing benign and malignant tumors. Despite NF1 being one of the most common autosomal dominant genetic disorders, data from adult individuals in several world regions remain elusive, including Hispanics. Methods The present is a retrospective cohort study conducted among adult patients with a confirmed diagnosis of NF1 who attended a single cancer-reference center, the Instituto Nacional de Cancerología in Mexico City from 2001 to 2021. Data were extracted from electronic health records and collected in an anonymous database by an NF1-expert physician in order to obtain demographic characteristics and detailed information regarding the development of tumors among this patient subgroup. All patients with malignant tumors or with benign tumors, which severely affected their quality of life, were included in this study. Results Patient records were reviewed from 2001 to 2021. A total of N = 29 patients met the criteria, with a higher proportion of female compared with male subjects [N = 22 (75.9%) vs. N = 7 (24.1%)]. Patients had a mean age at diagnosis of tumors of 32.2 years (SD = 11.2 years). In terms of malignant neoplasms, the most frequent malignant tumor presented by patients in this cohort was malignant peripheral nerve sheath tumors (N = 7, 24.1%), this was followed by breast cancer (n = 4, 13.8% among all patients, 18.2% among female patients). Other tumors also identified in this cohort included melanoma, gastrointestinal stromal tumors, and rectal cancer. Conclusion In Mexico, patients diagnosed with NF1 develop diverse tumors as adults. As described in other studies, the most frequent malignant tumor in this patient population is the malignant peripheral nerve sheath tumor. Further studies are required to increase the scarce information available for adult Hispanics with NF1.
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Affiliation(s)
- Silvia Vidal-Millan
- Hereditary Cancer Clinic, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | - Kena Daza-Galicia
- Subdirection of Basic Research, Instituto Nacional de Cancerología, Mexico City, Mexico
- Faculty of Higher Studies Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Pavel Salvador Pichardo-Rojas
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, United States
| | - Alejandro Salazar-Pigeon
- Plan of Combined Studies in Medicine (PECEM-MD/PhD), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Talia Wegman-Ostrosky
- Subdirection of Basic Research, Instituto Nacional de Cancerología, Mexico City, Mexico
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2
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Diaz E, Bergqvist C, Peiffer B, Fertitta L, Jannic A, Ferkal S, Zehou O, Hemery F, Sbidian E, Wolkenstein P. In-Hospital Clinical Features, Morbidity, and Mortality of Patients with Neurofibromatosis 1 in France: A Nationwide, Population-Based Retrospective Cohort Study. J Invest Dermatol 2023; 143:2408-2415.e7. [PMID: 37257636 DOI: 10.1016/j.jid.2023.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 06/02/2023]
Abstract
Neurofibromatosis 1 (NF1) is a multisystem disease that can affect nearly every organ system. The aim of our study was to describe the in-hospital population with NF1 in France. We conducted a nationwide retrospective cohort study using the French hospital administrative database. A total of 11,425 patients with NF1 (53.4% female, 19,080 person years) were identified from January 2013 to December 2019. A total of 23% had at least one diagnosis of a comorbidity or NF1-associated complication or disease, and it was highest in the age group of 10-15 years. A total of 2,601 (22.8%) had a diagnosis of cancer. There were 366 (3.2%) in-hospital deaths, and we observed a standardized mortality ratio of 4.14 (95% confidence interval = 3.71-4.56), with a higher standardized mortality ratio in women and in the age group of 10-15 years. The standardized incident ratio (SIR) of cancer was 10.3 (95% confidence interval = 9.6-11.1). We observed high SIR values for cancer in childhood, with a decrease toward that of the general population by age 70 years. We observed high SIRs for NF1-associated cancers: CNS SIR of 195.4 (95% confidence interval = 172.2-220.9) and small intestine SIR of 102.9 (95% confidence interval = 71.7-143.2). The study provides a better understanding of the prognosis in people living with NF1.
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Affiliation(s)
- Emmanuelle Diaz
- Department of Dermatology, Henri Mondor Hospital, Créteil, France; Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France.
| | - Christina Bergqvist
- Department of Dermatology, Henri Mondor Hospital, Créteil, France; Reference center of Neurofibromatosis type 1, Henri Mondor Hospital, Créteil, France
| | - Bastien Peiffer
- Department of Dermatology, Henri Mondor Hospital, Créteil, France
| | - Laura Fertitta
- Department of Dermatology, Henri Mondor Hospital, Créteil, France; Reference center of Neurofibromatosis type 1, Henri Mondor Hospital, Créteil, France
| | - Arnaud Jannic
- Department of Dermatology, Henri Mondor Hospital, Créteil, France; Reference center of Neurofibromatosis type 1, Henri Mondor Hospital, Créteil, France
| | - Salah Ferkal
- Department of Dermatology, Henri Mondor Hospital, Créteil, France; Reference center of Neurofibromatosis type 1, Henri Mondor Hospital, Créteil, France; Clinical Investigation Center, Clinical Investigation Center 1430, Henri Mondor Hospital, Créteil, France
| | - Ouidad Zehou
- Department of Dermatology, Henri Mondor Hospital, Créteil, France
| | - François Hemery
- Department of Medical Information, Henri Mondor Hospital, Créteil, France
| | - Emilie Sbidian
- Department of Dermatology, Henri Mondor Hospital, Créteil, France; Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France; Clinical Investigation Center, Clinical Investigation Center 1430, Henri Mondor Hospital, Créteil, France
| | - Pierre Wolkenstein
- Department of Dermatology, Henri Mondor Hospital, Créteil, France; Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France; Reference center of Neurofibromatosis type 1, Henri Mondor Hospital, Créteil, France
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3
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Santos MR, Pereira AM. Neurofibromatosis type 1 and pulmonary arterial hypertension: A case report. Rev Port Cardiol 2022; 41:511.e1-511.e5. [DOI: 10.1016/j.repc.2019.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/11/2019] [Indexed: 10/18/2022] Open
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4
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Yasuda K, Nobeyama Y, Asahina A. Improved renal function in neurofibromatosis type 1 patients. SKIN HEALTH AND DISEASE 2022; 2:e119. [PMID: 35677927 PMCID: PMC9168021 DOI: 10.1002/ski2.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 12/04/2022]
Abstract
Neurofibromatosis type 1 (NF1), or von Recklinghausen disease, is an autosomal dominant disease that presents with various symptoms, including café‐au‐lait spots and neurofibromas. NF1 patients occasionally suffer from renal artery vasculopathy, which impairs renal function, while results of a previous report suggested that male NF1 patients have a low creatinine level in peripheral blood. The assessment of renal function in NF1 patients remains inadequate. In this study, renal function in NF1 was assessed. We recruited 308 patients consisting of 149 NF1 patients (77 males and 72 females) and 159 control patients (102 males and 57 females). Creatinine, blood urea nitrogen and haemoglobin A1c in peripheral blood as well as protein, occult blood and sugar in urine were examined. In addition, the estimated glomerular filtration rate was calculated. The mean age and body mass index did not differ significantly between the NF1 patients and controls for both sexes. For both sexes, i) the mean creatinine value was significantly lower in the NF1 patients than in the controls; ii) the mean blood urea nitrogen value did not differ significantly between the NF1 patients and controls; iii) the mean blood urea nitrogen‐to‐creatinine ratio was significantly higher in the NF1 patients than in the controls; iv) the mean estimated glomerular filtration rate was significantly higher in the NF1 patients than in the controls; and v) the mean haemoglobin A1c value was significantly lower in the NF1 patients than in the controls. In conclusion, NF1 patients may have improved renal function. The clinical significances should be further examined.
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Affiliation(s)
- Ken‐ichi Yasuda
- Dermatology Jikei University School of Medicine Minato‐ku Tokyo Japan
| | | | - Akihiko Asahina
- Dermatology Jikei University School of Medicine Minato‐ku Tokyo Japan
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5
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Yang X, Desai K, Agrawal N, Mirchandani K, Chatterjee S, Sarpong E, Sen S. Characteristics, treatment patterns, healthcare resource use, and costs among pediatric patients diagnosed with neurofibromatosis type 1 and plexiform neurofibromas: a retrospective database analysis of a medicaid population. Curr Med Res Opin 2021; 37:1555-1561. [PMID: 34218725 DOI: 10.1080/03007995.2021.1940907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The objectives of this study were to describe the characteristics and initial treatment patterns, healthcare resource use (HCRU), and costs of patients newly diagnosed with neurofibromatosis type 1 (NF1)-related plexiform neurofibromas (PN). METHODS This was a retrospective study of individuals enrolled in the IBM MarketScan Multi-State Medicaid database from 1 October 2014 to 31 December 2017. Patients aged ≤18 years at the index date (first diagnosis of NF1 or PN, whichever occurred later) with at least 1 ICD-10-CM diagnosis code for both NF1 and PN were included. All-cause HCRU and the associated direct costs during the follow-up period were calculated per patient per year (PPPY) in 2018 USD. RESULTS A total of 383 patients were included with a mean follow-up of 448 days. Most patients were diagnosed by a specialist (63.5%). During the follow-up period, pain medications were used by 58.5% of patients, 25.1% were treated with chemotherapy, 7.1% received surgery for PN, 1.6% received MEK inhibitors, and 0.8% received radiation. Mean PPPY inpatient, outpatient, ER, pharmacy, and other visits were 1.4, 17.3, 1.6, 13.6, and 25.8, respectively. Mean ± SD (median) total PPPY healthcare costs were $17,275 ± $61,903 ($2889), with total medical costs of $14,628 ± $56,203 ($2334) and pharmacy costs of $2646 ± $13,303 ($26). CONCLUSIONS This study showed that many pediatric patients newly diagnosed with NF1 and PN were initially treated with supportive care only, highlighting a substantial unmet medical need. This study also highlights the considerable economic burden among patients with NF1 and PN.
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Affiliation(s)
- Xiaoqin Yang
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Kaushal Desai
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | | | - Eric Sarpong
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Shuvayu Sen
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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6
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Rabab’h O, Gharaibeh A, Al-Ramadan A, Ismail M, Shah J. Pharmacological Approaches in Neurofibromatosis Type 1-Associated Nervous System Tumors. Cancers (Basel) 2021; 13:cancers13153880. [PMID: 34359780 PMCID: PMC8345673 DOI: 10.3390/cancers13153880] [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: 05/27/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Neurofibromatosis type 1 (NF1) is a common cancer predisposition genetic disease that is associated with significant morbidity and mortality. In this literature review, we discuss the major pathways in the nervous system that are affected by NF1, tumors that are associated with NF1, drugs that target these pathways, and genetic models of NF1. We also summarize the latest updates from clinical trials that are evaluating pharmacological agents to treat these tumors and discuss the efforts that are being made to cure the disease in the future Abstract Neurofibromatosis type 1 is an autosomal dominant genetic disease and a common tumor predisposition syndrome that affects 1 in 3000 to 4000 patients in the USA. Although studies have been conducted to better understand and manage this disease, the underlying pathogenesis of neurofibromatosis type 1 has not been completely elucidated, and this disease is still associated with significant morbidity and mortality. Treatment options are limited to surgery with chemotherapy for tumors in cases of malignant transformation. In this review, we summarize the advances in the development of targeted pharmacological interventions for neurofibromatosis type 1 and related conditions.
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Affiliation(s)
- Omar Rabab’h
- Insight Research Institute, Flint, MI 48507, USA; (O.R.); (A.G.); (A.A.-R.); (M.I.)
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, MI 48502, USA
| | - Abeer Gharaibeh
- Insight Research Institute, Flint, MI 48507, USA; (O.R.); (A.G.); (A.A.-R.); (M.I.)
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, MI 48502, USA
- Insight Institute of Neurosurgery & Neuroscience, Flint, MI 48507, USA
- Insight Surgical Hospital, Warren, MI 48091, USA
| | - Ali Al-Ramadan
- Insight Research Institute, Flint, MI 48507, USA; (O.R.); (A.G.); (A.A.-R.); (M.I.)
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, MI 48502, USA
| | - Manar Ismail
- Insight Research Institute, Flint, MI 48507, USA; (O.R.); (A.G.); (A.A.-R.); (M.I.)
| | - Jawad Shah
- Insight Research Institute, Flint, MI 48507, USA; (O.R.); (A.G.); (A.A.-R.); (M.I.)
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, MI 48502, USA
- Insight Institute of Neurosurgery & Neuroscience, Flint, MI 48507, USA
- Insight Surgical Hospital, Warren, MI 48091, USA
- Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
- Correspondence:
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7
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Establishment of in-hospital clinical network for patients with neurofibromatosis type 1 in Nagoya University Hospital. Sci Rep 2021; 11:11933. [PMID: 34099792 PMCID: PMC8184989 DOI: 10.1038/s41598-021-91345-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/21/2021] [Indexed: 11/09/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a genetic multisystem disorder. Clinicians must be aware of the diverse clinical features of this disorder in order to provide optimal care for it. We have set up an NF1 in-hospital medical care network of specialists regardless of patient age, launching a multidisciplinary approach to the disease for the first time in Japan. From January 2014 to December 2020, 246 patients were enrolled in the NF1 patient list and medical records. Mean age was 26.0 years ranging from 3 months to 80 years. The number of patients was higher as age at first visit was lower. There were 107 males (41%) and 139 females. After 2011, the number of patients has increased since the year when the medical care network was started. Regarding orthopedic signs, scoliosis was present in 60 cases (26%), and bone abnormalities in the upper arm, forearm, and tibia in 8 cases (3.5%). Neurofibromas other than cutaneous neurofibromas were present in 90 cases (39%), and MPNST in 17 cases (7.4%). We launched a multidisciplinary NF1 clinic system for the first time in Japan. For patients with NF1, which is a hereditary and systemic disease associated with a high incidence of malignant tumors, it will be of great benefit when the number of such clinics in Japan and the rest of Asia is increased.
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8
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Mao A, Rana HN, Elramah M, Martin B. An Unusual Case of Retroperitoneal Plexiform Neurofibromas Found in a Trauma Patient. Cureus 2021; 13:e12997. [PMID: 33659131 PMCID: PMC7920225 DOI: 10.7759/cureus.12997] [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] [Indexed: 11/07/2022] Open
Abstract
The spectrum of presentation for patients who have neurofibromatosis type 1 (NF1), or von Recklinghausen disease, is very diverse due to a phenomenon known as variable expressivity. Patients may or may not present with cutaneous lesions or central nervous system (CNS) manifestations. However, multiple neurofibromas are the pathognomonic hallmark of NF1. The most common abdominal neoplasm is plexiform neurofibromas that affect the retroperitoneal region. We highlight the hospital course of a patient with an unknown history of NF1 who presented for head trauma with plexiform neurofibromas found incidentally on imaging. The radiographic features of neurofibromas are described in addition to the discussion of management and prognosis of NF1.
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Affiliation(s)
- Allen Mao
- Radiology, USA Health University Hospital, Mobile, USA
| | - Hunaid N Rana
- Radiology, USA Health University Hospital, Mobile, USA
| | | | - Brett Martin
- Radiology, USA Health University Hospital, Mobile, USA
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9
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Yang X, Desai K, Agrawal N, Mirchandani K, Chatterjee S, Sarpong E, Sen S. Treatment, Resource Use and Costs Among Pediatric Patients with Neurofibromatosis Type 1 and Plexiform Neurofibromas. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:421-428. [PMID: 33117057 PMCID: PMC7548319 DOI: 10.2147/phmt.s265690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022]
Abstract
Background Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic condition which predisposes individuals to tumors of the nervous system, skin, bones, and eyes. Plexiform neurofibromas (PNs) occur in 20-50% of NF1 cases, causing multiple morbidities and conferring a risk of malignancy. NF1 with PN is poorly characterized in the literature with regard to treatment patterns, healthcare resource utilization, and costs in the real world. Methods This was a retrospective analysis of data from a commercial claims database in the US between October 2014 and March 2018. Persons with at least 1 diagnostic code for both NF1 and PN, aged ≤18 years on the index date, and continuously enrolled for ≥12 months before the index date were included. The index date was defined as the date of the first diagnosis of NF1 or PN during the study period, whichever occurred later. Healthcare resource utilization during follow-up included outpatient, inpatient, emergency room (ER), and pharmacy encounters; corresponding costs were calculated as the mean per patient per year (PPPY) in 2018 US dollars. Treatments were classified as PN surgery, pain medication, chemotherapy, radiotherapy, and targeted therapies. All analyses were descriptive. Results A total of 301 patients were included. In the follow-up period, nearly all patients (99.7%) had outpatient visits, while 81.1% had pharmacy visits, 25.2% had ER visits, and 13.0% had inpatient visits. Mean ± SD [median] total healthcare costs PPPY were $38,292 ± $80,556 [$16,037]. During follow-up, 44.2% of patients used pain medications, 23.9% received chemotherapy, 5.0% underwent surgery for PN, 1.3% received radiotherapy, and 1.0% received targeted therapies. Conclusion Commercially insured pediatric patients diagnosed with NF1 and PN were treated primarily with supportive care, highlighting a substantial unmet need in the United States.
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Affiliation(s)
- Xiaoqin Yang
- Merck & Co., Inc. Center for Observational and Real-World Evidence, Kenilworth, NJ, USA
| | - Kaushal Desai
- Merck & Co., Inc. Center for Observational and Real-World Evidence, Kenilworth, NJ, USA
| | | | | | | | - Eric Sarpong
- Merck & Co., Inc. Center for Observational and Real-World Evidence, Kenilworth, NJ, USA
| | - Shuvayu Sen
- Merck & Co., Inc. Center for Observational and Real-World Evidence, Kenilworth, NJ, USA
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10
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Edris Sharif Rahmani, Azarpara H, Abazari MF, Mohajeri MR, Nasimi M, Ghorbani R, Azizpour A, Rahimi H. Novel Mutation C.7348C>T in NF1 Gene Identified by Whole-Exome Sequencing in Patient with Overlapping Clinical Symptoms of Neurofibromatosis Type 1 and Bannayan–Riley–Ruvalcaba Syndrome. CYTOL GENET+ 2020. [DOI: 10.3103/s0095452720040106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Lee YH, Kwon MJ, Park JH, Jeong SJ, Kim TH, Jeong HW, Lee SH. Neurofibromatosis Type 1 with the Development of Pheochromocytoma and Breast Cancer. Intern Med 2020; 59:1665-1669. [PMID: 32269189 PMCID: PMC7402965 DOI: 10.2169/internalmedicine.4148-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/26/2020] [Indexed: 11/23/2022] Open
Abstract
A 40-year-old woman presented with a left adrenal incidentaloma. Based on the presence of café-au-lait spots, cutaneous neurofibroma, and family history, she was diagnosed with neurofibromatosis type 1 (NF1). Adrenal incidentaloma screening showed an elevated normetanephrine level; the left adrenal mass showed the uptake of I-123 meta-iodobenzylguanidine. She underwent left adrenalectomy, and pheochromocytoma was diagnosed. One year later, the results of a biopsy of a palpable mass in the left breast suggested invasive ductal carcinoma. The patient underwent neoadjuvant chemotherapy followed by left breast-conserving surgery. We herein report a rare case of an NF1 patient who developed both pheochromocytoma and breast cancer.
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Affiliation(s)
- Yu Hee Lee
- Department of Internal Medicine, College of Medicine, Inje University, Korea
| | - Min Jeong Kwon
- Department of Internal Medicine, College of Medicine, Inje University, Korea
| | - Jeong Hyun Park
- Department of Internal Medicine, College of Medicine, Inje University, Korea
| | - Su Jin Jeong
- Department of Pathology, College of Medicine, Inje University, Korea
| | - Tae Hyun Kim
- Department of Surgery, College of Medicine, Inje University, Korea
| | - Hae Woong Jeong
- Department of Radiology, College of Medicine, Inje University, Korea
| | - Soon Hee Lee
- Department of Internal Medicine, College of Medicine, Inje University, Korea
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12
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Kallionpää RA, Peltonen S, Leppävirta J, Pöyhönen M, Auranen K, Järveläinen H, Peltonen J. Haploinsufficiency of the NF1 gene is associated with protection against diabetes. J Med Genet 2020; 58:378-384. [PMID: 32571896 PMCID: PMC8142421 DOI: 10.1136/jmedgenet-2020-107062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022]
Abstract
Background The hereditary predisposition to diabetes is only partially explained by genes identified so far. Neurofibromatosis type 1 (NF1) is a rare monogenic dominant syndrome caused by aberrations of the NF1 gene. Here, we used a cohort of 1410 patients with NF1 to study the association of the NF1 gene with type 1 (T1D) and type 2 diabetes (T2D). Methods A total of 1410 patients were confirmed to fulfil the National Institutes of Health diagnostic criteria for NF1 by individually reviewing their medical records. The patients with NF1 were compared with 14 017 controls matched for age, sex and area of residence as well as 1881 non-NF1 siblings of the patients with NF1. Register-based information on purchases of antidiabetic medication and hospital encounters related to diabetes were retrieved. The Cox proportional hazards model was used to calculate the relative risk for diabetes in NF1. Results Patients with NF1 showed a lower rate of T2D when compared with a 10-fold control cohort (HR 0.27, 95% CI 0.17 to 0.43) or with their siblings without NF1 (HR 0.28, 95% CI 0.16 to 0.47). The estimates remained practically unchanged after adjusting the analyses for history of obesity and dyslipidaemias. The rate of T1D in NF1 was decreased although statistically non-significantly (HR 0.58, 95% CI 0.27 to 1.25). Conclusion Haploinsufficiency of the NF1 gene may protect against T2D and probably T1D. Since NF1 negatively regulates the Ras signalling pathway, the results suggest that the Ras pathway may be involved in the pathogenesis of diabetes.
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Affiliation(s)
| | - Sirkku Peltonen
- Department of Dermatology and Venereology, University of Turku, Turku, Finland.,Department of Dermatology, Turku University Hospital, Turku, Finland
| | - Jussi Leppävirta
- Department of Clinical Genetics, HUSLAB, Helsinki University Hospital (HUS) Diagnostic Center, Helsinki, Finland.,Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - Minna Pöyhönen
- Department of Clinical Genetics, HUSLAB, Helsinki University Hospital (HUS) Diagnostic Center, Helsinki, Finland.,Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - Kari Auranen
- Department of Mathematics and Statistics and Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Hannu Järveläinen
- Institute of Biomedicine, University of Turku, Turku, Finland.,Department of Internal Medicine, Satakunta Central Hospital, Pori, Finland
| | - Juha Peltonen
- Institute of Biomedicine, University of Turku, Turku, Finland
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13
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Findakly D, Solsi A, Arslan W. A Novel Combination of Metachronous Primary Malignancies of the Thyroid and Breast in a Patient with Neurofibromatosis Type 1. Cureus 2020; 12:e7590. [PMID: 32399324 PMCID: PMC7212712 DOI: 10.7759/cureus.7590] [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: 12/02/2022] Open
Abstract
Neurofibromatosis 1 (NF1) is a genetic condition of variable presentations. It has been shown to increase the risk of multiple cancers. Therefore, NF1 has been identified as a tumor-provoking condition. We present a case of a 39-year-old woman with NF1 who was diagnosed initially with papillary thyroid carcinoma (PTC) and subsequently presented with a painful breast lump. Core biopsy revealed an invasive ductal carcinoma (IDC) for which selective estrogen receptor modulator (SERM) therapy was initiated. A lumpectomy was performed soon after, which confirmed IDC. Following surgery, the patient received a combination of anthracycline and cyclophosphamide (AC), which was later followed by a taxol-based chemotherapy regimen. This study aims to throw light on the rare phenomenon of metachronous malignancy: the occurrence of successive primary cancers in the same patient. We believe that raising awareness regarding the different neoplasms associated with NF1 is important to promote appropriate preemptive screening for early detection of a second primary neoplasm, which can help lower the morbidity and mortality associated with this condition through expedited intervention.
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Affiliation(s)
- Dawood Findakly
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
| | - Anup Solsi
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
| | - Waqas Arslan
- Hematology and Oncology, Creighton University Maricopa Medical Center, Phoenix, USA
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14
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Abstract
Phakomatoses present with characteristic findings on the skin, central or peripheral nervous system, and tumors. Neurofibromatosis type 1 is the most common syndrome and is characterized by Café-au-lait macules, intertriginous freckling, Lisch nodules, and tumors including neurofibromas, malignant peripheral nerve sheath tumors, and gliomas. Tuberous Sclerosis Complex is characterized by benign hamartomas presenting with hypomelanotic macules, shagreen patches, angiofibromas, confetti lesions and tumors including cortical tubers, subependymal nodules, subependymal giant cell astrocytomas and tumors of the kidney, lung, and heart. Managing these disorders requires disease specific supportive care, tumor monitoring, surveillance for selected cancers, and treatment of comorbid conditions.
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Affiliation(s)
- Benjamin Becker
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
| | - Roy E Strowd
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA; Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest Baptist Health, Winston Salem, NC 27157, USA; Translational Science Institute, Wake Forest Baptist Health, Winston Salem, NC 27157, USA
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15
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Fletcher JS, Pundavela J, Ratner N. After Nf1 loss in Schwann cells, inflammation drives neurofibroma formation. Neurooncol Adv 2019; 2:i23-i32. [PMID: 32642730 PMCID: PMC7317060 DOI: 10.1093/noajnl/vdz045] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Plexiform neurofibromas (PNF) are peripheral nerve tumors caused by bi-allelic loss of NF1 in the Schwann cell (SC) lineage. PNF are common in individuals with Neurofibromatosis type I (NF1) and can cause significant patient morbidity, spurring research into potential therapies. Immune cells are rare in peripheral nerve, whereas in PNF 30% of the cells are monocytes/macrophages. Mast cells, T cells, and dendritic cells (DCs) are also present. NF1 mutant neurofibroma SCs with elevated Ras-GTP signaling resemble injury-induced repair SCs, in producing growth factors and cytokines not normally present in SCs. This provides a cytokine-rich environment facilitating PNF immune cell recruitment and fibrosis. We propose a model based on genetic and pharmacologic evidence in which, after loss of Nf1 in the SC lineage, a lag occurs. Then, mast cells and macrophages are recruited to nerve. Later, T cell/DC recruitment through CXCL10/CXCR3 drives neurofibroma initiation and sustains PNF macrophages and tumor growth. Stat3 signaling is an additional critical mediator of neurofibroma initiation, cytokine production, and PNF growth. At each stage of PNF development therapeutic benefit should be achievable through pharmacologic modulation of leukocyte recruitment and function.
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Affiliation(s)
- Jonathan S Fletcher
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Immunology Graduate Program, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jay Pundavela
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nancy Ratner
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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16
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Suarez-Kelly LP, Yu L, Kline D, Schneider EB, Agnese DM, Carson WE. Increased breast cancer risk in women with neurofibromatosis type 1: a meta-analysis and systematic review of the literature. Hered Cancer Clin Pract 2019; 17:12. [PMID: 30962859 PMCID: PMC6434896 DOI: 10.1186/s13053-019-0110-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/08/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a cancer predisposing syndrome. Studies suggest that women < 50 years old (y.o.) with NF1 have an increased breast cancer (BC) incidence and BC associated mortality. However, this has not been widely recognized secondary to small study populations. METHODS A systematic literature review was conducted through database searches for BC and NF1: 3456 articles identified, 166 reviewed, 58 used for descriptive analysis and 4 utilized for meta-analysis. Fisher's exact tests, Kaplan-Meier curves and random-effects meta-analysis models were used for analysis. RESULTS Two hundred eighty-six cases of NF1 and female BC were identified with a median age of 46 years at diagnosis; 53% were < 50. Peak age of BC diagnosis was between 34 to 44 years. Women < 50 y.o. presented with more advanced disease vs. those ≥50 (56% vs. 22% stage III-IV, respectively; p = 0.005). Median survival for the entire cohort was 5 years vs. the reported median BC survival of over 20 years in the general population using the SEER database. Median age at BC death was 48.5 years; 64% of deceased patients were < 50. Meta-analysis of a total of 4178 women with NF1 revealed a BC standardized incidence ratio (SIR) of 3.07 (95%CI 2.16-4.38) for women with NF1 vs. the general population. Women < 50 y.o. demonstrated a higher SIR of 5.08 (95%CI 3.77-6.81) compared to 1.92 (95%CI 1.40-2.63) if ≥50 y.o. CONCLUSIONS This systematic literature review and meta-analysis suggests that women with NF1 < 50 y.o. have a five-fold increased risk of BC, present with more advanced disease, and may have an increased BC related mortality. Increased awareness and implementation of recent National Comprehensive Cancer Network early BC screening guidelines for this high-risk patient population is essential. Additional evaluation on the influence of NF1 gene mutations identified in patients undergoing hereditary cancer genetic testing on breast cancer risk in individuals without clinical evidence of NF1 is needed.
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Affiliation(s)
- Lorena P. Suarez-Kelly
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Lianbo Yu
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210 USA
| | - David Kline
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210 USA
| | - Eric B. Schneider
- Division of Critical Care, Trauma & Burn, Department of Surgery, The Ohio State University, Columbus, OH 43210 USA
| | - Doreen M. Agnese
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - William E. Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
- The Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, The Ohio State University, N924 Doan Hall 410 W. 10th Ave, Columbus, OH 43210-1228 USA
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17
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Alotaiby FM, Fitzpatrick S, Upadhyaya J, Islam MN, Cohen D, Bhattacharyya I. Demographic, Clinical and Histopathological Features of Oral Neural Neoplasms: A Retrospective Study. Head Neck Pathol 2018; 13:208-214. [PMID: 29931661 PMCID: PMC6513954 DOI: 10.1007/s12105-018-0943-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/12/2018] [Indexed: 11/26/2022]
Abstract
Intraoral neural neoplasms though unusual may be clinically significant. The aim of this study was to categorize and evaluate oral neural tumors in a large oral pathology biopsy service. With IRB approval, a retrospective search of all neural neoplasms of the oral cavity in the archives of the University of Florida Oral Pathology Biopsy Service spanning from 1994 to 2015 was performed. Extraoral cases as well as cases with insufficient patient information were excluded. A total of 340 out of 164,578 submitted specimens in a 22 year period (0.2%) were included with a mean age of 43.3 years (range: 6-89), and 44% male and 56% female. The most commonly affected locations were: tongue (37.5%), palate (22%), lip (19%), and gingiva (14%). The microscopic diagnoses rendered, in descending order of frequency were: neurofibromas (NFs): 123 (36%), granular cell tumor (GCT): 108 (32%), schwannomas: 61 (17%), palisaded encapsulated neuromas: 39 (11%), benign neural lesion not otherwise specified: 8 (2%), and mucosal neuroma c/w multiple endocrine neoplasia type 2B (MEN 2B): 1 (< 0.5%). Six cases of NF reported a history of neurofibromatosis Type 1 (NF 1). Four cases showed multifocal lesions. Immunohistochemical staining was performed on equivocal cases (25% of the lesions) and all were confirmed by their S-100 positivity. Intraoral neural neoplasms, though uncommon should be in the differential diagnosis of oral soft tissue entities and specific consideration to syndromal linkage is paramount as this may impact patient management.
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Affiliation(s)
- Faraj M Alotaiby
- Oral and Maxillofacial Diagnostic Sciences College of Dentistry, University of Florida, 1395 Center Dr, Gainesville, FL, 32610, USA.
| | - Sarah Fitzpatrick
- Oral and Maxillofacial Diagnostic Sciences College of Dentistry, University of Florida, 1395 Center Dr, Gainesville, FL, 32610, USA
| | - Jasbir Upadhyaya
- Oral and Maxillofacial Diagnostic Sciences College of Dentistry, University of Florida, 1395 Center Dr, Gainesville, FL, 32610, USA
| | - Mohammad N Islam
- Oral and Maxillofacial Diagnostic Sciences College of Dentistry, University of Florida, 1395 Center Dr, Gainesville, FL, 32610, USA
| | - Donald Cohen
- Oral and Maxillofacial Diagnostic Sciences College of Dentistry, University of Florida, 1395 Center Dr, Gainesville, FL, 32610, USA
| | - Indraneel Bhattacharyya
- Oral and Maxillofacial Diagnostic Sciences College of Dentistry, University of Florida, 1395 Center Dr, Gainesville, FL, 32610, USA
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18
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Martins AS, Jansen AK, Rodrigues LOC, Matos CM, Souza MLR, Miranda DM, Rezende NAD. Increased insulin sensitivity in individuals with neurofibromatosis type 1. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:41-46. [PMID: 29694637 PMCID: PMC10118684 DOI: 10.20945/2359-3997000000007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/12/2017] [Indexed: 11/23/2022]
Abstract
Objects To compare insulin resistance (IR) and metabolic aspects of patients with neurofibromatosis type 1 (NF1) and individuals without the disease. Subjects and methods Forty patients with NF1 were matched by sex, age, and body mass index (BMI) to 40 controls from the community. Blood samples were collected for biochemical assessment. Homeostasis model assessment adiponectin (HOMA-AD), Homeostasis model assessment insulin resistance (HOMA-IR), and adiponectin/leptin ratio (ALR) were used to identify IR. Results The median HOMA-IR values were similar between the groups. However, the HOMA-AD value was significantly lower and the ALR significantly higher in the NF1 group. Fasting blood glucose (FBG), leptin, and visfatin levels of patients with NF1 were significantly lower, although adiponectin levels were significantly higher than those in the controls. Fasting insulin and blood glucose levels 2 hours after administration of 75 g of dextrose, glycated hemoglobin, and resistin showed no significant differences between groups. The HOMA-AD correlated with BMI, FBG, blood glucose levels 2 hours after administration of 75 g of dextrose, fasting insulin, glycated hemoglobin, adiponectin, leptin, visfatin, ALR, and HOMA-IR. The ALR correlated with BMI leptin, visfatin, and adiponectin. Conclusions Lower levels of FBG, leptin, visfatin, and HOMA-AD, and higher adiponectin levels and ALR may be related to increased insulin sensitivity and lower occurrence of type 2 diabetes mellitus in patients with NF1.
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Affiliation(s)
- Aline Stangherlin Martins
- Centro de Referência de Neurofibromatose, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Ann Kristine Jansen
- Departamento de Nutrição, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | | | - Camila Maria Matos
- Centro de Referência de Neurofibromatose, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | | | - Débora Marques Miranda
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Nilton Alves de Rezende
- Centro de Referência de Neurofibromatose, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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19
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Lee Y, Tan LYR, Ho YH, Leow MKS. Giant phaeochromocytoma presenting with an acute stroke: reappraising phaeochromocytoma surveillance for the neurofibromatosis type 1 phakomatosis. BMJ Case Rep 2017; 2017:bcr-2017-222553. [PMID: 29102976 DOI: 10.1136/bcr-2017-222553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a multisystem genetic disorder associated with reduced lifespan attributed largely to malignancy and vascular causes. One of the tumours associated with NF1 is phaeochromocytoma. The phaeochromocytoma has earned the moniker, a 'great mimicker', due to its varied means of presentation. We present a patient with NF1 who was diagnosed with a giant 20 cm phaeochromocytoma after suffering from an ischaemic stroke. Current guidelines do not advocate surveillance of phaeochromocytoma in asymptomatic patients with NF1, unlike other genetic syndromes associated with phaeochromocytoma. However, there is increasing evidence that this approach may not help in the early detection and treatment of this potentially life-threatening disease. Our patient remained hypertensive after surgery despite achieving biochemical cure. The suggested chronicity of the underlying tumour in our patient is a reminder to practising clinicians to rethink our strategy in identifying phaeochromocytoma in adults with NF1.
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Affiliation(s)
- Yingshan Lee
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Asia
| | | | - Yong Howe Ho
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Asia
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20
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An HY, Hong KT, Kang HJ, Choi JY, Hong C, Kim HY, Choi TH, Kang CH, Kim HS, Cheon JE, Park SH, Park JD, Park KD, Shin HY. Malignant peripheral nerve sheath tumor in children: A single-institute retrospective analysis. Pediatr Hematol Oncol 2017; 34:468-477. [PMID: 29286874 DOI: 10.1080/08880018.2017.1408730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Malignant peripheral nerve sheath tumors are rare tumors that originate from Schwann cells. Patients with neurofibromatosis type 1 are prone to develop these tumors. Due to their rarity and lack of established treatment, the prognosis of malignant peripheral nerve sheath tumors is poor. A retrospective study was conducted on children treated for malignant peripheral nerve sheath tumors at the Seoul National University Children's Hospital between 2007 and 2016. Eleven patients were diagnosed with malignant nerve sheath tumors at a median age of 12 years, eight of whom had neurofibromatosis type 1. All the patients underwent chemotherapy and received surgical resection, and 5 patients relapsed. The 2-year overall survival rate was 72.7%, and the 2-year event-free survival rate was 58.2%. Univariate analysis was performed to assess the correlations between the clinical factors. There was no statistically significant difference in the overall survival rate according to the patients' clinical factors. However, there was a decreasing trend in the relationship between the event-free survival rate and the prevalence of neurofibromatosis type 1. Regular follow up of neurofibromatosis type 1. Regular follow-up of neurofibromatosis type 1 patients may identify detection of early relapse of malignant peripheral nerve sheath tumors. Genetic studies of these patients and tumors may identify opportunities for targeted therapy.
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Affiliation(s)
- Hong Yul An
- a Department of Pediatrics , Seoul National University College of Medicine , Seoul , Korea.,b Cancer Research Institute , Seoul National University College of Medicine , Seoul , Korea
| | - Kyung Taek Hong
- a Department of Pediatrics , Seoul National University College of Medicine , Seoul , Korea
| | - Hyoung Jin Kang
- a Department of Pediatrics , Seoul National University College of Medicine , Seoul , Korea
| | - Jung Yoon Choi
- a Department of Pediatrics , Seoul National University College of Medicine , Seoul , Korea.,b Cancer Research Institute , Seoul National University College of Medicine , Seoul , Korea
| | - CheRy Hong
- a Department of Pediatrics , Seoul National University College of Medicine , Seoul , Korea
| | - Hyun-Young Kim
- c Department of Surgery , Seoul National University College of Medicine , Seoul , Korea
| | - Tae Hyun Choi
- d Department of Plastic and Reconstructive Surgery , Seoul National University College of Medicine , Seoul , Korea
| | - Chang Hyun Kang
- e Department of Thoracic and Cardiovascular Surgery , Seoul National University Hospital , Seoul National University College of Medicine , Seoul , Korea
| | - Han-Soo Kim
- f Department of Orthopedic Surgery , Seoul National University College of Medicine , Seoul , Korea
| | - Jung-Eun Cheon
- g Department of Radiology, Seoul National University College of Medicine , Seoul National University Children's Hospital , Seoul , Korea
| | - Sung-Hye Park
- h Department of Pathology , Seoul National University, College of Medicine , Seoul , Korea
| | - June Dong Park
- a Department of Pediatrics , Seoul National University College of Medicine , Seoul , Korea
| | - Kyung Duk Park
- a Department of Pediatrics , Seoul National University College of Medicine , Seoul , Korea
| | - Hee Young Shin
- a Department of Pediatrics , Seoul National University College of Medicine , Seoul , Korea
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21
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Sarmento DJDS, Carvalho SHGD, Araújo JCWPD, Carvalho MDV, Silveira ÉJDD. Florid cemento-osseous dysplasia and peripheral giant cell granuloma in a patient with neurofibromatosis 1. An Bras Dermatol 2017; 92:249-252. [PMID: 28538890 PMCID: PMC5429116 DOI: 10.1590/abd1806-4841.20175277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/26/2016] [Indexed: 11/21/2022] Open
Abstract
We report a 35-year-old mulatto female patient with neurofibromatosis Type 1 who
presented with facial asymmetry. The patient had two lesions: florid
cemento-osseous dysplasia associated with peripheral giant cell granuloma. She
was referred for surgical treatment of the peripheral giant cell granuloma and
the florid cemento-osseous dysplasia was treated conservatively by a
multidisciplinary team. So far, no changes have been observed in the patient's
clinical status. We observed no recurrence of peripheral giant cell granuloma.
To the best of our knowledge, the present case is the first report of a patient
with neurofibromatosis Type 1 associated with a giant cell lesion and florid
cemento-osseous dysplasia.
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22
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Abdel-Rahman O. Risk of cardiac death among cancer survivors in the United States: a SEER database analysis. Expert Rev Anticancer Ther 2017; 17:873-878. [PMID: 28618843 DOI: 10.1080/14737140.2017.1344099] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Population-based data on the risk of cardiac death among cancer survivors are needed. This scenario was evaluated in cancer survivors (>5 years) registered within the Surveillance, Epidemiology and End Results (SEER) database. METHODS The SEER database was queried using SEER*Stat to determine the frequency of cardiac death compared to other causes of death; and to determine heart disease-specific and cancer-specific survival rates in survivors of each of the 10 most common cancers in men and women in the SEER database. RESULTS For cancer-specific survival rate, the highest rates were related to thyroid cancer survivors; while the lowest rates were related to lung cancer survivors. For heart disease-specific survival rate, the highest rates were related to thyroid cancer survivors; while the lowest rates were related to both lung cancer survivors and urinary bladder cancer survivors. The following factors were associated with a higher likelihood of cardiac death: male gender, old age at diagnosis, black race and local treatment with radiotherapy rather than surgery (P < 0.0001 for all parameters). CONCLUSION Among cancer survivors (>5 years), cardiac death is a significant cause of death and there is a wide variability among different cancers in the relative importance of cardiac death vs. cancer-related death.
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Affiliation(s)
- Omar Abdel-Rahman
- a Clinical Oncology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt
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23
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Affiliation(s)
- D Gareth R Evans
- St Mary's Hospital, Central Manchester Hospitals Foundation Trust, Manchester, United Kingdom
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24
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Martins AS, Jansen AK, Rodrigues LOC, Matos CM, Souza MLR, de Souza JF, Diniz MDFHS, Barreto SM, Diniz LM, de Rezende NA, Riccardi VM. Lower fasting blood glucose in neurofibromatosis type 1. Endocr Connect 2016; 5:28-33. [PMID: 26631381 PMCID: PMC4703950 DOI: 10.1530/ec-15-0102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 12/02/2015] [Indexed: 12/23/2022]
Abstract
Studies indicate a lower occurrence of diabetes mellitus (DM) in patients with neurofibromatosis type 1 (NF1). Fasting blood glucose (FBG) level is the main criterion used to diagnose DM and glucose intolerance. Therefore, this study compared FBG level between adults with NF1 and non-NF1 controls. We selected clinical records of 57 out of 701 individuals attending the Neurofibromatosis Outpatient Reference Center of the Clinics Hospital of the Federal University of Minas Gerais in Brazil. The selected patients with NF1 were matched to non-NF1 controls selected from the Brazilian Longitudinal Study of Adult Health according to sex, age (range, 35-74 years) and BMI at a ratio of 1:3. In both groups, individuals with DM were excluded. Median FBG level in the NF1 group (86 mg/dl (range, 56-127 mg/dl)) was lower than that in the non-NF1 control group (102 mg/dl (range, 85-146 mg/dl)) (P<0.001). Prevalence of FBG level ≥100 mg/dl in the NF1 group (16%) was lower than that in the non-NF1 control group (63%) (P<0.05). The chance of a high FBG level was 89% lower in the NF1 group (odds ratio, 0.112; 95% CI, 0.067-0.188) (P<0.05). In conclusion, adults with NF1 showed a lower FBG level and a lower prevalence of high FBG level compared with non-NF1 controls.
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Affiliation(s)
- Aline Stangherlin Martins
- Neurofibromatosis Outpatient Reference CenterFederal University of Minas Gerais, Alameda Álvaro Celso 55, Belo Horizonte, Minas Gerais, BrazilDepartment of Nutrition, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Medical Clinic, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Preventive and Social Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Internal Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilThe Neurofibromatosis Institute5415 Briggs Avenue, La Crescenta, CA, USA
| | - Ann Kristine Jansen
- Neurofibromatosis Outpatient Reference CenterFederal University of Minas Gerais, Alameda Álvaro Celso 55, Belo Horizonte, Minas Gerais, BrazilDepartment of Nutrition, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Medical Clinic, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Preventive and Social Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Internal Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilThe Neurofibromatosis Institute5415 Briggs Avenue, La Crescenta, CA, USA
| | - Luiz Oswaldo Carneiro Rodrigues
- Neurofibromatosis Outpatient Reference CenterFederal University of Minas Gerais, Alameda Álvaro Celso 55, Belo Horizonte, Minas Gerais, BrazilDepartment of Nutrition, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Medical Clinic, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Preventive and Social Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Internal Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilThe Neurofibromatosis Institute5415 Briggs Avenue, La Crescenta, CA, USA
| | - Camila Maria Matos
- Neurofibromatosis Outpatient Reference CenterFederal University of Minas Gerais, Alameda Álvaro Celso 55, Belo Horizonte, Minas Gerais, BrazilDepartment of Nutrition, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Medical Clinic, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Preventive and Social Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Internal Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilThe Neurofibromatosis Institute5415 Briggs Avenue, La Crescenta, CA, USA
| | - Marcio Leandro Ribeiro Souza
- Neurofibromatosis Outpatient Reference CenterFederal University of Minas Gerais, Alameda Álvaro Celso 55, Belo Horizonte, Minas Gerais, BrazilDepartment of Nutrition, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Medical Clinic, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Preventive and Social Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Internal Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilThe Neurofibromatosis Institute5415 Briggs Avenue, La Crescenta, CA, USA
| | - Juliana Ferreira de Souza
- Neurofibromatosis Outpatient Reference CenterFederal University of Minas Gerais, Alameda Álvaro Celso 55, Belo Horizonte, Minas Gerais, BrazilDepartment of Nutrition, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Medical Clinic, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Preventive and Social Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Internal Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilThe Neurofibromatosis Institute5415 Briggs Avenue, La Crescenta, CA, USA
| | - Maria de Fátima Haueisen Sander Diniz
- Neurofibromatosis Outpatient Reference CenterFederal University of Minas Gerais, Alameda Álvaro Celso 55, Belo Horizonte, Minas Gerais, BrazilDepartment of Nutrition, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Medical Clinic, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Preventive and Social Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Internal Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilThe Neurofibromatosis Institute5415 Briggs Avenue, La Crescenta, CA, USA
| | - Sandhi Maria Barreto
- Neurofibromatosis Outpatient Reference CenterFederal University of Minas Gerais, Alameda Álvaro Celso 55, Belo Horizonte, Minas Gerais, BrazilDepartment of Nutrition, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Medical Clinic, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Preventive and Social Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Internal Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilThe Neurofibromatosis Institute5415 Briggs Avenue, La Crescenta, CA, USA
| | - Leonardo Mauricio Diniz
- Neurofibromatosis Outpatient Reference CenterFederal University of Minas Gerais, Alameda Álvaro Celso 55, Belo Horizonte, Minas Gerais, BrazilDepartment of Nutrition, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Medical Clinic, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Preventive and Social Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Internal Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilThe Neurofibromatosis Institute5415 Briggs Avenue, La Crescenta, CA, USA
| | - Nilton Alves de Rezende
- Neurofibromatosis Outpatient Reference CenterFederal University of Minas Gerais, Alameda Álvaro Celso 55, Belo Horizonte, Minas Gerais, BrazilDepartment of Nutrition, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Medical Clinic, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Preventive and Social Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Internal Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilThe Neurofibromatosis Institute5415 Briggs Avenue, La Crescenta, CA, USA Neurofibromatosis Outpatient Reference CenterFederal University of Minas Gerais, Alameda Álvaro Celso 55, Belo Horizonte, Minas Gerais, BrazilDepartment of Nutrition, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Medical Clinic, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Preventive and Social Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Internal Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilThe Neurofibromatosis Institute5415 Briggs Avenue, La Crescenta, CA, USA
| | - Vincent Michael Riccardi
- Neurofibromatosis Outpatient Reference CenterFederal University of Minas Gerais, Alameda Álvaro Celso 55, Belo Horizonte, Minas Gerais, BrazilDepartment of Nutrition, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Medical Clinic, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Preventive and Social Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilDepartment of Internal Medicine, Federal University of Minas GeraisProfessor Alfredo Balena Avenue, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, BrazilThe Neurofibromatosis Institute5415 Briggs Avenue, La Crescenta, CA, USA
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Crawford HA, Barton B, Wilson MJ, Berman Y, McKelvey-Martin VJ, Morrison PJ, North KN. Uptake of health monitoring and disease self-management in Australian adults with neurofibromatosis type 1: strategies to improve care. Clin Genet 2015; 89:385-91. [PMID: 26081173 DOI: 10.1111/cge.12627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/14/2015] [Accepted: 06/15/2015] [Indexed: 01/18/2023]
Abstract
Lifelong health monitoring is recommended in neurofibromatosis type 1 (NF1) because of the progressive and unpredictable range of disabling and potentially life-threatening symptoms that arise. In Australia, strategies for NF1 health surveillance are less well developed for adults than they are for children, resulting in inequalities between pediatric and adult care. The aims of this study were to determine the uptake of health monitoring and capacity of adults with NF1 to self-manage their health. Australian adults with NF1 (n = 94, 18-40 years) participated in a semi-structured interview. Almost half reported no regular health monitoring. Thematic analysis of interviews identified four main themes as to why: (i) did not know where to seek care, (ii) unaware of the need for regular monitoring, (iii) futility of health monitoring as nothing can be done for NF1, and (iv) feeling healthy, therefore monitoring unnecessary. Overall, there were low levels of patient activation, indicating that adults with NF1 lacked knowledge and confidence to manage their health and health care. Findings are discussed in the context of service provision for adults with NF1 in New South Wales, Australia.
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Affiliation(s)
- H A Crawford
- Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia.,The Institute for Neuroscience and Muscle Research, Westmead, New South Wales, Australia
| | - B Barton
- Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia.,Children's Hospital Education Research Institute (CHERI), The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - M J Wilson
- Department of Genetic Medicine, Westmead Hospital, Westmead, New South Wales, Australia.,Discipline of Genetics, University of Sydney, Sydney, New South Wales, Australia
| | - Y Berman
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Discipline of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - V J McKelvey-Martin
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - P J Morrison
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, Northern Ireland, UK.,Northern Ireland Regional Genetics Service, Department of Medical Genetics, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - K N North
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
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Batista PB, Bertollo EMG, Costa DDS, Eliam L, Cunha KSG, Cunha-Melo JR, Darrigo Junior LG, Geller M, Gianordoli-Nascimento IF, Madeira LG, Mendes HM, Miranda DMD, Mata-Machado NA, Morato EG, Pavarino ÉC, Pereira LB, Rezende NAD, Rodrigues LDO, Sette JBC, Silva CMD, Souza JFD, Souza MLRD, Martins AS, Valadares ER, Vidigal PVT, Waisberg V, Waisberg Y, Rodrigues LOC. Neurofibromatosis: part 2 – clinical management. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:531-43. [DOI: 10.1590/0004-282x20150042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/20/2015] [Indexed: 11/21/2022]
Abstract
Part 1 of this guideline addressed the differential diagnosis of the neurofibromatoses (NF): neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2) and schwannomatosis (SCH). NF shares some features such as the genetic origin of the neural tumors and cutaneous manifestations, and affects nearly 80 thousand Brazilians. Increasing scientific knowledge on NF has allowed better clinical management and reduced rate of complications and morbidity, resulting in higher quality of life for NF patients. Most medical doctors are able to perform NF diagnosis, but the wide range of clinical manifestations and the inability to predict the onset or severity of new features, consequences, or complications make NF management a real clinical challenge, requiring the support of different specialists for proper treatment and genetic counseling, especially in NF2 and SCH. The present text suggests guidelines for the clinical management of NF, with emphasis on NF1.
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Validity of participant-reported diagnoses in an online patient registry: a report from the NF1 Patient Registry Initiative. Contemp Clin Trials 2014; 40:212-7. [PMID: 25533730 DOI: 10.1016/j.cct.2014.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/10/2014] [Accepted: 12/12/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND With increased internet accessibility worldwide, it is now possible to assemble individuals with rare diseases through web-based patient registries. However, the validity of participant-reported medical diagnoses is unknown. The objective of this study was to evaluate the accuracy of participant-reported Neurofibromatosis Type 1 (NF1) diagnoses among participants in the NF1 Patient Registry Initiative (NPRI). METHODS Subjects enrolled in the NPRI from 5/17/2011 to 7/7/2014 were included. Medical records (MRs) were obtained for participants who returned medical record release forms (MRRFs) during the study period. Participants were classified as having definite, probable, suspected, or no NF1 diagnosis based on MR information. To assess whether a returned MRRF served as a reliable marker of MR-documented NF1, we calculated the positive predictive value (PPV) as the proportion of individuals with MR-documented NF1 among those from whom MRs were obtained. We further examined whether a returned MRRF predicted the number of reported NF1 clinical signs in multivariable linear regression analyses. RESULTS A total of 1456 individuals were included in the analyses. Of 416 individuals who returned MRRFs, 205 MRs were reviewed within the study period. The PPV ranged from 72.0 to 98.5% when including definite or definite/probable/suspected cases, respectively. The mean number of reported NF1 clinical signs was similar between those who returned (mean=3.3 ± 1.2) and did not return (mean=3.2 ± 1.3) their MRRFs. MRRF return was not a significant predictor of the number of NF1 clinical signs after adjusting for covariates. CONCLUSION These data strongly suggest that individuals enrolling in the NPRI accurately report their NF1 diagnosis.
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Trilling B, Faucheron JL. Intestinal obstruction in von Recklinghausen's disease. Colorectal Dis 2014; 16:762-8. [PMID: 24766607 DOI: 10.1111/codi.12649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 02/07/2014] [Indexed: 02/08/2023]
Abstract
AIM Gastrointestinal manifestations occur in up to 25% of patients with neurofibromatosis type 1. This review reports all published cases of acute intestinal obstruction due to neurofibromatosis type 1 and identifies mechanisms of obstruction, the nature of the tumour and the outcome. METHOD A systematic review of the literature on acute intestinal obstruction due to neurofibromatosis type 1 was performed by searching the major electronic databases. All relevant references were reviewed for possible inclusion. All the references of the relevant articles were screened for any further articles that were missed in the initial search. RESULTS We identified 25 articles from 1972 to 2013 reporting 25 patients with von Recklinghausen's disease who underwent laparotomy for acute intestinal obstruction. Three further patients were operated on in our institution. The mean age of the patients was 44.2 years and the male/female ratio 15/13. The mechanisms of obstruction were intrinsic obstruction (16), extrinsic obstruction (8) and intussusception (4). Histology was reported to show neurofibroma (19), gastrointestinal stromal tumour (5) and adenocarcinoma (4). Among patients whose outcome was mentioned (17), 10 were asymptomatic after a mean follow-up of 1.5 years. CONCLUSION Acute bowel obstruction is a rare manifestation of neurofibromatosis type 1. Surgery is often necessary to treat the complication and to determine the exact nature of the tumour and the prognosis.
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Affiliation(s)
- B Trilling
- Colorectal Unit, Department of Surgery, University Hospital, Grenoble, Cedex, France
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Johnson KJ, Mueller NL, Williams K, Gutmann DH. Evaluation of participant recruitment methods to a rare disease online registry. Am J Med Genet A 2014; 164A:1686-94. [DOI: 10.1002/ajmg.a.36530] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 02/14/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Kimberly J. Johnson
- Brown School; Washington University; St. Louis Missouri
- Department of Pediatrics; School of Medicine; Washington University; St. Louis Missouri
- Siteman Cancer Center; Washington University; St. Louis Missouri
| | | | | | - David H. Gutmann
- Department of Neurology; School of Medicine; Washington University; St. Louis Missouri
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Marwah S, Gurawalia JP, Sheoran KD, Marwah N, Gupta S, Ranga H. Malignant peripheral nerve sheath tumor of the colon in a patient with von Recklinghausen’s disease: report of a case. Clin J Gastroenterol 2013; 6:429-33. [DOI: 10.1007/s12328-013-0422-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 08/27/2013] [Indexed: 01/14/2023]
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Evans DGR, Ingham SL. Reduced life expectancy seen in hereditary diseases which predispose to early-onset tumors. APPLICATION OF CLINICAL GENETICS 2013; 6:53-61. [PMID: 23935382 PMCID: PMC3735038 DOI: 10.2147/tacg.s35605] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
There are several hereditary diseases that are a predisposition to early-onset tumors. These include syndromic conditions like neurofibromatosis 1 and 2, von Hippel-Lindau syndrome, Gorlin syndrome, multiple endocrine neoplasia, and familial adenomatous polyposis; and conditions which are usually not possible to diagnose clinically in a single individual, such as Lynch syndrome and BRCA1/2. Understanding of the mortality in hereditary cancer predisposing diseases is important for developing effective disease treatment programs. A number of studies have been undertaken to investigate the genetic predictors, prevalence and incidence, and treatment outcomes of these diseases; however, the majority examine only the most common of these diseases (eg, neurofibromatosis or BRCA), or look into postoperative survival. The mortality of individuals who are diagnosed with one of these hereditary diseases remains an area for investigation. This review is the first to attempt identification of studies investigating life expectancy in hereditary diseases which predispose to early-onset tumors.
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Affiliation(s)
- D Gareth R Evans
- Genetic Medicine, Manchester Academic Health Science Centre, Central Manchester Foundation Trust, St Mary's Hospital, Manchester, UK
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Van Lierde A, Menni F, Bedeschi MF, Natacci F, Guez S, Vizziello P, Costantino MA, Lalatta F, Esposito S. Healthcare transition in patients with rare genetic disorders with and without developmental disability: Neurofibromatosis 1 and williams-beuren syndrome. Am J Med Genet A 2013; 161A:1666-74. [DOI: 10.1002/ajmg.a.35982] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 02/10/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Andrea Van Lierde
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation; Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan; Italy
| | - Francesca Menni
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation; Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan; Italy
| | | | - Federica Natacci
- Genetic Unit; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan; Italy
| | - Sophie Guez
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation; Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan; Italy
| | - Paola Vizziello
- Child and Adolescent Neuropsychiatric Unit; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan; Italy
| | - Maria Antonella Costantino
- Child and Adolescent Neuropsychiatric Unit; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan; Italy
| | - Faustina Lalatta
- Genetic Unit; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan; Italy
| | - Susanna Esposito
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation; Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan; Italy
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Rodrigues LO, Rodrigues LOC, Castro LL, Rezende NA, Ribeiro ALP. Non-invasive endothelial function assessment in patients with neurofibromatosis type 1: a cross-sectional study. BMC Cardiovasc Disord 2013; 13:18. [PMID: 23497412 PMCID: PMC3606630 DOI: 10.1186/1471-2261-13-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 02/19/2013] [Indexed: 01/30/2023] Open
Abstract
Background Neurofibromatosis type 1 (NF1) is a multi-systemic disease caused by neurofibromin deficiency. The reduced life expectancy of patients with NF1 has been attributed to NF1-associated malignant neoplasms. However, an analysis of death certificates in the USA suggests that vascular disease could be an important cause of early death among these patients. Endothelial dysfunction (ED) is related to vasculopathy and is an early marker of subclinical atherosclerosis. Since neurofibromin has already been demonstrated to affect endothelial cell function, ED may be associated with NF1. The purpose of this study was to assess endothelial function in patients with NF1 using a non-invasive method. Methods NF1 patients and healthy control subjects, aged 18 to 35 years, were included. Subjects were excluded if they had any risk factor for vascular disease or any other condition known to affect endothelial function. Endothelial function was assessed using reactive hyperemia-peripheral arterial tone (RH-PAT) technology. ED was defined as a reactive hyperemia index (RHI) lower than 1.35. Results Four of the 29 (13.8%) NF1 patients and 1 of the 30 (3.3%) healthy volunteers had ED (p = 0.153). RHI medians and interquartile intervals were 1.8 (1.58-2.43) for the NF1 group and 2.02 (1.74 – 2.49) for the control group (p = 0.361). Conclusion The prevalence of ED was similar in NF1 patients and healthy controls.
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Affiliation(s)
- Luiza O Rodrigues
- Department of Internal Medicine, Federal University of Minas Gerais, Av, Prof, Alfredo Balena, 190-246, Belo Horizonte, MG, Cep:30130-100, Brazil.
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Oates EC, Payne JM, Foster SL, Clarke NF, North KN. Young Australian adults with NF1 have poor access to health care, high complication rates, and limited disease knowledge. Am J Med Genet A 2013; 161A:659-66. [DOI: 10.1002/ajmg.a.35840] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 12/04/2012] [Indexed: 11/09/2022]
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Risk of benign tumours of nervous system, and of malignant neoplasms, in people with neurofibromatosis: population-based record-linkage study. Br J Cancer 2012; 108:193-8. [PMID: 23257896 PMCID: PMC3553528 DOI: 10.1038/bjc.2012.535] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: The neurofibromatoses (NF) are genetic disorders. Increased risks of some cancers in people with NF are well recognised, but there is no comprehensive enumeration of the risks across the whole range of site-specific cancers. Our aim was to provide this. Methods: A linked data set of hospital admissions and deaths in England was used to compare rates of tumours in an NF cohort with rates in a comparison cohort, with results expressed as rate ratios (RR). Results: The RR for all cancers combined, in people with both types of NF combined, was 4.3 (95% confidence interval (CI): 4.0–4.6), based on 769 cases of cancer in 8003 people with NF. Considering only people with presumed NF1 (as defined in the main article), the RR for all cancers excluding nervous system malignancies remained elevated (2.7, 95% CI: 2.4–2.9); and risks were significantly high for cancer of the oesophagus (3.3), stomach (2.8), colon (2.0), liver (3.8), lung (3.0), bone (19.6), thyroid (4.9), malignant melanoma (3.6), non-Hodgkin’s lymphoma (3.3), chronic myeloid leukaemia (6.7), female breast (2.3) and ovary (3.7). Conclusion: Neurofibromatosis was associated with an increased risk of many individual cancers. The relationships between NF and cancers may hold clues to mechanisms of carcinogenesis more generally.
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Kolberg M, Høland M, Agesen TH, Brekke HR, Liestøl K, Hall KS, Mertens F, Picci P, Smeland S, Lothe RA. Survival meta-analyses for >1800 malignant peripheral nerve sheath tumor patients with and without neurofibromatosis type 1. Neuro Oncol 2012; 15:135-47. [PMID: 23161774 PMCID: PMC3548581 DOI: 10.1093/neuonc/nos287] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
There are conflicting reports as to whether malignant peripheral nerve sheath tumor (MPNST) patients with neurofibromatosis type 1 (NF1) have worse prognosis than non-NF1 MPNST patients. Large clinical studies to address this problem are lacking due to the rareness of MPNST. We have performed meta-analyses testing the effect of NF1 status on MPNST survival based on publications from the last 50 years, including only nonoverlapping patients reported from each institution. In addition, we analyzed survival characteristics for 179 MPNST patients from 3 European sarcoma centers. The meta-analyses including data from a total of 48 studies and >1800 patients revealed a significantly higher odds ratio for overall survival (OR(OS)) and disease-specific survival (OR(DSS)) in the non-NF1 group (OR(OS) = 1.75, 95% confidence interval [CI] = 1.28-2.39, and OR(DSS) = 1.68, 95% CI = 1.18-2.40). However, in studies published in the last decade, survival in the 2 patient groups has been converging, as especially the NF1 group has shown improved prognosis. For our own MPNST patients, NF1 status had no effect on overall or disease-specific survival. The compiled literature from 1963 to the present indicates a significantly worse outcome of MPNST in patients with NF1 syndrome compared with non-NF1 patients. However, survival for the NF1 patients has improved in the last decade, and the survival difference is diminishing. These observations support the hypothesis that MPNSTs arising in NF1 and non-NF1 patients are not different per se. Consequently, we suggest that the choice of treatment for MPNST should be independent of NF1 status.
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Affiliation(s)
- Matthias Kolberg
- Department of Cancer Prevention, Institute for Cancer Research, the Norwegian Radium Hospital, Montebello, Oslo University Hospital, NO-0424 Oslo, Norway.
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A safe method for excision of a giant neurofibroma on both buttocks using a loop-shaped suture. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-011-0657-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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