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Tarur SU, James J, Aschettino DL, Oundjian NJ. Neck Mass in a 12-year-old Girl with Autism Spectrum Disorder. Pediatr Rev 2024; 45:465-468. [PMID: 39085186 DOI: 10.1542/pir.2022-005696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 12/09/2022] [Accepted: 12/16/2022] [Indexed: 08/02/2024]
Affiliation(s)
| | - Jamila James
- Department of Pediatrics, Harlem Hospital Center, affiliate of Columbia University, New York, NY
| | - Diana Lynn Aschettino
- Department of Pediatrics, Harlem Hospital Center, affiliate of Columbia University, New York, NY
| | - Nelly Jouayed Oundjian
- Department of Pediatrics, Harlem Hospital Center, affiliate of Columbia University, New York, NY
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2
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Patnaik A, Pattnaik N, Sekar A, Singh DK. Meningioma getting a common presentation in uncommon Cowden syndrome: A case report. J Neurosci Rural Pract 2023; 14:756-758. [PMID: 38059233 PMCID: PMC10696359 DOI: 10.25259/jnrp_305_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/20/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Ashis Patnaik
- Department of Neurosurgery, AIIMS, Bhubaneswar, Odisha, India
| | - Naina Pattnaik
- Department of Periodontology, Hi-Tech Dental College and Hospital, Bhubaneswar, Odisha, India
| | - Arunkumar Sekar
- Department of Neurosurgery, AIIMS, Bhubaneswar, Odisha, India
| | - Dhirendra Kumar Singh
- Department of Periodontology, Kalinga Institute of Dental Science, Hi-Tech Dental College and Hospital, Bhubaneswar, Odisha, India
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Agarwal P, Sachan A, Goel V, Jindal S, Jain P. Cowden Syndrome With Gall Bladder Polyps and Incidental Gall Bladder Carcinoma. Cureus 2023; 15:e39794. [PMID: 37398799 PMCID: PMC10313238 DOI: 10.7759/cureus.39794] [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] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Cowden syndrome is an uncommon autosomal dominant disorder characterized by multiple hamartomas in various tissues. It is associated with germline mutation in the phosphatase and tensin homolog (PTEN) gene. It has an increased risk of malignancies of various organs (commonly breast, thyroid, and endometrium) and benign overgrowth of tissues like skin, colon, and thyroid. Here, we present a case of Cowden syndrome in a middle-aged female who presented with acute cholecystitis with gall bladder polyps along with intestinal polyps. She underwent total proctocolectomy with ileal pouch-anal anastomosis (IPAA) with diversion ileostomy and cholecystectomy, which was further proceeded to completion of radical cholecystectomy based on the final histopathology report as incidental gall bladder carcinoma. To the best of our knowledge, this association is seen for the first time in the literature. In Cowden syndrome, patients should be counseled for regular follow-up and instructed to be aware of the signs and symptoms of different types of cancers with higher incidence.
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Affiliation(s)
- Praveen Agarwal
- Surgical Gastroenterology, Fortis Hospital, Shalimar Bagh, Delhi, IND
| | - Ashish Sachan
- Surgical Gastroenterology, Fortis Hospital, Shalimar Bagh, Delhi, IND
| | - Vivek Goel
- Surgical Gastroenterology, Fortis Hospital, Shalimar Bagh, Delhi, IND
| | - Sourabh Jindal
- Surgical Gastroenterology, Fortis Hospital, Shalimar Bagh, Delhi, IND
| | - Pradeep Jain
- Surgical Gastroenterology, Fortis Hospital, Shalimar Bagh, Delhi, IND
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Rahmatinejad Z, Goshayeshi L, Bergquist R, Goshayeshi L, Golabpour A, Hoseini B. PTEN hamartoma tumour syndrome: case report based on data from the Iranian hereditary colorectal cancer registry and literature review. Diagn Pathol 2023; 18:43. [PMID: 37016356 PMCID: PMC10071641 DOI: 10.1186/s13000-023-01331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND PTEN hamartoma tumour syndrome (PHTS) is a rare hereditary disorder caused by germline pathogenic mutations in the PTEN gene. This study presents a case of PHTS referred for genetic evaluation due to multiple polyps in the rectosigmoid area, and provides a literature review of PHTS case reports published between March 2010 and March 2022. CASE PRESENTATION A 39-year-old Iranian female with a family history of gastric cancer in a first-degree relative presented with minimal bright red blood per rectum and resistant dyspepsia. Colonoscopy revealed the presence of over 20 polyps in the rectosigmoid area, while the rest of the colon appeared normal. Further upper endoscopy showed multiple small polyps in the stomach and duodenum, leading to a referral for genetic evaluation of hereditary colorectal polyposis. Whole-exome sequencing led to a PHTS diagnosis, even though the patient displayed no clinical or skin symptoms of the condition. Further screenings identified early-stage breast cancer and benign thyroid nodules through mammography and thyroid ultrasound. METHOD AND RESULTS OF LITERATURE REVIEW A search of PubMed using the search terms "Hamartoma syndrome, Multiple" [Mesh] AND "case report" OR "case series" yielded 43 case reports, predominantly in women with a median age of 39 years. The literature suggests that patients with PHTS often have a family history of breast, thyroid and endometrial neoplasms along with pathogenic variants in the PTEN/MMAC1 gene. Gastrointestinal polyps are one of the most common signs reported in the literature, and the presence of acral keratosis, trichilemmomas and mucocutaneous papillomas are pathognomonic characteristics of PHTS. CONCLUSION When a patient presents with more than 20 rectosigmoid polyps, PHTS should be considered. In such cases, it is recommended to conduct further investigations to identify other potential manifestations and the phenotype of PHTS. Women with PHTS should undergo annual mammography and magnetic resonance testing for breast cancer screening from the age of 30, in addition to annual transvaginal ultrasounds and blind suction endometrial biopsies.
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Affiliation(s)
- Zahra Rahmatinejad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ladan Goshayeshi
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robert Bergquist
- Ingerod, Brastad, SE-454 94, Sweden
- Formerly UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Lena Goshayeshi
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Golabpour
- School of Allied Medical Sciences, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Benyamin Hoseini
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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5
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Cancer treatment and decision making in individuals with intellectual disabilities: a scoping literature review. Lancet Oncol 2022; 23:e174-e183. [DOI: 10.1016/s1470-2045(21)00694-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
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Cherkas E, Champion AF, Gates JC. Sclerotherapy for atypical oral manifestation of Cowden syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:e290-e293. [PMID: 32636168 DOI: 10.1016/j.oooo.2020.05.018] [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: 03/17/2020] [Revised: 05/13/2020] [Accepted: 05/31/2020] [Indexed: 11/18/2022]
Abstract
Cowden syndrome is an autosomal dominant disorder characterized by hamartomas, as well as benign and malignant neoplasms that may present in organ systems throughout the body. It also poses an increased lifetime cancer risk in those with the disorder. Its clinical presentation is often variable, and diagnosis can be challenging. In the head and neck region, it can present as thyroid enlargement or mass formation, cutaneous and mucocutaneous lesions of the skin and the oral cavity. The most typical oral manifestations of Cowden syndrome are oral papillomatosis and a cobblestone appearance of the mucosa. We present a case of vascular malformation of the tongue in a patient with Cowden syndrome. This lesion was similar in appearance to a cutaneous hamartoma on the patient's upper extremity. He had received prior surgical intervention for this tongue mass, and complete resection was recommended subsequently. However, in search of a less invasive treatment to minimize impact on speech and oral function, sclerotherapy was performed, resulting in resolution of the lesion. Sclerotherapy is a well-documented treatment for head and neck vascular malformations, but it is not universally employed. In our patient with atypical oral manifestation of Cowden syndrome, bleomycin sclerotherapy was employed, resulting in resolution of the lesion, as well as preservation of speech articulation and oral function.
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Affiliation(s)
- Elliot Cherkas
- Medical Student, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Allen F Champion
- Assistant Professor, Thomas Jefferson University, Department of Oral and Maxillofacial Surgery, Philadelphia, PA, USA
| | - James C Gates
- Clinical Instructor, Thomas Jefferson University, Department of Oral and Maxillofacial Surgery, Philadelphia, PA, USA.
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A Pediatric Case of Cowden Syndrome with Graves' Disease. Case Rep Pediatr 2017; 2017:2750523. [PMID: 28251007 PMCID: PMC5306985 DOI: 10.1155/2017/2750523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/20/2016] [Accepted: 01/05/2017] [Indexed: 12/03/2022] Open
Abstract
Cowden syndrome (CS) is a rare dominantly inherited multisystem disorder, characterized by an extraordinary malignant potential. In 80% of cases, the human tumor suppressor gene phosphatase and tensin homolog (PTEN) is mutated. We present a case of a 17-year-old boy with genetically confirmed CS and Graves' disease (GD). At the age of 15, he presented with intention tremor, palpitations, and marked anxiety. On examination, he had macrocephaly, coarse facies, slight prognathism, facial trichilemmomas, abdominal keratoses, leg hemangioma, and a diffusely enlarged thyroid gland. He started antithyroid drug (ATD) therapy with methimazole and, after a 2-year treatment period without achieving a remission status, a total thyroidectomy was performed. Diagnosis and management of CS should be multidisciplinary. Thyroid disease is frequent, but its management has yet to be fully defined. The authors present a case report of a pediatric patient with CS and GD and discuss treatment options.
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Maldonado G, Peruzzo J, Tubone MQ, Reinehr CPH, Escobar GF. Syndrome in question. A case of Cowden´s syndrome. An Bras Dermatol 2015; 90:131-3. [PMID: 25672315 PMCID: PMC4323714 DOI: 10.1590/abd1806-4841.20153098] [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: 08/27/2013] [Accepted: 10/09/2013] [Indexed: 11/28/2022] Open
Abstract
The authors describe a case of Cowden´s syndrome in a female patient with classic
cutaneous lesions, plus papillomatous lesions in the gastrointestinal tract and
a previous history of thyroid carcinoma. Mucocutaneous lesions occur in 90% of
Cowden's syndrome cases and are characterized by facial trichilemmomas, oral
mucosal papillomas and benign acral keratoses. Sites of extracutaneous
involvement include: the thyroid, gastrointestinal tract, breast and endometrial
tissue. There is risk of malignancies in these organs and they need to be
monitored with imaging tests. The early diagnosis of the syndrome by a
dermatologist through mucocutaneous lesions enables the investigation and
diagnosis of extracutaneous involvement.
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Affiliation(s)
| | - Juliano Peruzzo
- Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Flores IL, Romo SA, Tejeda Nava FJ, Roger dos Santos Silva A, Vargas PA, Paes de Almeida O, Lopes MA. Oral presentation of 10 patients with Cowden syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:e301-10. [PMID: 24560406 DOI: 10.1016/j.oooo.2014.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/18/2013] [Accepted: 01/07/2014] [Indexed: 12/19/2022]
Abstract
Cowden syndrome (CS) is an autosomal dominant genodermatosis that frequently affects several tissues with hamartomatous growth. The oral cavity is quite commonly involved with papillomatous lesions, which can be crucial to early diagnosis of this disease. In this series, 10 patients with a great diversity of manifestations associated with CS are presented, in whom oral papillomatosis was a constant and relevant finding to establish the diagnosis of CS. The role of the dentist in recognizing the oral lesions, the other diagnostic criteria, the risk for the development of malignancies, and the importance of lifetime follow-up are discussed.
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Affiliation(s)
- Isadora Luana Flores
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Saray Aranda Romo
- Faculty of Stomatology, Autonomous University of San Luis Potosí, San Luis Potosí, Mexico
| | | | - Alan Roger dos Santos Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Márcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.
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Porto ACS, Roider E, Ruzicka T. Cowden Syndrome: report of a case and brief review of literature. An Bras Dermatol 2013; 88:52-5. [PMID: 24346879 PMCID: PMC3876002 DOI: 10.1590/abd1806-4841.20132578] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/02/2013] [Indexed: 11/22/2022] Open
Abstract
We present the case of a female patient with facial cutaneous lesions, a cobblestone-like pattern of the oral mucosa, and verruciform lesions on the hand since her youth. She reported a history of breast cancer, endometrial cancer, melanoma and multiple benign tumors and cysts. PTEN gene analysis was performed and confirmed Cowden Syndrome, a rare genodermatosis with an autosomal dominant pattern of inheritance, characterized by multiple hamartomas. The phosphatase and tensin homolog (PTEN) gene negatively regulates cell proliferation and cell cycle progression. Loss of PTEN function contributes to an increased risk of cancer. We emphasize the importance of early detection and accurate management of Cowden Syndrome.
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Affiliation(s)
- Ana Carolina Souza Porto
- Residents in Dermatology - Medical Department of Dermatology and
Allergy, Ludwig-Maximilian University of Munich, Germany
| | - Elisabeth Roider
- Residents in Dermatology - Medical Department of Dermatology and
Allergy, Ludwig-Maximilian University of Munich, Germany
| | - Thomas Ruzicka
- Director of the Department of Dermatology and Allergy,
Ludwig-Maximilian University of Munich, Germany
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