1
|
Lee NW, Jeong JE, Kim YH, Ki CS, Kim JK. A case of type A insulin resistance syndrome in a 14-year-old adolescent girl without common clinical features. Ann Pediatr Endocrinol Metab 2023; 28:S17-S19. [PMID: 36731506 PMCID: PMC10783927 DOI: 10.6065/apem.2244106.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/15/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Na won Lee
- Department of Pediatrics, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ji Eun Jeong
- Department of Pediatrics, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Young Hwan Kim
- Department of Pediatrics, Daegu Catholic University School of Medicine, Daegu, Korea
| | | | - Jin Kyung Kim
- Department of Pediatrics, Daegu Catholic University School of Medicine, Daegu, Korea
| |
Collapse
|
2
|
Zhao L, Dai H, Zhang Q, Hu W, Jin P. Identification of a novel mutation in patients with type A insulin resistance syndrome. Hum Hered 2022; 87:000525223. [PMID: 35661079 DOI: 10.1159/000525223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/14/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Type A insulin resistance syndrome is a rare type of congenital insulin resistance often caused by heterozygous mutations in the insulin receptor gene (INSR). The aim of this study is to explore the clinical and genetic characteristics of three patients with type A insulin resistance syndrome from two Chinese families. METHODS The peripheral blood samples were collected from each family members. Whole-exome sequencing were performed on three patients. RESULTS Patient #1 was diagnosed with hyperinsulinemia at the age of 11 years and presented with hirsutism, acanthosis nigricans, and polycystic ovaries by 13 years. A heterozygous c.3470A > G mutation in the INSR gene was identified in patient #1. Patient #2 was a 13-year-old girl who presented with insulin resistance, polycystic ovary, and hyperandrogenemia. A novel c.3601C > G INSR mutation was identified in patient #2. Co-segregated analysis showed that the c.3601C > G mutation was also found in her father, who had hyperinsulinemia and diabetes mellitus, which was consistent with autosomal dominant inheritance. SIFT and PolyPhen-2 predicted that the c.3470A > G and c.3601C > G mutations in INSR had damaging effects. CONCLUSION Our study expands the genotypic and phenotypic spectrum of type A insulin resistance syndrome. Awareness of the clinical features coupled with INSR gene screening is key to early detection and active intervention.
Collapse
|
3
|
Zhang X, Qu YY, Liu L, Qiao YN, Geng HR, Lin Y, Xu W, Cao J, Zhao JY. Homocysteine inhibits pro-insulin receptor cleavage and causes insulin resistance via protein cysteine-homocysteinylation. Cell Rep 2021; 37:109821. [PMID: 34644569 DOI: 10.1016/j.celrep.2021.109821] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/06/2021] [Accepted: 09/21/2021] [Indexed: 01/10/2023] Open
Abstract
Elevation in homocysteine (Hcy) level is associated with insulin resistance; however, the causality between them and the underlying mechanism remain elusive. Here, we show that Hcy induces insulin resistance and causes diabetic phenotypes by protein cysteine-homocysteinylation (C-Hcy) of the pro-insulin receptor (pro-IR). Mechanistically, Hcy reacts and modifies cysteine-825 of pro-IR in the endoplasmic reticulum (ER) and abrogates the formation of the original disulfide bond. C-Hcy impairs the interaction between pro-IR and the Furin protease in the Golgi apparatus, thereby hindering the cleavage of pro-IR. In mice, an increase in Hcy level decreases the mature IR level in various tissues, thereby inducing insulin resistance and the type 2 diabetes phenotype. Furthermore, inhibition of C-Hcy in vivo and in vitro by overexpressing protein disulfide isomerase rescues the Hcy-induced phenotypes. In conclusion, C-Hcy in the ER can serve as a potential pharmacological target for developing drugs to prevent insulin resistance and increase insulin sensitivity.
Collapse
Affiliation(s)
- Xuan Zhang
- State Key Laboratory of Genetic Engineering, Zhongshan Hospital of Fudan University, School of Life Sciences, Children's Hospital of Fudan University, Fudan University Shanghai Cancer Center, and Institutes of Biomedical Sciences, Fudan University, Shanghai 200438, P.R. China
| | - Yuan-Yuan Qu
- State Key Laboratory of Genetic Engineering, Zhongshan Hospital of Fudan University, School of Life Sciences, Children's Hospital of Fudan University, Fudan University Shanghai Cancer Center, and Institutes of Biomedical Sciences, Fudan University, Shanghai 200438, P.R. China
| | - Lian Liu
- State Key Laboratory of Genetic Engineering, Zhongshan Hospital of Fudan University, School of Life Sciences, Children's Hospital of Fudan University, Fudan University Shanghai Cancer Center, and Institutes of Biomedical Sciences, Fudan University, Shanghai 200438, P.R. China
| | - Ya-Nan Qiao
- State Key Laboratory of Genetic Engineering, Zhongshan Hospital of Fudan University, School of Life Sciences, Children's Hospital of Fudan University, Fudan University Shanghai Cancer Center, and Institutes of Biomedical Sciences, Fudan University, Shanghai 200438, P.R. China
| | - Hao-Ran Geng
- State Key Laboratory of Genetic Engineering, Zhongshan Hospital of Fudan University, School of Life Sciences, Children's Hospital of Fudan University, Fudan University Shanghai Cancer Center, and Institutes of Biomedical Sciences, Fudan University, Shanghai 200438, P.R. China
| | - Yan Lin
- State Key Laboratory of Genetic Engineering, Zhongshan Hospital of Fudan University, School of Life Sciences, Children's Hospital of Fudan University, Fudan University Shanghai Cancer Center, and Institutes of Biomedical Sciences, Fudan University, Shanghai 200438, P.R. China
| | - Wei Xu
- State Key Laboratory of Genetic Engineering, Zhongshan Hospital of Fudan University, School of Life Sciences, Children's Hospital of Fudan University, Fudan University Shanghai Cancer Center, and Institutes of Biomedical Sciences, Fudan University, Shanghai 200438, P.R. China
| | - Jing Cao
- Department of Anatomy and Neuroscience Research Institute, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - Jian-Yuan Zhao
- State Key Laboratory of Genetic Engineering, Zhongshan Hospital of Fudan University, School of Life Sciences, Children's Hospital of Fudan University, Fudan University Shanghai Cancer Center, and Institutes of Biomedical Sciences, Fudan University, Shanghai 200438, P.R. China; Department of Anatomy and Neuroscience Research Institute, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, China.
| |
Collapse
|
4
|
Takeuchi T, Ishigaki Y, Hirota Y, Hasegawa Y, Yorifuji T, Kadowaki H, Akamizu T, Ogawa W, Katagiri H. Clinical characteristics of insulin resistance syndromes: A nationwide survey in Japan. J Diabetes Investig 2020; 11:603-616. [PMID: 31677333 PMCID: PMC7232299 DOI: 10.1111/jdi.13171] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/25/2019] [Accepted: 10/30/2019] [Indexed: 01/08/2023] Open
Abstract
AIMS/INTRODUCTION Insulin resistance syndrome (IRS) of type A or B is triggered by gene abnormalities of or autoantibodies to the insulin receptor, respectively. Rabson-Mendenhall/Donohue syndrome is also caused by defects of the insulin receptor gene (INSR), but is more serious than type A IRS. Here, we carried out a nationwide survey of these syndromes in Japan. MATERIALS AND METHODS We sent questionnaires to a total of 1,957 academic councilors or responsible individuals at certified facilities of the Japan Diabetes Society, as well as at the department pediatrics or neonatology in medical centers with >300 beds. RESULTS We received 904 responses with information on 23, 30 and 10 cases of type A or B IRS and Rabson-Mendenhall/Donohue syndrome, respectively. Eight cases with type A IRS-like clinical features, but without an abnormality of INSR, were tentatively designated type X IRS, with five of these cases testing positive for PIK3R1 mutations. Fasting serum insulin levels at diagnosis (mean ± standard deviation) were 132.0 ± 112.4, 1122.1 ± 3292.5, 2895.5 ± 3181.5 and 145.0 ± 141.4 μU/mL for type A IRS, type B IRS, Rabson-Mendenhall/Donohue syndrome and type X IRS, respectively. Type A and type X IRS, as well as Rabson-Mendenhall/Donohue syndrome were associated with low birthweight. Type B IRS was diagnosed most frequently in older individuals, and was often associated with concurrent autoimmune conditions and hypoglycemia. CONCLUSIONS Information yielded by this first nationwide survey should provide epidemiological insight into these rare conditions and inform better healthcare for affected patients.
Collapse
Affiliation(s)
- Takehito Takeuchi
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and EndocrinologyIwate Medical UniversityMoriokaJapan
| | - Yushi Hirota
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Yutaka Hasegawa
- Division of Diabetes, Metabolism and EndocrinologyIwate Medical UniversityMoriokaJapan
| | - Tohru Yorifuji
- Division of Pediatric Endocrinology and MetabolismChildren’s Medical CenterOsaka City General HospitalOsakaJapan
| | | | - Takashi Akamizu
- First Department of MedicineWakayama Medical UniversityWakayamaJapan
| | - Wataru Ogawa
- Division of Diabetes and EndocrinologyKobe University Graduate School of MedicineKobeJapan
| | - Hideki Katagiri
- Department of Metabolism and DiabetesTohoku University Graduate School of MedicineSendaiJapan
| |
Collapse
|
5
|
Chen Y, Huang L, Qi X, Chen C. Insulin Receptor Trafficking: Consequences for Insulin Sensitivity and Diabetes. Int J Mol Sci 2019; 20:ijms20205007. [PMID: 31658625 PMCID: PMC6834171 DOI: 10.3390/ijms20205007] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/04/2019] [Accepted: 10/08/2019] [Indexed: 12/12/2022] Open
Abstract
Insulin receptor (INSR) has been extensively studied in the area of cell proliferation and energy metabolism. Impaired INSR activities lead to insulin resistance, the key factor in the pathology of metabolic disorders including type 2 diabetes mellitus (T2DM). The mainstream opinion is that insulin resistance begins at a post-receptor level. The role of INSR activities and trafficking in insulin resistance pathogenesis has been largely ignored. Ligand-activated INSR is internalized and trafficked to early endosome (EE), where INSR is dephosphorylated and sorted. INSR can be subsequently conducted to lysosome for degradation or recycled back to the plasma membrane. The metabolic fate of INSR in cellular events implies the profound influence of INSR on insulin signaling pathways. Disruption of INSR-coupled activities has been identified in a wide range of insulin resistance-related diseases such as T2DM. Accumulating evidence suggests that alterations in INSR trafficking may lead to severe insulin resistance. However, there is very little understanding of how altered INSR activities undermine complex signaling pathways to the development of insulin resistance and T2DM. Here, we focus this review on summarizing previous findings on the molecular pathways of INSR trafficking in normal and diseased states. Through this review, we provide insights into the mechanistic role of INSR intracellular processes and activities in the development of insulin resistance and diabetes.
Collapse
Affiliation(s)
- Yang Chen
- School of Biomedical Sciences, The University of Queensland, Brisbane 4072, Australia.
| | - Lili Huang
- School of Biomedical Sciences, The University of Queensland, Brisbane 4072, Australia.
| | - Xinzhou Qi
- School of Biomedical Sciences, The University of Queensland, Brisbane 4072, Australia.
| | - Chen Chen
- School of Biomedical Sciences, The University of Queensland, Brisbane 4072, Australia.
| |
Collapse
|
6
|
Takasawa K, Tsuji-Hosokawa A, Takishima S, Wada Y, Nagasaki K, Dateki S, Numakura C, Hijikata A, Shirai T, Kashimada K, Morio T. Clinical characteristics of adolescent cases with Type A insulin resistance syndrome caused by heterozygous mutations in the β-subunit of the insulin receptor (INSR) gene. J Diabetes 2019; 11:46-54. [PMID: 29877041 DOI: 10.1111/1753-0407.12797] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/02/2018] [Accepted: 06/01/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Type A insulin resistance (IR) is a rare form of severe congenital IR that is frequently caused by heterozygous mutations in the insulin receptor (INSR) gene. Although Type A IR requires appropriate intervention from the early stages of diabetes, proper diagnosis of this disease is challenging, and accumulation of cases with detailed clinical profiles and genotypes is required. METHODS Herein we report on six peripubertal patients with clinically diagnosed Type A IR, including four patients with an identified INSR mutation. To clarify the clinical features of Type A IR due to INSR mutation, we validated the clinical characteristics of Type A IR patients with identified INSR mutations by comparing them with mutation-negative patients. RESULTS Four heterozygous missense mutations within the β-subunit of INSR were detected: Gly1146Arg, Arg1158Trp, Arg1201Trp, and one novel Arg1201Pro mutation. There were no obvious differences in clinical phenotypes, except for normal lipid metabolism and autosomal dominant inheritance, between Type A IR due to INSR mutations and Type A IR due to other factors. However, our analysis revealed that the extent of growth retardation during the fetal period is correlated with the severity of insulin signaling impairment. CONCLUSIONS The present study details the clinical features of four patients with genetically proven Type A IR. Further accumulation of genetically proven cases and long-term treatment prognoses following early diagnosis are required to further elucidate the dynamics of this disease.
Collapse
Affiliation(s)
- Kei Takasawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsumi Tsuji-Hosokawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeru Takishima
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Pediatrics, Soka Municipal Hospital, Soka, Japan
| | - Yasunori Wada
- Department of Pediatrics, Iwate Medical University School of Medicine, Morioka, Japan
| | - Keisuke Nagasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sumito Dateki
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chikahiko Numakura
- Department of Pediatrics, Yamagata University School of Medicine, Yamagata, Japan
| | - Atsushi Hijikata
- Faculty of Bioscience, Nagahama Institute of Bio-Science and Technology, Nagahama, Japan
| | - Tsuyoshi Shirai
- Faculty of Bioscience, Nagahama Institute of Bio-Science and Technology, Nagahama, Japan
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
7
|
Domínguez-García A, Martínez R, Urrutia I, Garin I, Castaño L. Identification of a novel insulin receptor gene heterozygous mutation in a patient with type A insulin resistance syndrome. J Pediatr Endocrinol Metab 2014; 27:561-4. [PMID: 24468607 DOI: 10.1515/jpem-2013-0284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 12/02/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several types of mutations in the insulin receptor gene have been identified in patients with genetic syndromes of insulin resistance. PATIENT REPORT We describe a 12-year-old girl with type A insulin resistance with hyperandrogenism, hyperinsulinemia, and diabetes mellitus but without the dysmorphic characteristic of leprechaunism or Rabson-Mendenhall syndrome. The proband's mother had hyperinsulinemia and diabetes mellitus but did not show any common clinical features of type A insulin resistance. The proband's brother also had hyperinsulinemia but manifested neither glucose intolerance nor common clinical features of type A insulin resistance. A novel heterozygous mutation, p.Asn1164Thr, of the insulin receptor gene (INSR) was identified in this family. CONCLUSION These cases illustrate the diversity of clinical phenotypes associated with mutations of the insulin receptor gene.
Collapse
|
8
|
Ardon O, Procter M, Tvrdik T, Longo N, Mao R. Sequencing analysis of insulin receptor defects and detection of two novel mutations in INSR gene. Mol Genet Metab Rep 2014; 1:71-84. [PMID: 27896077 PMCID: PMC5121292 DOI: 10.1016/j.ymgmr.2013.12.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 12/24/2013] [Indexed: 02/07/2023] Open
Abstract
Mutations in the insulin receptor gene cause the inherited insulin resistant syndromes Leprechaunism and Rabson–Mendenhall syndrome. These recessive conditions are characterized by intrauterine and post-natal growth restrictions, dysmorphic features, altered glucose homeostasis, and early demise. The insulin receptor gene (INSR) maps to the short arm of chromosome 19 and is composed of 22 exons. Here we optimize the conditions for sequencing this gene and report novel mutations in patients with severe insulin resistance. Methods PCR amplification of the 22 coding exons of the INSR gene was performed using M13-tailed primers. Bidirectional DNA sequencing was performed with BigDye Terminator chemistry and M13 primers and the product was analyzed on the ABI 3100 genetic analyzer. Data analysis was performed using Mutation Surveyor software comparing the sequence to a reference INSR sequence (Genbank NC_000019). Results We sequenced four patients with Leprechaunism or Rabson–Mendenhall syndromes as well as seven samples from normal individuals and confirmed previously identified mutations in the affected patients. Three of the four mutations identified in this group caused premature insertion of a stop codon. In addition, the INSR gene was sequenced in 14 clinical samples from patients with suspected insulin resistance and one novel mutation was found in an infant with a suspected diagnosis of Leprechaunism. Discussion Leprechaunism and Rabson–Mendenhall syndrome are very rare and difficult to diagnose. Diagnosis is currently based mostly on clinical criteria. Clinical availability of DNA sequencing can provide an objective way of confirming or excluding the diagnosis.
Collapse
Affiliation(s)
- O Ardon
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA; Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA; Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - M Procter
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - T Tvrdik
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - N Longo
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA; Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA; Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - R Mao
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA; Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
9
|
Falik Zaccai TC, Kalfon L, Klar A, Elisha MB, Hurvitz H, Weingarten G, Chechik E, Fleisher Sheffer V, Haj Yahya R, Meidan G, Gross-Kieselstein E, Bauman D, Hershkovitz S, Yaron Y, Orr-Urtreger A, Wertheimer E. Two novel mutations identified in familial cases with Donohue syndrome. Mol Genet Genomic Med 2013; 2:64-72. [PMID: 24498630 PMCID: PMC3907912 DOI: 10.1002/mgg3.43] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/24/2013] [Indexed: 12/29/2022] Open
Abstract
Donohue syndrome (DS) is a rare and lethal autosomal recessive disease caused by mutations in the insulin receptor (INSR) gene, manifesting marked insulin resistance, severe growth retardation, hypertrichosis, and characteristic dysmorphic features. We report the clinical, molecular, and biochemical characterization of three new patients with DS, and address genotype–phenotype issues playing a role in the pathophysiology of DS. A female infant born to first-degree cousins Muslim Arab parents and two brothers born to first-degree cousins Druze parents presented classical features of DS with hypertrophic cardiomyopathy and died in infancy. Each patient was found homozygous for one missense mutation within the extracellular domain of the INSR gene. Western blot analysis identified the proreceptor of INSR, but not its mature subunits alpha and beta. Of 95 healthy Muslims, no heterozygous was found and of 52 healthy Druze from the same village, one was heterozygous. This study presents two novel familial mutations in the alpha subunit of the INSR which appear to impair post-translational processing of the INSR, resulting loss of its function. Both mutations cause DS with hypertrophic cardiomyopathy and early death. Identification of the causative mutation enables prevention of this devastating disease.
Collapse
Affiliation(s)
- Tzipora C Falik Zaccai
- Institute of Human Genetics, Western Galilee Medical Center Naharia, Israel ; Faculty of Medicine in Galilee, Bar-Ilan University Safed, Israel
| | - Limor Kalfon
- Institute of Human Genetics, Western Galilee Medical Center Naharia, Israel
| | - Aharon Klar
- Department of Pediatrics, Bikur Cholim General Hospital, affiliated with the Hebrew University-Hadassah Medical School Jerusalem, Israel
| | | | - Haggit Hurvitz
- Department of Pediatrics, Bikur Cholim General Hospital, affiliated with the Hebrew University-Hadassah Medical School Jerusalem, Israel
| | - Galina Weingarten
- Department of Pathology, Sackler School of Medicine, Tel Aviv University Tel Aviv, Israel
| | | | | | - Raid Haj Yahya
- Department of Pediatrics, Bikur Cholim General Hospital, affiliated with the Hebrew University-Hadassah Medical School Jerusalem, Israel
| | - Gal Meidan
- Department of Pathology, Sackler School of Medicine, Tel Aviv University Tel Aviv, Israel
| | - Eva Gross-Kieselstein
- Department of Pediatrics, Bikur Cholim General Hospital, affiliated with the Hebrew University-Hadassah Medical School Jerusalem, Israel
| | - Dvora Bauman
- Department of Obstetrics and Gynecology, Bikur Cholim General Hospital Jerusalem, Israel
| | - Sylvia Hershkovitz
- Department of Neonatology, Western Galilee Medical Center Naharia, Israel
| | - Yuval Yaron
- Genetics Institute, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University Tel Aviv, Israel
| | - Avi Orr-Urtreger
- Genetics Institute, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University Tel Aviv, Israel
| | - Efrat Wertheimer
- Department of Pathology, Sackler School of Medicine, Tel Aviv University Tel Aviv, Israel
| |
Collapse
|
10
|
|
11
|
Areolar sebaceous hyperplasia with underlying primary duct carcinoma of the breast in a woman with Donohue syndrome (leprechaunism). Am J Dermatopathol 2011; 34:e15-8. [PMID: 22172957 DOI: 10.1097/dad.0b013e318231311a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Areolar hyperplasia is only reported when exaggerated, and even so, exaggerated areolar sebaceous hyperplasia is rare. We have recently seen a case of areolar sebaceous hyperplasia in a 32-year-old woman with Donohue syndrome (leprechaunism), who also had an invasive ductal carcinoma in the same breast. The patient showed typical "elfin-like" face with wide nostrils and thick lips, large and low-set ears, and dysplastic nails. The areola showed a yellowish thickened plaque of 5-cm diameter that corresponded to a hyperplasia of the sebaceous glands. Immunohistochemistry for the mismatch repair proteins (MLH1, MSH2, MSH6, and PMS2) was performed on the sebaceous hyperplasia and on the breast carcinoma, and no lack of expression of the markers was evidenced. We have found no other reported case of areolar sebaceous hyperplasia either in cases of breast carcinoma or in cases of leprechaunism.
Collapse
|