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Keppler-Noreuil KM, Sapp JC, Lindhurst MJ, Parker VER, Blumhorst C, Darling T, Tosi LL, Huson SM, Whitehouse RW, Jakkula E, Grant I, Balasubramanian M, Chandler KE, Fraser JL, Gucev Z, Crow YJ, Brennan LM, Clark R, Sellars EA, Pena LDM, Krishnamurty V, Shuen A, Braverman N, Cunningham ML, Sutton VR, Tasic V, Graham JM, Geer J, Henderson A, Semple RK, Biesecker LG. Clinical delineation and natural history of the PIK3CA-related overgrowth spectrum. Am J Med Genet A 2014; 164A:1713-33. [PMID: 24782230 PMCID: PMC4320693 DOI: 10.1002/ajmg.a.36552] [Citation(s) in RCA: 198] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/01/2014] [Indexed: 02/02/2023]
Abstract
Somatic mutations in the phosphatidylinositol/AKT/mTOR pathway cause segmental overgrowth disorders. Diagnostic descriptors associated with PIK3CA mutations include fibroadipose overgrowth (FAO), Hemihyperplasia multiple Lipomatosis (HHML), Congenital Lipomatous Overgrowth, Vascular malformations, Epidermal nevi, Scoliosis/skeletal and spinal (CLOVES) syndrome, macrodactyly, and the megalencephaly syndrome, Megalencephaly-Capillary malformation (MCAP) syndrome. We set out to refine the understanding of the clinical spectrum and natural history of these phenotypes, and now describe 35 patients with segmental overgrowth and somatic PIK3CA mutations. The phenotypic data show that these previously described disease entities have considerable overlap, and represent a spectrum. While this spectrum overlaps with Proteus syndrome (sporadic, mosaic, and progressive) it can be distinguished by the absence of cerebriform connective tissue nevi and a distinct natural history. Vascular malformations were found in 15/35 (43%) and epidermal nevi in 4/35 (11%) patients, lower than in Proteus syndrome. Unlike Proteus syndrome, 31/35 (89%) patients with PIK3CA mutations had congenital overgrowth, and in 35/35 patients this was asymmetric and disproportionate. Overgrowth was mild with little postnatal progression in most, while in others it was severe and progressive requiring multiple surgeries. Novel findings include: adipose dysregulation present in all patients, unilateral overgrowth that is predominantly left-sided, overgrowth that affects the lower extremities more than the upper extremities and progresses in a distal to proximal pattern, and in the most severely affected patients is associated with marked paucity of adipose tissue in unaffected areas. While the current data are consistent with some genotype-phenotype correlation, this cannot yet be confirmed.
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Affiliation(s)
- Kim M Keppler-Noreuil
- National Human Genome Research Institute, National Institutes of HealthBethesda, Maryland,*Correspondence to:, Kim M. Keppler-Noreuil, M.D., National Human Genome Research Institute/NIH, 49 Convent Drive 4A83, Bethesda, MD 20892., E-mail:
| | - Julie C Sapp
- National Human Genome Research Institute, National Institutes of HealthBethesda, Maryland
| | - Marjorie J Lindhurst
- National Human Genome Research Institute, National Institutes of HealthBethesda, Maryland
| | - Victoria ER Parker
- The University of Cambridge Metabolic Research Laboratories, Institute of Metabolic ScienceCambridge, UK
| | - Cathy Blumhorst
- National Human Genome Research Institute, National Institutes of HealthBethesda, Maryland
| | - Thomas Darling
- Department of Dermatology, Uniformed Services University of the Health SciencesBethesda, Maryland
| | - Laura L Tosi
- Division of Orthopaedic Surgery and Sports Medicine, Children's National Medical CenterWashington, District of Columbia
| | - Susan M Huson
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC)Manchester, UK
| | - Richard W Whitehouse
- Department of Radiology, Central Manchester University Hospitals NHS Foundation Trust Manchester Royal Infirmary Oxford Road ManchesterManchester, UK
| | - Eveliina Jakkula
- Department of Clinical Genetics, Helsinki University Central HospitalHelsinki, Finland
| | - Ian Grant
- Department of Plastic Surgery, Cambridge University Hospitals NHS TrustCambridge, UK
| | - Meena Balasubramanian
- Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation TrustSheffield, UK
| | - Kate E Chandler
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC)Manchester, UK
| | - Jamie L Fraser
- National Human Genome Research Institute, National Institutes of HealthBethesda, Maryland
| | - Zoran Gucev
- Department of Endocrinology and Genetics, Medical Faculty SkopjeSkopje, Macedonia
| | - Yanick J Crow
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC)Manchester, UK
| | - Leslie Manace Brennan
- Medical Genetics, Kaiser Permanente Oakland, University of CaliforniaSan Francisco, California
| | - Robin Clark
- Division of Medical Genetics, Department of Pediatrics, Loma Linda University Medical CenterLoma Linda, California
| | - Elizabeth A Sellars
- Section of Genetics and Metabolism, Arkansas Children's HospitalLittle Rock, Arkansas
| | - Loren DM Pena
- Division of Genetics, Department of Pediatrics, Duke University Medical CenterDurham, North Carolina
| | | | - Andrew Shuen
- Department of Medical Genetics, McGill University Health CentreMontreal, Quebec, Canada
| | - Nancy Braverman
- Department of Human Genetics and Pediatrics, McGill University, Montreal Children's Hospital Research InstituteMontreal, Canada
| | - Michael L Cunningham
- Division of Craniofacial Medicine, University of Washington School of MedicineSeattle, Washington
| | - V Reid Sutton
- Department of Molecular and Human Genetics, Baylor College of MedicineHouston, Texas
| | - Velibor Tasic
- University Children's Hospital, Medical SchoolSkopje, Macedonia
| | - John M Graham
- Clinical Genetics and Dysmorphology, Department of Pediatrics, Harbor-UCLA Medical CenterLos Angeles, California
| | - Joseph Geer
- Greenwood Genetics CenterGreenwood, South Carolina
| | - Alex Henderson
- Northern Genetics Service, Newcastle Upon Tyne HospitalsNewcastle Upon Tyne, UK
| | - Robert K Semple
- The University of Cambridge Metabolic Research Laboratories, Institute of Metabolic ScienceCambridge, UK
| | - Leslie G Biesecker
- National Human Genome Research Institute, National Institutes of HealthBethesda, Maryland
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