1
|
Antal G, Zsigmond A, Till Á, Orsi E, Szanto I, Büki G, Kereskai L, Herbert Z, Hadzsiev K, Bene J. Case report: Initial atypical skeletal symptoms and dental anomalies as first signs of Gardner syndrome: the importance of genetic analysis in the early diagnosis. Pathol Oncol Res 2024; 30:1611768. [PMID: 38807857 PMCID: PMC11130347 DOI: 10.3389/pore.2024.1611768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/29/2024] [Indexed: 05/30/2024]
Abstract
Background: Gardner syndrome is a rare genetic cancer predisposition disorder characterized by intestinal polyposis, multiple osteomas, and soft and hard tissue tumors. Dental anomalies are present in approximately 30%-70% of patients with Gardner syndrome and can be discovered during routine dental examinations. However, sometimes the diagnosis is challenging due to the high clinical variability and incomplete clinical picture. Herein, we report a family with various dental and bone anomalies, in which the definitive diagnosis was established with the help of a comprehensive genetic analysis based on state-of-the-art next-generation sequencing technology. Case presentation: A 17-year-old female index patient presented with dental (caries, impacted, retained and anteriorly located teeth) and atypical bone anomalies not resembling Gardner syndrome. She was first referred to our Genetic Counselling Unit at the age of 11 due to an atypical bone abnormality identified by a panoramic X-ray. Tooth 3.6 was surgically removed and the histopathology report revealed a Paget's disease-like bone metabolic disorder with mixed osteoblastic and osteoclastic activity of the mandible. A small lumbar subcutaneous tumor was discovered by physical examination. Ultrasound examination of the tumor raised the possibility of a soft tissue propagation of chondromatosis. Her sister, 2 years younger at the age of 14, had some benign tumors (multiple exostoses, odontomas, epidermoid cysts) and impacted teeth. Their mother had also skeletal symptoms. Her lower teeth did not develop, the 9th-10th ribs were fused, and she complained of intermittent jaw pain. A cranial CT scan showed fibrous dysplasia on the cranial bones. Whole exome sequencing identified a heterozygous pathogenic nonsense mutation (c.4700C>G; p.Ser1567*) in the APC gene in the index patient's DNA. Targeted sequencing revealed the same variant in the DNA of the other affected family members (the sister and the mother). Conclusion: Early diagnosis of this rare, genetically determined syndrome is very important, because of the potentially high malignant transformation of intestinal polyps. Dentists should be familiar with the typical maxillofacial features of this disorder, to be able to refer patients to genetic counseling. Dental anomalies often precede the intestinal polyposis and facilitate the early diagnosis, thereby increasing the patients' chances of survival. Genetic analysis may be necessary in patients with atypical phenotypic signs.
Collapse
Affiliation(s)
- Gréta Antal
- Department of Dentistry, Oral and Maxillofacial Surgery, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Anna Zsigmond
- Department of Medical Genetics, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Ágnes Till
- Department of Medical Genetics, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Eniko Orsi
- Department of Dentistry, Oral and Maxillofacial Surgery, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Ildiko Szanto
- Department of Dentistry, Oral and Maxillofacial Surgery, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Gergely Büki
- Department of Medical Genetics, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - László Kereskai
- Department of Pathology, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Zsuzsanna Herbert
- Department of Medical Imaging, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Kinga Hadzsiev
- Department of Medical Genetics, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Judit Bene
- Department of Medical Genetics, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| |
Collapse
|
2
|
Olaopa OI, Dada AA, Soneye OY, Iyapo O, Akinniyi TA, Adisa AO, Kanmodi KK, Olaopa AO, Emeka CI, Ehanire ID, Coker MO. A rare case of Gardner syndrome in an African adult male: A case report. Clin Case Rep 2024; 12:e8735. [PMID: 38576527 PMCID: PMC10991715 DOI: 10.1002/ccr3.8735] [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: 02/03/2024] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024] Open
Abstract
Gardner's syndrome with the complete manifestation of colonic and extracolonic features is uncommon. Therefore, every clinician should view extracolonic features with a high index of suspicion. This may be key to early diagnosis, definitive management in these patients and importantly, helps prevent malignant transformation of existing colonic polyps.
Collapse
Affiliation(s)
- Olusegun I. Olaopa
- Department of Dental ServicesFederal Medical Centre, Ebute‐MettaLagosLagos StateNigeria
| | - Adedamola A. Dada
- Department of SurgeryFederal Medical Centre, Ebute‐MettaLagosLagos StateNigeria
| | | | - Oluwadamilare Iyapo
- Department of Pathologic ServicesFederal Medical Centre, Ebute‐MettaLagosLagos StateNigeria
| | - Taofeek A. Akinniyi
- Department of Oral and Maxillofacial SurgeryObafemi Awolowo University Teaching Hospitals ComplexIle‐IfeOsun StateNigeria
| | - Akinyele O. Adisa
- Department of Oral PathologyCollege of Medicine, University of IbadanIbadanOyo StateNigeria
| | - Kehinde K. Kanmodi
- School of DentistryUniversity of RwandaKigaliRwanda
- Faculty of DentistryUniversity of PuthisastraPhnom PenhCambodia
| | | | - Christian I. Emeka
- Department of Dental ServicesFederal Medical Centre, Ebute‐MettaLagosLagos StateNigeria
| | - Imudia D. Ehanire
- Department of SurgeryFederal Medical Centre, Ebute‐MettaLagosLagos StateNigeria
| | - Modupe O. Coker
- Department of Oral BiologyRutgers School of Dental MedicineNewarkNew JerseyUSA
| |
Collapse
|
3
|
Zeng M, Yao X, Pan Y, Gu H, Xiong F, Yin X, Wu B, Chen T. A novel APC mutation associated with Gardner syndrome in a Chinese family. Gene 2024; 896:148051. [PMID: 38043837 DOI: 10.1016/j.gene.2023.148051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/19/2023] [Accepted: 11/29/2023] [Indexed: 12/05/2023]
Abstract
Gardner syndrome (GS) is a specific form of familial adenomatous polyposis (FAP), which manifests as colorectal polyps, multiple osteomas and soft tissue tumors, and in the oral cavity as osteomas of the jaws, odontomas, and abnormal tooth counts. The underlying cause of GS is attributed to mutations in the APC gene. Mutations in this gene disrupt the normal functioning of the protein and lead to the development of GS. To further investigate GS, a family affected by the syndrome was selected from Dongguan, Guangdong Province. The family members underwent a comprehensive survey, which involved collecting clinical data and peripheral venous blood samples. The samples were then used for genetic analysis. Whole exome sequencing (WES) and Sanger sequencing techniques were utilized to screen and identify specific mutation sites in the APC gene. The clinical findings for the GS family included the presence of gastrointestinal polyps and odontomas. After analyzing the genetic sequencing results, a novel mutation site c.4266dupA on the APC gene was found in the patients, which leading to the APC protein truncation. As a result of this study, it is suggested that odontoma may be an early indicator of GS. Additionally, the identification of this novel mutation site in the APC gene expands the known spectrum of genetic mutations associated with the disease. This discovery has significant implications for the early diagnosis of GS, thus enabling timely intervention to reduce the risk of developing colon cancer and other related diseases.
Collapse
Affiliation(s)
- Ming Zeng
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; School of Stomatology, Southern Medical University, Guangzhou 510515, China
| | - Xinchen Yao
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; School of Stomatology, Southern Medical University, Guangzhou 510515, China
| | - Yuhua Pan
- Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
| | - Hongxiang Gu
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastro Enterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Fu Xiong
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, China; Guangdong Provincial Key Laboratory of Single Cell Technology and Application, Guangzhou, Guangdong, China; Department of Fetal Medicine and Prenatal Diagnosis, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xuemin Yin
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
| | - Buling Wu
- Shenzhen Stomatological Hospital (Pingshan), Southern Medical University, Shenzhen 518118, China.
| | - Ting Chen
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
| |
Collapse
|
4
|
Borghesi A, Tonni I, Pezzotti S, Maroldi R. Peripheral osteoma, compound odontoma, focal cemento-osseous dysplasia, and cemento-ossifying fibroma in the same hemimandible: CBCT findings of an unusual case. Radiol Case Rep 2017; 12:756-759. [PMID: 29484064 PMCID: PMC5823294 DOI: 10.1016/j.radcr.2017.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/04/2017] [Accepted: 08/20/2017] [Indexed: 11/16/2022] Open
Abstract
Peripheral osteoma is the most common subtype of osteoma that arises most frequently in the craniofacial bones. It may occur at any age with a male-to-female ratio of 2:1. Peripheral osteoma may affect the mandible, particularly the ramus and the condyle. Compound odontoma is a subtype of odontoma that occurs in young subjects without gender predilection. It affects the maxilla more frequently than the mandible. Focal cemento-osseous dysplasia and cemento-ossifying fibroma are 2 benign fibro-osseous lesions with a female predominance that occur most commonly in the posterior region of the mandible. We report the first case involving the simultaneous occurrence of these 4 benign lesions in the same hemimandible diagnosed by CBCT.
Collapse
Affiliation(s)
- Andrea Borghesi
- Department of Radiology, Medical School, University of Brescia, Piazzale Spedali Civili 1, I 25123, Brescia, Italy
| | - Ingrid Tonni
- Dental Clinic, Dental School, University of Brescia, Italy
| | - Stefania Pezzotti
- Department of Radiology, Medical School, University of Brescia, Piazzale Spedali Civili 1, I 25123, Brescia, Italy
| | - Roberto Maroldi
- Department of Radiology, Medical School, University of Brescia, Piazzale Spedali Civili 1, I 25123, Brescia, Italy
| |
Collapse
|
5
|
Koh KJ, Park HN, Kim KA. Gardner syndrome associated with multiple osteomas, intestinal polyposis, and epidermoid cysts. Imaging Sci Dent 2016; 46:267-272. [PMID: 28035305 PMCID: PMC5192025 DOI: 10.5624/isd.2016.46.4.267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/05/2016] [Accepted: 09/03/2016] [Indexed: 01/06/2023] Open
Abstract
Gardner syndrome is known as a variant of familial adenomatous polyposis. This syndrome is characterized by multiple intestinal polyposes, osteomas, and epidermoid cysts. In addition, dental abnormalities include an increased frequency of multiple odontomas, as well as supernumerary and impacted teeth. The authors report the case of a 7-year-old male patient with Gardner syndrome. Radiographic findings revealed multiple osteomas in both sides of the maxilla, multiple diffuse enostoses in both jaws, and a complex odontoma in the left mandibular body. Two years later, multiple epidermoid cysts on the scalp were found. Since this patient was suspected to have Gardner syndrome, the authors recommended gastrointestinal endoscopy to check for intestinal polyposis. Gastrointestinal endoscopic examination revealed multiple polyposes in the upper gastrointestinal tract and fundus of the stomach. As a result, the final diagnosis was Gardner syndrome.
Collapse
Affiliation(s)
- Kwang-Joon Koh
- Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, Jeonju-si, Republic of Korea
| | - Ha-Na Park
- Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, Jeonju-si, Republic of Korea
| | - Kyoung-A Kim
- Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, Jeonju-si, Republic of Korea
| |
Collapse
|
6
|
Bony outgrowths on the jaws of an extinct sperm whale support macroraptorial feeding in several stem physeteroids. Naturwissenschaften 2014; 101:517-21. [PMID: 24821119 DOI: 10.1007/s00114-014-1182-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/28/2014] [Accepted: 05/03/2014] [Indexed: 10/25/2022]
Abstract
Several extinct sperm whales (stem Physeteroidea) were recently proposed to differ markedly in their feeding ecology from the suction-feeding modern sperm whales Kogia and Physeter. Based on cranial, mandibular, and dental morphology, these Miocene forms were tentatively identified as macroraptorial feeders, able to consume proportionally large prey using their massive teeth and robust jaws. However, until now, no corroborating evidence for the use of teeth during predation was available. We report on a new specimen of the stem physeteroid Acrophyseter, from the late middle to early late Miocene of Peru, displaying unusual bony outgrowths along some of the upper alveoli. Considering their position and outer shape, these are identified as buccal maxillary exostoses. More developed along posterior teeth and in tight contact with the high portion of the dental root outside the bony alveoli, the exostoses are hypothesized to have developed during powerful bites; they may have worked as buttresses, strengthening the teeth when facing intense occlusal forces. These buccal exostoses further support a raptorial feeding technique for Acrophyseter and, indirectly, for other extinct sperm whales with a similar oral apparatus (Brygmophyseter, Livyatan, Zygophyseter). With a wide size range, these Miocene stem physeteroids were major marine macropredators, occupying ecological niches nowadays mostly taken by killer whales.
Collapse
|
7
|
Curé JK, Vattoth S, Shah R. Radiopaque jaw lesions: an approach to the differential diagnosis. Radiographics 2013; 32:1909-25. [PMID: 23150848 DOI: 10.1148/rg.327125003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Radiopaque jaw lesions are frequently encountered at radiography and computed tomography, but they are usually underevaluated or underdescribed in radiology reports. A systematic approach to the evaluation of radiopaque jaw lesions is necessary to diagnose the lesion or at least provide a meaningful differential diagnosis. To evaluate a radiopaque jaw lesion, the first, most important step is to categorize the lesion according to its attenuation, its relationship to the teeth, and its location with respect to the tooth. These basic observations are essential to the evaluation of any type of jaw lesion. Once these observations have been made, it is easy to create a proper differential diagnosis. The presence of important characteristics, such as margination, a perilesional halo, bone expansion, and growth pattern, as well as whether the lesion is sclerotic, has ground-glass attenuation, or is mixed lytic and sclerotic, further narrows the differential diagnosis. It is important to note that some radiopaque jaw lesions may be entirely lucent early in their evolution. Awareness of the demographic distribution of these lesions and their associated clinical features, as well as the radiologic approach, is important to explore the "terra incognita" of radiopaque jaw lesions.
Collapse
Affiliation(s)
- Joel K Curé
- Department of Radiology, Neuroradiology Section, University of Alabama at Birmingham, Birmingham, Ala., USA
| | | | | |
Collapse
|
8
|
Almeida FT, Leite AF, de Souza Figueiredo PT, Melo NS, Sousa JB, Almeida R, Acevedo AC, Silva Guerra EN. Dento-osseous anomalies associated to familial adenomatous polyposis mimicking florid cemento-osseous dysplasia. J Craniomaxillofac Surg 2012; 40:e498-502. [DOI: 10.1016/j.jcms.2012.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 03/13/2012] [Accepted: 03/13/2012] [Indexed: 12/11/2022] Open
|
9
|
Panjwani S, Bagewadi A, Keluskar V, Arora S. Gardner's Syndrome. J Clin Imaging Sci 2011; 1:65. [PMID: 22347683 PMCID: PMC3279692 DOI: 10.4103/2156-7514.92187] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 01/01/2012] [Indexed: 11/04/2022] Open
Abstract
Gardner's syndrome is an autosomal dominant disease and is a subtype of familial adenomatous polyposis. It is characterized by adenomatous intestinal polyps, multiple osteomas in the skull, maxillae, mandible, and multiple cutaneous and subcutaneous masses (epidermoids and desmoid). Intestinal polyps, if not treated, have 100% chance of becoming malignant. We report a case of a 25-year-old female patient with Gardner's syndrome, with clinical manifestations including impacted supernumerary teeth, odontomes, sebaceous cyst on the scalp, and osteomas. It is important for the general dental practitioners to be aware of the clinical and radiological characteristics of Gardner's syndrome.
Collapse
Affiliation(s)
- Sapna Panjwani
- Department of Oral Medicine and Radiology, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Ghaziabad, Uttar Pradesh, India
| | | | | | | |
Collapse
|
10
|
Wang XP, Fan J. Molecular genetics of supernumerary tooth formation. Genesis 2011; 49:261-77. [PMID: 21309064 DOI: 10.1002/dvg.20715] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 01/02/2011] [Accepted: 01/06/2011] [Indexed: 01/07/2023]
Abstract
Despite advances in the knowledge of tooth morphogenesis and differentiation, relatively little is known about the aetiology and molecular mechanisms underlying supernumerary tooth formation. A small number of supernumerary teeth may be a common developmental dental anomaly, while multiple supernumerary teeth usually have a genetic component and they are sometimes thought to represent a partial third dentition in humans. Mice, which are commonly used for studying tooth development, only exhibit one dentition, with very few mouse models exhibiting supernumerary teeth similar to those in humans. Inactivation of Apc or forced activation of Wnt/β(catenin signalling results in multiple supernumerary tooth formation in both humans and in mice, but the key genes in these pathways are not very clear. Analysis of other model systems with continuous tooth replacement or secondary tooth formation, such as fish, snake, lizard, and ferret, is providing insights into the molecular and cellular mechanisms underlying succesional tooth development, and will assist in the studies on supernumerary tooth formation in humans. This information, together with the advances in stem cell biology and tissue engineering, will pave ways for the tooth regeneration and tooth bioengineering.
Collapse
Affiliation(s)
- Xiu-Ping Wang
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts 02115, USA.
| | | |
Collapse
|
11
|
The surgical management of oral and maxillofacial manifestations of Gardner syndrome. J Oral Maxillofac Surg 2010; 68:2549-54. [PMID: 20594634 DOI: 10.1016/j.joms.2009.09.084] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 08/01/2009] [Accepted: 09/23/2009] [Indexed: 11/23/2022]
|
12
|
|
13
|
|
14
|
Lee BD, Lee W, Oh SH, Min SK, Kim EC. A case report of Gardner syndrome with hereditary widespread osteomatous jaw lesions. ACTA ACUST UNITED AC 2009; 107:e68-72. [PMID: 19157925 DOI: 10.1016/j.tripleo.2008.10.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 07/24/2008] [Accepted: 10/21/2008] [Indexed: 11/19/2022]
Abstract
Gardner syndrome (GS) is an abnormality of familial adenomatous polyposis accompanied by characteristic jaw lesions. Gardner syndrome intestinal polyps have a 100% risk of undergoing malignant transformation; consequently, early identification and surgical intervention of the disease are important to prolong the life of the patient. We present a case of GS in a 55-year-old woman. Familial adenomatous polyposis, osteomatous jaw and ocular lesions, several dental abnormalities, and an abdominal desmoid tumor are the characteristic features of this case. This case demonstrates the presence of unusual, widespread, hereditary, osteomatous jaw lesions that caused diagnostic confusion with familial gigantiform cementoma.
Collapse
Affiliation(s)
- Byung Do Lee
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Wonkwang University, Iksan City, Korea.
| | | | | | | | | |
Collapse
|
15
|
Huber MA. Gastrointestinal illnesses and their effects on the oral cavity. Oral Maxillofac Surg Clin North Am 2008; 20:625-34. [PMID: 18940628 DOI: 10.1016/j.coms.2008.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many disease processes affecting the gastrointestinal (GI) tract may cause observable changes to the oral cavity. In fact, oral cavity changes may represent the first clinical manifestation of an underlying GI condition. Recognition and appropriate referral of a possible GI condition contribute to overall health and wellness in patients. Some of the more important GI conditions that may manifest oral cavity involvement include: reflux disorders, inherited GI polyposis syndromes, and inflammatory bowel disease. This article briefly reviews the aforementioned topics.
Collapse
Affiliation(s)
- Michaell A Huber
- Division of Oral Medicine, Department of Dental Diagnostic Science, University of Texas Health Science Center, Mail Code 7919, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
| |
Collapse
|