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Peng S, Behbahani M, Sharma S, Wadhwani NR, Rastatter JC, Alden TD. An adolescent case of sellar osteochondromyxoma in the setting of spondyloepiphyseal dysplasia. Childs Nerv Syst 2023; 39:1083-1087. [PMID: 36723686 DOI: 10.1007/s00381-022-05786-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/06/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Osteochondromyxomas (OMX) are rare congenital bone tumors that have only been described in the context of Carney complex syndrome (CNC). Data on OMX as a separate entity and in association with other disorders remain limited, making both diagnosis and treatment difficult. METHODS A case report of a 17-year-old female diagnosed with sellar OMX is presented in the setting of spondyloepiphyseal dysplasia (SED). We discuss the radiographic and histopathological interpretations in addition to reviewing the current literature on OMX. RESULTS A successful gross total resection of the tumor was achieved via an endonasal endoscopic transsphenoidal approach. A diagnosis was established radiographically and pathologically. CONCLUSION The diagnosis and treatment of OMX are best achieved via tissue biopsy. Following confirmed osteochondromyxoma cases long term for recurrence and outcomes will be essential in understanding its natural tumor history and in establishing standard treatments.
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Affiliation(s)
- Sophia Peng
- Department of Neurological Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Mandana Behbahani
- Division of Neurosurgery, Ann and Robert H. Lurie Children's Hospital, 225 E. Chicago Ave, Box 28, Chicago, IL, 60611, USA.,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shelly Sharma
- Division of Neurosurgery, Ann and Robert H. Lurie Children's Hospital, 225 E. Chicago Ave, Box 28, Chicago, IL, 60611, USA
| | - Nitin R Wadhwani
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Jeff C Rastatter
- Division of Otolaryngology, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Tord D Alden
- Division of Neurosurgery, Ann and Robert H. Lurie Children's Hospital, 225 E. Chicago Ave, Box 28, Chicago, IL, 60611, USA. .,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Sharath KGG, Shruthi P, Pooja BV, Ravi MR. Trigeminal Nerve Melanotic Schwannoma in Carney Complex. Indian J Radiol Imaging 2022; 32:422-425. [PMID: 36177281 PMCID: PMC9514904 DOI: 10.1055/s-0042-1754316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
AbstractMelanotic schwannoma (MS) is a rare peripheral nerve sheath tumor commonly found in the thoracic paraspinal region. It is present in an intracranial location rarely, with 18 out of 105 MS cases described in the literature. Trigeminal nerve was involved in only six of these cases. Fifty percent of psammomatous melanotic schwannoma (PMS) patients have Carney complex. Carney complex is an autosomal dominant disorder featuring peripheral nerve tumors (schwannomas), myxomas (heart, skin, and breast), skin pigmentation (lentigines and blue nevi), and endocrine tumors (adrenal, testicular, and pituitary). We present a case of left trigeminal nerve PMS as a part of Carney complex. Patient had diffuse lentiginosis. Magnetic Resonance Imaging revealed enhancing lesion along left trigeminal nerve with widened Meckel's cave and foramen ovale. Final diagnosis of PMS was derived on clinical, radiological, and histopathological findings with immunohistochemistry correlation.
Key Message
Trigeminal nerve can be rarely involved in melanotic schwannoma (MS). Knowledge of typical radiological features of MS is crucial for its diagnosis. Its association with Carney complex should be sought.
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Affiliation(s)
- Kumar GG Sharath
- Department of Diagnostic and Interventional Neuroradiology, Apollo Hospitals, Sheshadripurum, Bengaluru, Karnataka, India
| | - Panduranga Shruthi
- Department of Radiology and Imaging, Apollo Hospitals, Jayanagar, Bengaluru, Karnataka, India
| | - B Varwatte Pooja
- Department of Radiology and Imaging, Apollo Hospitals, Jayanagar, Bengaluru, Karnataka, India
| | - Mohan Rao Ravi
- Department of Neurosurgery, Apollo Hospitals, Sheshadripuram, Bengaluru, Karnataka, India
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Khan Z, Pabani UK, Gupta A, Lohano S, Mlawa G. A Case Presentation Based on Incidental Diagnosis of Atrial Myxoma in a Patient Presenting With Atrial Fibrillation and Suspected Carney Complex. Cureus 2022; 14:e21157. [PMID: 35165607 PMCID: PMC8831319 DOI: 10.7759/cureus.21157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 12/14/2022] Open
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Dermatological and endocrine elements in Carney complex (Review). Exp Ther Med 2021; 22:1313. [PMID: 34630667 DOI: 10.3892/etm.2021.10748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/23/2021] [Indexed: 11/05/2022] Open
Abstract
Carney complex (CΝC) is a very rare, autosomal dominant, hereditary syndrome. Seventy percent of individuals with CNC have germline inactivating or deleting mutations of the CNC1 gene [currently known as protein kinase cAMP-dependent type I regulatory subunit α (PRKAR1A), located at the 17q22-24 chromosome level], with 30% of cases presenting with phosphodiesterase gene mutations. A member of the lentiginosis family, dermatological features include: skin pigmentation, cutaneous/mucosal myxomas, usually diagnosed by the age of 20 years (neonatal presentation is exceptional, requiring a meticulous differential diagnosis). Melanocyte-derived tumors such as epithelioid blue nevi (with different levels of pigmentation) and pigmented epithelioid melanocytoma (previously 'animal-type melanoma') are often found. Myxomas, mesenchymal tumors with mostly a benign pattern, may be recurrent. Primary cutaneous melanotic schwannoma are atypical, while non-skin sites are frequent. Corticotropinomas or somatotropinomas are part of the hereditary syndrome-related pituitary adenomas (representing 5% of all). Primary pigmented nodular adrenocortical disease involves bilateral cortical hyperplasia causing Cushing syndrome (CS) at an earlier age than non-CNC cases; osteoporotic fractures seem more prevalent compare to CS of other etiologies. Typically benign, a few cases of adrenocortical carcinoma have been identified. A total of 5% of familial non-medullary thyroid cancer is syndromic, also including CNC. CNC-related thyroid frame includes: hyperthyroidism, follicular hyperplasia/adenomas, follicular carcinoma (usually aggressive, bilateral or multifocal). Large cell calcifying Sertoli cell tumors of the testes have malignant behavior in adults; in children these may induce precocious puberty. Two particular mammary tumors are found: myxoid fibroadenomas and breast myxomatosis. Cutaneous/subcutaneous lesions, pigmented or not, or any focal swelling of non-identified cause needs careful examination, since dermatological elements are among the earliest and most discernable by which to detect lesions in CNC, a systemic condition with multi-level endocrine involvement.
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Cervantes-Molina LA, Ramírez-Cedillo D, Masini-Aguilera ID, López-Taylor JG, Machuca-Hernández M, Pineda-De Paz DO. Recurrent Atrial Myxoma in a Patient with Carney Complex. A Case Report and Literature Review. Arq Bras Cardiol 2020; 114:31-33. [PMID: 32428101 PMCID: PMC8149110 DOI: 10.36660/abc.20190405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/25/2019] [Accepted: 08/18/2019] [Indexed: 11/20/2022] Open
Affiliation(s)
- Laura A. Cervantes-Molina
- Hospital Civil de GuadalajaraUnidad Hospitalaria Fray Antonio AlcaldeGuadalajaraJaliscoMéxicoHospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde - Cardiovascular Surgery, Guadalajara, Jalisco - México
| | - David Ramírez-Cedillo
- Hospital Civil de GuadalajaraUnidad Hospitalaria Fray Antonio AlcaldeGuadalajaraJaliscoMéxicoHospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde - Cardiovascular Surgery, Guadalajara, Jalisco - México
| | - Italo D. Masini-Aguilera
- Hospital Civil de GuadalajaraUnidad Hospitalaria Fray Antonio AlcaldeGuadalajaraJaliscoMéxicoHospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde - Cardiovascular Surgery, Guadalajara, Jalisco - México
| | - Jaime G. López-Taylor
- Hospital Civil de GuadalajaraUnidad Hospitalaria Fray Antonio AlcaldeGuadalajaraJaliscoMéxicoHospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde - Cardiovascular Surgery, Guadalajara, Jalisco - México
| | - Michel Machuca-Hernández
- Hospital Civil de GuadalajaraUnidad Hospitalaria Fray Antonio AlcaldeGuadalajaraJaliscoMéxicoHospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde - Cardiovascular Surgery, Guadalajara, Jalisco - México
| | - Dulman O. Pineda-De Paz
- Hospital Civil de GuadalajaraUnidad Hospitalaria Fray Antonio AlcaldeGuadalajaraJaliscoMéxicoHospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde - Cardiovascular Surgery, Guadalajara, Jalisco - México
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Yu W, Zhang ZZ, Wang O, Huang MQ, Xia WB, Guermazi A. Ring sign: an imaging sign for osteochondromyxoma in Carney complex. Quant Imaging Med Surg 2020; 9:1958-1965. [PMID: 31929968 DOI: 10.21037/qims.2019.11.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To introduce the concept of "ring sign" and to evaluate its role in the diagnostic imaging of osteochondromyxoma in patients with Carney complex (CNC). Methods Three patients presenting osteochondromyxoma with CNC were included for evaluation of the ring sign on different imaging modalities, including radiographs, computed tomography, and magnetic resonance imaging. The literature was reviewed for further discussion. Results The ring sign in osteochondromyxoma could be seen on radiographs, computed tomography, and magnetic resonance images in all three patients at each of the involved sites. The morphological patterns and the number of ring signs varied by case, site, and imaging method. Some previous reports have shown images that contain ring signs, but do not identify them as such. Conclusions Ring sign can be considered as a relatively specific sign, helpful for the imaging diagnosis of osteochondromyxoma in the CNC.
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Affiliation(s)
- Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Zai-Zhu Zhang
- Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Ou Wang
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Ming-Qian Huang
- Department of Radiology, Stony brook University Hospital, Syosset, NY 11791, USA
| | - Wei-Bo Xia
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA 02118, USA
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Ralser DJ, Strizek B, Kupczyk P, Stoffel-Wagner B, Altengarten J, Müller A, Woelfle J, Gembruch U, Klingmueller D, Merz WM, Paschkowiak-Christes A. Obstetric and Neonatal Outcome of Pregnancy in Carney Complex: A Case Report. Front Endocrinol (Lausanne) 2020; 11:296. [PMID: 32457700 PMCID: PMC7225262 DOI: 10.3389/fendo.2020.00296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/20/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Carney complex (CNC) is a rare multiple endocrine neoplasia syndrome with autosomal dominant inheritance. Affected individuals present with mucocutaneous lentigines/blue nevi, cardiac and noncardiac myxomatous tumors, and multiple endocrine tumors. Mutations in PRKAR1A have been identified as genetic cause of the disease. Here, we report on pregnancy, delivery and puerperium in a woman with genetically confirmed CNC and her newborn. Case: The 31 year-old gravida 5 para 1 with CNC was referred at 26 weeks of gestation. Adrenocorticotropin-independent hypercortisolism, hyperglycemia, hypertension, low serum potassium, and osteoporotic fractures were present. Treatment with metyrapone, a reversible 11-beta-hydroxylase inhibitor, was initiated. The maternal condition improved, and a 5 weeks' pregnancy prolongation could be achieved. Elective repeat cesarean section was performed at 31 weeks of gestation for recurrent vaginal bleeding. The neonate developed transient hyponatremia necessitating hydrocortisone substitution for 2 weeks. Conclusion: In our case, treatment of CNC-associated hypercortisolism in pregnancy with metyrapone was effective. Maternal side effects did not occur. The newborn presented with transient hypocortisolism most likely due to transplacental drug effect. Our case illustrates that the treatment of rare diseases in pregnancy represents a challenge requiring interdisciplinary team work.
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Affiliation(s)
- Damian J. Ralser
- Department of Obstetrics and Gynecology, University Bonn Medical School, Bonn, Germany
- *Correspondence: Damian J. Ralser
| | - Brigitte Strizek
- Department of Obstetrics and Gynecology, University Bonn Medical School, Bonn, Germany
| | - Patrick Kupczyk
- Department of Radiology, University Bonn Medical School, Bonn, Germany
| | - Birgit Stoffel-Wagner
- Institute of Clinical Chemistry and Clinical Pharmacology, University Bonn Medical School, Bonn, Germany
| | - Julia Altengarten
- Department of Dermatology, University Bonn Medical School, Bonn, Germany
| | - Andreas Müller
- Department of Neonatology and Pediatric Critical Care Medicine, University Bonn Medical School, Bonn, Germany
| | - Joachim Woelfle
- Pediatric Endocrinology and Diabetology Division, Children's Hospital, University Bonn Medical School, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Gynecology, University Bonn Medical School, Bonn, Germany
| | - Dietrich Klingmueller
- Division of Endocrinology and Diabetes, Department of Medicine I, University Bonn Medical School, Bonn, Germany
| | - Waltraut M. Merz
- Department of Obstetrics and Gynecology, University Bonn Medical School, Bonn, Germany
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