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Lawson B, Rajendran I, Smith J, Shakur A, Sadler V, Sadler TJ, Addley HC, Freeman S. Mimics of primary ovarian cancer and primary peritoneal carcinomatosis - A pictorial review. Clin Radiol 2024; 79:736-748. [PMID: 39068115 DOI: 10.1016/j.crad.2024.07.004] [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: 04/11/2024] [Revised: 06/26/2024] [Accepted: 07/05/2024] [Indexed: 07/30/2024]
Abstract
Numerous conditions can mimic ovarian malignancy. Identifying the origin of a pelvic mass or disseminated peritoneal abnormality on imaging is important to ensure that the patient receives optimal management by the appropriate clinical team. Ovarian cancer mimics include infections and other neoplastic processes, for example, actinomycosis, lymphoma, and sarcoma. We will illustrate intraperitoneal and extraperitoneal ovarian and non-ovarian mimics. Primary peritoneal carcinomatosis mimics include processes such as deep infiltrating endometriosis and rare causes such as gliomatosis peritonei and diffuse peritoneal leiomyomatosis. We aim to illustrate the multimodality key imaging appearances of common and rarer types of mimics.
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Affiliation(s)
- B Lawson
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - I Rajendran
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - J Smith
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - A Shakur
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - V Sadler
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - T J Sadler
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - H C Addley
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - S Freeman
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
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Khatiwada A, Jha A, Shrivastav S, Verma S, K C S. Large ovarian mature teratoma with gliomatosis peritonei in a young female: A case report. Radiol Case Rep 2024; 19:3970-3974. [PMID: 39050644 PMCID: PMC11267994 DOI: 10.1016/j.radcr.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/01/2024] [Accepted: 06/04/2024] [Indexed: 07/27/2024] Open
Abstract
Gliomatosis peritonei is an extremely rare condition usually associated with either immature teratoma or, less commonly, mature teratoma. We present a case of a young female with long-standing progressive abdominal distension, who was diagnosed with mature ovarian teratoma with gliomatosis peritonei and gross ascites. The final diagnosis in this case was determined through the correlation of imaging, operative, and histopathological findings. The presence of enhancing peritoneal nodules usually leads to a suspicion of peritoneal carcinomatosis or abdominal tuberculosis, especially in endemic regions; however, gliomatosis peritonei should always be considered in the differential diagnosis, particularly when associated with teratomas. Radiological findings combined with histopathological reports are valuable in reaching the final diagnosis in these cases.
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Affiliation(s)
- Abhikanta Khatiwada
- Department of Radiology, Tribhuvan University Teaching Hospital, Maharajgunj Road, Kathmandu, Nepal
| | - Anamika Jha
- Department of Radiology, Tribhuvan University Teaching Hospital, Maharajgunj Road, Kathmandu, Nepal
| | - Shreya Shrivastav
- Department of Pathology, Tribhuvan University Teaching Hospital, Maharajgunj Road, Kathmandu, Nepal
| | - Suman Verma
- Department of Obstetrics and Gyencology, Tribhuvan University Teaching Hospital, Maharajgunj Road, Kathmandu, Nepal
| | - Sharada K C
- Department of Internal Medicine, NAIHS, Syanobharyang, Kathmandu, Nepal
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Campos NMF, Almeida V, Curvo Semedo L. Peritoneal disease: key imaging findings that help in the differential diagnosis. Br J Radiol 2022; 95:20210346. [PMID: 34767464 PMCID: PMC8822557 DOI: 10.1259/bjr.20210346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The peritoneum is a unique serosal membrane, which can be the site of primary tumors and, more commonly, secondary pathologic processes. Peritoneal carcinomatosis is the most common malignant condition to affect the peritoneal cavity, and the radiologist plays an important role in making the diagnosis and assessing the extent of disease, especially in sites that may hinder surgery. In this review, we address the role of the radiologist in the setting of peritoneal pathology, focusing on peritoneal carcinomatosis as this is the predominant malignant process, followed by revising typical imaging findings that can guide the differential diagnosis.We review the most frequent primary and secondary peritoneal tumor and tumor-like lesions, proposing a systemic approach based on clinical history and morphological appearance, namely distinguishing predominantly cystic from solid lesions, both solitary and multiple.
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Affiliation(s)
- Nuno M F Campos
- Department of Medical Imaging, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Vânia Almeida
- Department of Pathology, Coimbra Hospital and University Centre, Coimbra, Portugal
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Bajracharya A, Shrestha S, Singh M, Dhakal HP. Mature ovarian teratoma with gliomatosis peritonei: A rare case report. Clin Case Rep 2021; 9:e04879. [PMID: 34594559 PMCID: PMC8462438 DOI: 10.1002/ccr3.4879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/13/2021] [Accepted: 09/12/2021] [Indexed: 01/06/2023] Open
Abstract
Gliomatosis peritonei (GP) is rarely observed along with mature ovarian teratoma. However, it is important to recognize the benign nature of GP when associated with mature ovarian teratoma. Treatment for primary tumor and long-term follow-up is vital.
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Affiliation(s)
- Anu Bajracharya
- Department of Gynecologic OncologyNepal Cancer Hospital and Research CenterLalitpurNepal
| | - Suraj Shrestha
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | - Moushumi Singh
- Department of PathologyNepal Cancer Hospital and Research CenterLalitpurNepal
| | - Hari Prasad Dhakal
- Department of PathologyNepal Cancer Hospital and Research CenterLalitpurNepal
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Saleh M, Bhosale P, Menias CO, Ramalingam P, Jensen C, Iyer R, Ganeshan D. Ovarian teratomas: clinical features, imaging findings and management. Abdom Radiol (NY) 2021; 46:2293-2307. [PMID: 33394097 DOI: 10.1007/s00261-020-02873-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 12/11/2022]
Abstract
Ovarian teratomas are the most common type of germ cell tumors. There are three major subtypes of ovarian teratomas including mature, immature, and monodermal teratomas. Ultrasound, computed tomography and magnetic resonance imaging can demonstrate specific imaging findings for mature teratoma. Imaging features of immature and monodermal teratomas are less specific, but a combination of clinical features and imaging findings can help in the diagnosis. Imaging is also very helpful in guiding management. In this article, we review the epidemiology, histopathology, clinical presentation, imaging features and management of ovarian teratomas.
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Affiliation(s)
- Mohammed Saleh
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Christine O Menias
- Department of Radiology, Mayo Clinic in Arizona, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Preetha Ramalingam
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Corey Jensen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Revathy Iyer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Dhakshinamoorthy Ganeshan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Unit 1473, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA.
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Lin CS, Huang C, Li PC, Hsu YH, Ding DC. Huge ovarian mature cystic teratoma with gliomatosis peritonei and massive ascites in a postmenopausal woman. Tzu Chi Med J 2019; 31:289-291. [PMID: 31867262 PMCID: PMC6905228 DOI: 10.4103/tcmj.tcmj_176_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 11/18/2022] Open
Abstract
Teratoma of the ovary is the most frequently encountered germ cell tumor. It usually occurs in young women. Gliomatosis peritonei (GP) is mature neural glial tissue implanted onto the peritoneal surface. We present a case of a mature teratoma accompanied by GP and massive ascites in postmenopausal women. A 54-year-old, G0P0, woman presented in the gynecology outpatient department with abdominal distension for 6 months. Computed tomography scan of the abdomen and pelvis displayed an ovarian mass about 20 cm × 18 cm with peritoneal seeding, ascites, and enlarged paraaortic lymph nodes. A total hysterectomy and bilateral adnexectomy were performed. The pathology showed the left ovary contained a dermoid cyst. The biopsy of the peritoneal nodule displayed glial tissue confirming the diagnosis of GP. The patient remained in good condition 6 months postoperatively. We suggest GP be considered in patients presenting with teratomas and massive ascites. The radiological diagnosis is challenging due to the rarity of GP. Continued follow-up of patients with teratomas and GP is mandatory due to the potential of malignant transformation.
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Affiliation(s)
| | - Ci Huang
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital , Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Pei-Chen Li
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital , Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yung-Hsiang Hsu
- Department of Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital , Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Wang J, Xu J, Zhang M, Li B. Gliomatosis peritonei with bilateral ovarian teratomas: A report of two cases. Oncol Lett 2016; 12:2078-2080. [PMID: 27602142 DOI: 10.3892/ol.2016.4866] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/17/2016] [Indexed: 11/06/2022] Open
Abstract
Gliomatosis peritonei (GP) is characterized by the presence of benign, mature neuroglial implants throughout the peritoneum and is typically accompanied by mature or immature ovarian teratomas. GP is a condition that has only been described relatively recently, with ~100 cases reported in the English literature. The majority of reported cases have focused on the pathology and clinical treatment of the disease; radiological findings are distinct, but the discussion of this is scarce in the literature. The current study presents two cases of GP with bilateral ovarian teratomas and provides a review of the relevant literature, with particular emphasis on the radiological differential diagnosis. The present study reinforces previously reported observations from imaging analysis and suggests that radiological investigation alone cannot sufficiently aid the differentiation of benign glial deposits from diffuse peritoneal malignant seeding. However, radiologists should be familiar with this rare condition in order to provide an accurate diagnosis, particularly in ovarian tumor staging, which may markedly impact the administered treatment. It is recommended that doctors undertake long-term follow-ups in patients presenting with GP due to the potential for malignant transformation.
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Affiliation(s)
- Jiawei Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Jingjing Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Baizhou Li
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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Primary and secondary disease of the peritoneum and mesentery: review of anatomy and imaging features. ACTA ACUST UNITED AC 2015; 40:626-42. [PMID: 25189130 DOI: 10.1007/s00261-014-0232-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The largest and most complex serosal membrane in the body, the peritoneum, lines the abdominal cavity, and the abdominopelvic viscera. It is frequently involved in a variety of benign and malignant processes. While secondary involvement of the peritoneum is more common, primary tumors can be a diagnostic challenge. Knowledge of the anatomy is crucial in understanding the various pathologic processes. Cross-sectional imaging plays an important role in diagnosing and evaluating the extent of the disease processes. This article reviews the imaging anatomy of the peritoneum and mesentery and the common pathologies involving it.
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Yoon NR, Lee JW, Kim BG, Bae DS, Sohn I, Sung CO, Song SY. Gliomatosis peritonei is associated with frequent recurrence, but does not affect overall survival in patients with ovarian immature teratoma. Virchows Arch 2012; 461:299-304. [DOI: 10.1007/s00428-012-1285-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 07/02/2012] [Accepted: 07/06/2012] [Indexed: 10/27/2022]
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10
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Gliomatose péritonéale isolée : à propos d’une observation. IMAGERIE DE LA FEMME 2010. [DOI: 10.1016/j.femme.2010.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Boufettal H, Elmouatacim K, Noun M, Hermas S, Samouh N, Benayad S, Azzouzi S, Zamiati S. [Peritoneal gliomatosis: a case report with review of the literature]. JOURNAL DE RADIOLOGIE 2010; 91:579-81. [PMID: 20657359 DOI: 10.1016/s0221-0363(10)70092-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Gliomatosis peritonei of the scrotal sac associated with an immature gastric teratoma. Pediatr Radiol 2010; 40:1288-92. [PMID: 20135112 DOI: 10.1007/s00247-009-1506-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 11/12/2009] [Accepted: 11/20/2009] [Indexed: 10/19/2022]
Abstract
A male infant presented with bilateral scrotal masses 7 months after removal of an immature gastric teratoma. After surgical excision, histology showed gliomatosis peritonei. We report an unusual presentation of gliomatosis peritonei arising from a rare lesion of immature gastric teratoma.
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Targnion A, Broze B, Habonimana E, Jouan H, Frémond B. [Gliomatosis peritonei, an unusual abdominal carcinomatosis: report of two cases]. Arch Pediatr 2010; 17:1169-73. [PMID: 20452193 DOI: 10.1016/j.arcped.2010.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Revised: 09/23/2009] [Accepted: 03/25/2010] [Indexed: 11/26/2022]
Abstract
We report on 2 cases of ovarian teratoma associated with gliomatosis peritonei in 2 young girls aged 9 and 14 years. Gliomatosis peritonei is an unusual miliary-like peritoneal carcinomatosis of glial tissue. In our experience, follow-up was important to detect abdominal recurrence of glial implants, which had to be removed by iterative surgery. We report a 14-year follow-up and an unusual pleural metastatic disease.
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Affiliation(s)
- A Targnion
- Service de chirurgie pédiatrique, CHU Anne-de-Bretagne, hôpital Sud, 16, boulevard de Bulgarie, 35203 Rennes, France.
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Levy AD, Shaw JC, Sobin LH. Secondary tumors and tumorlike lesions of the peritoneal cavity: imaging features with pathologic correlation. Radiographics 2009; 29:347-73. [PMID: 19325052 DOI: 10.1148/rg.292085189] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Tumors and tumorlike lesions that secondarily involve the mesothelial or submesothelial layers of the peritoneum are a diverse group of disorders that range in biologic behavior from benign to highly malignant. The anatomy of peritoneal ligaments and mesenteries and the normal circulation of peritoneal fluid dictate location and distribution of these diseases within the peritoneal cavity. Peritoneal carcinomatosis is the most common secondary tumor to affect the peritoneal cavity. When it arises from carcinomas of the gastrointestinal tract or ovary, the prognosis is grave. However, when low-grade mucinous adenocarcinoma of the appendix spreads to the peritoneal cavity, the consequence is typically pseudomyxoma peritonei, which is a clinical syndrome, characterized by recurrent and recalcitrant voluminous mucinous ascites due to surface growth on the peritoneum without significant invasion of underlying tissues. Carcinomas from elsewhere in the body, as well as lymphomas and sarcomas, may also produce diffuse peritoneal metastasis. Granulomatous peritonitis is the consequence of disseminated infection such as tuberculosis or histoplasmosis, foreign materials, or rupture of a tumor or hollow viscus. Finally, a group of benign miscellaneous conditions that range from common disorders such as endometriosis and splenosis to very rare conditions such as gliomatosis peritonei and melanosis may also affect the peritoneum diffusely. Secondary tumors and tumorlike lesions of the peritoneum have overlapping imaging features when compared with each other and primary peritoneal tumors. Knowledge of peritoneal anatomy, normal fluid circulation within the peritoneal cavity, and clinical and pathologic features of secondary peritoneal lesions is essential for identification of these lesions.
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Affiliation(s)
- Angela D Levy
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA.
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Cheng FWT, To KF, Lee V, Shing MMK, Leung WK, Li CK. One man, one disease? BMJ Case Rep 2009; 2009:bcr07.2008.0516. [PMID: 21686767 DOI: 10.1136/bcr.07.2008.0516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the case of a 12-year-old girl with a strong family history of malignancy who presented with immature teratoma and gliomatosis peritonei. Despite first and second line chemotherapy, the disease ran an unusually refractory course. Although the presentation was not the typical tumour presentation of Li-Fraumeni syndrome (LFS), we proceeded to undertake tumour genetic testing of the patient and her parents. LFS was diagnosed in this patient and her father with a sequence variation of CGG>TGG, R248W, which is one of the most common transcriptionally inactive mutations detected in LFS. Genetic counselling was offered to the father. A tumour screening programme and genetic screening for the p53 gene mutation for the surviving family members can be offered once consent is obtained from the father. This case illustrates the importance of cancer genetic study, even if the tumour presentation is not typical for any familial cancer syndrome.
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Affiliation(s)
- Frankie Wai Tsoi Cheng
- Prince of Wales Hospital, The Chinese University of Hong Kong, Department of Paediatrics, Shatin, New Territories, Hong Kong
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