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Dao DPD, Pixley JN, Akkurt ZM, Feldman SR. A Review of Topical Sirolimus for the Treatment of Facial Angiofibromas in Tuberous Sclerosis Complex. Ann Pharmacother 2024; 58:428-433. [PMID: 37386842 DOI: 10.1177/10600280231182421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE This article assesses the efficacy, safety, pharmacology, and clinical applications of topical sirolimus 0.2% gel for the treatment of tuberous sclerosis complex (TSC)-associated facial angiofibromas. DATA SOURCES A review of the literature was conducted using the Medline (PubMed) and EMBASE databases using the keywords topical sirolimus, rapamycin, Hyftor, and tuberous sclerosis. STUDY SELECTION AND DATA EXTRACTION Articles written in English and relevant to the topic were included. DATA SYNTHESIS In the phase 2 trial, the mean improvement factor, a composite measure of improved tumor size and redness, was achieved in all patient groups (P < 0.001) with significant responses among the adult and pediatric subgroups at week 12. There were no serious adverse events recorded. In the phase 3 trial, 60% of participants responded to treatment in the sirolimus group compared with 0% in the placebo group with different response rates between the adult and pediatric subgroups at week 12. Sirolimus gel had no serious adverse events, and dry skin was the most common adverse reaction. Patients who had completed the 12-week trials were then enrolled in a long-term trial; angiofibromas had response rates of 78.2% to 0.2% sirolimus gel. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON TO EXISTING DRUGS Topical sirolimus 0.2% is a first-in-class, newly Food and Drug Administration (FDA)-approved, mammalian target of rapamycin (mTOR) inhibitor that is a promising and safe, noninvasive alternative to surgical procedures for TSC-associated angiofibromas. CONCLUSIONS Topical sirolimus 0.2% gel is a moderately effective treatment for TSC-associated facial angiofibromas with an adequate safety profile.
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Affiliation(s)
- Diem-Phuong D Dao
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jessica N Pixley
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Zeynep M Akkurt
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Hong CH, Lee CH. Ambient-stable topical rapamycin cream is effective in treating angiofibromas in tuberous sclerosis complex. Br J Dermatol 2023; 189:507-508. [PMID: 37672663 DOI: 10.1093/bjd/ljad334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Chien-Hui Hong
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Dermatology, National Yang-Ming Chiao-Tung University College of Medicine, Taipei, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Dermatology, Chang Gung University College of Medicine, Taoyuan, Taiwan
- School of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Li W, Ni Y, Lu H, Hu L, Wang D. Current perspectives on the origin theory of juvenile nasopharyngeal angiofibroma. Discov Med 2019; 27:245-254. [PMID: 31421693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Juvenile nasopharyngeal angiofibroma (JNA) is a histopathologically benign and highly vascular neoplasm, which is mainly seen in young adolescent men. It is a rare tumor, accounting for 0.05% of all head and neck neoplasms. The etiology of JNA has always been a controversial topic. Some researchers believe that it is a genuine tumor. Others consider that it is the result of vascular malformation caused by the non-absorption of artery residues in the first branchial arch during development, and that hormone and genetic effects are also related to its etiology. In addition, the JNA was so called because it was previously thought to originate from the nasopharynx. However, the origin site of JNA is not completely clear. Several studies emphasized that it originated from the upper lip of the sphenopalatine foramen at the junction of the sphenoid process of the palate and the pterygoid process, while others stressed that it originated from the pterygoid canal. Thus, further studies are needed for identifying the ultimate origin.
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Affiliation(s)
- Wanpeng Li
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Yang Ni
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Hanyu Lu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Li Hu
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Dehui Wang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, China
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Lee YI, Lee JH, Kim DY, Chung KY, Shin JU. Comparative Effects of Topical 0.2% Sirolimus for Angiofibromas in Adults and Pediatric Patients with Tuberous Sclerosis Complex. Dermatology 2018; 234:13-22. [PMID: 29925060 DOI: 10.1159/000489089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recent reports have suggested that the topical formulation of sirolimus is effective in treating facial angiofibromas in tuberous sclerosis complex (TSC). Here, we determined the safety and efficacy of 0.2% topical sirolimus for the treatment of facial angiofibroma and compared its effects based on age. METHOD This was a retrospective study which involved 36 TSC patients with facial angiofibromas who were treated with 0.2% sirolimus ointment. Its effect was evaluated using the Facial Angiofibroma Severity Index (FASI). In order to observe its comparative effect based on patient age, a subgroup analysis was performed, between the adult group (> 18 years old) and the pediatric group (≤18 years old). RESULTS The total FASI as well as its subcategories (erythema, size, and extent) showed statistically significant improvements after the topical treatment with 0.2% sirolimus ointment (FASI before treatment: 7.2 ± 1.1, FASI after treatment: 4.4± 1.4, p < 0.001). Among the subcategories of FASI, the erythema was most significantly reduced with the fastest response to the treatment. In a subgroup analysis, the pediatric group showed significantly greater improvements in FASI (improvement of FASI in the pediatric group = 49.7 ± 12.2%, adult group = 27.9 ± 15.6%, p < 0.001). The serial improvement analysis also showed that the pediatric group achieved a consistently greater improvement in FASI at all visits. Its 1-year application in 3 patients demonstrated a continuous maintenance effect. No significant adverse effects were observed. CONCLUSION 0.2% sirolimus ointment is safe and effective for facial angiofibromas. Considering its higher efficacy in younger patients, an early initiation of the treatment is recommended.
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Favia G, Tempesta A, Limongelli L, Maiorano E. Tuberous sclerosis: histological analysis with confocal laser scanning microscope of gingival angiofibromatosis. Pathologica 2015; 107:197-200. [PMID: 26946876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Tuberous sclerosis (TS) is an autosomal dominant neuro-cutaneous syndrome characterized by multiple hamartomas in various organs, especially on skin and central nervous system. The most common features of TS include facial angiofibromas, hypomelanotic cutaneous macules, shagreen patches in the lumbar area, cerebral cortical tubers, sub-ependymal nodules, sub-ependymal giant cell astrocytomas, cardiac rhabdomyomas, and renal angiomyolipomas. Frequently oral manifestations such as fibrous hyperplasia, angiofibromas and dental enamel pitting are also observed. The aim of this case report was to describe the histological aspects of oral diffuse hyperplastic angiofibromatosis, never reported in the English literature and analyzed by Confocal Laser Scanning Microscope (CLSM), and to highlight the surgical implications of these aspects such as use of Diode Laser. CASE REPORT A 14-years-old female patient with TS diagnosis came to our attention for diffuse gingival hyperplasia on the mandible. Clinical examination highlighted epidermal hamartomas on the whole body, especially on the face and scalp. Pathologic hyperplastic tissue was removed by pulsed diode laser at the power of 5-6W, and the surgical samples were sent for conventional and CLSM histopathological examination. After laser excision, wounds healed quickly without complications. At CLSM examination collagen fibres, showing intense fluorescence and with variable spatial orientation, and variably sized blood vessels were noticed suggesting the diagnosis of gingival angiofibromatosis, a still unreported finding in TS patients. CONCLUSIONS CLSM analysis allows to highlight some unusual histopathological features of TS; diode laser is very effective for the treatment of gingival angiofibromatosis.
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Abstract
CONCLUSION Mesenchymal-endothelial transition is proposed for juvenile angiofibromas (JAs). Propranolol might be an interesting new medical option in JA treatment, as it reduces mesenchymal cell growth and decreases the number of CD31-positive cells in vitro. OBJECTIVE Juvenile angiofibromas (JAs) are rare fibro-vascular tumors affecting almost exclusively adolescent males. Based on morphological aspects of irregularly configured vascular spaces and clinical features, JAs have been proposed to represent a vascular malformation. In general, mesenchymal-endothelial transition has been noted as an important process in tumorigenesis as well as in embryonal development. METHODS The study analyzed effects of vascular endothelial growth factor (VEGF)/basic fibroblast growth factor (bFGF) and propranolol on endothelial differentiation (CD31+) of cultured JA cells and their expression of angiogenic growth factors using aortic ring assay and enzyme-linked immunosorbent assay. RESULTS Following VEGF/bFGF supplement to cultured mesenchymal cells, an average of 4.47% (± 2.35%) CD31-positive cells were found (p < 0.001). Propranolol addition reduced the number of CD31-positive cells and inhibited mesenchymal cell growth. The aortic ring assay and ELISA investigation indicated no increased angiogenic growth factor secretion from cultured JA mesenchymal cells.
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Affiliation(s)
- Philipp Kulas
- Department of Otorhinolaryngology, Saarland University Medical Center , Homburg/Saar , Germany
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Dill PE, De Bernardis G, Weber P, Lösch U. Topical everolimus for facial angiofibromas in the tuberous sclerosis complex. A first case report. Pediatr Neurol 2014; 51:109-13. [PMID: 24810875 DOI: 10.1016/j.pediatrneurol.2014.02.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 02/05/2014] [Accepted: 02/19/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Facial angiofibromas are present in most of the patients with the tuberous sclerosis complex and may cause severe disfiguration of the face. The tumor growth in tuberous sclerosis complex is promoted by the disinhibition of the mammalian target of rapamycin pathway. Thus, the systemic treatment with mammalian target of rapamycin inhibitors such as sirolimus and everolimus has recently been established to treat specific tuberous sclerosis complex-associated lesions. For patients who suffer from disfiguring facial angiofibromas only, there is a need for a topical use of mammalian target of rapamycin inhibitors. Sirolimus has been shown to be beneficial in treating facial angiofibromas. But the topical use of everolimus, which has the approval to treat tuberous sclerosis complex-associated tumors, namely giant cell astrocytomas and renal angiofibromas, has not been reported. PATIENTS AND RESULTS We present a 10-year-old girl whose facial angiofibromas were successfully treated with an everolimus ointment without relevant side effects. In addition, we provide a short pharmacological overview of sirolimus and everolimus with focus on the topical use. CONCLUSIONS Topical everolimus seems to be a favorable and safe option for patients with facial angiofibromas who do not require systemic treatment.
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Affiliation(s)
- Patricia E Dill
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland; INSERM Unité 1511, Paris, France.
| | - Gaston De Bernardis
- INSERM Unité 1511, Paris, France; Division of Pediatric Surgery, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Peter Weber
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Uli Lösch
- Hospital Pharmacy, University Hospital Basel, University of Basel, Basel, Switzerland
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Tyburczy ME, Wang JA, Li S, Thangapazham R, Chekaluk Y, Moss J, Kwiatkowski DJ, Darling TN. Sun exposure causes somatic second-hit mutations and angiofibroma development in tuberous sclerosis complex. Hum Mol Genet 2014; 23:2023-9. [PMID: 24271014 PMCID: PMC3959815 DOI: 10.1093/hmg/ddt597] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 11/19/2013] [Accepted: 11/21/2013] [Indexed: 01/09/2023] Open
Abstract
Tuberous sclerosis complex (TSC) is characterized by the formation of tumors in multiple organs and is caused by germline mutation in one of two tumor suppressor genes, TSC1 and TSC2. As for other tumor suppressor gene syndromes, the mechanism of somatic second-hit events in TSC tumors is unknown. We grew fibroblast-like cells from 29 TSC skin tumors from 22 TSC subjects and identified germline and second-hit mutations in TSC1/TSC2 using next-generation sequencing. Eighteen of 22 (82%) subjects had a mutation identified, and 8 of the 18 (44%) subjects were mosaic with mutant allele frequencies of 0 to 19% in normal tissue DNA. Multiple tumors were available from four patients, and in each case, second-hit mutations in TSC2 were distinct indicating they arose independently. Most remarkably, 7 (50%) of the 14 somatic point mutations were CC>TT ultraviolet 'signature' mutations, never seen as a TSC germline mutation. These occurred exclusively in facial angiofibroma tumors from sun-exposed sites. These results implicate UV-induced DNA damage as a cause of second-hit mutations and development of TSC facial angiofibromas and suggest that measures to limit UV exposure in TSC children and adults should reduce the frequency and severity of these lesions.
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Affiliation(s)
- Magdalena E. Tyburczy
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ji-an Wang
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA and
| | - Shaowei Li
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA and
| | - Rajesh Thangapazham
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA and
| | - Yvonne Chekaluk
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Joel Moss
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - David J. Kwiatkowski
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Thomas N. Darling
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA and
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Sofoudis C, Kalampokas T, Boutas I, Kalampokas E, Salakos N. Morbus Bourneville: a case report and review of the literature. CLIN EXP OBSTET GYN 2014; 41:95-97. [PMID: 24707696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Tuberous sclerosis (TS) or tuberous sclerosis complex (TSC), also known as Bourneville disease or Bourneville-Pringle disease, is an autosomal dominant disorder classically characterized by the presence of hamartomatous growths in multiple organs. A combination of symptoms may include seizures, developmental delay, behavioral problems, skin abnormalities, and lung and kidney diseases. The authors present a case of a 18 year-old female patient with a history of TS, epileptic episodes, mental retardation, and papillary formations in multiple organs located at the abdominal, axillary, cervical, facial, and genital region.
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Tiedemann Svendsen M, Bygum A, Hansen LK, Broesby-Olsen S. [Facial angiofibromas associated to tuberous sclerosis treated with topical sirolimus]. Ugeskr Laeger 2013; 175:2569-2570. [PMID: 24629155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We present a five-year-old boy with facial angiofibromas associated to tuberous sclerosis successfully treated with topical sirolimus 0.4% applied three times a week for six months. After six months we observed a nearly complete resolution of facial angiofibromas. The blood levels of sirolimus remained under a detectable limit and no side-effects were observed. Topically applied sirolimus seems to be a safe and effective alternative to surgery or laser therapy.
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Abstract
Facial angiofibromas are dermatological manifestations of tuberous sclerosis complex, a neurocutaneous disorder characterized by excess cell growth and proliferation. Oral rapamycin has been used to treat visceral tuberous sclerosis-related tumors; however, the side effect profile of this medicine precludes its routine use in patients lacking significant internal involvement. The authors formulated a novel rapamycin cream that is easy to compound and apply, does not cause local or systemic side effects, and results in a dramatic improvement of facial angiofibromas.
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Affiliation(s)
- James W Wheless
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38105, USA.
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Pires CF, Anunciação GMADS, De Sousa WL, Santos BMDM, Anunciação FAC, Pires AF, Pires LF. [Tuberous sclerosis in childhood]. Dermatol Online J 2008; 14:14. [PMID: 19061596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Tuberous sclerosis is an autosomal dominant disease that results from mutations in one of two tumor suppressor genes, TSC1 and TSC2. We are reporting a two-year-old girl who presented with hypopigmented macules (ash leaf) in the skin and small erythematous facial papules (angiofibromas). Her mother was known to have tuberous sclerosis that was diagnosed at age seven. Although the signs of tuberous sclerosis were specifically looked for in this patient because of her mother, subtle angiofibromas in a young child can be easily missed.
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Abstract
Tuberous sclerosis complex (TSC) is an autosomal-dominant phacomatosis that manifests with visceral harmatomas, epilepsy, and mental retardation. Paranasal angiofibromas may cause bleeding and difficulties in nasal breathing and can stigmatise the individual. When treating TSC patients, the otolaryngologist must take patient compliance and the tendency to develop malignancies into account. We report on a 34-year-old woman who was treated successfully by a combination of CO(2) laser treatment and fibrin glue. The cosmetic results were excellent.
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Affiliation(s)
- A Pantelis
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde/Chirurgie, Rheinische Friedrich-Wilhelms-Universität, Sigmund-Freud-Str. 25, 53105, Bonn.
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Elifritz J, Krishnan RS, Donnelly H. Numerous fibrous papules of the face unassociated with any genodermatosis. Dermatol Online J 2007; 13:12. [PMID: 18319009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Numerous angiofibromas on the face are commonly associated with tuberous sclerosis or multiple endocrine neoplasia type 1. We present a healthy 66-year-old female with numerous facial angiofibromas, without evidence of tuberous sclerosis, multiple endocrine neoplasia type 1, or any of the less common syndromes associated with many angiofibromas on the face. To our knowledge, there have been no previously reported cases of patients with numerous facial angiofibromas who did not have an associated genodermatosis.
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Hori K, Soejima K, Nozaki M, Sakurai H, Takeuchi M, Yamaki T, Iwasaka S, Kono T, Honda T, Isago T. Treatment of facial angiofibroma of tuberous sclerosis using cultured epithelial autografts. Ann Plast Surg 2007; 57:415-7. [PMID: 16998334 DOI: 10.1097/01.sap.0000221621.34715.21] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Treatment of facial angiofibroma of tuberous sclerosis is problematic, because the skin lesions involve entire dermis. Five patients aged from 14 to 33 (mean: 23.6) years old with angiofibroma of tuberous sclerosis were treated with cultured epithelial autografts between 1995 and 2004. The entire area of the facial lesions was excised using a razor to remove large nodules, and then the remaining lesions were further abraded to a rather deep layer of the dermis to smooth the skin and remove small nodules. Then a cultured autologous epithelium was grafted onto the wound. In all patients, epithelization was complete within 10 (mean: 9) days after the surgery. All patients were followed up for more than 6 months and showed neither depigmentation due to scar formation nor hypertrophic scars. In some patients, some pebbly regrowth had occurred at 5 years postoperatively, but the appearance was quite acceptable.
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Affiliation(s)
- Keijiro Hori
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan.
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La Placa M, Gibellini D, Bianchi T, Patrizi A. Overexpression of MLH-1 and psoriasin genes in cutaneous angiofibromas from tuberous sclerosis complex patients. J Cutan Pathol 2006; 33:608-13. [PMID: 16965334 DOI: 10.1111/j.1600-0560.2006.00483.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is associated with mutations in two likely tumor-suppressor genes (TSC1 and TSC2) and characterized by the development of tumor-like growths (angiofibromas) in a variety of tissues and organs, particularly brain and skin. METHODS Employing a DNA-microarray assay, able to detect mRNA production from 1176 different basic genes, we analyzed the gene-expression levels in a cutaneous hamartoma sample from a TSC patient. Altered gene expressions detected by microarray technology were further checked by quantitative reverse-transcriptase polymerase chain reaction (RT-PCR) in the same material and in cutaneous hamartoma samples obtained from five other TSC patients. RESULTS The results obtained by the microarray technology in one hamartoma specimen, confirmed by the RT-PCR results obtained in the same material and in five other hamartoma specimens, demonstrated that TSC-related angiofibromas exhibit significant mRNA overexpression of two genes, represented by MLH-1 and psoriasin. CONCLUSIONS The overexpression of MLH-1, which codes for a DNA mismatch repair protein, and psoriasin, which codes for a specific chemoattractant factor for CD4+ T cells, implicated in the pathogenesis of inflammatory skin disease, and expressed in excess during abnormal pathways of cell growth, may shed light on the pathogenesis of the proliferative skin lesion.
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Affiliation(s)
- Michelangelo La Placa
- Department of Clinical and Experimental Medicine, Dermatology Section, University of Bologna, Bologna, Italy.
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Septer S, Thompson ES, Willemsen-Dunlap A. Anesthesia concerns for children with tuberous sclerosis. AANA J 2006; 74:219-25. [PMID: 16786916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Tuberous sclerosis (TS) is a relatively rare, autosomal dominant syndrome that displays high genetic penetrance in affected families. It is identified by a classic triad of symptoms including epilepsy, skin lesions, and mental retardation. Tuberous sclerosis causes hamartomas in multiple organ systems, including the brain, skin, heart, kidneys, lungs, and liver. Awareness of the signs and symptoms and the organs involved is critical to provide safe and effective anesthesia care. We describe a 10-year-old girl with TS scheduled to receive a general anesthetic for laser treatment of facial angiofibromas. The patient had several coexisting maladies from TS, including hypertension, autism, seizure disorder, cardiac rhabdomyomas, developmental delay, and bilateral polycystic renal disease. The laser procedure was performed, and there were no surgical or anesthetic complications. However, the potential for complications due to TS remained high throughout the provision of anesthesia care. Increased knowledge of TS and diligence in anesthesia practice can greatly reduce these risks.
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Affiliation(s)
- Mark Quigg
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA.
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Sudeep K, John M. Acute abdominal pain and palpable mass. Tuberous sclerosis. N Z Med J 2005; 118:U1692. [PMID: 16224859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- K Sudeep
- Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract
BACKGROUND Juvenile nasopharyngeal angiofibroma (JNA) is a rare tumor of adolescent males and there is a paucity of Indian studies on this subject. AIMS To present the experience of management of JNA at a single institution. SETTING AND DESIGN This is a retrospective observational study of patients with JNA who presented at the Tata Memorial Hospital between May 1988 and August 2001. MATERIALS AND METHODS Thirty-two patients with JNA were treated in the study period. Since the time period was prolonged and diagnostic and therapeutic protocols had undergone many changes, the patients were divided into two groups, namely 1988-1996 and 1997-2001. The age distribution, disease patterns, management approaches and treatment outcomes of patients in the two groups were recorded. Statistical analyses were done using students 't' test and test for proportion. RESULTS The mean age at presentation was 16 years and more than 90% of the patients had Stage III or IV disease. Preoperative embolization was carried out in 19 patients. The surgical approaches used were median maxillectomy, infratemporal fossa, transpalatal, maxillary swing and craniofacial approach. The recurrence rate, complete resection rate and cure rates were 12.5%, 41% and 63% respectively. CONCLUSION Surgery is the mainstay of treatment of JNA. Preoperative embolization and newer surgical approaches result in less blood loss and complete resection. Aggressive re-resection should be done for resectable recurrences reserving radiotherapy for unresectable, recurrent/ residual disease.
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Affiliation(s)
- Rajesh C Mistry
- Department of Head and Neck services, Tata Memorial Hospital, Ernest Borges Road, Parel, Mumbai, India.
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22
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Satgé D, Vidalo E, Desfarges F, de Geeter B. A Third Case of Cardiac Neoplasm in a Fetus with Beckwith-Wiedemann Syndrome: Epicardial Angiofibroma. Fetal Diagn Ther 2004; 20:44-7. [PMID: 15608459 DOI: 10.1159/000081368] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2003] [Accepted: 12/05/2003] [Indexed: 11/19/2022]
Abstract
OBJECTIVE A personal observation of a 20-week-old fetus with Beckwith-Wiedemann syndrome (BWS) presenting epicardial angiofibroma prompted us to evaluate cardiac neoplasms in this genetic condition. METHOD We performed an autopsy and a histological evaluation of the fetus, and searched the literature for cardiac anomalies in BWS. RESULTS Although cardiac tumors are exceptional and although BWS is rare, we found two other cardiac neoplasms in infants with BWS, whereas no more than one was expected. CONCLUSION Besides an excess of cardiac malformation, BWS seems to favor an excess of cardiac tumors, which may occur very early.
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Affiliation(s)
- Daniel Satgé
- Laboratoire d'Anatomie Pathologique Centre Hospitalier, Tulle, France.
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23
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Abstract
OBJECTIVE Angiofibromas in the head and neck area usually arise in the nasopharynx (NA) in adolescent males. They may also occur outside the nasopharynx (ENA) and can therefore be misdiagnosed. An ill-advised biopsy may result in brisk bleeding. This study was undertaken to evaluate the incidence and clinical features of ENA. MATERIAL AND METHODS A review of the international literature was performed. RESULTS A total of 65 patients with ENAs from 16 different countries were reported in the literature. Two patients had a congenital lesion, the oldest being 78 years old. A total of 48 patients were male (73%). The maxilla was the most commonly affected site (24.6%), with the ethmoid, nasal cavity or septum and other sites being involved less frequently. Symptoms arose in 40 patients within 6 months. Among a wide variety of symptoms, epistaxis with or without nasal obstruction was reported for 18 patients. Brisk bleeding resulting from a total of 23 biopsies occurred in 13 patients, and required blood transfusion in 11. Death was reported for two patients as a result of acute respiratory compromise and endocranial extension. CONCLUSION ENAs are extremely rare compared to NAs and have to be acknowledged as a different entity. In comparison to patients with NAs, as female adults are affected, the lesion is diagnosed earlier and is less vascularized and the patients are older. Surgical resection is sufficient treatment due to a tendency for local and less aggressive growth.
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Affiliation(s)
- J P Windfuhr
- Department of Otorhinolaryngology, Plastic Head and Neck Surgery, St. Anna Hospital, DE-47259 Duisburg, Germany.
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24
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Abstract
For over 150 years the aetiology of juvenile angiofibroma has been addressed in numerous theories, but actual details remained unknown. Interesting new findings, reviewed here, are beginning to elucidate the aetiology of this fascinating tumour.
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Affiliation(s)
- Bernhard Schick
- Department of Otolaryngology, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91054, Erlangen, Germany
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25
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Fackler I, DeClue JE, Rust H, Vu PA, Kutzner H, Rütten A, Kaddu S, Sander CA, Volkenandt M, Johnson MW, Vinters HV, Wienecke R. Loss of expression of tuberin and hamartin in tuberous sclerosis complex-associated but not in sporadic angiofibromas. J Cutan Pathol 2003; 30:174-7. [PMID: 12641776 DOI: 10.1034/j.1600-0560.2003.2o066.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Angiofibromas occur sporadically, and they develop in most patients with tuberous sclerosis complex (TSC), which is associated with alterations of the tumor suppressor genes TSC1 or TSC2. Loss of tuberin, the protein product of TSC2, has been shown in the interstitial fibroblast compartment of TSC-associated angiofibromas. It is unclear whether there is also a loss of hamartin, the product of TSC1 in TSC-associated and sporadic angiofibromas. METHODS The expression of hamartin and tuberin was analyzed by immunohistochemistry in 59 TSC-associated and 12 sporadic angiofibromas using affinity-purified antibodies. RESULTS Loss of expression of both tuberin and hamartin was detected in 14 angiofibromas, loss of only tuberin in three, and loss of only hamartin in four TSC-associated angiofibromas; but there was no loss in the sporadic angiofibromas. Only the interstitial cells, but not the vascular cells, showed a loss of expression of tuberin or hamartin. CONCLUSIONS Loss of tuberin or hamartin occurred in a minority of the TSC-linked angiofibromas, but not in the sporadic angiofibromas. The absence of both tuberin and hamartin in some of the tumors suggests that the stability of tuberin and hamartin, which are believed to form an active complex in vivo, is negatively affected by the absence of either of the partners.
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Affiliation(s)
- Ingrid Fackler
- Department of Dermatology, Ludwig-Maximilians-University Munich, Munich, Germany
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26
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Del Pozo J, Martínez W, Calvo R, Almagro M, Fonseca E. Unilateral angiofibromas. An oligosymptomatic and segmentary form of tuberous sclerosis. Eur J Dermatol 2002; 12:262. [PMID: 11989480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- J Del Pozo
- Department of Dermatology, Hospital Juan-Canalejo, Xubias de Arriba 84, 1500 La Coruña, Spain
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27
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Affiliation(s)
- Beth A Gavren
- Oral and Maxillofacial Surgery, Catholic Medical Center of Brooklyn and Queens, NY, USA
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28
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Abstract
BACKGROUND Even though numerous theories have speculated either on the vascular or fibrous tumour component as tissue of origin, aetiology of angiofibroma still remain unclear. Histological investigations recently led Beham and coworkers to the assumption that angiofibromas have to be considered as vascular malformations. METHODS After giving a literature review of the various theories on tumour origin the proposal to consider angiofibromas as vascular malformations is discussed on an embryological base. Taking typical clinical features of the tumour and knowledge of vasculogenesis into account a new explanation for origin of the vascular tumour component is presented. RESULTS The vascular component of angiofibromas can be explained embryologically due to incomplete regression of the first branchial arch artery (vascular atavism). This vessel arises regularly between embryological day 22 and 24 and recedes during regular development completely until delivery via temporary formation of a vascular plexus. In the late stages of embryological development remnants of the plexus are found at the area of the sphenopalatine foramen, the typical site of angiofibroma origin. Incomplete regression of the vascular plexus of the former first branchial arch artery may form the vascular component of an angiofibroma arising due to growth stimulation at the time of adolescents. CONCLUSIONS Incomplete regression of the first branchial arch artery presenting an atavism is suited to explain the vascular tumour component of angiofibromas considering main tumour characteristics (origin in the posterior nasal cavity close to the sphenopalatine foramen, main blood supply from the maxillary artery with possible feeders arising from the internal carotid artery). Our embryological contributions support to define angiofibromas as vascular malformations.
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Affiliation(s)
- B Schick
- Klinik für HNO-Krankheiten, Kopf- und Halschirurgie, Universitätskliniken des Saarlandes, Homburg/Saar.
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29
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Abstract
Tuberous sclerosis with macrodactyly is a very uncommon presentation. We report a 15-year-old girl with a thick, loose hyperpigmented area on the dorsum of the left hand with macrodactyly. A skin biopsy specimen from the dorsum of the left hand revealed dense collagenization in the dermis. Radiographs showed marked irregular thickening of the cortex of the metacarpals and phalanges of the left index and middle fingers.
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Affiliation(s)
- B Sahoo
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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30
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Cutando A, Gil JA, López J. Oral health management implications in patients with tuberous sclerosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90:430-5. [PMID: 11027378 DOI: 10.1067/moe.2000.105766] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report 6 cases of patients with tuberous sclerosis and concomitant dental pathosis. The multiple manifestations in tuberous sclerosis determine its impact on dental therapy. A lack of awareness of this condition may compound the possible side effects of dental treatment. Possible preventive measures by dentists are highlighted in this presentation. Medical evaluation and the control of risk factors in relation to general anesthesia and sedation are key considerations for the management of patients with tuberous sclerosis.
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Affiliation(s)
- A Cutando
- Dental School, Granada University, Spain
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31
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Silvestre JF, Bañuls J, Ramón R, Guijarro J, Botella R, Betlloch I. Unilateral multiple facial angiofibromas: a mosaic form of tuberous sclerosis. J Am Acad Dermatol 2000; 43:127-9. [PMID: 10863238 DOI: 10.1067/mjd.2000.106361] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Tuberous sclerosis has many forms of clinical presentation. Rarely, multiple facial angiofibromas of unilateral distribution have been reported. We describe 2 patients with such a presentation and hypothesize that this is a mosaic form of tuberous sclerosis.
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Affiliation(s)
- J F Silvestre
- Department of Dermatology, Hospital General de Alicante, Alicante, Spain
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32
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Abstract
Nasopharyngeal angiofibromas (NA) are rare tumor-like lesions characterized by architecturally irregular vessels set in a fibrous stroma. The unique morphology, the strong predilection for male adolescents, and the uncertainty about its etiology contributes to significant confusion regarding the classification of NA, which still has not been solved today. Based on immunohistochemical and electron microscopic examinations, we demonstrate in detail the various unusual vascular architectural features of NA. They represent discontinuous vascular basal laminae, focal lack of pericytes, and pronounced irregularity of the smooth muscle layers. In thick smooth muscle layers and pads, the orientation of muscle cells is frequently disturbed, and the individual cells differ in size and shape. Occasionally, the muscle layers disperse peripherally into individual cells, creating the impression of vessel-independent smooth muscle cells within the stroma. The summation of all morphological irregularities demonstrated in this paper allows the conclusion that NA represent vascular malformations.
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Affiliation(s)
- A Beham
- Institute of Pathology, University of Graz Medical School, Austria
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33
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Abstract
Cutaneous lesions are an important feature of tuberous sclerosis (TS). Facial angiofibromas usually begin to appear at the end of the first decade of life and are considered to occur in about 88% of adults with TS. They are only rarely reported on sites other than the face or front. In this paper, we report two patients with the complete syndrome of TS that had, in addition to classic facial lesions, multiple papules on the genital area. Histopathology confirmed the diagnosis of angiofibroma. One patient's lesions were misdiagnosed as genital warts and were so being treated before the correct diagnosis was made. Although we don't know the incidence of genital angiofibromas in TS patients, we believe that they might be underreported, because dermatologists generally don't look for them when they see these patients.
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Affiliation(s)
- M M Nico
- Department of Dermatology, University of São Paulo, Brazil
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34
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35
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Adams SP. Dermacase. Tuberous sclerosis (Bourneville's disease). Can Fam Physician 1998; 44:1251, 1257. [PMID: 9640517 PMCID: PMC2278250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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36
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Abstract
Tuberous sclerosis is an inherited syndrome with mental retardation, epilepsy, and acne rosacea being the classic triad of manifestations. The facial skin problems can present a cosmetic deformity or, as in the three patients presented here, can produce difficulties with hygiene and nasal breathing. Various approaches to treatment have been described over the last century, but no long-term results have been presented. Because of the full-thickness skin involvement, complete removal is not practical, and treatment should be directed toward acceptable long-term results with minimal surgical morbidity. Shaving and dermabrasion of the involved area produce very satisfactory results, but long-term follow-up of approximately 10 years reveals that there is a variable amount of recurrence and that subsequent treatment will be required.
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Affiliation(s)
- C N Verheyden
- Division of Plastic Surgery, Scott & White Clinic and Memorial Hospital, Temple, Texas, USA
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37
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McGrae JD, Hashimoto K. Unilateral facial angiofibromas--a segmental form of tuberous sclerosis. Br J Dermatol 1996; 134:727-30. [PMID: 8733380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Multiple facial angiofibromas are thought to be a pathognomonic and common, feature of tuberous sclerosis. In contrast, it is rare to see multiple angiofibromas limited to one side of the face. We have studied a patient with multiple angiofibromas of one cheek, in order to search for other manifestations of tuberous sclerosis and to determine the histochemical identity of the angiofibromas. No evidence of other pathology known to be associated with the tuberous sclerosis complex was uncovered. Histopathology of the unilateral lesions revealed focal fibroplasia and positive cellular staining for factor XIIIa and vimentin, similar to that described for bilateral angiofibromas. We suggested that the segmental expression of tuberous sclerosis, in the form of unilateral facial angiofibromas, may result from a postzygotic mutation.
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Affiliation(s)
- J D McGrae
- Section of Dermatology, Michigan State University, Flint, Michigan 48532-2312, USA
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