1
|
Milon V, Malinge MC, Blanluet M, Tessarech M, Battault C, Prestwich S, Vary B, Gueracher P, Legoff L, Barth M, Houdayer C, Guichet A, Rousseau A, Bonneau D, Procaccio V, Bris C, Colin E. Diagnosis of tuberous sclerosis in the prenatal period: a retrospective study of 240 cases and review of the literature. Eur J Hum Genet 2024:10.1038/s41431-024-01631-w. [PMID: 38806662 DOI: 10.1038/s41431-024-01631-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 05/04/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare multisystemic disorder caused by a pathogenic variant in the TSC1 or TSC2 gene. A great phenotypic variability characterises TSC. The condition predisposes to the formation of hamartomas in various tissues, neurologic and neurodevelopmental disorders such as epilepsy, psychiatric disorders, as well as intellectual disability in 50%. TSC may be responsible for cardiac rhabdomyomas (CRs), cortical tubers, or subependymal nodules during foetal life. Detecting multiple CRs is associated with a very high risk of TSC, but the CR could be single and isolated. Few data exist to estimate the risk of TSC in these cases. We report the largest series of prenatal genetic tests for TSC with a retrospective study of 240 foetuses presenting with suggestive antenatal signs. We also provide a review of the literature to specify the probability of clinical or genetic diagnosis of TSC in case of detection of single or multiple CRs. Indeed, an early diagnosis is crucial for the counselling of the couple and their families. In this series, a definite diagnosis was assessed in 50% (41/82) of foetuses who initially presented with a single CR and 80.3% (127/158) in cases of multiple CRs. The prevalence of parental germinal mosaicism was 2.6% (3/115).
Collapse
Affiliation(s)
- Vincent Milon
- Genetics Department, Angers Hospital, F-49000, Angers, France.
| | | | - Maud Blanluet
- Genetics Department, Angers Hospital, F-49000, Angers, France
| | - Marine Tessarech
- Genetics Department, Angers Hospital, F-49000, Angers, France
- Univ Angers, [CHU Angers], Inserm, CNRS, MITOVASC, Équipe CARME ou Equipe MITOLAB, SFR ICAT, F-49000, Angers, France
| | | | - Sarah Prestwich
- Genetics Department, Angers Hospital, F-49000, Angers, France
| | - Béatrice Vary
- Genetics Department, Angers Hospital, F-49000, Angers, France
| | | | - Louis Legoff
- Genetics Department, Angers Hospital, F-49000, Angers, France
- Univ Angers, [CHU Angers], Inserm, CNRS, MITOVASC, Équipe CARME ou Equipe MITOLAB, SFR ICAT, F-49000, Angers, France
| | - Magalie Barth
- Genetics Department, Angers Hospital, F-49000, Angers, France
- Univ Angers, [CHU Angers], Inserm, CNRS, MITOVASC, Équipe CARME ou Equipe MITOLAB, SFR ICAT, F-49000, Angers, France
| | - Clara Houdayer
- Genetics Department, Angers Hospital, F-49000, Angers, France
- Univ Angers, [CHU Angers], Inserm, CNRS, MITOVASC, Équipe CARME ou Equipe MITOLAB, SFR ICAT, F-49000, Angers, France
| | - Agnès Guichet
- Genetics Department, Angers Hospital, F-49000, Angers, France
- Univ Angers, [CHU Angers], Inserm, CNRS, MITOVASC, Équipe CARME ou Equipe MITOLAB, SFR ICAT, F-49000, Angers, France
| | - Audrey Rousseau
- Tissular and Cellular Pathology Department, Angers Hospital, F-49000, Angers, France
| | - Dominique Bonneau
- Genetics Department, Angers Hospital, F-49000, Angers, France
- Univ Angers, [CHU Angers], Inserm, CNRS, MITOVASC, Équipe CARME ou Equipe MITOLAB, SFR ICAT, F-49000, Angers, France
| | - Vincent Procaccio
- Genetics Department, Angers Hospital, F-49000, Angers, France
- Univ Angers, [CHU Angers], Inserm, CNRS, MITOVASC, Équipe CARME ou Equipe MITOLAB, SFR ICAT, F-49000, Angers, France
| | - Céline Bris
- Genetics Department, Angers Hospital, F-49000, Angers, France
- Univ Angers, [CHU Angers], Inserm, CNRS, MITOVASC, Équipe CARME ou Equipe MITOLAB, SFR ICAT, F-49000, Angers, France
| | - Estelle Colin
- Genetics Department, Angers Hospital, F-49000, Angers, France.
- Univ Angers, [CHU Angers], Inserm, CNRS, MITOVASC, Équipe CARME ou Equipe MITOLAB, SFR ICAT, F-49000, Angers, France.
| |
Collapse
|
2
|
Peng L, Cai Y, Wu J, Ling W, Wu Q, Guo S, Huang B, Jiang C, Weng Z. Prenatal diagnosis and clinical management of cardiac rhabdomyoma: a single-center study. Front Cardiovasc Med 2024; 11:1340271. [PMID: 38433754 PMCID: PMC10904520 DOI: 10.3389/fcvm.2024.1340271] [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: 11/27/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Objective The study aims to assess the ultrasonic features of fetal cardiac rhabdomyoma (CR), track the perinatal outcome and postnatal disease progression, investigate the clinical utility of ultrasound, MRI and tuberous sclerosis complex (TSC) gene analysis in CR evaluation, and offer evidence for determing of fetal CR prognosis. Methods We conducted a retrospective analysis of prenatal ultrasound-diagnosed fetal CR cases in our hospital from June 2011 to June 2022, tracked the perinatal outcomes, regularly followed live infants to analyze cardiac lesion changes and disease progression, and compared the sensitivities of ultrasound, MRI and their combination in the detecting of intracranial sclerosing nodules. Results Our study included 54 fetuses with CR: 32 pregnancies were terminated, 22 were delivered, 35 were diagnosed with TSC, 13 had simple CR without TSC, and in 6 cases, remained unclear whether TSC accompanied the CR due to insufficient evidence. 45 fetuses (83.3%) had multiple lesions, while 9 fetuses (16.7%) presented with a single lesion. Twelve cases had intracardiac complications, all associated with multiple lesions, and these cases exhibited larger maximum tumor diameters than the non-complicated group. Multiple intracardiac lesions were more prevalent in the TSC group than in the simple CR group. However, there was no significant difference in maximum tumor diameter between the two groups. Among 30 fetuses who underwent fetal brain MRI, 23 were eventually diagnosed with TSC, with 11 fetuses showing intracranial sclerosis nodules by ultrasound and 15 by MRI, and the diagnostic consistency was moderate (k = 0.60). Twenty-two fetuses were born and followed up for 6-36 months. CR lesions diminished or disappeared in 18 infants (81.8%), while they remained unchanged in 4 infants (18.2%). Ten out of 12 (83.3%) surviving children diagnosed with TSC developed epilepsy, and 7 (58.3%) had neurodevelopmental dysfunction. Conclusions The majority of CR cases involve multiple lesions, which are a primary risk factor for TSC. Through prenatal ultrasound examination is crucial for assessing fetal CR prognosis. Although ultrasound combined with MRI can detect intracranial sclerosis nodules in TSC fetuses, its sensitivity is limited. TSC gene sequencing is an essential diagnostic method. Simple CR cases without TSC generally have a favorable prognosis.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Caihong Jiang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zongjie Weng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| |
Collapse
|
3
|
Fogante M, Ventura F, Schicchi N, Regnicolo L, Potente C, Argalia G, Polonara G. Cardiac rhabdomyomas and cerebral lesions in 4 pediatric patients with tuberous sclerosis. Radiol Case Rep 2023; 18:2645-2648. [PMID: 37287722 PMCID: PMC10241653 DOI: 10.1016/j.radcr.2023.04.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 06/09/2023] Open
Abstract
Rhabdomyoma is the most common primary cardiac tumor in pediatric patients. A strong association exists between cardiac rhabdomyomas and tuberous sclerosis (TS), an autosomal dominant disease, characterized by diffuse lesions in the nervous system, such as cortical-subcortical tubers and subependymal nodules. In TS, cardiac rhabdomyomas typically are diagnosed in childhood, but they could be detected in the neonatal period with echocardiography and magnetic resonance imaging and may precede cerebral lesions. Therefore, the precocious detection of cardiac rhabdomyomas in pediatric patients can suggest the diagnosis of TS and the early detection of cerebral lesions, improving the management of the related symptoms. We reported the cases of 4 pediatric patients, in which the detection of cardiac rhabdomyomas lead to the early discovery of cerebral lesions and the diagnosis of the TS.
Collapse
Affiliation(s)
- Marco Fogante
- Department of Radiology, University Hospital of Marche, Via Conca 71, Ancona 60126, Italy
| | | | - Nicolò Schicchi
- SOS Diagnostica Radiologica Cardiovascolare – University Hospital of Marche, Ancona, Italy
| | - Luana Regnicolo
- Department of Neuroradiology, University Hospital of Marche, Ancona, Italy
| | - Chiara Potente
- Department of Neuroradiology, University Hospital of Marche, Ancona, Italy
| | - Giulio Argalia
- Department of Radiology, University Hospital of Marche, Via Conca 71, Ancona 60126, Italy
| | - Gabriele Polonara
- Department of Specialized Clinical Sciences and Odontostomatology, Polytechnic University of Marche, Ancona, Italy
| |
Collapse
|
4
|
霞 王, 一峰 丁, 渊峰 周, 莉斐 郁, 水珍 周, 艺 王, 佶 王. 产前诊断和干预改善结节性硬化症儿童的发育和癫痫结局. Dev Med Child Neurol 2023; 65:e43-e47. [PMID: 36039502 DOI: 10.1111/dmcn.15374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
5
|
Grgat D, Dilber D, Hrabak Paar M. Common benign primary pediatric cardiac tumors: a primer for radiologists. Jpn J Radiol 2022; 41:477-487. [PMID: 36495370 DOI: 10.1007/s11604-022-01371-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
Cardiac tumors are neoplasms arising from or located in the heart or the pericardium. Although rare, primary cardiac tumors in children require an accurate and timely diagnosis. Most pediatric primary cardiac tumors are benign (around 90%). Echocardiography is the first imaging modality used due to its availability, noninvasiveness, inexpensiveness, and absence of ionizing radiation. Computed tomography (CT) and magnetic resonance imaging (MRI) offer better soft tissue visualization as well as better visualization of extracardiac structures. A great advantage of MRI is the possibility of measuring cardiac function and blood flow, which can be important for obstructing cardiac tumors. In this article, we will offer a brief review of clinical, echocardiographic, CT, and MRI features of cardiac rhabdomyomas, fibromas, teratomas, and lipomas providing their differential diagnosis.
Collapse
Affiliation(s)
- Dora Grgat
- Institute for Emergency Medicine of Zagreb County, Velika Gorica, Croatia
| | - Daniel Dilber
- School of Medicine, Department of Pediatrics, University of Zagreb, University Hospital Center Zagreb, Zagreb, Croatia
| | - Maja Hrabak Paar
- School of Medicine, Department of Diagnostic and Interventional Radiology, University of Zagreb, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
| |
Collapse
|
6
|
Wang X, Ding Y, Zhou Y, Yu L, Zhou S, Wang Y, Wang J. Prenatal diagnosis and intervention improve developmental outcomes and epilepsy prognosis in children with tuberous sclerosis complex. Dev Med Child Neurol 2022; 64:1230-1236. [PMID: 35612999 DOI: 10.1111/dmcn.15265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 12/15/2022]
Abstract
AIM To assess whether prenatal diagnosis and early intervention are beneficial for developmental outcomes and epilepsy prognosis in individuals with tuberous sclerosis complex (TSC). METHOD This retrospective study originated from a single-centre TSC-specific cohort. We enrolled 273 individuals (138 males, 145 females; 2 years-7 years 6 months, mean 4 years 5 months, SD 1 year 6 months) with definitive TSC who completed TSC1/TSC2 genetic testing and were followed up to 2 years of age. The benefits of early attention and intervention were assessed by comparing epilepsy and developmental outcomes between groups with or without a prenatal diagnosis and with or without presymptomatic preventive intervention. RESULTS The epilepsy occurrence rate was significantly lower in individuals diagnosed prenatally than in individuals diagnosed postnatally (p = 0.027). In individuals diagnosed prenatally, the epilepsy rate in the preventive intervention subgroup was significantly lower than that in the subgroup without preventive intervention (p = 0.008). Significant improvements in cognitive, language, and motor development were observed in individuals diagnosed prenatally compared to individuals diagnosed postnatally and in the preventive intervention subgroup compared to the subgroup without preventive intervention (p < 0.05). INTERPRETATION Based on this study, we cautiously speculate that early postpartum intervention may reduce the incidence of epilepsy and intractable epilepsy and improve developmental outcomes. Prophylactic intervention with sirolimus and vigabatrin may reduce the incidence of epilepsy. Larger prospective randomized controlled studies are required to support these findings. WHAT THIS PAPER ADDS Prenatal diagnosis and early intervention may improve developmental outcomes in children with tuberous sclerosis complex (TSC). Prophylactic intervention with sirolimus and vigabatrin may reduce the incidence of epilepsy. Cardiac and/or intracranial lesions combined with genetic testing can be used to diagnose TSC prenatally.
Collapse
Affiliation(s)
- Xia Wang
- Department of Neonatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yifeng Ding
- Department of Neurology, Children's Hospital of Fudan University & National Children Medical Center, Shanghai, China
| | - Yuanfeng Zhou
- Department of Neurology, Children's Hospital of Fudan University & National Children Medical Center, Shanghai, China
| | - Lifei Yu
- Department of Neurology, Children's Hospital of Fudan University & National Children Medical Center, Shanghai, China
| | - Shuizhen Zhou
- Department of Neurology, Children's Hospital of Fudan University & National Children Medical Center, Shanghai, China
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University & National Children Medical Center, Shanghai, China
| | - Ji Wang
- Department of Neurology, Children's Hospital of Fudan University & National Children Medical Center, Shanghai, China
| |
Collapse
|
7
|
Qian T, Wu Z, Yang Y, Xie L, Yin N, Lu T, Huang C, Yang H. Surgery for Primary Cardiac Tumors in Children: Successful Management of Large Fibromas. Front Cardiovasc Med 2022; 9:808394. [PMID: 35321111 PMCID: PMC8934860 DOI: 10.3389/fcvm.2022.808394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Pediatric primary cardiac tumors (PCTs) are rare. Its clinical features and prognoses are not well defined. The management of asymptomatic patients with cardiac fibromas remains controversial. Objective We aimed to examine our experience in surgical resection of pediatric PCT, with specific focuses on the management of large fibromas. Methods This study included all the children who underwent surgical resection of PCT in our institution between December 2008 and June 2021. The last follow-up was performed between June 1st and August 26th, 2021. Kaplan–Meier method was used to estimate the postoperative survival, freedom from reoperation, event-free survival, and also related risk factors. The tumor volume and volume index (volume divided by body surface area) were measured for cardiac fibromas. Results Of the 39 patients with median operative age of 9.5 [interquartile range (IQR): 1.2–16.5] years, 35 (89.7%) had benign tumors (fibromas for 15, myxomas for 13, and others for 7). The length and volume of fibromas were independent of age and symptoms (Ps > 0.05). The fibroma volume index was negatively correlated with age (P = 0.039), with a mean value of 105 ± 70 ml/m2. Of the 15 patients with fibromas, 5 were asymptomatic, 4 received partial resection, 4 required transmural resection, and 4 presented postoperative left ventricular (LV) dysfunction (ejection fraction <50%). During the median follow-up period of 3.1 years and maximum of 12.5 years, adverse events included 2 early and 1 late death, 4 reoperations, 4 tumor recurrences, and 1 LV dysfunction lasting over one year. The 8-year survival, freedom from reoperation, and event-free survival rates were 90.4, 81.8, and 64.2%, respectively. Malignant tumor (P < 0.001) was associated with more adverse events. Transmural resection (P = 0.022) and larger tumor volume index than LV end-diastolic volume (P = 0.046) were risk factors for LV dysfunction following fibromas resection. Conclusion Pediatric surgery for PCT can be performed with low mortalities and few adverse events. The size of cardiac fibroma in children relatively decreases with the increase of age. Larger tumor volume index than LV end-diastolic volume index and transmural tumor resection predicts postoperative LV dysfunction.
Collapse
Affiliation(s)
- Tao Qian
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- National Health Commission Key Laboratory of Birth Defects Research, Prevention, and Treatment, Changsha, China
- *Correspondence: Zhongshi Wu
| | - Yifeng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Li Xie
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ni Yin
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ting Lu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Can Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Yang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| |
Collapse
|