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Zhou Z, Sun Z, Zhang J, Zhou Y. Asymptomatic nasal nodule in an adolescent girl. Pediatr Dermatol 2024. [PMID: 38890000 DOI: 10.1111/pde.15678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/01/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Zhiyue Zhou
- Department of Dermatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Zhaojun Sun
- Department of Dermatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Jianglin Zhang
- Department of Dermatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Youyou Zhou
- Department of Dermatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
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Gao Q, Yang Z, Ma N, Chen S, Li Y. Treatment of giant neurofibromas in extremities and trunk wall of neurofibromatosis type 1 patients: a Chinese 12-year single-institution experience. ANZ J Surg 2024. [PMID: 38819112 DOI: 10.1111/ans.19101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 05/03/2024] [Accepted: 05/12/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUNDS Giant neurofibromas occurring in individuals diagnosed with neurofibromatosis type 1 (NF1) often result in considerable disfigurement, functional impairment, and diminished quality of life. Although debulking surgery poses inherent risks of complications, it remains the most efficacious approach to address these issues. The primary objective of this study was to share our surgical experience with giant neurofibromas in the extremities and trunk wall of NF1 patients which may help surgeons to minimize intraoperative bleeding and facilitate tumor excision. METHODS A retrospective review was conducted at a single center, encompassing 36 NF1 patients with giant neurofibromas in the extremities and trunk wall who underwent debulking surgery from July 2010 to July 2022. RESULTS Twenty-one male and fifteen female NF1 patients who received one to four surgical interventions were evaluated. The average age at the time of surgery was 17.8 years. The median follow-up time was 52 months. Our findings revealed relatively low rates of complications and recurrence. Notably, patients expressed satisfaction with both the aesthetic and functional results. CONCLUSIONS Debulking surgery of giant neurofibromas in the extremities and trunk wall of NF1 patients can effectively reduce the tumor burden, leading to improvements in both the appearance and function.
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Affiliation(s)
- Qianqian Gao
- The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhe Yang
- The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Ma
- The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sen Chen
- The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangqun Li
- The 2nd Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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3
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Bernal Masferrer L, Matei MC, Gilaberte Calzada Y, Navarro Campoamor L. Congenital and Hereditary Nail Disease. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00341-7. [PMID: 38663727 DOI: 10.1016/j.ad.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/30/2024] [Accepted: 04/08/2024] [Indexed: 05/31/2024] Open
Abstract
Nail disorders in newborns can show independently or as components of systemic illnesses or genodermatoses. The examination of these abnormalities is complex and sometimes challenging. However, familiarity with these disorders can significantly contribute to uncovering potential underlying conditions. This review includes the physiological nail changes seen within the first few months of life, such as Beau's lines, onychoschizia, koilonychia, congenital nail fold hypertrophy of the first digit, and onychocryptosis. This review also focuses on the most relevant congenital disorders reported and how to perform differential diagnosis. Finally, this review highlights those hereditary diseases in which nail involvement is crucial for diagnosis, such as nail-patella syndrome, congenital pachyonychia, or congenital dyskeratosis, among others.
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Affiliation(s)
| | - M C Matei
- Departamento de Dermatología, Hospital Miguel Servet, Zaragoza, España.
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Bildirici Y, Kocaaga A, Karademir-Arslan CN, Yimenicioglu S. Evaluation of Molecular and Clinical Findings in Children With Neurofibromatosis Type 1: Identification of 15 Novel Variants. Pediatr Neurol 2023; 149:69-74. [PMID: 37806041 DOI: 10.1016/j.pediatrneurol.2023.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is the most common neurocutaneous disease and is caused by mutations in the NF1 gene. The most common clinical features of NF1 are pigmentary abnormalities such as café-au-lait spots and inguinal or axillary freckling, cutaneous and plexiform neurofibromas, hamartomas of the iris, optic gliomas, and bone lesions. The aim of this retrospective study was to define the clinical and molecular characteristics of a pediatric sample of NF1, as well as the mutational spectrum and genotype-phenotype correlation. METHODS The study included 40 children with clinically suspected NF1. The patients were screened for NF1 mutations by DNA-based sequencing. In addition, all the patients were studied by multiplex ligation-dependent probe amplification (MLPA) to identify any duplications or deletions in NF1. The demographic, clinical, and genetic features of the children were characterized. RESULTS A total of 40 children with NF1 were included. Of those, 28 were female and 12 were male. The mean age was 8.91 years. An NF1 variant was discovered in 28 of 40 patients (70%). Among these mutations, intronic mutations were the most frequently detected mutations; 15 of these variants had not been previously reported. Only one patient had a whole NF1 gene deletion. CONCLUSIONS This study expands the spectrum of mutations in the NF1 gene. This study also showed that genetic screening using both next-generation sequencing and MLPA had a positive effect on diagnosis and genetic counseling in patients with suspected NF1.
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Affiliation(s)
- Yasar Bildirici
- Department of Pediatrics, Eskişehir City Hospital, Eskişehir, Turkey
| | - Ayca Kocaaga
- Department of Medical Genetics, Eskişehir City Hospital, Eskişehir, Turkey.
| | | | - Sevgi Yimenicioglu
- Department of Pediatric Neurology, Eskişehir City Hospital, Eskişehir, Turkey
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5
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Kim HJ, Lee SH. Unusual skin pigmentation after unilateral adrenalectomy due to pheochromocytoma: a case report. Gland Surg 2023; 12:860-866. [PMID: 37441017 PMCID: PMC10333771 DOI: 10.21037/gs-22-521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/17/2023] [Indexed: 07/15/2023]
Abstract
Background Skin pigmentation after adrenalectomy occurs due to an increase in adrenocorticotropic hormone (ACTH) following adrenal insufficiency. ACTH-induced pigmentation usually appears as generalized hyperpigmentation and is known to appear after bilateral adrenalectomy. We report a case of unusual transient hyperpigmentation that developed immediately after unilateral adrenalectomy for pheochromocytoma and spontaneously resolved without corticosteroid supplementation. Case Description A 29-year-old woman was admitted to the hospital due to sudden-onset chest pain and headache. A 2.8-cm left adrenal mass with heterogeneous enhancement was incidentally found in chest computed tomography during the evaluation. Multiple old infarctions were observed in brain magnetic resonance imaging (MRI), and left ventricular thrombi were found by echocardiography. Biochemical evidence confirmed the diagnosis of pheochromocytoma, while serum ACTH and cortisol levels were within normal ranges. The patient underwent laparoscopic left adrenalectomy via a posterior retroperitoneal approach and recovered without immediate postoperative complications. On day 3 after surgery, a crescent-shaped café-au-lait skin pigmentation occurred on both the subcostal and the lumbar areas of the abdomen. Serial serum cortisol slightly decreased during the immediate postoperative period and recovered on day 3. Serum ACTH was elevated. Under close observation without corticosteroid supplementation, the pigmentation faded on day 8 after surgery. On day 15, the pigmentation clearly disappeared and serum ACTH decreased to within the normal range. A month later, ACTH and all adrenal hormones were within normal range. Conclusions We hypothesized that skin pigmentation appeared due to an imbalance of the hypothalamic-pituitary-adrenal (HPA) axis after resection of one adrenal gland. Skin pigmentation may be the first and early manifestation of adrenal insufficiency in patients who undergo unilateral adrenalectomy due to a non-Cushing's tumor. Therefore, a careful physical examination may allow early detection of adrenal insufficiency and optimal treatment planning.
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Affiliation(s)
- Hee Ju Kim
- Division of Endocrine Surgery, Department Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - So Hee Lee
- Division of Endocrine Surgery, Department Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
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6
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Gao Q, Qu S, Ma N, Wang W, Chen S, Yang Z, Li Y. Risk factors for intraoperative hemorrhage of Type I neurofibromatosis. BMC Surg 2023; 23:157. [PMID: 37301968 DOI: 10.1186/s12893-023-02067-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Neurofibromatosis (NF) is an inherited disease and a benign tumor originating from nerve sheath cells. Neurofibromatosis type I (NF1) is the most common type, and most cases are characterized by neurofibromas. Neurofibromas in NF1 are mainly treated by surgery. Our study explores the risk factors for intraoperative hemorrhage in Type I neurofibromatosis patients who underwent neurofibroma resection. METHODS A cross-sectional comparison of the patients who had undergone resection of neurofibroma for NF1. Data regarding patient characteristics and data about operative outcomes were recorded. The definition of intraoperative hemorrhage group was the intraoperative blood loss greater than 200 ml. RESULTS Of 94 eligible patients, 44 patients were in the hemorrhage group and 50 patients were in the non-hemorrhage group. Multiple logistic regression analysis demonstrated that the area of excision, classification, surgical site, primary surgical, and organ deformation were significant independent predictors of hemorrhage. CONCLUSION Early treatment can reduce the tumor cross-sectional area, avoid organ deformation, and reduce intraoperative blood loss. For plexiform neurofibroma or neurofibroma of the head and face, the amount of blood loss should be predicted correctly, and preoperative evaluation and blood preparation should be paid more attention to.
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Affiliation(s)
- Qianqian Gao
- 2nd Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, 100144, Beijing, China
| | - Siwei Qu
- 2nd Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, 100144, Beijing, China
| | - Ning Ma
- 2nd Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, 100144, Beijing, China
| | - Weixin Wang
- 2nd Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, 100144, Beijing, China
| | - Sen Chen
- 2nd Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, 100144, Beijing, China
| | - Zhe Yang
- 2nd Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, 100144, Beijing, China.
| | - Yangqun Li
- 2nd Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, 100144, Beijing, China.
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Poplausky D, Young JN, Tai H, Rivera-Oyola R, Gulati N, Brown RM. Dermatologic Manifestations of Neurofibromatosis Type 1 and Emerging Treatments. Cancers (Basel) 2023; 15:2770. [PMID: 37345107 DOI: 10.3390/cancers15102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 06/23/2023] Open
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant tumor predisposition syndrome that increases one's risk for both benign and malignant tumors. NF1 affects every organ in the body, but the most distinctive symptoms that are often the most bothersome to patients are the cutaneous manifestations, which can be unsightly, cause pain or pruritus, and have limited therapeutic options. In an effort to increase awareness of lesser-known dermatologic associations and to promote multidisciplinary care, we conducted a narrative review to shed light on dermatologic associations of NF1 as well as emerging treatment options. Topics covered include cutaneous neurofibromas, plexiform neurofibromas, diffuse neurofibromas, distinct nodular lesions, malignant peripheral nerve sheath tumors, glomus tumors, juvenile xanthogranulomas, skin cancer, and cutaneous T-cell lymphoma.
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Affiliation(s)
- Dina Poplausky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jade N Young
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Hansen Tai
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ryan Rivera-Oyola
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Nicholas Gulati
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rebecca M Brown
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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8
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Neurofibromatosis Type 1: Pediatric Aspects and Review of Genotype-Phenotype Correlations. Cancers (Basel) 2023; 15:cancers15041217. [PMID: 36831560 PMCID: PMC9954221 DOI: 10.3390/cancers15041217] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant condition, with a birth incidence of approximately 1:2000-3000, caused by germline pathogenic variants in NF1, a tumor suppressor gene encoding neurofibromin, a negative regulator of the RAS/MAPK pathway. This explains why NF1 is included in the group of RASopathies and shares several clinical features with Noonan syndrome. Here, we describe the main clinical characteristics and complications associated with NF1, particularly those occurring in pediatric age. NF1 has complete penetrance and shows wide inter- and intrafamilial phenotypic variability and age-dependent appearance of manifestations. Clinical presentation and history of NF1 are multisystemic and highly unpredictable, especially in the first years of life when penetrance is still incomplete. In this scenario of extreme phenotypic variability, some genotype-phenotype associations need to be taken into consideration, as they strongly impact on genetic counseling and prognostication of the disease. We provide a synthetic review, based on the most recent literature data, of all known genotype-phenotype correlations from a genetic and clinical perspective. Molecular diagnosis is fundamental for the confirmation of doubtful clinical diagnoses, especially in the light of recently revised diagnostic criteria, and for the early identification of genotypes, albeit few, that correlate with specific phenotypes.
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Cavallo ND, Maggi G, Ferraiuolo F, Sorrentino A, Perrotta S, Carotenuto M, Santangelo G, Santoro C. Neuropsychiatric Manifestations, Reduced Self-Esteem and Poor Quality of Life in Children and Adolescents with Neurofibromatosis Type 1 (NF1): The Impact of Symptom Visibility and Bullying Behavior. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020330. [PMID: 36832459 PMCID: PMC9955783 DOI: 10.3390/children10020330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant condition, associated with neurocutaneous manifestations and neuropsychiatric manifestations. The present study explored the prevalence of bullying/cyberbullying behaviors and victimization behaviors in a cohort of children and adolescents with NF1. Possible gender differences and predictors of psychological symptoms, quality of life (QoL), and self-esteem were also examined. Thirty-eight school-aged participants with NF1 completed a psychological evaluation designed to assess anxiety and depression symptomatology, QoL, self-esteem, and the prevalence and extent of bullying/cyberbullying and victimization behaviors. We found that our participants frequently reported victimization behaviors rather than bullying/cyberbullying ones. Moreover, participants complained of depressive and anxiety symptomatology together with reduced self-esteem, and low psychosocial quality of life, with females reporting more severe performances than males. Furthermore, we found that reduced self-esteem was associated with more visibility of the NF1 symptoms, and victimization behaviors were found to mediate the relationship between anxiety and psychosocial QoL. Our findings indicated the presence of a maladaptive loop in children and adolescents with NF1 patients characterized by psychological symptoms, unfavorable self-perception, low self-esteem, and psychosocial difficulties that might be worsened by experiencing victimization behaviors. These results suggest the need to use a multidisciplinary approach in the diagnosis and treatment of NF1.
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Affiliation(s)
- Nicola Davide Cavallo
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Gianpaolo Maggi
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Francesco Ferraiuolo
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Anna Sorrentino
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Silverio Perrotta
- Department of Women’s and Children’s Health, and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Marco Carotenuto
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Clinic, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
- Correspondence:
| | - Claudia Santoro
- Department of Women’s and Children’s Health, and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Clinic, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
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Ho JD, Ho JA, Ruddock R, Spencer SA. Isolated, Nonsyndromic Mucocutaneous Plexiform Neurofibromas: A Systematic Review of the Clinicopathologic Features. Am J Dermatopathol 2022; 44:904-912. [DOI: 10.1097/dad.0000000000002322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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AlAnsari GA, Bukhari N, Abdulkader MM, Alotain I, Taha MS. Malignant anaplastic meningioma in neurofibromatosis type 1 patient: a rare case report. AME Case Rep 2022; 6:36. [PMID: 36339910 PMCID: PMC9634465 DOI: 10.21037/acr-22-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/25/2022] [Indexed: 09/29/2023]
Abstract
BACKGROUND Meningiomas are usually associated with neurofibromatosis type 2 (NF-2), while gliomas are usually associated with neurofibromatosis type 1 (NF-1). NF-1 is an autosomal dominant genetic disorder associated with skin manifestations, bone conditions, and different types of benign and malignant tumors. Grade 3 anaplastic meningiomas are rare tumors with a poor prognosis. Systemic treatments in grade 3 meningiomas are experimental, with some reports suggestive of minimal clinical benefits. They are used occasionally for recurrent cases with no surgical or radiotherapy roles. In our case, we will focus the discussion on grade 3 anaplastic meningioma in a patient with NF-1, using chemotherapy for this aggressive, recurrent tumor. To our knowledge, this is the first case of NF-1 associated with malignant anaplastic meningioma in English literature. CASE DESCRIPTION In this case report, we present a 25-year-old left-handed female patient who fits the diagnostic criteria for NF-1. She presented with focal seizure and was diagnosed with grade 3 anaplastic meningioma, a highly aggressive tumor. She experienced a rapid recurrence after her initial surgery and eventually received multiple lines of treatments, including radiation and chemotherapy [temozolomide (TMZ)]. CONCLUSIONS Systemic therapy in grade 3 meningiomas is still experimental and may have a slight clinical benefit. As a result, further prospective, multicentric studies are needed to ascertain these outcomes. Patients should be included in prospective trials because of the poor prognosis and aggressive nature of grade 3 meningiomas. In addition, discovering specific molecular biomarkers will allow us to suggest an individualized treatment. This case suggests that the differential diagnosis of a mass in a patient with NF-1 should include tumors known to be associated with the syndrome as well as sporadic, unrelated neoplasms.
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Affiliation(s)
- Ghada A. AlAnsari
- Department of Neurosurgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Nedal Bukhari
- Department of Medical Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
- Department of Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Marwah M. Abdulkader
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ibrahim Alotain
- Department of Radiation Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mahmoud S. Taha
- Department of Neurosurgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Thomas IN, Balasundaram A, James JJ, Shanmugam NP. Ankle Swelling in Patients With Type 1 Neurofibromatosis: A Report of Two Cases With Rare Presentation of Common Genodermatosis. Cureus 2022; 14:e28938. [PMID: 36237736 PMCID: PMC9547610 DOI: 10.7759/cureus.28938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/20/2022] Open
Abstract
Neurofibromatosis type 1 is characterized by multiple cutaneous neurofibromas of varying sizes along with skeletal, neurologic, and ophthalmic features. Solitary swellings in neurofibromatosis type 1 are not commonly encountered except in the form of plexiform neurofibromas. We report two cases with neurofibromatosis type 1 presenting with solitary swelling in the ankles which were proven to be the diffuse type of neurofibroma, radiologically and histopathologically. Diffuse type neurofibroma presenting as ankle swelling in type 1 neurofibromatosis has not been reported before.
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13
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Identification of Germinal Neurofibromin Hotspots. Biomedicines 2022; 10:biomedicines10082044. [PMID: 36009591 PMCID: PMC9405573 DOI: 10.3390/biomedicines10082044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022] Open
Abstract
Neurofibromin is engaged in many cellular processes and when the proper protein functioning is impaired, it causes neurofibromatosis type 1 (NF1), one of the most common inherited neurological disorders. Recent advances in sequencing and screening of the NF1 gene have increased the number of detected variants. However, the correlation of these variants with the clinic remains poorly understood. In this study, we analyzed 4610 germinal NF1 variants annotated in ClinVar and determined on exon level the mutational spectrum and potential pathogenic regions. Then, a binomial and sliding windows test using 783 benign and 938 pathogenic NF1 variants were analyzed against functional and structural regions of neurofibromin. The distribution of synonymous, missense, and frameshift variants are statistically significant in certain regions of neurofibromin suggesting that the type of variant and its associated phenotype may depend on protein disorder. Indeed, there is a negative correlation between the pathogenic fraction prediction and the disorder data, suggesting that the higher an intrinsically disordered region is, the lower the pathogenic fraction is and vice versa. Most pathogenic variants are associated to NF1 and our analysis suggests that GRD, CSRD, TBD, and Armadillo1 domains are hotspots in neurofibromin. Knowledge about NF1 genotype–phenotype correlations can provide prognostic guidance and aid in organ-specific surveillance.
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Wang MX, Dillman JR, Guccione J, Habiba A, Maher M, Kamel S, Panse PM, Jensen CT, Elsayes KM. Neurofibromatosis from Head to Toe: What the Radiologist Needs to Know. Radiographics 2022; 42:1123-1144. [PMID: 35749292 DOI: 10.1148/rg.210235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2) are autosomal dominant inherited neurocutaneous disorders or phakomatoses secondary to mutations in the NF1 and NF2 tumor suppressor genes, respectively. Although they share a common name, NF1 and NF2 are distinct disorders with a wide range of multisystem manifestations that include benign and malignant tumors. Imaging plays an essential role in diagnosis, surveillance, and management of individuals with NF1 and NF2. Therefore, it is crucial for radiologists to be familiar with the imaging features of NF1 and NF2 to allow prompt diagnosis and appropriate management. Key manifestations of NF1 include café-au-lait macules, axillary or inguinal freckling, neurofibromas or plexiform neurofibromas, optic pathway gliomas, Lisch nodules, and osseous lesions such as sphenoid dysplasia, all of which are considered diagnostic features of NF1. Other manifestations include focal areas of signal intensity in the brain, low-grade gliomas, interstitial lung disease, various abdominopelvic neoplasms, scoliosis, and vascular dysplasia. The various NF1-associated abdominopelvic neoplasms can be categorized by their cellular origin: neurogenic neoplasms, interstitial cells of Cajal neoplasms, neuroendocrine neoplasms, and embryonal neoplasms. Malignant peripheral nerve sheath tumors and intracranial tumors are the leading contributors to mortality in NF1. Classic manifestations of NF2 include schwannomas, meningiomas, and ependymomas. However, NF2 may have shared cutaneous manifestations with NF1. Lifelong multidisciplinary management is critical for patients with either disease. The authors highlight the genetics and molecular pathogenesis, clinical and pathologic features, imaging manifestations, and multidisciplinary management and surveillance of NF1 and NF2. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Mindy X Wang
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Jonathan R Dillman
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Jeffrey Guccione
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Ahmed Habiba
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Marwa Maher
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Serageldin Kamel
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Prasad M Panse
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Corey T Jensen
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
| | - Khaled M Elsayes
- From the Department of Radiology (M.X.W., C.T.J., K.M.E.) and Department of Lymphoma and Myeloma (S.K.), University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX 77030-4009; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (J.R.D.); Department of Radiology, Stanford University, Stanford, Calif (J.G.); Department of Radiology (A.H.) and Faculty of Medicine (M.M.), Alexandria University, Alexandria, Egypt; and Department of Radiology, Mayo Clinic Arizona, Phoenix/Scottsdale, Ariz (P.M.P.)
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15
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Ardizzone A, Capra AP, Campolo M, Filippone A, Esposito E, Briuglia S. Neurofibromatosis: New Clinical Challenges in the Era of COVID-19. Biomedicines 2022; 10:biomedicines10050940. [PMID: 35625677 PMCID: PMC9138859 DOI: 10.3390/biomedicines10050940] [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: 03/25/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023] Open
Abstract
Rare diseases constitute a wide range of disorders thus defined for their low prevalence. However, taken together, rare diseases impact a considerable percentage of the world population, thus representing a public healthcare problem. In particular, neurofibromatoses are autosomal-dominant genetic disorders that include type 1 neurofibromatosis (NF1), type 2 neurofibromatosis (NF2) and schwannomatosis. Each of the three types is a genetically distinct disease with an unpredictable clinical course and for which there is still no resolutive cure. Therefore, a personalized therapeutic approach directed at improving the symptomatology as well as the search for new pharmacological strategies for the management of neurofibromatosis represents a priority for positive outcomes for affected patients. The coronavirus disease 2019 (COVID-19) pandemic has severely affected health systems around the world, impacting the provision of medical care and modifying clinical surveillance along with scientific research procedures. COVID-19 significantly worsened exchanges between healthcare personnel and neurofibromatosis patients, precluding continuous clinical monitoring in specialized clinic centers. In this new scenario, our article presents, for the first time, a comprehensive literature review on the clinical challenges for neurofibromatosis clinical care and research during the COVID-19 pandemic health emergency. The review was performed through PubMed (Medline) and Google Scholar databases until December 2021.
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Affiliation(s)
- Alessio Ardizzone
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (A.A.); (A.P.C.); (M.C.); (A.F.)
| | - Anna Paola Capra
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (A.A.); (A.P.C.); (M.C.); (A.F.)
| | - Michela Campolo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (A.A.); (A.P.C.); (M.C.); (A.F.)
| | - Alessia Filippone
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (A.A.); (A.P.C.); (M.C.); (A.F.)
| | - Emanuela Esposito
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (A.A.); (A.P.C.); (M.C.); (A.F.)
- Correspondence: ; Tel.: +39-090-676-5208
| | - Silvana Briuglia
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy;
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16
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Sandru F, Popa A, Paduraru DN, Filipescu A, Carsote M, Ghemigian A. Skin anomalies in acromegalic patients (Review of the practical aspects). Exp Ther Med 2021; 22:1330. [PMID: 34630684 DOI: 10.3892/etm.2021.10765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/11/2021] [Indexed: 12/12/2022] Open
Abstract
Acromegaly is a hormonal disorder which occurs as the result of growth hormone (GH) and insulin growth factor 1 (IGF-1) over-secretion; both hormones are related to skin anomalies. The skin acts as a large endocrine organ, hosting GH receptors in every cell while IGF-1 receptors are expressed only in keratinocytes. This review is a literature review of skin anomalies found in acromegaly, either related to the disease itself or associated with related complications such as secondary diabetes mellitus, or involving associated conditions such as genetic syndromes. The following clinical points are mentioned as follows. Excessive skin and enlargement of soft tissue are due to glycosaminoglycan deposits, edema, and hyperhidrosis (mostly facial and acral). Acanthosis nigricans, a body fold dermatosis associated with insulin resistance, involves local or diffuse hyperkeratotic plaques with or without hyperpigmentation, caused by growth factors including GH/IGF-1. Other findings include cherry angiomas (due to the effects of lipid anomalies on small vessels); oily skin features with keratosis, epidermoid cysts, crochordons, pseudo-acanthosis nigricans; a potentially higher prevalence of varicose veins and psoriasis; low level of evidence for basal cell carcinoma, respective hidroadenitis suppurativa has been noted. In addition, complicated uncontrolled secondary diabetes mellitus (DM) may result in necrobiosis lipoidica diabeticorum, diabetic dermopathy, skin bacterial infections, dermatological complications of diabetic neuropathy, and nephropathy. Finally, associated hereditary syndromes may cause collagenomas, fibromas/angiofibromas, lipomas in multiple endocrine neoplasia type 1 (MEN1) syndrome; café-au-lait macules, early onset neurofibromas, juvenile xanthogranuloma (involving non-Langerhans cell histiocytes), and intertriginous freckling in neurofibromatosis type 1. Clinical findings are differentiated from pseudo-acromegaly such as pachydermoperiostosis. Iatrogenic rash, lipodystrophy (lipoatrophy with/without lipohypertrophy) are rarely reported after pegvisomant/somatostatin analogues or after insulin use for DM. Experiments using human cell lines have shown that GH/IGF-1 over-secretion are prone to epithelial-to-mesenchymal transition (EMT) in melanoma. In non-acromegalic subjects, the exact role of GH/IGF-1 in skin tumorigenesis is yet to be determined. Skin in acromegaly speaks for itself, either as the first step of disease identification or as a complication or part of a complex syndromic context.
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Affiliation(s)
- Florica Sandru
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, 'Elias' Emergency Hospital, 011461 Bucharest, Romania
| | - Adelina Popa
- Department of Dermatology, 'Elias' Emergency Hospital, 011461 Bucharest, Romania
| | - Dan Nicolae Paduraru
- Department of General Surgery, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of General Surgery, University Emergency Hospital, 050098 Bucharest, Romania
| | - Alexandru Filipescu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Elias' Emergency Hospital, 022461 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Endocrinology, 'C. I. Parhon' National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Adina Ghemigian
- Department of Endocrinology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Endocrinology, 'C. I. Parhon' National Institute of Endocrinology, 011863 Bucharest, Romania
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17
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Raj R, Elshimy G, Mishra R, Jha N, Joseph V, Bratman R, Tella SH, Correa R. Dermatologic Manifestations of Endocrine Disorders. Cureus 2021; 13:e18327. [PMID: 34692360 PMCID: PMC8526081 DOI: 10.7759/cureus.18327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/05/2022] Open
Abstract
Endocrine disorders are known to involve all organ systems of the body, including the skin. The cutaneous manifestations of endocrine disorders can range from common findings such as acanthosis nigricans, pretibial myxedema, acne, hirsutism, hyper or hypopigmentation to rare cutaneous findings such as miliaria rubra, calciphylaxis, lentigines, and calcinosis cutis. These cutaneous symptoms can sometimes be the presenting symptoms or can even be pathognomonic of the underlying endocrine condition. In some cases, the cutaneous symptoms from an underlying endocrine abnormality may be the most prominent. These symptoms can significantly affect the quality of life of individuals. Often, individuals may seek health care from a dermatologist or primary care physician for isolated skin symptoms. Therefore, it is imperative for physicians to recognize the skin symptoms as the manifestation of the endocrine disorder for prompt diagnosis and treatment of the underlying endocrine disorder.
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Affiliation(s)
- Rishi Raj
- Endocrinology, Diabetes and Metabolism, Pikeville Medical Center, Pikeville, USA
| | - Ghada Elshimy
- Endocrinology, Diabetes and Metabolism, Augusta University Medical College of Georgia, Augusta, USA
| | - Rahul Mishra
- Internal Medicine, Maulana Azad Medical College, Delhi, IND
| | - Nivedita Jha
- Internal Medicine, Adichunchanagiri Institute of Medical Sciences, Karnataka, IND
| | - Vismaya Joseph
- Data Science, University of Texas at Dallas, Richardson, USA
| | - Russell Bratman
- Endocrinology, Diabetes and Metabolism, Brown University, Rhode Island, USA
| | | | - Ricardo Correa
- Endocrinology, Diabetes and Metabolism, University of Arizona College of Medicine - Phoenix, Phoenix, USA
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