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Özden C, Mautner VF, Farschtschi S, Molwitz I, Ristow I, Bannas P, Well L, Klutmann S, Adam G, Apostolova I, Buchert R. Asymmetry of thalamic hypometabolism on FDG-PET/CT in neurofibromatosis type 1: Association with peripheral tumor burden. J Neuroimaging 2024; 34:138-144. [PMID: 37942683 DOI: 10.1111/jon.13170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/15/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Thalamic hypometabolism is a consistent finding in brain PET with F-18 fluorodeoxyglucose (FDG) in patients with neurofibromatosis type 1 (NF1). However, the pathophysiology of this metabolic alteration is unknown. We hypothesized that it might be secondary to disturbance of peripheral input to the thalamus by NF1-characteristic peripheral nerve sheath tumors (PNSTs). To test this hypothesis, we investigated the relationship between thalamic FDG uptake and the number, volume, and localization of PNSTs. METHODS This retrospective study included 22 adult NF1 patients (41% women, 36.2 ± 13.0 years) referred to whole-body FDG-PET/contrast-enhanced CT for suspected malignant transformation of PNSTs and 22 sex- and age-matched controls. Brain FDG uptake was scaled voxelwise to the individual median uptake in cerebellar gray matter. Bilateral mean and left-right asymmetry of thalamic FDG uptake were determined using a left-right symmetric anatomical thalamus mask. PNSTs were manually segmented in contrast-enhanced CT. RESULTS Thalamic FDG uptake was reduced in NF1 patients by 2.0 standard deviations (p < .0005) compared to controls. Left-right asymmetry was increased by 1.3 standard deviations (p = .013). Thalamic hypometabolism was higher in NF1 patients with ≥3 PNSTs than in patients with ≤2 PNSTs (2.6 vs. 1.6 standard deviations, p = .032). The impact of the occurrence of paraspinal/paravertebral PNSTs and of the mean PNST volume on thalamic FDG uptake did not reach statistical significance (p = .098 and p = .189). Left-right asymmetry of thalamic FDG uptake was not associated with left-right asymmetry of PNST burden (p = .658). CONCLUSIONS This study provides first evidence of left-right asymmetry of thalamic hypometabolism in NF1 and that it might be mediated by NF1-associated peripheral tumors.
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Affiliation(s)
- Cansu Özden
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Klutmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivayla Apostolova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Buchert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Nagrani NS, Bhawan J. Histopathological Variants of Cutaneous Neurofibroma: A Compendious Review. Dermatopathology (Basel) 2022; 10:1-19. [PMID: 36648779 PMCID: PMC9844430 DOI: 10.3390/dermatopathology10010001] [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: 10/02/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
The first description of histopathological variants of neurofibroma dates back to 1994. Over the years, many individual case reports elucidating unusual histologic features in neurofibroma have been added to the literature, some of which have defined criteria, with the others falling under the roof of benign neural neoplasms. These unusual features, which sometimes may lead to pauses in identifying a common benign tumor such as neurofibroma. Awareness of these variants may help dermatopathologists avoid misinterpretation. Thus, this review aims to summarize all novel and unusual histopathological variants of cutaneous neurofibroma reported to date, in addition to any unusual variants that we encountered in our practice.
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Bettegowda C, Upadhayaya M, Evans DG, Kim A, Mathios D, Hanemann CO. Genotype-Phenotype Correlations in Neurofibromatosis and Their Potential Clinical Use. Neurology 2021; 97:S91-S98. [PMID: 34230207 DOI: 10.1212/wnl.0000000000012436] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/19/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Because clinically validated biomarkers for neurofibromatosis 1 (NF1) and neurofibromatosis 2 (NF2) have not been identified, we aimed to determine whether genotype-phenotype correlations are useful in clinical trials in NF1 and NF2. METHODS The Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) Biomarker Group first performed a systematic literature search and reviewed existing data on genetic biomarkers in NF1 and NF2 and in in malignant peripheral nerve sheath tumors. The group then met during a series of consensus meetings to develop a joint report. RESULTS We found that in NF2, the genetic severity score is clearly of potential clinical use. In NF1, despite over 3,000 constitutional variants having been described in the NF1 gene, only 4 actionable genotype-phenotype correlations exist. The diagnosis and treatment decision of these tumors should ideally include histopathology and compilation of some of the genetic markers. CONCLUSION We summarized emerging clinical use of genotype-phenotype correlations in neurofibromatosis.
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Affiliation(s)
- Chetan Bettegowda
- From Johns Hopkins University School of Medicine (C.B., D.M.), Baltimore, MD; Division Cancer and Genetics (M.U.), Cardiff University; Genomic Medicine (D.G.E.), University of Manchester, UK; Center for Cancer and Blood Disorders (A.K.), Children's National Hospital, Washington, DC; and Faculty of Health, Medicine, Dentistry and Health Sciences (C.O.H.), Institute of Translational and Stratified Medicine, University of Plymouth, UK
| | - Meena Upadhayaya
- From Johns Hopkins University School of Medicine (C.B., D.M.), Baltimore, MD; Division Cancer and Genetics (M.U.), Cardiff University; Genomic Medicine (D.G.E.), University of Manchester, UK; Center for Cancer and Blood Disorders (A.K.), Children's National Hospital, Washington, DC; and Faculty of Health, Medicine, Dentistry and Health Sciences (C.O.H.), Institute of Translational and Stratified Medicine, University of Plymouth, UK
| | - D Gareth Evans
- From Johns Hopkins University School of Medicine (C.B., D.M.), Baltimore, MD; Division Cancer and Genetics (M.U.), Cardiff University; Genomic Medicine (D.G.E.), University of Manchester, UK; Center for Cancer and Blood Disorders (A.K.), Children's National Hospital, Washington, DC; and Faculty of Health, Medicine, Dentistry and Health Sciences (C.O.H.), Institute of Translational and Stratified Medicine, University of Plymouth, UK
| | - AeRang Kim
- From Johns Hopkins University School of Medicine (C.B., D.M.), Baltimore, MD; Division Cancer and Genetics (M.U.), Cardiff University; Genomic Medicine (D.G.E.), University of Manchester, UK; Center for Cancer and Blood Disorders (A.K.), Children's National Hospital, Washington, DC; and Faculty of Health, Medicine, Dentistry and Health Sciences (C.O.H.), Institute of Translational and Stratified Medicine, University of Plymouth, UK
| | - Dimitrios Mathios
- From Johns Hopkins University School of Medicine (C.B., D.M.), Baltimore, MD; Division Cancer and Genetics (M.U.), Cardiff University; Genomic Medicine (D.G.E.), University of Manchester, UK; Center for Cancer and Blood Disorders (A.K.), Children's National Hospital, Washington, DC; and Faculty of Health, Medicine, Dentistry and Health Sciences (C.O.H.), Institute of Translational and Stratified Medicine, University of Plymouth, UK
| | - Clemens O Hanemann
- From Johns Hopkins University School of Medicine (C.B., D.M.), Baltimore, MD; Division Cancer and Genetics (M.U.), Cardiff University; Genomic Medicine (D.G.E.), University of Manchester, UK; Center for Cancer and Blood Disorders (A.K.), Children's National Hospital, Washington, DC; and Faculty of Health, Medicine, Dentistry and Health Sciences (C.O.H.), Institute of Translational and Stratified Medicine, University of Plymouth, UK.
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4
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Rozza-de-Menezes RE, Almeida LM, Andrade-Losso RM, de Souza Vieira G, Siqueira OHK, Brum CI, Riccardi VM, Cunha KS. A Clinicopathologic Study on the Role of Estrogen, Progesterone, and Their Classical and Nonclassical Receptors in Cutaneous Neurofibromas of Individuals With Neurofibromatosis 1. Am J Clin Pathol 2021; 155:738-747. [PMID: 33289020 DOI: 10.1093/ajcp/aqaa186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To evaluate the expression of progesterone receptor (PR), estrogen receptor (ER), and G protein-coupled estrogen receptor 1 (GPER-1) in cutaneous neurofibromas (cNFs) and their correlation with demographic, clinical, and laboratory data of individuals with neurofibromatosis 1 (NF1). The association of PROGINS polymorphism and PR expression in cNFs, as well as the serum steroidal hormones and the number of cNFs, was investigated. METHODS The sample comprised 80 large and 80 small cNFs from 80 individuals with NF1. PR, ER, GPER-1, and Ki-67 expression were investigated by immunohistochemistry in tissue micro- and macroarrays and quantified using a digital computer-assisted method. The number of cNFs, the levels of serum 17β estradiol and progesterone, and the PROGINS polymorphism were identified. RESULTS Twelve (8.5%) small cNFs were weakly positive for ER, 131 (92.3%) cNFs expressed PR, and all (100%) cNFs expressed GPER-1. Large cNFs showed a higher expression of PR (P < .0001) and GPER-1 (P = .019) and had a higher intensity of staining for these receptors (P < .0001). The cell proliferation index was positively correlated with PR (P = .001). Persons with more cNFs had higher serum levels of progesterone (P = .001). CONCLUSIONS These findings emphasize the role of estrogen and progesterone in cNF development and suggest that these hormones may act on cNF cells via a noncanonical pathway through GPER-1.
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Affiliation(s)
- Rafaela E Rozza-de-Menezes
- Graduate Program in Pathology, School of Medicine
- Department of Pathology, School of Medicine, Antonio Pedro University Hospital
- Department of General and Specialized Surgery, School of Medicine, Universidade Federal Fluminense, Niterói, Brazil
| | - Lilian M Almeida
- Graduate Program in Pathology, School of Medicine
- Department of Pathology, School of Medicine, Antonio Pedro University Hospital
| | - Raquel M Andrade-Losso
- Graduate Program in Pathology, School of Medicine
- Department of Pathology, School of Medicine, Antonio Pedro University Hospital
| | - Gustavo de Souza Vieira
- Graduate Program in Pathology, School of Medicine
- Department of Pathology, School of Medicine, Antonio Pedro University Hospital
| | - Orlando H K Siqueira
- Neurofibromatosis National Center (Centro Nacional de Neurofibromatose), Rio de Janeiro, Brazil
| | - Carolina I Brum
- Department of Pathology, School of Medicine, Universidade Federal de Goiás, Goiânia, Brazil
| | | | - Karin S Cunha
- Graduate Program in Pathology, School of Medicine
- Department of Pathology, School of Medicine, Antonio Pedro University Hospital
- Department of General and Specialized Surgery, School of Medicine, Universidade Federal Fluminense, Niterói, Brazil
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5
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Oliveira LB, Geller M, Cunha KS, Santos A, Bernacchi A, Rubenstein AE, Takirambudde S, Mezitis S, de Almeida Ito Brum C, Darrigo LG, Ribeiro MG. Clinical assessment of the use of topical liquid diclofenac following laser microporation of cutaneous neurofibromas in individuals with neurofibromatosis type 1. Heliyon 2021; 7:e06518. [PMID: 33817379 PMCID: PMC8010391 DOI: 10.1016/j.heliyon.2021.e06518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/16/2020] [Accepted: 03/11/2021] [Indexed: 11/03/2022] Open
Abstract
Background Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder with a prevalence of 1:3000 births and a wide variety of clinical manifestations. Cutaneous neurofibromas (cNF) are among the most common visible manifestations of NF1 and present a major clinical burden for patients. NF1 patients with cNF often report decreased quality of life, emotional well-being and physical comfort. Developing effective medical therapies for cNF has been identified as a priority for the majority of adults with NF1. Methods The study was an open, controlled and prospective proof-of-concept clinical trial. The topical treatment consisted of two steps: cNF microporation using a laser device followed by topical application of one drop of diclofenac 25 mg/mL on the surface of the cNF (T neurofibroma = treatment) or physiological saline (C neurofibroma = control) and reapplied twice daily for 3 days. Neurofibroma assessments included visual and dermatoscopy observations noting color and presence of necrosis, presence of flaccidity, measurements in two dimensions, photographs, and histopathology after excision. The primary efficacy variable was the presence of tissue necrosis. The primary safety variable was the occurrence of treatment-related adverse events. Results Six patients were included in the study. The treatment resulted in transitory topical changes (healing of the microporation grid with formation of scintillating tissue layer, hyperemia and desquamation), with no statistically significant variation in the dimensions of the T and C neurofibromas in relation to pretreatment measurements. There was no necrosis in the T or C neurofibromas. In the histopathological analysis, there was no significant difference in the distribution of chronic (lymphocytic) inflammatory infiltrate in the papillary reticular dermis (subepithelial), type of infiltrate (diffuse, perivascular, or both), presence of fibrosis, and presence of atrophy among the T and C neurofibromas. No adverse events attributable to the use of diclofenac were reported during the treatment period. Conclusions Treatment did not result in significant alterations in terms of presence of tissue necrosis, size, or histopathological features in the T neurofibromas or in comparison to the C neurofibromas. Topical diclofenac with laser microporation was well-tolerated, with no adverse events attributable to diclofenac reported. Whether these observations are due to minimal systemic and neurofibroma exposure remain to be explored in dosage studies with larger patient groups. Trial registration ClinicalTrials.gov (NCT03090971) retrospectively registered March 27, 2017.
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Affiliation(s)
- Lisa Brauer Oliveira
- Postgraduate Program in Clinical Medicine, Universidade Federal do Rio de Janeiro (UFRJ) - Rio de Janeiro, Brazil
| | - Mauro Geller
- Medical Genetics Service, Instituto de Puericultura e Pediatria Martagão Gesteira Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Department of Immunology and Microbiology, Centro Universitário Serra dos Órgãos (UNIFESO), Teresópolis, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Clinical Immunology, Instituto de Pós-Graduação Médica Carlos Chagas - Rio de Janeiro, Brazil
| | - Karin Soares Cunha
- Postgraduate Program in Pathology, Universidade Federal Fluminense (UFF) Medical School, Niterói, Brazil.,Pathology Department, Faculdade de Medicina - Universidade Federal Fluminense (UFF), Niterói, Brazil
| | - Alessandra Santos
- Postgraduate Program in Clinical Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Allan Bernacchi
- Department of Plastic Surgery, Serviço Prof. Pitanguy, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Allan E Rubenstein
- Department of Neurology and Pediatrics, NYU Langone Medical Center, New York, NY, USA
| | - Sanyu Takirambudde
- Department of Pediatrics, New York University Langone Medical Center, New York, NY, USA
| | - Spyros Mezitis
- Department of Endocrinology/Clinical Medicine, Weill Medical College of Cornell University, New York, NY, USA.,New York Presbyterian Hospital/Cornell Medicine, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | | | - Luiz Guilherme Darrigo
- Bone Marrow Transplant Unit, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcia Gonçalves Ribeiro
- Department of Pediatrics, Federal University of Rio de Janeiro Medical School (UFRJ), Rio de Janeiro, Brazil.,Medical Genetics Service, Instituto de Puericultura e Pediatria Martagão Gesteira, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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6
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Waqar M, Huson S, Evans DG, Ealing J, Karabatsou K, George KJ, Soh C. C2 neurofibromas in neurofibromatosis type 1: genetic and imaging characteristics. J Neurosurg Spine 2019; 30:126-132. [PMID: 30485203 DOI: 10.3171/2018.7.spine171340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 07/10/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVEC2 nerve root neurofibromas have been reported frequently in patients with neurofibromatosis type 1 (NF1), although their genetic and imaging characteristics are unexplored. The aim of this study was to characterize genetic and spinal imaging findings in a large cohort of NF1 patients with C2 neurofibromas.METHODSThe authors performed a review of national NF1 referrals between 2009 and 2016. Inclusion criteria were at least 1 C2 root neurofibroma and cervical-spine or whole-spine MRI scans available for analysis. Blinded imaging review was performed by a neuroradiologist with an interest in NF1.RESULTSFifty-four patients with 106 C2 neurofibromas were included. The median age was 32.5 years (range 15-61 years), and there were slightly more male patients (33 vs 21 female patients). Splice-site (30%) and missense (20%) variants were frequent. Spinal neurofibromas were distributed in all spine regions (65%) or in the cervical spine alone (22%). Most (93%) C2 neurofibromas were visible on MRI scans of the head. Intradural invasion and cord compression in the cervical spine included the C2 level in 95% and 80% of patients, respectively. Compared with all other cervical spine neurofibromas in these patients, C2 neurofibromas had higher rates of intraspinal extension (75% vs 32%; OR 6.20, 95% CI 3.85-9.97; p < 0.001), intradural invasion (53% vs 26%; OR 3.20, 95% CI 2.08-4.92; p < 0.001), and cord compression (25% vs 13%; OR 2.26, 95% CI 1.35-3.79; p = 0.002). However, C2 neurofibromas had lower rates of extraforaminal growth beyond the transverse process (12% vs 62%; OR 0.09, 95% CI 0.05-0.16; p < 0.001).CONCLUSIONSC2 neurofibromas are associated with an aggressive intraspinal phenotype, limited growth outside the spinal canal, and an uncommon genetic profile. These observations require future study.
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Affiliation(s)
- Mueez Waqar
- Departments of1Neurosurgery.,2Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, The University of Manchester, United Kingdom
| | - Susan Huson
- 2Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, The University of Manchester, United Kingdom.,3Department of Neurogenetics, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester; and
| | - D Gareth Evans
- 2Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, The University of Manchester, United Kingdom.,3Department of Neurogenetics, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester; and
| | - John Ealing
- 2Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, The University of Manchester, United Kingdom.,4Neurogenetics, and
| | - Konstantina Karabatsou
- Departments of1Neurosurgery.,2Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, The University of Manchester, United Kingdom
| | - K Joshi George
- Departments of1Neurosurgery.,2Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, The University of Manchester, United Kingdom
| | - Calvin Soh
- 2Manchester Academic Health Sciences Centre, Division of Evolution and Genomic Sciences, The University of Manchester, United Kingdom.,5Neuroradiology, Salford Royal NHS Foundation Trust, Salford
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Vetrano IG, Saletti V, Nazzi V. Fluorescein-guided resection of plexiform neurofibromas: how I do it. Acta Neurochir (Wien) 2019; 161:2141-2145. [PMID: 31435825 DOI: 10.1007/s00701-019-04038-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Plexiform neurofibromas (PN) can determine pain, nerve function impairment, and, when extremely large, also deformity. Surgical is often partial, with possible recurrence, and the risk of malignant transformation. METHOD We describe the surgical strategy in a case of huge multiple plexiform neurofibromas of the left arm. We attempted to achieve a safe resection under the intraoperative guidance of fluorescein, with a dedicated microscope filter (YELLOW560). This technique can be also applied to other locations. CONCLUSION Fluorescein-guided surgery, coupled with intraoperative neurophysiological monitoring, increases the safe resection rate, considering the risks of neurological deficits and the possible malignant transformation.
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8
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The evolution and multi-molecular properties of NF1 cutaneous neurofibromas originating from C-fiber sensory endings and terminal Schwann cells at normal sites of sensory terminations in the skin. PLoS One 2019; 14:e0216527. [PMID: 31107888 PMCID: PMC6527217 DOI: 10.1371/journal.pone.0216527] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 04/24/2019] [Indexed: 12/30/2022] Open
Abstract
In addition to large plexiform neurofibromas (pNF), NF1 patients are frequently disfigured by cutaneous neurofibromas (cNF) and are often afflicted with chronic pain and itch even from seemingly normal skin areas. Both pNFs and cNF consist primarily of benign hyperproliferating nonmyelinating Schwann cells (nSC). While pNF clearly arise within deep nerves and plexuses, the role of cutaneous innervation in the origin of cNF and in chronic itch and pain is unknown. First, we conducted a comprehensive, multi-molecular, immunofluorescence (IF) analyses on 3mm punch biopsies from three separate locations in normal appearing, cNF-free skin in 19 NF1 patients and skin of 16 normal subjects. At least one biopsy in 17 NF1 patients had previously undescribed micro-lesions consisting of a small, dense cluster of nonpeptidergic C-fiber endings and the affiliated nSC consistently adjoining adnexal structures—dermal papillae, hair follicles, sweat glands, sweat ducts, and arterioles—where C-fiber endings normally terminate. Similar micro-lesions were detected in hind paw skin of mice with conditionally-induced SC Nf1-/- mutations. Hypothesizing that these microlesions were pre-cNF origins of cNF, we subsequently analyzed numerous overt, small cNF (s-cNF, 3–6 mm) and discovered that each had an adnexal structure at the epicenter of vastly increased nonpeptidergic C-fiber terminals, accompanied by excessive nSC. The IF and functional genomics assays indicated that neurturin (NTRN) and artemin (ARTN) signaling through cRET kinase and GFRα2 and GFRα3 co-receptors on the aberrant C-fiber endings and nSC may mutually promote the onset of pre-cNF and their evolution to s-cNF. Moreover, TrpA1 and TrpV1 receptors may, respectively, mediate symptoms of chronic itch and pain. These newly discovered molecular characteristics might be targeted to suppress the development of cNF and to treat chronic itch and pain symptoms in NF1 patients.
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Stratton JA, Assinck P, Sinha S, Kumar R, Moulson A, Patrick N, Raharjo E, Chan JA, Midha R, Tetzlaff W, Biernaskie J. Factors Within the Endoneurial Microenvironment Act to Suppress Tumorigenesis of MPNST. Front Cell Neurosci 2018; 12:356. [PMID: 30364248 PMCID: PMC6193112 DOI: 10.3389/fncel.2018.00356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/21/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Deciphering avenues to adequately control malignancies in the peripheral nerve will reduce the need for current, largely-ineffective, standards of care which includes the use of invasive, nerve-damaging, resection surgery. By avoiding the need for en bloc resection surgery, the likelihood of retained function or efficient nerve regeneration following the control of tumor growth is greater, which has several implications for long-term health and well-being of cancer survivors. Nerve tumors can arise as malignant peripheral nerve sheath tumors (MPNST) that result in a highly-aggressive form of soft tissue sarcoma. Although the precise cause of MPNST remains unknown, studies suggest that dysregulation of Schwann cells, mediated by the microenvironment, plays a key role in tumor progression. This study aimed to further characterize the role of local microenvironment on tumor progression, with an emphasis on identifying factors within tumor suppressive environments that have potential for therapeutic application. Methods: We created GFP-tagged adult induced tumorigenic Schwann cell lines (iSCs) and transplanted them into various in vivo microenvironments. We used immunohistochemistry to document the response of iSCs and performed proteomics analysis to identify local factors that might modulate divergent iSC behaviors. Results: Following transplant into the skin, spinal cord or epineurial compartment of the nerve, iSCs formed tumors closely resembling MPNST. In contrast, transplantation into the endoneurial compartment of the nerve significantly suppressed iSC proliferation. Proteomics analysis revealed a battery of factors enriched within the endoneurial compartment, of which one growth factor of interest, ciliary neurotrophic factor (CNTF) was capable of preventing iSCs proliferation in vitro. Conclusions: This dataset describes a novel approach for identifying biologically relevant therapeutic targets, such as CNTF, and highlights the complex relationship that tumor cells have with their local microenvironment. This study has significant implications for the development of future therapeutic strategies to fight MPNSTs, and, consequently, improve peripheral nerve regeneration and nerve function.
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Affiliation(s)
- Jo Anne Stratton
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Peggy Assinck
- Department of International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, BC, Canada.,Graduate Program in Neuroscience, The University of British Columbia, Vancouver, BC, Canada
| | - Sarthak Sinha
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Ranjan Kumar
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Aaron Moulson
- Department of International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, BC, Canada
| | - Natalya Patrick
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Eko Raharjo
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer A Chan
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada.,Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Rajiv Midha
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Wolfram Tetzlaff
- Department of International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, BC, Canada
| | - Jeff Biernaskie
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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Rozza-de-Menezes RE, Brum CDAI, Gaglionone NC, de Sousa Almeida LM, Andrade-Losso RM, Paiva BVB, Faveret PLS, da Silva AV, Siqueira OHK, Riccardi VM, Cunha KS. Prevalence and clinicopathological characteristics of lipomatous neurofibromas in neurofibromatosis 1: An investigation of 229 cutaneous neurofibromas and a systematic review of the literature. J Cutan Pathol 2018; 45:743-753. [PMID: 29959804 DOI: 10.1111/cup.13315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/10/2018] [Accepted: 06/25/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Lipomatous neurofibroma (Lnf) is a histopathological variant with adipocytes noted among cells of cutaneous neurofibromas. We aimed to investigate the prevalence and clinicopathological features of Lnfs of neurofibromatosis 1 (NF1)-associated cutaneous neurofibromas and to review the literature systematically. We also evaluated the expression of leptin (a hormone involved in lipid metabolism) in neurofibromas to better understand the pathogenesis of Lnfs. METHODS A prospective histologic study was conducted on 229 cutaneous neurofibromas from 85 NF1 individuals. Leptin expression was immunohistochemically evaluated in 111 cutaneous neurofibromas. To systematically review the literature, two authors independently performed literature searches without year restriction. RESULTS Forty (17.5%) neurofibromas were lipomatous. Lnfs were significantly larger lesions and associated with females. Eighteen (7.9%) of all neurofibromas had multinucleated floret-like giant cells, and these were associated with Lnfs. All neurofibromas expressed leptin. We systematically reviewed 13 articles. Three large studies investigated Lnfs mainly in sporadic neurofibromas and suggested that 0.3% to 8.0% of tumors (NF1 and sporadic) are Lnfs. CONCLUSION In NF1, Lnfs are common, mainly in larger tumors and women. All cutaneous NF1-neurofibromas express leptin. It is unknown if the expression of leptin accounts for the lipomatous variant, but it may have a role in the pathogenesis of cutaneous neurofibroma.
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Affiliation(s)
- Rafaela Elvira Rozza-de-Menezes
- Department of Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, Brazil
- Neurofibromatosis National Center (Centro Nacional de Neurofibromatose, CNNF), Rio de Janeiro, Brazil
| | | | | | - Lilian Machado de Sousa Almeida
- Neurofibromatosis National Center (Centro Nacional de Neurofibromatose, CNNF), Rio de Janeiro, Brazil
- Graduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, Brazil
| | - Raquel Machado Andrade-Losso
- Neurofibromatosis National Center (Centro Nacional de Neurofibromatose, CNNF), Rio de Janeiro, Brazil
- Graduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, Brazil
| | | | | | - André Vallejo da Silva
- Breast Surgery Service, Antônio Pedro University Hospital, Universidade Federal Fluminense, Niterói, Brazil
| | | | | | - Karin Soares Cunha
- Department of Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, Brazil
- Neurofibromatosis National Center (Centro Nacional de Neurofibromatose, CNNF), Rio de Janeiro, Brazil
- Graduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, Brazil
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Alotaiby FM, Fitzpatrick S, Upadhyaya J, Islam MN, Cohen D, Bhattacharyya I. Demographic, Clinical and Histopathological Features of Oral Neural Neoplasms: A Retrospective Study. Head Neck Pathol 2018; 13:208-214. [PMID: 29931661 PMCID: PMC6513954 DOI: 10.1007/s12105-018-0943-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/12/2018] [Indexed: 11/26/2022]
Abstract
Intraoral neural neoplasms though unusual may be clinically significant. The aim of this study was to categorize and evaluate oral neural tumors in a large oral pathology biopsy service. With IRB approval, a retrospective search of all neural neoplasms of the oral cavity in the archives of the University of Florida Oral Pathology Biopsy Service spanning from 1994 to 2015 was performed. Extraoral cases as well as cases with insufficient patient information were excluded. A total of 340 out of 164,578 submitted specimens in a 22 year period (0.2%) were included with a mean age of 43.3 years (range: 6-89), and 44% male and 56% female. The most commonly affected locations were: tongue (37.5%), palate (22%), lip (19%), and gingiva (14%). The microscopic diagnoses rendered, in descending order of frequency were: neurofibromas (NFs): 123 (36%), granular cell tumor (GCT): 108 (32%), schwannomas: 61 (17%), palisaded encapsulated neuromas: 39 (11%), benign neural lesion not otherwise specified: 8 (2%), and mucosal neuroma c/w multiple endocrine neoplasia type 2B (MEN 2B): 1 (< 0.5%). Six cases of NF reported a history of neurofibromatosis Type 1 (NF 1). Four cases showed multifocal lesions. Immunohistochemical staining was performed on equivocal cases (25% of the lesions) and all were confirmed by their S-100 positivity. Intraoral neural neoplasms, though uncommon should be in the differential diagnosis of oral soft tissue entities and specific consideration to syndromal linkage is paramount as this may impact patient management.
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Affiliation(s)
- Faraj M Alotaiby
- Oral and Maxillofacial Diagnostic Sciences College of Dentistry, University of Florida, 1395 Center Dr, Gainesville, FL, 32610, USA.
| | - Sarah Fitzpatrick
- Oral and Maxillofacial Diagnostic Sciences College of Dentistry, University of Florida, 1395 Center Dr, Gainesville, FL, 32610, USA
| | - Jasbir Upadhyaya
- Oral and Maxillofacial Diagnostic Sciences College of Dentistry, University of Florida, 1395 Center Dr, Gainesville, FL, 32610, USA
| | - Mohammad N Islam
- Oral and Maxillofacial Diagnostic Sciences College of Dentistry, University of Florida, 1395 Center Dr, Gainesville, FL, 32610, USA
| | - Donald Cohen
- Oral and Maxillofacial Diagnostic Sciences College of Dentistry, University of Florida, 1395 Center Dr, Gainesville, FL, 32610, USA
| | - Indraneel Bhattacharyya
- Oral and Maxillofacial Diagnostic Sciences College of Dentistry, University of Florida, 1395 Center Dr, Gainesville, FL, 32610, USA
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12
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Guzzo M, Ferraro L, Ibba T, Quattrone P, Bianchi R, Rezzonico S, Scaramellini G. Schwannoma in the Parotid Gland. Experience at Our Institute and Review of the Literature. TUMORI JOURNAL 2018; 95:846-51. [DOI: 10.1177/030089160909500636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Schwannoma of the parotid gland is an uncommon tumor. When the facial nerve is involved by the tumor at the time of the operation, the surgical approach requires careful evaluation. The purpose of this study is to provide indications which can support the decision, taking into account the different clinical presentations of parotid schwannoma. In a retrospective study, eight cases of parotid schwannoma were collected between 1975 and 2006. In three cases the tumor affected the facial nerve itself and in the remaining ones it originated from intraparotid nonfacial peripheral nerves. When the facial nerve is involved by the tumor a conservative approach should always be considered. The indication for a surgical procedure should be discussed with the patient. If a conservative strategy is chosen, yearly follow-up by means of MRI and clinical observation should be planned.
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Affiliation(s)
- Marco Guzzo
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Letizia Ferraro
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tullio Ibba
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pasquale Quattrone
- Pathology and Cytology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Bianchi
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Rezzonico
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriele Scaramellini
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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13
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Rozza-de-Menezes RE, Gaglionone NC, Andrade-Losso RM, Siqueira OHK, Almeida LM, Peruzini KDS, Guimarães-Filho MAC, Brum CI, Geller M, Cunha KS. Receptor of ghrelin is expressed in cutaneous neurofibromas of individuals with neurofibromatosis 1. Orphanet J Rare Dis 2017; 12:186. [PMID: 29262839 PMCID: PMC5738781 DOI: 10.1186/s13023-017-0734-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/05/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Multiple cutaneous neurofibromas are a hallmark of neurofibromatosis 1 (NF1). They begin to appear during puberty and increase in number and volume during pregnancy, suggesting a hormonal influence. Ghrelin is a hormone that acts via growth hormone secretagogue receptor (GHS-R), which is overexpressed in many neoplasms and is involved in tumorigenesis. We aimed to investigate GHS-R expression in NF1 cutaneous neurofibromas and its relationship with tumors volume, and patient's age and gender. RESULTS Sample comprised 108 cutaneous neurofibromas (55 large and 53 small tumors) from 55 NF1 individuals. GHS-R expression was investigated by immunohistochemistry in tissue micro and macroarrays and quantified using a digital computer-assisted method. All neurofibromas expressed GHS-R, with a percentage of positive cells ranging from 4.9% to 76.1%. Large neurofibromas expressed more GHS-R than the small ones. The percentage of GHS-R-positive cells and intensity of GHS-R expression were positively correlated with neurofibromas volume. GHS-R expression was more common in female gender. CONCLUSIONS GHS-R is expressed in cutaneous neurofibromas. Larger neurofibromas have a higher percentage of positive cells and higher GHS-R intensity. Based on our results we speculate that ghrelin may have an action on the tumorigenesis of cutaneous neurofibromas. Future studies are required to understand the role of ghrelin in the pathogenesis of NF1-associated cutaneous neurofibroma.
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Affiliation(s)
- Rafaela E. Rozza-de-Menezes
- Graduate Program in Pathology, School of Medicine, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Av. Marquês do Paraná, 303, 4o andar, sala 01 – Centro, Niterói, RJ 24033-900 Brazil
- Neurofibromatosis National Center (Centro Nacional de Neurofibromatose), Rio de Janeiro, RJ Brazil
- School of Dentistry, Health Institute of Nova Friburgo, Universidade Federal Fluminense, Nova Friburgo, RJ Brazil
| | - Nicolle C. Gaglionone
- Graduate Program in Pathology, School of Medicine, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Av. Marquês do Paraná, 303, 4o andar, sala 01 – Centro, Niterói, RJ 24033-900 Brazil
| | - Raquel M. Andrade-Losso
- Graduate Program in Pathology, School of Medicine, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Av. Marquês do Paraná, 303, 4o andar, sala 01 – Centro, Niterói, RJ 24033-900 Brazil
- Neurofibromatosis National Center (Centro Nacional de Neurofibromatose), Rio de Janeiro, RJ Brazil
| | - Orlando H. K. Siqueira
- Department of General and Specialized Surgery, School of Medicine, Universidade Federal Fluminense, Niterói, RJ Brazil
| | - Lilian M. Almeida
- Graduate Program in Pathology, School of Medicine, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Av. Marquês do Paraná, 303, 4o andar, sala 01 – Centro, Niterói, RJ 24033-900 Brazil
- Neurofibromatosis National Center (Centro Nacional de Neurofibromatose), Rio de Janeiro, RJ Brazil
| | | | - Marco A. C. Guimarães-Filho
- Department of General and Specialized Surgery, School of Medicine, Universidade Federal Fluminense, Niterói, RJ Brazil
| | - Carolina I. Brum
- Department of Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, RJ Brazil
| | - Mauro Geller
- Department of Immunology and Microbiology, School of Medicine, Centro Universitário Serra dos Órgãos (UNIFESO), Teresópolis, RJ Brazil
- Instituto de Puericultura e Pediatria Martagão Gesteira, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Karin S. Cunha
- Graduate Program in Pathology, School of Medicine, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Av. Marquês do Paraná, 303, 4o andar, sala 01 – Centro, Niterói, RJ 24033-900 Brazil
- Neurofibromatosis National Center (Centro Nacional de Neurofibromatose), Rio de Janeiro, RJ Brazil
- Department of Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, RJ Brazil
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Sudden death due to rupture of the right internal carotid artery in neurofibromatosis type 1: A case report. Leg Med (Tokyo) 2016; 21:33-7. [PMID: 27497331 DOI: 10.1016/j.legalmed.2016.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 11/23/2022]
Abstract
Vascular involvement is a well-recognized manifestation of neurofibromatosis type 1 (NF1) which has the potential to be fatal when disrupted. We here present a case of sudden death due to the fatal arterial rupture resulted from infiltration of the neurofibromas. A 42-year-old man who suffered from NF1 presented a 1-h history of sudden onset of pain in his right cervical region. His condition worsened and became unconscious on his way to the emergency room. Despite resuscitation efforts, he died 30min later without regaining consciousness. Autopsy examination showed that a neurofibroma located around the right internal carotid artery, confirmed immunohistochemically with S-100, vimentin and CD34. Furthermore, proliferation of spindle cells positive for S-100 was seen in the wall of right internal carotid artery, which was disrupted and resulted in a hemorrhage. These findings suggest that the artery was disrupted by neurofibromas in the vascular wall, which led to fragility of the vessel. On the basis of these findings, we concluded that the cause of death was asphyxia resulting from airway obstruction compressed by the hematoma due to the arterial rupture. As the locality of the neurofibroma and hemorrhage were closed to the carotid baroreflex, we considered another possible mechanism of his sudden death, which could be cardiac inhibition induced by vagal stimulation. We hope this case will increase recognition of NF-1 vasculopathy when encountering any sudden death in NF1 patients.
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15
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Brain Herniation in Neurofibromatosis with Dysplasia of Occipital Bone and Posterior Skull Base. Case Rep Neurol Med 2015; 2015:816079. [PMID: 26600957 PMCID: PMC4639658 DOI: 10.1155/2015/816079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/19/2015] [Indexed: 11/26/2022] Open
Abstract
A 22-year-old female, a known case of neurofibromatosis 1 (NF1), presented with a congenital swelling in the left occipital region. She had developed recent onset dysphagia and localized occipital headache. Neuroradiology revealed a left occipital meningoencephalocele and a left parapharyngeal meningocele. This was associated with ventriculomegaly. She was advised on cranioplasty along with duraplasty which she denied. She agreed to a lumbar-peritoneal shunt. She described a dramatic improvement in her symptoms following the lumbar-peritoneal shunt. Occipital dysplasias, though uncommon, have been reported in the literature. We review this case and its management and discuss relevant literature on occipital dysplasias in NF1.
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16
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Riccardi VM. Ketotifen suppression of NF1 neurofibroma growth over 30 years. Am J Med Genet A 2015; 167:1570-7. [PMID: 25974154 DOI: 10.1002/ajmg.a.37045] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 01/29/2015] [Indexed: 01/23/2023]
Abstract
A patient with NF1 was treated with oral ketotifen for 30 years since infancy. Review of the patient's course and treatment details establishes a basis for reconsideration of several fundamental precepts about NF1 pathogenesis. The data suggest a distinctive benefit to treating an NF1 patient with an inhibitor of mast cell degranulation before cutaneous neurofibromas are clinically apparent: the neurofibromas appear to be arrested at a very early stage of development. The patient's skin was especially remarkable for both the paucity of cutaneous neurofibromas and the distinctive monotonous uniformity of those present, which were small and flat or barely sessile. While the data do not, of themselves, prove that ketotifen treatment commencing in childhood preempts neurofibroma maturation, in the context of earlier publications, they certainly warrant further investigation.
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17
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Jett K, Nguyen R, Arman D, Birch P, Chohan H, Farschtschi S, Fuensterer C, Kluwe L, Friedman JM, Mautner VF. Quantitative associations of scalp and body subcutaneous neurofibromas with internal plexiform tumors in neurofibromatosis 1. Am J Med Genet A 2015; 167:1518-24. [PMID: 25900062 DOI: 10.1002/ajmg.a.37068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 03/06/2015] [Indexed: 01/24/2023]
Abstract
Internal plexiform neurofibromas are a major cause of adverse outcomes in patients with neurofibromatosis 1 (NF1). We investigated the relationship of the numbers of subcutaneous neurofibromas of the scalp or body to internal plexiform tumor volume in 120 NF1 patients who had undergone whole body magnetic resonance imaging (MRI). We identified internal plexiform neurofibromas in 55% of patients, subcutaneous neurofibromas of the body in 75%, and subcutaneous neurofibromas of the scalp in 45%. The number of subcutaneous neurofibromas of the body and scalp were associated with each other (Spearman's Rho = 0.36; P < 0.001). The presence of internal tumors was associated with the presence (odds ratio [OR] = 4.38, 95% confidence interval [CI] 2.04-9.86, P < 0.001) and number (OR = 1.06 per neurofibroma, 95% CI 1.02-1.13, P < 0.001) of subcutaneous neurofibromas of the scalp. The total internal tumor volume was associated with the number of subcutaneous neurofibromas of the body (OR = 1.00086 per neurofibroma, 1.000089-1.0016, P = 0.029) and of the scalp (OR = 1.056 per neurofibroma, 1.029-1.083, P < 0.0001). Numbers of subcutaneous neurofibromas of the scalp and body are associated with internal plexiform tumor burden in NF1. Recognition of these associations may improve clinical management by helping to identify patients who will benefit most from whole body MRI and more intense clinical surveillance.
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Affiliation(s)
- Kimberly Jett
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Rosa Nguyen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Pediatrics, University of Maryland Medical Center, Baltimore, Maryland
| | - Darian Arman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Patricia Birch
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Harleen Chohan
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Lan Kluwe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Victor F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Neurofibromatosis in a toddler with back pain. J Pediatr Health Care 2014; 28:88-91. [PMID: 23434365 DOI: 10.1016/j.pedhc.2012.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 12/17/2012] [Accepted: 12/20/2012] [Indexed: 11/23/2022]
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20
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Ribeiro S, Napoli I, White IJ, Parrinello S, Flanagan AM, Suter U, Parada LF, Lloyd AC. Injury signals cooperate with Nf1 loss to relieve the tumor-suppressive environment of adult peripheral nerve. Cell Rep 2013; 5:126-36. [PMID: 24075988 DOI: 10.1016/j.celrep.2013.08.033] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 07/23/2013] [Accepted: 08/20/2013] [Indexed: 11/19/2022] Open
Abstract
Schwann cells are highly plastic cells that dedifferentiate to a progenitor-like state following injury. However, deregulation of this plasticity, may be involved in the formation of neurofibromas, mixed-cell tumors of Schwann cell (SC) origin that arise upon loss of NF1. Here, we show that adult myelinating SCs (mSCs) are refractory to Nf1 loss. However, in the context of injury, Nf1-deficient cells display opposing behaviors along the wounded nerve; distal to the injury, Nf1(-/-) mSCs redifferentiate normally, whereas at the wound site Nf1(-/-) mSCs give rise to neurofibromas in both Nf1(+/+) and Nf1(+/-) backgrounds. Tracing experiments showed that distinct cell types within the tumor derive from Nf1-deficient SCs. This model of neurofibroma formation demonstrates that neurofibromas can originate from adult SCs and that the nerve environment can switch from tumor suppressive to tumor promoting at a site of injury. These findings have implications for both the characterization and treatment of neurofibromas.
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Affiliation(s)
- Sara Ribeiro
- MRC Laboratory for Molecular Cell Biology, University College London, Gower Street, London WC1E 6BT, UK; UCL Cancer Institute, University College London, Gower Street, London WC1E 6BT, UK
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Salisbury EA, Lazard ZW, Ubogu EE, Davis AR, Olmsted-Davis EA. Transient brown adipocyte-like cells derive from peripheral nerve progenitors in response to bone morphogenetic protein 2. Stem Cells Transl Med 2012; 1:874-85. [PMID: 23283549 DOI: 10.5966/sctm.2012-0090] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Perineurial-associated brown adipocyte-like cells were rapidly generated during bone morphogenetic protein 2 (BMP2)-induced sciatic nerve remodeling in the mouse. Two days after intramuscular injection of transduced mouse fibroblast cells expressing BMP2 into wild-type mice, there was replication of beta-3 adrenergic receptor(+) (ADRB3(+)) cells within the sciatic nerve perineurium. Fluorescence-activated cell sorting and analysis of cells isolated from these nerves confirmed ADRB3(+) cell expansion and their expression of the neural migration marker HNK1. Similar analysis performed 4 days after BMP2 delivery revealed a significant decrease in ADRB3(+) cells from isolated sciatic nerves, with their concurrent appearance within the adjacent soft tissue, suggesting migration away from the nerve. These soft tissue-derived cells also expressed the brown adipose marker uncoupling protein 1 (UCP1). Quantification of ADRB3-specific RNA in total hind limb tissue revealed a 3-fold increase 2 days after delivery of BMP2, followed by a 70-fold increase in UCP1-specific RNA after 3 days. Expression levels then rapidly returned to baseline by 4 days. Interestingly, these ADRB3(+) UCP1(+) cells also expressed the neural guidance factor reelin. Reelin(+) cells demonstrated distinct patterns within the injected muscle, concentrated toward the area of BMP2 release. Blocking mast cell degranulation-induced nerve remodeling resulted in the complete abrogation of UCP1-specific RNA and protein expression within the hind limbs following BMP2 injection. The data collectively suggest that local BMP2 administration initiates a cascade of events leading to the expansion, migration, and differentiation of progenitors from the peripheral nerve perineurium to brown adipose-like cells in the mouse, a necessary prerequisite for associated nerve remodeling.
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Jouhilahti EM, Peltonen S, Heape AM, Peltonen J. The pathoetiology of neurofibromatosis 1. THE AMERICAN JOURNAL OF PATHOLOGY 2011; 178:1932-9. [PMID: 21457932 PMCID: PMC3081157 DOI: 10.1016/j.ajpath.2010.12.056] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 12/01/2010] [Accepted: 12/10/2010] [Indexed: 01/13/2023]
Abstract
Although a mutation in the NF1 gene is the only factor required to initiate the neurocutaneous-skeletal neurofibromatosis 1 (NF1) syndrome, the pathoetiology of the multiple manifestations of this disease in different organ systems seems increasingly complex. The wide spectrum of different clinical phenotypes and their development, severity, and prognosis seem to result from the cross talk between numerous cell types, cell signaling networks, and cell-extracellular matrix interactions. The bi-allelic inactivation of the NF1 gene through a "second hit" seems to be of crucial importance to the development of certain manifestations, such as neurofibromas, café-au-lait macules, and glomus tumors. In each case, the second hit involves only one cell type, which is subsequently clonally expanded in a discrete lesion. Neurofibromas, which are emphasized in this review, and cutaneous neurofibromas in particular, are known to contain a subpopulation of NF1-diploinsufficient Schwann cells and a variety of NF1-haploinsufficient cell types. A recent study identified a multipotent precursor cell population with an NF1(+/-) genotype that resides in human cutaneous neurofibromas and that has been suggested to play a role in their pathogenesis.
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Affiliation(s)
- Eeva-Mari Jouhilahti
- Department of Cell Biology and Anatomy, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Sirkku Peltonen
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland
| | - Anthony M. Heape
- Department of Anatomy and Cell Biology, Institute of Biomedicine, University of Oulu, Oulu, Finland
| | - Juha Peltonen
- Department of Cell Biology and Anatomy, Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland
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Oral soft tissue alterations in patients with neurofibromatosis. Clin Oral Investig 2011; 16:551-8. [PMID: 21301902 DOI: 10.1007/s00784-011-0519-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 01/25/2011] [Indexed: 01/12/2023]
Abstract
Our aim was to characterize the type and frequency of oral soft tissue alterations in neurofibromatosis. A total of 103 patients with neurofibromatosis 1 (NF1) and three patients with neurofibromatosis 2 (NF2) were clinically evaluated for their oral soft tissue alterations. Disturbing growths were removed from nine patients with NF1 and from one patient with NF2. The specimens were analyzed using routine histological methods and with immunohistochemistry using antibodies to S100, type IV collagen, CD34, neurofilament, and neuron-specific tubulin (TUBB3). Alterations including oral tumors, overgrowths of gingival soft tissue, and enlarged papillae of the tongue were discovered in 74% of NF1 patients. The results showed that three tumors clinically classified as plexiform neurofibromas and five out of six discrete mucosal tumors displayed histology and immunohistology consistent with that of neurofibroma. The histology of one palatal lesion resembled that of a scar, and the lesion removed from the patient with NF2 was classified as an amyloid tumor. To conclude, oral soft tissue growths are common findings in NF1, but most lesions do not require treatment and the patients may even not be aware of these alterations. Collagen IV, S100, and CD34 are useful biomarkers in the analysis of NF1-related oral soft tissue tumors. The clinicians should recognize that oral soft tissue alterations are relatively common in NF1. Some of the growths are disturbing, and plexiform neurofibromas may bear a risk of malignant transformation.
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Steib JP, Jean-Paul S, Bouchaïb J, Julia B, Walter A, Axel W, Schuller S, Sébastien S, Charles YP, Philippe C. Could an osteoinductor result in degeneration of a neurofibroma in NF1? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19 Suppl 2:S220-5. [PMID: 20449613 PMCID: PMC2899640 DOI: 10.1007/s00586-010-1416-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 04/17/2010] [Indexed: 10/19/2022]
Abstract
We report a case of fatal evolution of neurofibromatosis in a young boy. A laminectomy was performed when he was 9 years old. A secondary hyperkyphosis led to many surgeries resulting in recurrent malunions. When he was 23 years old, a breakage of his rods was treated by a new instrumentation and a T12-L1 interbody cage fitted with rh-BMP. Five months later, he developed a huge posterior tumour on his back. The biopsy diagnosed a neurofibrosarcoma. The growth of the tumour was extremely rapid. He died after several months from a septic shock. NF1 is characterised by neurofibromas that have a possibility of malign degeneration and conversion to a sarcoma. However, the chronology, rapidity of evolution and the exceptional volume of the tumour made us wonder whether the BMP had a part of responsibility as osteoinductor in the malignant degeneration, in this particular case, of neurofibromatosis. It seemed important to point out this case to the medical community.
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Affiliation(s)
- Jean-Paul Steib
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Pavillon Chirurgical B, BP 426, 67091 Strasbourg Cedex, France.
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Riccardi VM. Neurofibromatosis type 1 is a disorder of dysplasia: the importance of distinguishing features, consequences, and complications. ACTA ACUST UNITED AC 2010; 88:9-14. [PMID: 19691086 DOI: 10.1002/bdra.20616] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The disorder neurofibromatosis type 1 (NF1) is caused by mutations in the NF1 gene, which influences the availability of activated Ras and the latter's control of cellular proliferation. Emphasis on this aspect of NF1 has focused attention on the tumor suppression function of NF1 and thereby displaced attention from the gene's role in initial normal tissue formation, maintenance, and repair. METHODS Clinical and neuroimaging data systematically compiled over more than 30 years are analyzed to document the involvement of multiple organs and tissues, often with an embryonic origin. In addition, recent literature based on selective knockout mouse experiments is cited to corroborate embryonic dysplasia as an element of NF1 pathogenesis. RESULTS Tissue dysplasia, both ab initio and as part of tissue maintenance and wound healing, is a key clinical and pathogenetic aspect of NF1 and thereby provides a rationale for differentiating the elements of NF1 into features, consequences, and complications. CONCLUSIONS NF1 is a histogenesis control gene that also has properties that overlap with those of a tumor suppressor gene. Both its neoplastic and dysplastic manifestations become more amenable to understanding and treatment if they are differentiated at three levels--specifically, features, consequences and complications.
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Expression analysis of genes lying in the NF1 microdeletion interval points to four candidate modifiers for neurofibroma formation. Neurogenetics 2008; 10:79-85. [PMID: 18850118 DOI: 10.1007/s10048-008-0154-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 09/23/2008] [Indexed: 12/14/2022]
Abstract
The hallmark of neurofibromatosis type 1 (NF1) are multiple dermal neurofibromas. They show high inter- and intrafamilial variability for which the influence of modifying genes is discussed. NF1 patients presenting microdeletions spanning NF1 and several contiguous genes have an earlier onset and higher number of dermal neurofibromas than classical NF1 patients, pointing to one of the deleted genes as modifier. Expression analysis of 13 genes of the microdeletion region in dermal neurofibromas and other tissues revealed four candidates for the modification of neurofibroma formation: CENTA2, RAB11FIP4, C17orf79, and UTP6.
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Mautner VF, Asuagbor FA, Dombi E, Fünsterer C, Kluwe L, Wenzel R, Widemann BC, Friedman JM. Assessment of benign tumor burden by whole-body MRI in patients with neurofibromatosis 1. Neuro Oncol 2008; 10:593-8. [PMID: 18559970 DOI: 10.1215/15228517-2008-011] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
People with neurofibromatosis 1 (NF1) have multiple benign neurofibromas and a 10% lifetime risk of developing malignant peripheral nerve sheath tumors (MPNSTs). Most MPNSTs develop from benign plexiform neurofibromas, so the burden of benign tumors may be a risk factor for developing MPNST. We studied 13 NF1 patients with MPNSTs and 26 age- and sex-matched controls (NF1 patients who did not have MPNSTs) with detailed clinical examinations and whole-body MRI to characterize their body burden of internal benign neurofibromas. Internal plexiform neurofibromas were identified in 22 (56%) of the 39 NF1 patients studied. All six of the NF1 patients with MPNSTs under 30 years of age had neurofibromas visualized on whole-body MRI, compared to only 3 of 11 matched NF1 controls under age 30 (p < 0.05). Both the median number of plexiform neurofibromas (p < 0.05) and the median neurofibroma volume (p < 0.01) on whole-body MRI were significantly greater among MPNST patients younger than 30 years of age than among controls. No significant differences in whole-body MRI findings were observed between NF1 patients with MPNSTs and controls who were 30 years of age or older. Whole-body MRI of NF1 patients allows assessment of the burden of internal neurofibromas, most of which are not apparent on physical examination. Whole-body imaging of young NF1 patients may allow those at highest risk for developing MPNST to be identified early in life. Close surveillance of these high-risk patients may permit earlier diagnosis and more effective treatment of MPNSTs that develop.
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Affiliation(s)
- Victor-F Mautner
- Department of Maxillofacial Surgery, University Hospital Eppendorf, Hamburg, Germany
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