Biphenotypic Branchioma: A Better Name Than Ectopic Hamartomatous Thymoma for a Neoplasm with HRAS Mutation

Ectopic hamartomatous thymoma is a rare neck lesion originally thought to represent a non-neoplastic hamartoma, even though thymic origin has been questioned, and there is uncertainty about whether the lesion is a neoplasm. We investigated the genetics by performing targeted next generation sequencing (NGS). Three cases were identified from the authors' consultation files. A custom, targeted NGS panel including 1385 pan-cancer-related genes was performed on all cases. Three patients included 2 males and 1 female, aged 50, 58 and 70 years, respectively (mean 59.3 years), with tumors arising in the low anterior neck. All cases showed classical histologic features of EHT, with one case showing intraductal carcinoma in association with the EHT. By targeted NGS, one case harbored a hotspot HRAS mutation (p.Gln61Lys), while the other two cases only showed non oncogenic variants. Dual mesoderm and endoderm derivation/differentiation (biphenotypic) has been previously recognized, with epithelial and myoepithelial components, and arising from the apparatus contributing to neck development (branchial apparatus). Thus, EHT has been shown to have genetic alterations in HRAS. These findings, without evidence of thymic derivation or an ectopic tissue location, strongly support that EHT is a true neoplasm. The name biphenotyic branchioma more correctly reflects the true nature of this dual mesoderm and endoderm derived tumor occurring in the lower neck.

Branchio-oto-renal syndrome

Branchio-oto-renal syndrome (Melnick-Fraser syndrome) is a rare autosomal dominant disorder characterized by syndromic association of branchial cysts or fistulae along with external, middle & inner ear malformations and renal anomalies. Authors are reporting a 19 year male patient, who presented with profound deafness & low set "lop-ear" with right sided preauricular pit. USG abdomen revealed agenesis of the left kidney.

Image Cytometry DNA-Analysis of Fine Needle Aspiration Cytology to Aid Cytomorphology in the Distinction of Branchial Cleft Cyst from Cystic Metastasis of Squamous Cell Carcinoma: A Prospective Study

OBJECTIVE

Frequently, the distinction between branchial cleft cyst and cystic metastases from squamous cell carcinoma is difficult by cytomorphology. In a prospective study, we investigated the need for, and the value of, image cytometry DNA-analysis as a complement to cytologic evaluation of cystic lesions in the neck.

STUDY DESIGN

Image cytometry DNA-analysis was performed on the fine needle aspiration cytology smears from 50 patients, referred to our department, with a solitary cystic lesion in the lateral region of the neck.

METHODS

Smears from aspirates were Giemsa stained and cytologically evaluated. Ahrens image analysis was used for DNA analysis on smears stained with Schiff reagent, and lymphocytes were used as control cells. Epithelial cells with DNA values exceeding 5c were regarded as aneuploid, indicating malignancy.

RESULTS

Nine lesions were diagnosed as squamous cell cancer metastases cytologically. DNA analysis showed aneuploidy in all of them except one. Three of these lesions had earlier been diagnosed as branchial cleft cyst at the referring hospital. Eight lesions were cytologically inconclusive and four of them were revealed as cystic metastasis at histopathologic analysis, and DNA analysis showed aneuploidy in all but one, which could not be analyzed. Two of these lesions were also diagnosed as branchial cleft cysts at the referring hospital. All benign lesions were diploid. Nine lesions were thyroid and salivary gland lesions.

CONCLUSION

Image cytometry DNA-analysis was shown to help in the distinction between benign and malignant cystic lesions. Thus, when conventional cytomorphology does not suffice, DNA-analysis is clearly a valuable supplement.

Branchial cleft anomaly, congenital heart disease, and biliary atresia: Goldenhar complex or Lambert syndrome?

The features of Goldenhar complex have been well-described and classically include branchial arch abnormalities, epibulbar dermoid and vertebral abnormalities. We have identified an infant with these features in association with complex congenital heart disease and intrahepatic biliary atresia. Although Lambert described an autosomal recessive disorder with an association of biliary atresia and branchial arch abnormalities, none of those cases had epibulbar dermoid. Diagnostic considerations in this case include inclusion of biliary atresia as a new feature in the expanding spectrum of the Goldenhar complex, versus Lambert syndrome with epibulbar dermoid.

De novo direct duplication of 15q15-->q24 in a newborn boy with mild manifestations

Duplication of distal 15q results in a recognizable clinical phenotype. We report here on a 25-day-old boy with a de novo interstitial duplication of chromosome region 15q15-q24. The manifestations in this patient are milder than those of previously described patients and include minor facial anomalies, velopharyngeal insufficiency, branchial cleft cyst, and hydronephrosis. Fluorescence in situ hybridization (FISH) using a chromosome 15 painting probe confirmed that the extra material is of chromosome 15 origin. Further analysis with the SNRPN probe demonstrated that the duplication is telomeric to the Prader-Willi/Angelman syndrome critical region. This case delineates a broader spectrum for patients with duplication 15q syndrome.

[Branchio-oto-renal syndrome. 4 cases in three families]

Branchio-oto-renal syndrome is an inborn disease of autosomal dominant transmission and variable expression. The syndrome associates ear pits, branchial cleft fistulas or cysts, deafness and renal anomalies heavily compromising prognosis. We report four adults (2 males, 2 females) in three different families with branchio-oto-renal syndrome. All 4 probands were seen for renal failure, with hematuria in 2 and proteinuria in the 2 others. Among the 62 family members examined 19 had at least one sign of branchio-oto-renal syndrome. Four pregnancies were followed during the course of the study, only one reached term. The frequency of branchio-oto-renal syndrome is probably underestimated. Prevalence has been estimated at 1/40,000 births. It accounts for 2% of the cases of severe deafness in children. Neck and ear morphology should therefore be carefully examined in patients with renal or urinary tract dysplasia. Women with a mild form of the disease with moderate renal failure may give birth to an infant with very severe renal failure leading to death either in infancy or in utero due to severe renal agenesia or hypoplasia.

Branchio-oto-renal syndrome: incidence in three generations of a family

It is well known that the persistence of alterations in the normal embryological development of branchial arches can lead to preauricular and cervical fistulas within a family. However, until 1970, there were no reports of dysplasia affecting the branchial, otic, and renal systems (BOR syndrome) with dominant autosomic inheritance. The authors report on a family with BOR syndrome of different expressivity in three generations, and describe an unusual case of bilateral fistulas of the first and second branchial arches in a newborn.

Dominant branchial cleft syndrome with characteristics of both branchio-oto-renal and branchio-oculo-facial syndrome

A father and son are described with an autosomal dominant branchial cleft syndrome resembling both the branchio-oto-renal and the branchio-oculo-facial syndrome. Both syndromes may represent variant expressions of the same autosomal dominant gene.

The branchio-oto-renal syndrome (report of two family groups)

The major features of the Branchio-Oto-Renal syndrome (BOR syndrome), an autosomal dominant disorder, are branchial remnants, ear anomalies, deafness and renal dysplasia. We report two family groups affected by the BOR syndrome: in two-thirds of the affected children renal abnormalities led to severe renal insufficiency in early life. The necessity for a meticulous search for renal anomalies in individuals with aural and/or branchial abnormalities is emphasized. In affected families, genetic counselling is suggested.

Heterotopic cervical salivary gland tissue in a family with probable branchio-otorenal syndrome

Heterotopic cervical salivary gland tissue was found in a 4-yr-old girl with branchial and otologic abnormalities. Her mother and sister also had heterotopic cervical salivary tissue in association with anomalies that suggest the branchio-otorenal (BOR) syndrome. Heterotopic cervical salivary gland tissue may result from abnormal branchial development.

Familial mixed deafness with branchial arch defects (earpits-deafness syndrome)

The earpits-deafness syndrome is a rare autosomal dominant condition. This report documents 4 families and describes the characteristic radiological features of both the inner and the middle-ear lesions. Prospects for surgical intervention are discussed.

Gustatory lacrimation in association with the branchio-oto-renal syndrome

Branchio-oto-renal (BOR) syndrome is a developmental complex presenting with various combinations of ear pits, branchial cleft cysts, deafness and renal anomalies, which is inherited as an autosomal dominant trait. This report describes a father and 2 children with BOR syndrome in which gustatory lacrimation (GL) was also present in 2 of them. GL is considered to be a rare, non-hereditary type of anomalous, cranial nerve-end organ innervation. Since lacrimal stenosis, which can clinically mimic GL, is also a feature of the BOR syndrome, future reports require lacrimal reflex testing and duct patency evaluation to define this variation in the BOR phenotype.

Renal disorders in the branchio-oto-renal syndrome

Intravenous urography and measurements of renal function were performed in 16 patients suffering from branchio-oto-renal syndrome. Malformations were visible by intravenous urography in all patients. Four out of 16 patients had a diminished glomerular filtration rate. Renal histology available in two patients revealed oligomeganephronic renal hypoplasia and multicystic dysplasia, respectively. Without renal agenesis or severe renal hypoplasia or dysplasia present in early infancy, renal abnormality does not seem to be a progressive disorder.

[Branchio-oto-renal dysplasia. A hereditary dominant autosomal syndrome with variable expression]

A pedigree of branchio-oto-renal dysplasia (BOR syndrome) is reported. BOR syndrome is an autosomal dominant disorder in which affected individuals may have branchial fistulas or cysts, preauricular pits, structural defects of the outer, middle an inner ear with hearing loss, and renal anomalies which may range from mild hypoplasia to complete absence. As shown in our pedigree, all carriers of the gene may not present with all features of the syndrome. In all individuals presenting with preauricular pits and branchial clefts, both otologic and renal investigations should be performed. Genetic counselling of family members is indicated.

Familial aggregation of neuroectodermal and gastrointestinal tumors

A family with multiple tumors is presented. Four cases were childhood neoplasms derived from the neuroectoderm, as was a malignant melanoma in a young female and a branchiogenic cyst in her brother. He also had an early onset of an adenocarcinoma of the transverse colon. Four further cases of gastrointestinal tumors and one case of acute myelogenous leukemia had occurred in the family. One of the childhood tumors was a bilateral retinoblastoma. It is discussed as to whether the tumors in the studied family were due to a genetic factor resulting in a neuroectodermal embryopathy, or were caused by a retinoblastoma gene with a pleiotropic effect.

The branchio-oto-renal (BOR) syndrome: report of bilateral renal agenesis in three sibs

We report a man who had the branchio-oto-renal (BOR) syndrome with crossed renal ectopia. His three children were born with bilateral renal agenesis and the so-called Potter syndrome. This case illustrates the potential severity of the renal anomalies in the BOR syndrome and the inadequacy of oligohydramnios and maternal serum alpha-fetoprotein as screening methods for renal agenesis. This case also implies strongly the necessity for meticulous search for renal anomalies in individuals with the BOR syndrome and proper counseling regarding the possibility of lethal bilateral renal agenesis.

Brief clinical report: a new syndrome of hemangiomatous branchial clefts, lip pseudoclefts, and unusual facial appearance

Two unrelated children (one male, the other female) had unusual craniofacial anomalies consisting of hemangiomatous branchial clefts, lip pseudoclefts, and identical unusual facial appearance. One also had unilateral microphthalmia and both had congenital nasolacrimal duct obstruction. Two similar, sporadic cases from the literature were also identified. These four cases form the basis of a new, distinctly recognizable pattern of malformation.

First branchial cleft anomaly and congenital aural sinus--a case report

A case of first branchial cleft anomaly is reported. The case presented classical signs and symptoms and further had a family history of congenital aural sinuses through 3 successive generations. Clinical features of the patient are briefly described and the embryological relationship between first branchial cleft anomaly and congenital aural sinus is discussed.

Glomerular lesions in the branchio-oto-renal (BOR) syndrome

Three cases: two adults and one child, with histologically confirmed branchio-oto-renal syndrome showed prominent glomerular lesions. Typically there was segmental and focal hyalinization associated with dense deposits along the basement membrane and in the mesangium. Variable deposits of immunoglobulins IgG, IgM, and IgA as well as C3 were present. The branchio-oto-renal syndrome appears to be a familial nephropathy which may lead to renal failure.

Bilateral branchial cleft sinuses associated with intrauterine and postnatal growth retardation, premature aging, and unusual facial appearance: a new syndrome with dominant transmission

A mother and son with bilateral branchial sinuses, intrauterine and postnatal growth retardation, unusual facial appearance, and premature aging in the mother are reported. No other members of the family are similarly affected. No hormonal or systemic cause of growth retardation was identified. Chromosomal studies with G-banding were normal. It is suggested that this syndrome is a dominant trait, the mother being the initial mutant.

The earpits-deafness syndrome. Clinical and genetic aspects

Several pedigrees with 19 new cases of the earpits-deafness syndrome (McK +12510) [28] are presented. Mention is made of clinical findings obtained in audiometric and vestibular studies, studies of renal function and configuration and polytomographic studies of the labyrinth, and results of exploratory tympanotomies are discussed. The literature is reviewed and the features found in 138 cases and in our 19 cases are presented. The earpits-deafness syndrome is an autosomal dominant disorder in which affected individuals may have sensorineural, conductive or mixed hearing loss, preauricular pits, structural defects of the outer, middle and inner ear, lacrimal duct stenosis, branchial fistulas or cysts of the second branchial arch, and renal anomalies ranging from mild hypoplasia to complete absence. Not all the features of the syndrome are expressed in all carriers of the gene. Pits, branchial clefts and hearing loss are frequently expressed. The incidence of renal malformation is higher, as mentioned earlier in the literature. The poor results of exploratory tympanotomies are discussed. On the basis of personal observations as well as in view of data from the literature it is maintained that the BOR (branchio-oto-renal dysplasia) syndrome [12,30-32] and the BO (branchio-oto dysplasia) syndrome are in fact the same affection. It is also maintained that no separate syndromes can be distinguished on the basis of the type of hearing loss. The present knowledge of the syndrome is summarized in terms of the information available for genetic counselling.

Frequency of the branchio-oto-renal (BOR) syndrome in children with profound hearing loss

Nineteen of 421 white children in Montreal schools for the deaf had preauricular pits. The branchio-oto-renal (BOR syndrome was identified in four of the nine families who agreed to family investigation, including audiograms and intravenous pyelograms (IVPs) and may have been present in several others. The penetrance of this autosomal dominant syndrome appears to be high. It is estimated that severe renal dysplasia occurs in about 6% of heterozygotes. The presence of a preauricular pit at birth suggests that the child has at least one chance in 200 of severe hearing loss, and this warrants a careful family history, as well as alertness for any signs of hearing impairment. Offspring of affected individuals are eligible for parental diagnosis of renal dysplasia.

Seven cases of branchial cyst and sinuses in four generations

7 cases of isolated branchial anomalies distributed in four consecutive generations of a Central Indian family are described: 6 were males and 1 was female. 3 members had a left-sided branchial sinus, 1 had a right-sided sinus, 2 had bilateral sinuses, and 1 had a right-sided cyst. The family shows that branchial (lateral cervical) cysts and sinuses are inherited as autosomal dominant characters, and that the two anomalies are indistinguishable genetically.

Lateral fistulae and cysts of the neck. Heredity and diagnosis

A family with congenital fistulae from the second cleft or pouch over four generations is described. In order to obtain some idea of how often anomalies are found in relatives of patients with this type of malformation a material embracing 114 patients has been examined. The investigation demonstrates that patients with a complete lateral fistula of the neck from the second cleft or pouch showed a heredity of 35%, whilst patients with lateral neck cysts did not show any recognizable familial tendency. Views on differential diagnosis are presented, including the value of fine-needle biopsy, where in 92% of the cases a diagnosis of branchial cysts of the neck was obtained.

Genetic hearing loss with preauricular sinus and branchiogenic fistula

A mother and her two children had hearing loss associated with bilateral preauricular sinus and branchiogenic fistula. All six cochleas studied showed two turns rather than 2 1/2 turns. Complete studies including audiometry, tympanotomy findings, and temporal bone polytomography of these anomalies are reported. Similar cases reported in the English literature are reviewed. It seems that all previous cases may have had an abnormal cochlea as was seen in these cases.