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Özden C, Mautner VF, Farschtschi S, Molwitz I, Ristow I, Bannas P, Well L, Klutmann S, Adam G, Apostolova I, Buchert R. Asymmetry of thalamic hypometabolism on FDG-PET/CT in neurofibromatosis type 1: Association with peripheral tumor burden. J Neuroimaging 2024; 34:138-144. [PMID: 37942683 DOI: 10.1111/jon.13170] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/15/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Thalamic hypometabolism is a consistent finding in brain PET with F-18 fluorodeoxyglucose (FDG) in patients with neurofibromatosis type 1 (NF1). However, the pathophysiology of this metabolic alteration is unknown. We hypothesized that it might be secondary to disturbance of peripheral input to the thalamus by NF1-characteristic peripheral nerve sheath tumors (PNSTs). To test this hypothesis, we investigated the relationship between thalamic FDG uptake and the number, volume, and localization of PNSTs. METHODS This retrospective study included 22 adult NF1 patients (41% women, 36.2 ± 13.0 years) referred to whole-body FDG-PET/contrast-enhanced CT for suspected malignant transformation of PNSTs and 22 sex- and age-matched controls. Brain FDG uptake was scaled voxelwise to the individual median uptake in cerebellar gray matter. Bilateral mean and left-right asymmetry of thalamic FDG uptake were determined using a left-right symmetric anatomical thalamus mask. PNSTs were manually segmented in contrast-enhanced CT. RESULTS Thalamic FDG uptake was reduced in NF1 patients by 2.0 standard deviations (p < .0005) compared to controls. Left-right asymmetry was increased by 1.3 standard deviations (p = .013). Thalamic hypometabolism was higher in NF1 patients with ≥3 PNSTs than in patients with ≤2 PNSTs (2.6 vs. 1.6 standard deviations, p = .032). The impact of the occurrence of paraspinal/paravertebral PNSTs and of the mean PNST volume on thalamic FDG uptake did not reach statistical significance (p = .098 and p = .189). Left-right asymmetry of thalamic FDG uptake was not associated with left-right asymmetry of PNST burden (p = .658). CONCLUSIONS This study provides first evidence of left-right asymmetry of thalamic hypometabolism in NF1 and that it might be mediated by NF1-associated peripheral tumors.
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Affiliation(s)
- Cansu Özden
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Klutmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivayla Apostolova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Buchert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kresbach C, Dottermusch M, Eckhardt A, Ristow I, Paplomatas P, Altendorf L, Wefers AK, Bockmayr M, Belakhoua S, Tran I, Pohl L, Neyazi S, Bode H, Farschtschi S, Well L, Friedrich RE, Reuss D, Snuderl M, Hagel C, Mautner VF, Schüller U. Atypical neurofibromas reveal distinct epigenetic features with proximity to benign peripheral nerve sheath tumor entities. Neuro Oncol 2023; 25:1644-1655. [PMID: 36866403 PMCID: PMC10479771 DOI: 10.1093/neuonc/noad053] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Plexiform neurofibromas can transform into atypical neurofibromas (ANF) and then further progress to aggressive malignant peripheral nerve sheath tumors (MPNST). ANF have been described to harbor distinct histological features and frequent loss of CDKN2A/B. However, histological evaluation may be rater-dependent, and detailed knowledge about the molecular mechanisms of malignant transformation is scarce. In general, malignant transformation can be accompanied by significant epigenetic changes, and global DNA methylation profiling is able to differentiate relevant tumor subgroups. Therefore, epigenetic profiling might provide a valuable tool to distinguish and characterize ANF with differing extent of histopathological atypia from neurofibromas and MPNST. METHODS We investigated 40 tumors histologically diagnosed as ANF and compared their global methylation profile to other peripheral nerve sheath tumors. RESULTS Unsupervised class discovery and t-SNE analysis indicated that 36/40 ANF cluster with benign peripheral nerve sheath tumors with clear separation from MPNST. 21 ANF formed a molecularly distinct cluster in proximity to schwannomas. Tumors in this cluster had a frequent heterozygous or homozygous loss of CDKN2A/B and significantly more lymphocyte infiltration than MPNST, schwannomas, and NF. Few ANF clustered closely with neurofibromas, schwannomas, or MPNST, raising the question, whether diagnosis based on histological features alone might pose a risk to both over- and underestimate the aggressiveness of these lesions. CONCLUSIONS Our data suggest that ANF with varying histological morphology show distinct epigenetic similarities and cluster in proximity to benign peripheral nerve sheath tumor entities. Future investigations should pay special respect to correlating this methylation pattern to clinical outcomes.
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Affiliation(s)
- Catena Kresbach
- Department of Diagnostics, Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Matthias Dottermusch
- Department of Diagnostics, Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
| | - Alicia Eckhardt
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
- Lab of Radiobiology & Experimental Radiation Oncology, Hubertus Wald Tumorzentrum, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petros Paplomatas
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
| | - Lea Altendorf
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
| | - Annika K Wefers
- Department of Diagnostics, Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Michael Bockmayr
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | - Sarra Belakhoua
- Department of Pathology, NYU Langone Health and School of Medicine, New York, New York, USA
| | - Ivy Tran
- Department of Pathology, NYU Langone Health and School of Medicine, New York, New York, USA
| | - Lara Pohl
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
| | - Sina Neyazi
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
| | - Helena Bode
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhard E Friedrich
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David Reuss
- Department of Neuropathology, University of Heidelberg, Heidelberg, Germany
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health and School of Medicine, New York, New York, USA
| | - Christian Hagel
- Department of Diagnostics, Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Schüller
- Department of Diagnostics, Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
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Leidger A, Vosschulte M, Nieder TO, Mautner VF. Sexual Self-Esteem and Psychological Burden of Adults With Neurofibromatosis Type 1. Front Psychol 2022; 13:883019. [PMID: 35756263 PMCID: PMC9220094 DOI: 10.3389/fpsyg.2022.883019] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is one of the most common tumor predisposition syndromes which primarily affects the skin. NF1 is characterized by various degrees of skin tumors and pigmentation abnormalities such as café-au-lait macules. Other skin diseases, such as psoriasis or neurodermatitis, have a negative influence on sexuality and quality of life and represent a psychological burden for those affected. The present study investigated the extent to which skin tumors (disfigurement) are related to sexuality and psychosocial factors in NF1 individuals. An anonymous online survey was carried out on Facebook and the webpage of the German Neurofibromatosis Association and a total of 166 persons participated. Of these participants, 92 were affected by NF1.74 healthy persons took part in the survey as a comparative group. Results show a significant relation between sexuality, body image, quality of life and the presence of depressive symptoms of the NF1 affected persons. Individuals with NF1 show a more negative sexual self-esteem. These concerns should be taken into account in NF1- related health care approaches.
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Affiliation(s)
- Anna Leidger
- Clinic and Polyclinic of Neurology, Neurofibromatosis Outpatient Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marie Vosschulte
- Clinic and Polyclinic of Neurology, Neurofibromatosis Outpatient Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Timo O Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor-Felix Mautner
- Clinic and Polyclinic of Neurology, Neurofibromatosis Outpatient Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Wang S, Friedman JM, Suppa P, Buchert R, Mautner VF. White matter is increased in the brains of adults with neurofibromatosis 1. Orphanet J Rare Dis 2022; 17:115. [PMID: 35248131 PMCID: PMC8898512 DOI: 10.1186/s13023-022-02273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Neurofibromatosis 1 (NF1) is a rare autosomal dominant disease characterized by increased Schwann cell proliferation in peripheral nerves. Several small studies of brain morphology in children with NF1 have found increased total brain volume, total white matter volume and/or corpus callosum area. Some studies (mostly in children with NF1) also attempted to correlate changes in brain morphology and volume with cognitive or behavioural abnormalities, although the findings were inconsistent. We aimed to characterize alterations in brain volumes by three-dimensional (3D) MRI in adults with NF1 in major intracranial sub-regions. We also aimed to assess the effect of age on these volumes and correlated brain white matter and grey matter volumes with neuropsychometric findings in adults with NF1. Methods We obtained brain volume measurements using 3D magnetic resonance imaging for 351 adults with NF1 and, as a comparison group, 43 adults with neurofibromatosis 2 (NF2) or Schwannomatosis. We assessed a subset of 19 adults with NF1 for clinical severity of NF1 features and neurological problems and conducted psychometric testing for attention deficiencies and intelligence quotient. We compared brain volumes between NF1 patients and controls and correlated volumetric measurements to clinical and psychometric features in the NF1 patients. Results Total brain volume and total and regional white matter volumes were all significantly increased in adults with NF1. Grey matter volume decreased faster with age in adults with NF1 than in controls. Greater total brain volume and white matter volume were correlated with lower attention deficits and higher intelligence quotients in adults with NF1. Conclusion Our findings are consistent with the hypothesis that dysregulation of brain myelin production is a cardinal manifestation of NF1 and that these white matter changes may be functionally important in affected adults. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02273-1.
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Wang S, Mautner VF, Buchert R, Flibotte S, Suppa P, Friedman JM, Heran MKS. Alterations in brain morphology by MRI in adults with neurofibromatosis 1. Orphanet J Rare Dis 2021; 16:462. [PMID: 34727946 PMCID: PMC8561988 DOI: 10.1186/s13023-021-02097-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/24/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Neurofibromatosis 1 (NF1) is a rare autosomal dominant disease that causes the dysregulated growth of Schwann cells. Most reported studies of brain morphology in NF1 patients have included only children, and clinical implications of the observed changes later in life remain unclear. In this study, we used MRI to characterize brain morphology in adults with NF1. METHODS Planar (2D) MRI measurements of 29 intracranial structures were compared in 389 adults with NF1 and 112 age- and sex-matched unaffected control subjects. The 2D measurements were correlated with volumetric (3D) brain measurements in 99 of the adults with NF1 to help interpret the 2D findings. A subset (n = 70) of these NF1 patients also received psychometric testing for attention deficits and IQ and was assessed for clinical severity of NF1 features and neurological problems. Correlation analysis was performed between the MRI measurements and clinical and psychometric features of these patients. RESULTS Four of nine corpus callosum measurements were significantly greater in adults with NF1 than in sex- and age-matched controls. All seven brainstem measurements were significantly greater in adults with NF1 than in controls. Increased corpus callosum and brainstem 2D morphology were correlated with increased total white matter volume among the NF1 patients. No robust correlations were observed between the 2D size of these structures and clinical or neuropsychometric assessments. CONCLUSION Our findings are consistent with the hypothesis that dysregulation of brain myelin production is an important manifestation of NF1 in adults.
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Affiliation(s)
- Su Wang
- Department of Medical Genetics, University of British Columbia, Children's and Women's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Victor-Felix Mautner
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Buchert
- Department of Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stephane Flibotte
- UBC/LSI Bioinformatics Facility, University of British Columbia, Vancouver, BC, Canada
| | - Per Suppa
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia, Children's and Women's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Manraj K S Heran
- Diagnostic and Therapeutic Neuroradiology, University of British Columbia, Vancouver, Canada
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Kehrer-Sawatzki H, Wahlländer U, Cooper DN, Mautner VF. Atypical NF1 Microdeletions: Challenges and Opportunities for Genotype/Phenotype Correlations in Patients with Large NF1 Deletions. Genes (Basel) 2021; 12:genes12101639. [PMID: 34681033 PMCID: PMC8535936 DOI: 10.3390/genes12101639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/30/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
Patients with neurofibromatosis type 1 (NF1) and type 1 NF1 deletions often exhibit more severe clinical manifestations than patients with intragenic NF1 gene mutations, including facial dysmorphic features, overgrowth, severe global developmental delay, severe autistic symptoms and considerably reduced cognitive abilities, all of which are detectable from a very young age. Type 1 NF1 deletions encompass 1.4 Mb and are associated with the loss of 14 protein-coding genes, including NF1 and SUZ12. Atypical NF1 deletions, which do not encompass all 14 protein-coding genes located within the type 1 NF1 deletion region, have the potential to contribute to the delineation of the genotype/phenotype relationship in patients with NF1 microdeletions. Here, we review all atypical NF1 deletions reported to date as well as the clinical phenotype observed in the patients concerned. We compare these findings with those of a newly identified atypical NF1 deletion of 698 kb which, in addition to the NF1 gene, includes five genes located centromeric to NF1. The atypical NF1 deletion in this patient does not include the SUZ12 gene but does encompass CRLF3. Comparative analysis of such atypical NF1 deletions suggests that SUZ12 hemizygosity is likely to contribute significantly to the reduced cognitive abilities, severe global developmental delay and facial dysmorphisms observed in patients with type 1 NF1 deletions.
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Affiliation(s)
- Hildegard Kehrer-Sawatzki
- Institute of Human Genetics, University of Ulm, 89081 Ulm, Germany
- Correspondence: ; Tel.: +49-731-500-65421
| | - Ute Wahlländer
- Kliniken des Bezirks Oberbayern (KBO), Children Clinical Center Munich, 81377 Munich, Germany;
| | - David N. Cooper
- Institute of Medical Genetics, Cardiff University, Heath Park, Cardiff CF14 4XN, UK;
| | - Victor-Felix Mautner
- Department of Neurology, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany;
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7
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Godel T, Bäumer P, Farschtschi S, Püschel K, Hofstadler B, Heiland S, Gelderblom M, Bendszus M, Hagel C, Mautner VF. Long-term Follow-up and Histological Correlation of Peripheral Nervous System Alterations in Neurofibromatosis Type 2. Clin Neuroradiol 2021; 32:277-285. [PMID: 34652463 PMCID: PMC8894150 DOI: 10.1007/s00062-021-01102-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/18/2021] [Accepted: 09/07/2021] [Indexed: 12/22/2022]
Abstract
Purpose To examine long-term alterations of the dorsal root ganglia (DRG) and the peripheral nerve in patients with neurofibromatosis type 2 (NF2) by in vivo high-resolution magnetic resonance neurography (MRN) and their correlation to histology. Methods In this prospective study the lumbosacral DRG, the right sciatic, tibial, and peroneal nerves were examined in 6 patients diagnosed with NF2 and associated polyneuropathy (PNP) by a standardized MRN protocol at 3 T. Volumes of DRG L3–S2 as well as peripheral nerve lesions were assessed and compared to follow-up examinations after 14–100 months. In one patient, imaging findings were further correlated to histology. Results Follow-up MRN examination showed a non-significant increase of volume for the DRG L3: +0.41% (p = 0.10), L4: +22.41% (p = 0.23), L5: +3.38% (p = 0.09), S1: +10.63% (p = 0.05) and S2: +1.17% (p = 0.57). Likewise, peripheral nerve lesions were not significantly increased regarding size (2.18 mm2 vs. 2.15 mm2, p = 0.89) and number (9.00 vs. 9.33, p = 0.36). Histological analyses identified schwannomas as the major correlate of both DRG hyperplasia and peripheral nerve lesions. For peripheral nerve microlesions additionally clusters of onion-bulb formations were identified. Conclusion Peripheral nervous system alterations seem to be constant or show only a minor increase in adult NF2. Thus, symptoms of PNP may not primarily attributed to the initial schwannoma growth but to secondary long-term processes, with symptoms only occurring if a certain threshold is exceeded. Histology identified grouped areas of Schwann cell proliferations as the correlate of DRG hyperplasia, while for peripheral nerve lesions different patterns could be found.
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Affiliation(s)
- Tim Godel
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Philipp Bäumer
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Center for Radiology dia.log, Vinzenz-von-Paul Str. 8, 84503, Altötting, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Barbara Hofstadler
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Kordes U, Mautner VF, Oyen F, Hagel C, Hartmann C, Heuser M, Frühwald M, Hasselblatt M, Oehl-Huber K, Siebert R, Schneppenheim R, Schüller U. Evidence for a low-penetrant extended phenotype of rhabdoid tumor predisposition syndrome type 1 from a kindred with gain of SMARCB1 exon 6. Pediatr Blood Cancer 2021; 68:e29185. [PMID: 34101994 DOI: 10.1002/pbc.29185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/27/2021] [Accepted: 05/30/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Uwe Kordes
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Oyen
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Hartmann
- Department of Neuropathology, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Michael Frühwald
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Kathrin Oehl-Huber
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Reinhard Schneppenheim
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Research Institute Children's Cancer Center Hamburg, Hamburg, Germany
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Well L, Careddu A, Stark M, Farschtschi S, Bannas P, Adam G, Mautner VF, Salamon J. Author Correction: Phenotyping spinal abnormalities in patients with Neurofibromatosis type 1 using whole-body MRI. Sci Rep 2021; 11:17669. [PMID: 34462554 PMCID: PMC8405783 DOI: 10.1038/s41598-021-97577-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Anna Careddu
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Maria Stark
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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10
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Well L, Careddu A, Stark M, Farschtschi S, Bannas P, Adam G, Mautner VF, Salamon J. Phenotyping spinal abnormalities in patients with Neurofibromatosis type 1 using whole-body MRI. Sci Rep 2021; 11:16889. [PMID: 34413392 PMCID: PMC8376946 DOI: 10.1038/s41598-021-96310-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
Neurofibromatosis Type 1 (NF1) has been reported to be associated with a variety of spinal abnormalities. The purpose of this study was to quantify the prevalence of spinal abnormalities in a collective of NF1 patients that is representative for the general NF1 population, to associate the co-appearance of spinal abnormalities with both NF1 and clinical symptoms and to investigate if different mutations of the NF1 gene affect the prevalence of these abnormalities. Retrospectively, 275 patients with NF1 and an age- and sex-matched collective of 262 patients were analyzed. The prevalence of spinal abnormalities was recorded. Mutational analysis of the NF1 gene was obtained in 235 NF1 patients. Associations between spinal abnormalities, clinical symptoms and genotype were investigated by binary logistic regression analysis. Prevalence of all spinal abnormalities was higher in NF1 patients than in the control group. Six characteristics of spinal abnormalities were significantly associated with NF1 (all p < 0.05). An influence of scalloping on scoliosis (OR 3.01; p = 0.002); of meningoceles (OR 7.63) and neuroforaminal tumors (OR 2.96) on scalloping, and of dural ectasia on neuroforaminal tumors (OR 1.93) was identified. Backpain and loss of motor function were associated with neuroforaminal tumors, spinal tumors and scalloping of vertebral bodies (all p < 0.05). Specific mutations of the NF1 gene were not relevantly associated with the development of spinal abnormalities. These findings can aid clinicians to improve clinical care of NF1 patients by creating awareness for co-appearences of specific spinal abnormalities and associated symptoms.
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Affiliation(s)
- Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Anna Careddu
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Maria Stark
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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11
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Ahlawat S, Ly KI, Fayad LM, Fisher MJ, Lessing AJ, Berg DJ, Salamon JM, Mautner VF, Babovic-Vuksanovic D, Dombi E, Harris G, Plotkin SR, Blakeley J. Imaging Evaluation of Plexiform Neurofibromas in Neurofibromatosis Type 1: A Survey-Based Assessment. Neurology 2021; 97:S111-S119. [PMID: 34230200 DOI: 10.1212/wnl.0000000000012437] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/23/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess imaging utilization practices across clinical specialists in neurofibromatosis type 1 (NF1) for the evaluation of symptomatic and asymptomatic children and adults with or without plexiform neurofibromas (PN). METHODS An institutional review board-exempt survey was administered to medical practitioners caring for individuals with NF1 at the Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) meeting in September 2019. The survey included questions on respondent demographic data (9 questions), type of imaging obtained for asymptomatic (4 questions) and symptomatic (4 questions) people with and without PN, and utilization of diffusion-weighted imaging (2 questions). RESULTS Thirty practitioners participated in the survey. Most were academic neuro-oncologists at high-volume (>10 patients/week) NF1 centers. Of 30 respondents, 26 had access to whole-body MRI (WB-MRI). The most common approach to an asymptomatic person without PN was no imaging (adults: 57% [17/30]; children: 50% [15/30]), followed by a screening WB-MRI (adults: 20% [6/30]; children: 26.7% [8/30]). The most common approach to a person with symptoms or known PN was regional MRI (adults: 90% [27/30]; children: 93% [28/30]), followed by WB-MRI (adults: 20% [6/30]; children: 36.7% [11/30]). WB-MRI was most often obtained to evaluate a symptomatic child with PN (37% [11/30]). CONCLUSIONS More than 90% of practitioners indicated they would obtain a regional MRI in a symptomatic patient without known or visible PN. Otherwise, there was little consensus on imaging practices. Given the high prevalence of PN and risk of malignant conversion in this patient population, there is a need to define imaging-based guidelines for optimal clinical care and the design of future clinical trials.
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Affiliation(s)
- Shivani Ahlawat
- The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F.), Johns Hopkins University, Baltimore, MD; Stephen E. and Catherine Pappas Center for Neuro-Oncology (K.I.L., S.R.P.) and Department of Radiology (G.H.), Massachusetts General Hospital, Boston; Division of Oncology (M.J.F.), The Children's Hospital of Philadelphia, PA; Neurofibromatosis Northeast (A.J.L., D.J.B.), Burlington, MA; Department of Neurology (J.M.S.), University Medical Center Hamburg-Eppendorf; Department of Diagnostic and Interventional Radiology and Nuclear Medicine (V.-F.M.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; Mayo Clinic (D.B.-V.), Rochester, MN; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology (J.B.), Johns Hopkins University, Baltimore, MD.
| | - K Ina Ly
- The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F.), Johns Hopkins University, Baltimore, MD; Stephen E. and Catherine Pappas Center for Neuro-Oncology (K.I.L., S.R.P.) and Department of Radiology (G.H.), Massachusetts General Hospital, Boston; Division of Oncology (M.J.F.), The Children's Hospital of Philadelphia, PA; Neurofibromatosis Northeast (A.J.L., D.J.B.), Burlington, MA; Department of Neurology (J.M.S.), University Medical Center Hamburg-Eppendorf; Department of Diagnostic and Interventional Radiology and Nuclear Medicine (V.-F.M.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; Mayo Clinic (D.B.-V.), Rochester, MN; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology (J.B.), Johns Hopkins University, Baltimore, MD
| | - Laura M Fayad
- The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F.), Johns Hopkins University, Baltimore, MD; Stephen E. and Catherine Pappas Center for Neuro-Oncology (K.I.L., S.R.P.) and Department of Radiology (G.H.), Massachusetts General Hospital, Boston; Division of Oncology (M.J.F.), The Children's Hospital of Philadelphia, PA; Neurofibromatosis Northeast (A.J.L., D.J.B.), Burlington, MA; Department of Neurology (J.M.S.), University Medical Center Hamburg-Eppendorf; Department of Diagnostic and Interventional Radiology and Nuclear Medicine (V.-F.M.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; Mayo Clinic (D.B.-V.), Rochester, MN; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology (J.B.), Johns Hopkins University, Baltimore, MD
| | - Michael J Fisher
- The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F.), Johns Hopkins University, Baltimore, MD; Stephen E. and Catherine Pappas Center for Neuro-Oncology (K.I.L., S.R.P.) and Department of Radiology (G.H.), Massachusetts General Hospital, Boston; Division of Oncology (M.J.F.), The Children's Hospital of Philadelphia, PA; Neurofibromatosis Northeast (A.J.L., D.J.B.), Burlington, MA; Department of Neurology (J.M.S.), University Medical Center Hamburg-Eppendorf; Department of Diagnostic and Interventional Radiology and Nuclear Medicine (V.-F.M.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; Mayo Clinic (D.B.-V.), Rochester, MN; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology (J.B.), Johns Hopkins University, Baltimore, MD
| | - Andrés J Lessing
- The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F.), Johns Hopkins University, Baltimore, MD; Stephen E. and Catherine Pappas Center for Neuro-Oncology (K.I.L., S.R.P.) and Department of Radiology (G.H.), Massachusetts General Hospital, Boston; Division of Oncology (M.J.F.), The Children's Hospital of Philadelphia, PA; Neurofibromatosis Northeast (A.J.L., D.J.B.), Burlington, MA; Department of Neurology (J.M.S.), University Medical Center Hamburg-Eppendorf; Department of Diagnostic and Interventional Radiology and Nuclear Medicine (V.-F.M.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; Mayo Clinic (D.B.-V.), Rochester, MN; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology (J.B.), Johns Hopkins University, Baltimore, MD
| | - Dale J Berg
- The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F.), Johns Hopkins University, Baltimore, MD; Stephen E. and Catherine Pappas Center for Neuro-Oncology (K.I.L., S.R.P.) and Department of Radiology (G.H.), Massachusetts General Hospital, Boston; Division of Oncology (M.J.F.), The Children's Hospital of Philadelphia, PA; Neurofibromatosis Northeast (A.J.L., D.J.B.), Burlington, MA; Department of Neurology (J.M.S.), University Medical Center Hamburg-Eppendorf; Department of Diagnostic and Interventional Radiology and Nuclear Medicine (V.-F.M.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; Mayo Clinic (D.B.-V.), Rochester, MN; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology (J.B.), Johns Hopkins University, Baltimore, MD
| | - Johannes M Salamon
- The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F.), Johns Hopkins University, Baltimore, MD; Stephen E. and Catherine Pappas Center for Neuro-Oncology (K.I.L., S.R.P.) and Department of Radiology (G.H.), Massachusetts General Hospital, Boston; Division of Oncology (M.J.F.), The Children's Hospital of Philadelphia, PA; Neurofibromatosis Northeast (A.J.L., D.J.B.), Burlington, MA; Department of Neurology (J.M.S.), University Medical Center Hamburg-Eppendorf; Department of Diagnostic and Interventional Radiology and Nuclear Medicine (V.-F.M.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; Mayo Clinic (D.B.-V.), Rochester, MN; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology (J.B.), Johns Hopkins University, Baltimore, MD
| | - Victor-Felix Mautner
- The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F.), Johns Hopkins University, Baltimore, MD; Stephen E. and Catherine Pappas Center for Neuro-Oncology (K.I.L., S.R.P.) and Department of Radiology (G.H.), Massachusetts General Hospital, Boston; Division of Oncology (M.J.F.), The Children's Hospital of Philadelphia, PA; Neurofibromatosis Northeast (A.J.L., D.J.B.), Burlington, MA; Department of Neurology (J.M.S.), University Medical Center Hamburg-Eppendorf; Department of Diagnostic and Interventional Radiology and Nuclear Medicine (V.-F.M.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; Mayo Clinic (D.B.-V.), Rochester, MN; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology (J.B.), Johns Hopkins University, Baltimore, MD
| | - Dusica Babovic-Vuksanovic
- The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F.), Johns Hopkins University, Baltimore, MD; Stephen E. and Catherine Pappas Center for Neuro-Oncology (K.I.L., S.R.P.) and Department of Radiology (G.H.), Massachusetts General Hospital, Boston; Division of Oncology (M.J.F.), The Children's Hospital of Philadelphia, PA; Neurofibromatosis Northeast (A.J.L., D.J.B.), Burlington, MA; Department of Neurology (J.M.S.), University Medical Center Hamburg-Eppendorf; Department of Diagnostic and Interventional Radiology and Nuclear Medicine (V.-F.M.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; Mayo Clinic (D.B.-V.), Rochester, MN; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology (J.B.), Johns Hopkins University, Baltimore, MD
| | - Eva Dombi
- The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F.), Johns Hopkins University, Baltimore, MD; Stephen E. and Catherine Pappas Center for Neuro-Oncology (K.I.L., S.R.P.) and Department of Radiology (G.H.), Massachusetts General Hospital, Boston; Division of Oncology (M.J.F.), The Children's Hospital of Philadelphia, PA; Neurofibromatosis Northeast (A.J.L., D.J.B.), Burlington, MA; Department of Neurology (J.M.S.), University Medical Center Hamburg-Eppendorf; Department of Diagnostic and Interventional Radiology and Nuclear Medicine (V.-F.M.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; Mayo Clinic (D.B.-V.), Rochester, MN; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology (J.B.), Johns Hopkins University, Baltimore, MD
| | - Gordon Harris
- The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F.), Johns Hopkins University, Baltimore, MD; Stephen E. and Catherine Pappas Center for Neuro-Oncology (K.I.L., S.R.P.) and Department of Radiology (G.H.), Massachusetts General Hospital, Boston; Division of Oncology (M.J.F.), The Children's Hospital of Philadelphia, PA; Neurofibromatosis Northeast (A.J.L., D.J.B.), Burlington, MA; Department of Neurology (J.M.S.), University Medical Center Hamburg-Eppendorf; Department of Diagnostic and Interventional Radiology and Nuclear Medicine (V.-F.M.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; Mayo Clinic (D.B.-V.), Rochester, MN; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology (J.B.), Johns Hopkins University, Baltimore, MD
| | - Scott R Plotkin
- The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F.), Johns Hopkins University, Baltimore, MD; Stephen E. and Catherine Pappas Center for Neuro-Oncology (K.I.L., S.R.P.) and Department of Radiology (G.H.), Massachusetts General Hospital, Boston; Division of Oncology (M.J.F.), The Children's Hospital of Philadelphia, PA; Neurofibromatosis Northeast (A.J.L., D.J.B.), Burlington, MA; Department of Neurology (J.M.S.), University Medical Center Hamburg-Eppendorf; Department of Diagnostic and Interventional Radiology and Nuclear Medicine (V.-F.M.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; Mayo Clinic (D.B.-V.), Rochester, MN; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology (J.B.), Johns Hopkins University, Baltimore, MD
| | - Jaishri Blakeley
- The Russell H. Morgan Department of Radiology and Radiological Science (S.A., L.M.F.), Johns Hopkins University, Baltimore, MD; Stephen E. and Catherine Pappas Center for Neuro-Oncology (K.I.L., S.R.P.) and Department of Radiology (G.H.), Massachusetts General Hospital, Boston; Division of Oncology (M.J.F.), The Children's Hospital of Philadelphia, PA; Neurofibromatosis Northeast (A.J.L., D.J.B.), Burlington, MA; Department of Neurology (J.M.S.), University Medical Center Hamburg-Eppendorf; Department of Diagnostic and Interventional Radiology and Nuclear Medicine (V.-F.M.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; Mayo Clinic (D.B.-V.), Rochester, MN; Pediatric Oncology Branch (E.D.), National Cancer Institute, Bethesda, MD; and Department of Neurology (J.B.), Johns Hopkins University, Baltimore, MD
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12
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Well L, Döbel K, Kluwe L, Bannas P, Farschtschi S, Adam G, Mautner VF, Salamon J. Genotype-phenotype correlation in neurofibromatosis type-1: NF1 whole gene deletions lead to high tumor-burden and increased tumor-growth. PLoS Genet 2021; 17:e1009517. [PMID: 33951044 PMCID: PMC8099117 DOI: 10.1371/journal.pgen.1009517] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Abstract
Neurofibromatosis type-1 (NF1) patients suffer from cutaneous and subcutaneous neurofibromas (CNF) and large plexiform neurofibromas (PNF). Whole gene deletions of the NF1 gene can cause a more severe phenotype compared to smaller intragenic changes. Two distinct groups of NF1 whole gene deletions are type-1 deletions and atypical deletions. Our aim was to assess volumes and averaged annual growth-rates of CNF and PNF in patients with NF1 whole gene deletions and to compare these with NF1 patients without large deletions of the NF1 gene. We retrospectively evaluated 140 whole-body MR examinations of 38 patients with NF1 whole gene deletions (type-1 group: n = 27/atypical group n = 11) and an age- and sex matched collective of 38 NF1-patients. Age-dependent subgroups were created (0-18 vs >18 years). Sixty-four patients received follow-up MRI examinations (NF1whole gene deletion n = 32/control group n = 32). Whole-body tumor-volumes were semi-automatically assessed (MedX, V3.42). Tumor volumes and averaged annual growth-rates were compared. Median tumor-burden was significantly higher in the type-1 group (418ml; IQR 77 - 950ml, p = 0.012) but not in the atypical group (356ml;IQR 140-1190ml, p = 0.099) when compared to the controls (49ml; IQR 11-691ml). Averaged annual growth rates were significantly higher in both the type-1 group (14%/year; IQR 45-36%/year, p = 0.004) and atypical group (11%/year; IQR 5-23%/year, p = 0.014) compared to the controls (4%/year; IQR1-8%/year). Averaged annual growth rates were significantly higher in pediatric patients with type-1 deletions (21%/year) compared with adult patients (8%/year, p = 0.014) and also compared with pediatric patients without large deletions of the NF1 gene (3.3%/year, p = 0.0015). NF1 whole gene deletions cause a more severe phenotype of NF1 with higher tumor burden and higher growth-rates compared to NF1 patients without large deletions of the NF1 gene. In particular, pediatric patients with type-1 deletions display a pronounced tumor growth.
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Affiliation(s)
- Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Kimberly Döbel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lan Kluwe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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13
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von Cossel K, Muschol N, Friedrich RE, Glatzel M, Ammer L, Lohmöller B, Bendszus M, Mautner VF, Godel T. Assessment of small fiber neuropathy in patients carrying the non-classical Fabry variant p.D313Y. Muscle Nerve 2021; 63:745-750. [PMID: 33543778 DOI: 10.1002/mus.27196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The pathophysiological significance of the Fabry-related, non-classical variant p.D313Y still remains to be solved. This study assesses the involvement of the peripheral nervous system with respect to small fiber neuropathy and neuropathic pain in female patients carrying p.D313Y. METHODS This study examined nine females carrying the Fabry-related p.D313Y variant by obtaining skin punch biopsies above the right lateral malleolus. Intraepidermal nerve fiber density was determined for each patient and compared to reference values matched for the patient's decade of life and sex. Moreover, each patient was characterized by a detailed neurological examination and by pain assessment via questionnaire. RESULTS Compared to sex-matched lower fifth percentile reference values per decade, intraepidermal nerve fiber density was decreased in seven out of nine patients. Four patients reported acral paresthesias and neuropathic pain with an average visual analogue scale score of 7 out of 10 points. Two patients experienced acute pain crises. Six out of seven patients diagnosed with small fiber neuropathy had a their medical history of hypo- and/or hyperhidrosis. DISCUSSION The diagnosis of small fiber neuropathy was made in seven out of nine females carrying the non-classical variant p.D313Y. Moreover, neuropathic pain and symptoms indicative of autonomic nervous system dysfunction seem to be common findings that may be of clinical significance and may warrant therapeutic intervention.
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Affiliation(s)
- Katharina von Cossel
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Muschol
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhard E Friedrich
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luise Ammer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Lohmöller
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Godel
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg, Germany
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14
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Ronellenfitsch MW, Harter PN, Kirchner M, Heining C, Hutter B, Gieldon L, Schittenhelm J, Schuhmann MU, Tatagiba M, Marquardt G, Wagner M, Endris V, Brandts CH, Mautner VF, Schröck E, Weichert W, Brors B, von Deimling A, Mittelbronn M, Steinbach JP, Reuss DE, Glimm H, Stenzinger A, Fröhling S. Targetable ERBB2 mutations identified in neurofibroma/schwannoma hybrid nerve sheath tumors. J Clin Invest 2021; 130:2488-2495. [PMID: 32017710 DOI: 10.1172/jci130787] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/30/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUNDNeurofibroma/schwannoma hybrid nerve sheath tumors (N/S HNSTs) are neoplasms associated with larger nerves that occur sporadically and in the context of schwannomatosis or neurofibromatosis type 2 or 1. Clinical management of N/S HNSTs is challenging, especially for large tumors, and established systemic treatments are lacking.METHODSWe used next-generation sequencing and array-based DNA methylation profiling to determine the clinically actionable genomic and epigenomic landscapes of N/S HNSTs.RESULTSWhole-exome sequencing within a precision oncology program identified an activating mutation (p.Asp769Tyr) in the catalytic domain of the ERBB2 receptor tyrosine kinase in a patient with schwannomatosis-associated N/S HNST, and targeted treatment with the small-molecule ERBB inhibitor lapatinib led to prolonged clinical benefit and a lasting radiographic and metabolic response. Analysis of a multicenter validation cohort revealed recurrent ERBB2 mutations (p.Leu755Ser, p.Asp769Tyr, p.Val777Leu) in N/S HNSTs occurring in patients who met diagnostic criteria for sporadic schwannomatosis (3 of 7 patients), but not in N/S HNSTs arising in the context of neurofibromatosis (6 patients) or outside a tumor syndrome (1 patient), and showed that ERBB2-mutant N/S HNSTs cluster in a distinct subgroup of peripheral nerve sheath tumors based on genome-wide DNA methylation patterns.CONCLUSIONThese findings uncover a key biological feature of N/S HNSTs that may have important diagnostic and therapeutic implications.FUNDINGThis work was supported by grant H021 from DKFZ-HIPO, the University Cancer Center Frankfurt, and the Frankfurt Research Funding Clinician Scientist Program.
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Affiliation(s)
- Michael W Ronellenfitsch
- Dr. Senckenberg Institute of Neurooncology and.,University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Frankfurt am Main, Germany.,Frankfurt Cancer Institute and
| | - Patrick N Harter
- University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Frankfurt am Main, Germany.,Frankfurt Cancer Institute and.,Institute of Neurology (Edinger Institute), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Martina Kirchner
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Heining
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Dresden and German Cancer Research Center (DKFZ), Dresden, Germany.,DKTK partner site Dresden, Dresden, Germany.,Center for Personalized Oncology, NCT Dresden and University Hospital Carl Gustav Carus Dresden at Technical University Dresden, Dresden, Germany
| | - Barbara Hutter
- Division of Applied Bioinformatics, DKFZ and NCT Heidelberg, Heidelberg, Germany.,Heidelberg Center for Personalized Oncology (HIPO), DKFZ, Heidelberg, Germany.,DKTK partner site Heidelberg, Heidelberg, Germany
| | - Laura Gieldon
- DKTK partner site Dresden, Dresden, Germany.,Institute for Clinical Genetics, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany.,European Reference Network for Genetic Tumour Risk Syndromes, Hereditary Cancer Syndrome Center Dresden, Dresden, Germany.,DKFZ, Heidelberg, Germany.,NCT Dresden, Dresden, Germany.,Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, Institute of Pathology and Neuropathology, and Comprehensive Cancer Center Tübingen-Stuttgart
| | - Martin U Schuhmann
- Department of Neurosurgery, and.,Center for Neurofibromatosis, Center for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, and.,Center for Neurofibromatosis, Center for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | | | | | - Volker Endris
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian H Brandts
- University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Frankfurt am Main, Germany.,Frankfurt Cancer Institute and.,Hematology/Oncology, Department of Medicine, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Evelin Schröck
- DKTK partner site Dresden, Dresden, Germany.,Institute for Clinical Genetics, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany.,European Reference Network for Genetic Tumour Risk Syndromes, Hereditary Cancer Syndrome Center Dresden, Dresden, Germany.,DKFZ, Heidelberg, Germany.,NCT Dresden, Dresden, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University Munich, Munich, Germany.,DKTK partner site Munich, Munich, Germany
| | - Benedikt Brors
- Division of Applied Bioinformatics, DKFZ and NCT Heidelberg, Heidelberg, Germany.,Heidelberg Center for Personalized Oncology (HIPO), DKFZ, Heidelberg, Germany.,DKTK partner site Heidelberg, Heidelberg, Germany
| | - Andreas von Deimling
- DKTK partner site Heidelberg, Heidelberg, Germany.,Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, DKFZ, Heidelberg, Germany
| | - Michel Mittelbronn
- Institute of Neurology (Edinger Institute), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Luxembourg Centre of Neuropathology (LCNP), Dudelange, Luxembourg.,Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg City, Luxembourg.,Department of Oncology, Luxembourg Institute of Health (LIH), Strassen, Luxembourg.,National Center of Pathology (NCP), Laboratoire National de Santé, Dudelange, Luxembourg
| | - Joachim P Steinbach
- Dr. Senckenberg Institute of Neurooncology and.,University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Frankfurt am Main, Germany.,Frankfurt Cancer Institute and
| | - David E Reuss
- DKTK partner site Heidelberg, Heidelberg, Germany.,Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, DKFZ, Heidelberg, Germany
| | - Hanno Glimm
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Dresden and German Cancer Research Center (DKFZ), Dresden, Germany.,DKTK partner site Dresden, Dresden, Germany.,Center for Personalized Oncology, NCT Dresden and University Hospital Carl Gustav Carus Dresden at Technical University Dresden, Dresden, Germany.,Translational Functional Cancer Genomics and
| | - Albrecht Stenzinger
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,DKTK partner site Heidelberg, Heidelberg, Germany
| | - Stefan Fröhling
- Heidelberg Center for Personalized Oncology (HIPO), DKFZ, Heidelberg, Germany.,DKTK partner site Heidelberg, Heidelberg, Germany.,Division of Translational Medical Oncology, NCT Heidelberg and DKFZ, Heidelberg, Germany
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15
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Depping MK, Uhlenbusch N, von Kodolitsch Y, Klose HFE, Mautner VF, Löwe B. Supportive care needs of patients with rare chronic diseases: multi-method, cross-sectional study. Orphanet J Rare Dis 2021; 16:44. [PMID: 33482869 PMCID: PMC7825171 DOI: 10.1186/s13023-020-01660-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 05/18/2020] [Accepted: 12/22/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND In the absence of a cure for the majority of rare diseases, the disease management aims to provide optimal supportive care. The goal of this study was to assess supportive care needs in patients with chronic rare diseases. METHODS Cross-sectional mixed-method study was conducted using validated self-report scales and open-ended questions to assess supportive care needs. Participants affected by rare diseases across Germany were contacted via patient organizations and centers for rare diseases. N = 304 participants with 81 different rare diseases completed the study, 81.6% were female, mean age was 44.2 years (SD = 12.8, range 16-74). The quantitative results regarding supportive care needs were compared to a reference population of patients affected by cancer (N = 888). Main outcomes were unmet supportive care needs of patients with rare diseases, as assessed by the Supportive Care Needs Survey (SNCS-SF34) and an open-ended question on support wishes. RESULTS Patients with rare diseases did not feel sufficiently supported with regard to psychological support, health system and information, physical and daily living, patient care and support, and sexuality needs. The unmet supportive care needs were significantly higher in the patient sample with rare diseases compared to the SCNS-SF34 reference sample of patients with cancer. 60% of patients with rare diseases did not feel sufficiently socially supported. CONCLUSIONS Patients affected by rare diseases have high unmet support needs in all areas studied. Multidisciplinary care, including psychological support and the provision of information regarding the healthcare system, treatment options, disease course and sexuality, might help address these needs.
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Affiliation(s)
- Miram K Depping
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany.
| | - Natalie Uhlenbusch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans F E Klose
- Center for Oncology, Medical Clinic and Policlinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor-Felix Mautner
- Clinic and Policlinic for Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
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16
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Avanesov M, Well L, Laqmani A, Derlin T, Riccardi VM, Adam G, Mautner VF, Salamon J. Structural alteration of lung parenchyma in patients with NF1: a phenotyping study using multidetector computed tomography (MDCT). Orphanet J Rare Dis 2021; 16:29. [PMID: 33446201 PMCID: PMC7809820 DOI: 10.1186/s13023-021-01672-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 01/05/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diffuse interstitial lung disease have been described in Neurofibromatosis type 1 (NF1), but its diversity and prevalence remain unknown. The aim of this study was to assess the prevalence and characteristics of (NF1)-associated lung manifestations in a large single-center study using multidetector computed tomography (MDCT) and to evaluate the smoking history, patients' age, genetics, and the presence of malignant peripheral nerve sheath tumors (MPNST) as potential influencing factors for lung pathologies. METHODS In this retrospective study, 71 patients with NF1 were evaluated for the presence of distinctive lung manifestations like reticulations, consolidations, type of emphysema, pulmonary nodules and cysts. All patients underwent F-18-FDG PET/CT scans, which were reviewed by two experienced radiologists in consensus. Patients' subgroups were formed based on their smoking history (current smokers/previous smokers/never smokers), age (< 12 years, 12-18 years, > 18 years), and presence of MPNST (MPNST/no MPNST). In 57 patients (80%), genetic analysis of sequences coding for the neurofibromin on chromosome 17 was performed, which was correlated with different lung pathologies. RESULTS Among all NF1 patients (33 ± 14 years, 56% females), 17 patients (24%) were current smokers and 62 patients (87%) were > 18 years old. Pulmonary cysts, nodules, and paraseptal emphysema were the most common pulmonary findings (35%, 32%, 30%). The presence of pulmonary metastases, MPNST and centrilobular emphysema was associated with smoking. Cysts were observed only in adults, whereas no significant correlation between age and all other pulmonary findings was found (p > 0.05). Presence of MPNST was accompanied by higher rates of intrapulmonary nodules and pulmonary metastasis. Neither the presence nor absence of any of the specific gene mutations was associated with any particular lung pathology (p > 0.05). CONCLUSIONS All pulmonary findings in NF1 patients occurred independently from specific mutation subtypes, suggesting that many NF1 mutations can cause various pulmonary pathologies. The presence of pulmonary metastases, MPNST and centrilobular emphysema was associated with smoking, indicating the value of smoking secession or the advice not to start smoking in NF1 patients as preventive strategy for clinicians. For screening of pulmonary manifestations in NF1 patients, an MDCT besides medical history and physical examination is mandatory in clinical routine.
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Affiliation(s)
- Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Azien Laqmani
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | | | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor-Felix Mautner
- Clinic and Polyclinic for Neurology, Neurofibromatosis Outpatient Clinic, UKE, Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Zipfel J, Al-Hariri M, Gugel I, Haas-Lude K, Grimm A, Warmann S, Krimmel M, Mautner VF, Tatagiba M, Schuhmann MU. Correction to: Surgical management of peripheral nerve sheath tumours in children, with special consideration of neurofibromatoses. Childs Nerv Syst 2021; 37:2953. [PMID: 34282474 PMCID: PMC8423676 DOI: 10.1007/s00381-021-05228-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A correction to this paper has been published: https://doi.org/10.1007/s00381-021-05228-2
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Affiliation(s)
- Julian Zipfel
- Division of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany.
- Department of Neurosurgery, University Hospital Tübingen, Tubingen, Germany.
- Centre for Neurofibromatosis at the Centre of Rare Diseases, University Hospital and University of Tübingen, Tubingen, Germany.
| | - Meizer Al-Hariri
- Department of Neurosurgery, University Hospital Tübingen, Tubingen, Germany
| | - Isabel Gugel
- Department of Neurosurgery, University Hospital Tübingen, Tubingen, Germany
- Centre for Neurofibromatosis at the Centre of Rare Diseases, University Hospital and University of Tübingen, Tubingen, Germany
| | - Karin Haas-Lude
- Centre for Neurofibromatosis at the Centre of Rare Diseases, University Hospital and University of Tübingen, Tubingen, Germany
- Department of Paediatric Neurology, University Children's Hospital Tübingen, Tubingen, Germany
| | - Alexander Grimm
- Department of Neurology, University Hospital Tübingen, Tubingen, Germany
| | - Steven Warmann
- Department of Paediatric Surgery, University Children's Hospital Tübingen, Tubingen, Germany
| | - Michael Krimmel
- Department of Maxillofacial Surgery, University Hospital Tübingen, Tubingen, Germany
| | - Victor-Felix Mautner
- Neurofibromatosis Centre Hamburg, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcos Tatagiba
- Division of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Department of Neurosurgery, University Hospital Tübingen, Tubingen, Germany
- Centre for Neurofibromatosis at the Centre of Rare Diseases, University Hospital and University of Tübingen, Tubingen, Germany
| | - Martin U Schuhmann
- Division of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Department of Neurosurgery, University Hospital Tübingen, Tubingen, Germany
- Centre for Neurofibromatosis at the Centre of Rare Diseases, University Hospital and University of Tübingen, Tubingen, Germany
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18
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Godel T, von Cossel K, Friedrich RE, Glatzel M, Canaan-Kühl S, Duning T, Kronlage M, Heiland S, Bendszus M, Muschol N, Mautner VF. Assessment of Peripheral Nervous System Alterations in Patients with the Fabry Related GLA-Variant p.A143T. Diagnostics (Basel) 2020; 10:diagnostics10121027. [PMID: 33266233 PMCID: PMC7760340 DOI: 10.3390/diagnostics10121027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/03/2020] [Revised: 11/23/2020] [Accepted: 11/28/2020] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study is to examine alterations of the peripheral nervous system (PNS) in oligo-symptomatic patients carrying the Fabry related GLA-gene variant p.A143T by Magnetic Resonance Neurography (MRN) and skin biopsy. This prospective study assessed dorsal root ganglia (DRG) volume L3 to S2, vascular permeability of the DRG L5, S1, and the spinal nerve L5 in five patients carrying p.A143T in comparison to patients with classical Fabry mutations and healthy controls. Moreover, skin punch biopsies above the lateral malleolus of the right foot were obtained in four patients and intraepidermal nerve fiber density (IENFD) was counted individually. Compared to controls, DRG volumes of p.A143T patients were enlarged by 30% (L3, p < 0.05), 35% (L4, p < 0.05), 29% (L5, p = 0.15), 36% (S1, p < 0.01), and 18% (S2, p < 0.05), but less pronounced compared to patients carrying a classical Fabry mutation. Compared to healthy controls, vascular permeability was decreased by 40% (L5 right), 49% (L5 left), 48% (S1 right), and 49% (S1) (p < 0.01–p < 0.001), but non-significant less than patients carrying a classical Fabry mutation. Compared to sex-matched 5% lower normative reference values per decade, IENFD was decreased in three of four patients. MRN and determination of IENFD is able to detect early alteration of the PNS segment in oligo-symptomatic patients with the disease-modifying GLA-variant p.A143T on an individual basis. This procedure might also help in further GLA-variants of uncertain significance for early identification of patients with single major organ manifestation.
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Affiliation(s)
- Tim Godel
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (M.K.); (S.H.); (M.B.)
- Correspondence: ; Tel.: +49-6221-5634791
| | - Katharina von Cossel
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (K.v.C.); (N.M.)
| | - Reinhard E. Friedrich
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
| | - Sima Canaan-Kühl
- Division of Nephrology and Intensive Care Medicine, CCM, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany;
| | - Thomas Duning
- Department of Neurology, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
| | - Moritz Kronlage
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (M.K.); (S.H.); (M.B.)
| | - Sabine Heiland
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (M.K.); (S.H.); (M.B.)
| | - Martin Bendszus
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (M.K.); (S.H.); (M.B.)
| | - Nicole Muschol
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (K.v.C.); (N.M.)
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
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19
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Farschtschi S, Mautner VF, McLean ACL, Schulz A, Friedrich RE, Rosahl SK. The Neurofibromatoses. Dtsch Arztebl Int 2020; 117:354-360. [PMID: 32657748 DOI: 10.3238/arztebl.2020.0354] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 04/18/2019] [Accepted: 03/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Neurofibromatosis of types 1 and 2 (NF1, NF2) and schwannomatosis are the diseases that make up the neurofibromatosis spectrum. With respective incidences of 1 in 3000, 1 in 33 000, and 1 in 60 000 births, they form part of the group of rare tumor-suppressor syndromes. They give rise to a greater tumor burden for the nervous system than any other type of neoplastic disease. New approaches to symptomatic treatment are emerging. METHODS This review is based on articles retrieved by a selective literature search on the pathogenesis, diagnosis, and treatment of the neurofibromatoses. RESULTS NF1 and NF2 are monogenic diseases, while the genetics of schwannomatosis is complex. The three entities are clinically and pathophysiologically distinct. An important aspect of their tumor biology is the alternation of growth phases and growth pauses. Correlations between genotypes and phenotypes are variable, while new mutations and genetic mosaics are common. Ninety-nine percent of patients with NF1 have six or more café-au-lait spots by the age of 12 months; 90-95% of patients with NF2 develop bilateral vestibular schwannomas. In schwannomatosis, pain is the most prominent symptom; two-thirds of those affected develop spinal schwannomas. The severity and prognosis of these disorders are not closely correlated with the radiological findings; rather, neurologic deficits, malignant transformation, and psychosocial stress are of greater clinical importance. Advances in knowledge of pathophysiology have led to the development of targeted treatment approaches. Examples include the off-label treatment of vestibular schwannomas with bevacizumab and of plexiform neurofibromas with MEK inhibitors. CONCLUSION Patients with neurofibromatoses need individualized care. They should be treated in centers of expertise where interdisciplinary consultation is available and new types of pharmacotherapy can be provided.
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Affiliation(s)
- Said Farschtschi
- International Center for Neurofibromatoses (ICNF), Department of Neurology, University MedicalCenter Hamburg-Eppendorf
| | - Victor-Felix Mautner
- International Center for Neurofibromatoses (ICNF), Department of Neurology, University MedicalCenter Hamburg-Eppendorf
| | | | | | - Reinhard E Friedrich
- Department of Oromaxillofacial Surgery, University Medical Center Hamburg-Eppendorf
| | - Steffen K Rosahl
- Neurofibromatosis Center, Department of Neurosurgery, Helios Hospital Erfurt
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20
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Gugel I, Grimm F, Zipfel J, Teuber C, Ernemann U, Kluwe L, Tatagiba M, Mautner VF, Schuhmann MU. Age at Onset and Presenting Symptoms of Neurofibromatosis Type 2 as Prognostic Factors for Clinical Course of Vestibular Schwannomas. Cancers (Basel) 2020; 12:cancers12092355. [PMID: 32825434 PMCID: PMC7563356 DOI: 10.3390/cancers12092355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/14/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/16/2022] Open
Abstract
The presenting symptoms of the tumor suppressor gene syndrome neurofibromatosis type 2 (NF2) are often non-specific and unrelated to the disease hallmark bilateral vestibular schwannomas (VS). However, age at onset and presenting symptoms may have predictive values for the clinical course of VS. In this retrospective single-center study, we addressed this issue by reviewing 106 patients with 194 VS. Presenting symptoms attributable to VS commonly occur in 87% of adults and 31% of children. Age at onset significantly correlates with tumor volumes at presentation (p = 0.034). In addition, age at onset significantly correlates with pure-tone average (p = 0.0001), speech discrimination scores (p = 0.001), age at beginning of hearing loss (p = 0.0001), age at deafness (p = 0.0001), and age at first surgery (p = 0.0001). Patients presenting with VS related symptoms had significantly (p < 0.05) worse hearing values at presentation and after surgery. These patients also exhibited higher growth rates and tumor volumes compared to patients with non-VS related presenting symptoms, but this difference did not reach the significance level of p < 0.05. Due to the late appearance of these symptoms, the time of beginning hearing loss, surgery and deafness is significantly delayed (p < 0.05) compared to patients not presenting with VS. In summary, age at onset and type of presenting symptom provide excellent prognostic parameters for predicting VS- and hearing-related clinical course.
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Affiliation(s)
- Isabel Gugel
- Department of Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany; (F.G.); (J.Z.); (C.T.); (M.T.); (M.U.S.)
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, 72076 Tübingen, Germany;
- Correspondence: ; Tel.: +49-7071-2980325; Fax: +49-7071-295245
| | - Florian Grimm
- Department of Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany; (F.G.); (J.Z.); (C.T.); (M.T.); (M.U.S.)
| | - Julian Zipfel
- Department of Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany; (F.G.); (J.Z.); (C.T.); (M.T.); (M.U.S.)
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, 72076 Tübingen, Germany;
- Division of Pediatric Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Christian Teuber
- Department of Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany; (F.G.); (J.Z.); (C.T.); (M.T.); (M.U.S.)
| | - Ulrike Ernemann
- Department of Neuroradiology, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Lan Kluwe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
- Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany; (F.G.); (J.Z.); (C.T.); (M.T.); (M.U.S.)
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Victor-Felix Mautner
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, 72076 Tübingen, Germany;
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Martin Ulrich Schuhmann
- Department of Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany; (F.G.); (J.Z.); (C.T.); (M.T.); (M.U.S.)
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, 72076 Tübingen, Germany;
- Division of Pediatric Neurosurgery, University Hospital Tübingen, 72076 Tübingen, Germany
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21
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Farschtschi SC, Mainka T, Glatzel M, Hannekum AL, Hauck M, Gelderblom M, Hagel C, Friedrich RE, Schuhmann MU, Schulz A, Morrison H, Kehrer-Sawatzki H, Luhmann J, Gerloff C, Bendszus M, Bäumer P, Mautner VF. C-Fiber Loss as a Possible Cause of Neuropathic Pain in Schwannomatosis. Int J Mol Sci 2020; 21:ijms21103569. [PMID: 32443592 PMCID: PMC7278954 DOI: 10.3390/ijms21103569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 01/22/2023] Open
Abstract
Schwannomatosis is the third form of neurofibromatosis and characterized by the occurrence of multiple schwannomas. The most prominent symptom is chronic pain. We aimed to test whether pain in schwannomatosis might be caused by small-fiber neuropathy. Twenty patients with schwannomatosis underwent neurological examination and nerve conduction studies. Levels of pain perception as well as anxiety and depression were assessed by established questionnaires. Quantitative sensory testing (QST) and laser-evoked potentials (LEP) were performed on patients and controls. Whole-body magnetic resonance imaging (wbMRI) and magnetic resonance neurography (MRN) were performed to quantify tumors and fascicular nerve lesions; skin biopsies were performed to determine intra-epidermal nerve fiber density (IENFD). All patients suffered from chronic pain without further neurological deficits. The questionnaires indicated neuropathic symptoms with significant impact on quality of life. Peripheral nerve tumors were detected in all patients by wbMRI. MRN showed additional multiple fascicular nerve lesions in 16/18 patients. LEP showed significant faster latencies compared to normal controls. Finally, IENFD was significantly reduced in 13/14 patients. Our study therefore indicates the presence of small-fiber neuropathy, predominantly of unmyelinated C-fibers. Fascicular nerve lesions are characteristic disease features that are associated with faster LEP latencies and decreased IENFD. Together these methods may facilitate differential diagnosis of schwannomatosis.
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Affiliation(s)
- Said C. Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
- Correspondence: ; Tel.: +49(0)407410-53869
| | - Tina Mainka
- Department of Neurology, Charité University Medicine, 10117 Berlin, Germany;
- Berlin Institute of Health, 10178 Berlin, Germany
| | - Markus Glatzel
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.G.); (C.H.)
| | - Anna-Lena Hannekum
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
| | - Michael Hauck
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
- Department of Neurophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
| | - Christian Hagel
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.G.); (C.H.)
| | - Reinhard E. Friedrich
- Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Martin U. Schuhmann
- Department of Neurosurgery, University Medical Center Tübingen, 72076 Tübingen, Germany;
| | - Alexander Schulz
- Leibniz Institute on Aging, Fritz Lipmann Institute, 07745 Jena, Germany; (A.S.); (H.M.)
- MVZ Human Genetics, 99084 Erfurt, Germany
| | - Helen Morrison
- Leibniz Institute on Aging, Fritz Lipmann Institute, 07745 Jena, Germany; (A.S.); (H.M.)
| | | | - Jan Luhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
| | - Martin Bendszus
- Department of Neuroradiology, University Medical Center Heidelberg, 69120 Heidelberg, Germany; (M.B.); (P.B.)
| | - Philipp Bäumer
- Department of Neuroradiology, University Medical Center Heidelberg, 69120 Heidelberg, Germany; (M.B.); (P.B.)
- Department of Radiology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
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22
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Kluwe L, Friedrich RE, Farschtschi SC, Hagel C, Kehrer-Sawatzki H, Mautner VF. Null phenotype of neurofibromatosis type 1 in a carrier of a heterozygous atypical NF1 deletion due to mosaicism. Hum Mutat 2020; 41:1226-1231. [PMID: 32248581 DOI: 10.1002/humu.24022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/02/2020] [Accepted: 03/28/2020] [Indexed: 11/11/2022]
Abstract
We coincidently detected an atypical deletion of at least 1.3-Mb, encompassing the NF1 tumor suppressor gene and several adjacent genes at an apparent heterozygous level in the blood of a 65-year-old female patient. She had multiple subcutaneous tumors that appeared with a certain similarity of subcutaneous neurofibromas, which, however, was revealed as lipomas by histological examination. Comprehensive and exhaustive clinical and radiological examinations did not detect any neurofibromatosis type 1-related clinical symptoms in the patient. Multiplex ligation-dependent probe amplification detected no or only very low level of the 1.3-Mb NF1 deletion in six lipomas and two skin biopsies. Digital polymerase chain reaction estimated the proportion of cells carrying a heterozygous NF1 deletion at 87% in the blood, and 8%, 10%, 13%, 17%, and 20%, respectively, in the five lipomas investigated by this method, confirming our hypothesis of mosaicism. Our findings suggest that de novo cases of genetic disease are potentially mosaic regardless of finding the mutation at an apparently heterozygous level in the blood and that the possibility of mosaicism should be considered in genotype-phenotype studies and genetic counseling.
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Affiliation(s)
- Lan Kluwe
- Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhard E Friedrich
- Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Said C Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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23
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Farschtschi S, Kluwe L, Park SJ, Oh SJ, Mah N, Mautner VF, Kurtz A. Upregulated immuno-modulator PD-L1 in malignant peripheral nerve sheath tumors provides a potential biomarker and a therapeutic target. Cancer Immunol Immunother 2020; 69:1307-1313. [PMID: 32193699 PMCID: PMC7303069 DOI: 10.1007/s00262-020-02548-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 03/10/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Malignant peripheral nerve sheath tumors (MPNSTs) are rare aggressive sarcomas with poor prognosis. More than half of MPNSTs develop from benign precursor tumors associated with neurofibromatosis type 1 (NF1) which is a tumor suppressor gene disorder. Early detection of malignant transformation in NF1 patients is pivotal to improving survival. The primary aim of this study was to evaluate the role of immuno-modulators as candidate biomarkers of malignant transformation in NF1 patients with plexiform neurofibromas as well as predictors of response to immunotherapeutic approaches. METHODS Sera from a total of 125 NF1 patients with quantified internal tumor load were included, and 25 of them had MPNSTs. A total of six immuno-modulatory factors (IGFBP-1, PD-L1, IFN-α, GM-CSF, PGE-2, and AXL) were measured in these sera using respective ELISA. RESULTS NF1 patients with MPNSTs had significantly elevated PD-L1 levels in their sera compared to NF1 patients without MPNSTs. By contrast, AXL concentrations were significantly lower in sera of NF1-MPNST patients. IGFBP-1 and PGE2 serum levels did not differ between the two patient groups. IFN-α and GM-CSF were below the detectable level in most samples. CONCLUSION The immuno-modulator PD-L1 is upregulated in MPNST patients and therefore may provide as a potential biomarker of malignant transformation in patients with NF1 and as a response predictor for immunotherapeutic approaches.
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Affiliation(s)
- Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Lan Kluwe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Su-Jin Park
- BIH Center for Regenerative Therapies, Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Su-Jun Oh
- BIH Center for Regenerative Therapies, Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Nancy Mah
- BIH Center for Regenerative Therapies, Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Andreas Kurtz
- BIH Center for Regenerative Therapies, Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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24
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Kehrer-Sawatzki H, Kluwe L, Salamon J, Well L, Farschtschi S, Rosenbaum T, Mautner VF. Clinical characterization of children and adolescents with NF1 microdeletions. Childs Nerv Syst 2020; 36:2297-2310. [PMID: 32533297 PMCID: PMC7575500 DOI: 10.1007/s00381-020-04717-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE An estimated 5-11% of patients with neurofibromatosis type 1 (NF1) harbour NF1 microdeletions encompassing the NF1 gene and its flanking regions. The purpose of this study was to evaluate the clinical phenotype in children and adolescents with NF1 microdeletions. METHODS We retrospectively analysed 30 children and adolescents with NF1 microdeletions pertaining to externally visible neurofibromas. The internal tumour load was determined by volumetry of whole-body magnetic resonance imaging (MRI) in 20 children and adolescents with NF1 microdeletions. Furthermore, the prevalence of global developmental delay, autism spectrum disorder and attention deficit hyperactivity disorder (ADHD) were evaluated. RESULTS Children and adolescents with NF1 microdeletions had significantly more often cutaneous, subcutaneous and externally visible plexiform neurofibromas than age-matched patients with intragenic NF1 mutations. Internal neurofibromas were detected in all 20 children and adolescents with NF1 microdeletions analysed by whole-body MRI. By contrast, only 17 (61%) of 28 age-matched NF1 patients without microdeletions had internal tumours. The total internal tumour load was significantly higher in NF1 microdeletion patients than in NF1 patients without microdeletions. Global developmental delay was observed in 28 (93%) of 30 children with NF1 microdeletions investigated. The mean full-scale intelligence quotient in our patient group was 77.7 which is significantly lower than that of patients with intragenic NF1 mutations. ADHD was diagnosed in 15 (88%) of 17 children and adolescents with NF1 microdeletion. Furthermore, 17 (71%) of the 24 patients investigated had T-scores ≥ 60 up to 75, indicative of mild to moderate autistic symptoms, which are consequently significantly more frequent in patients with NF1 microdeletions than in the general NF1 population. Also, the mean total T-score was significantly higher in patients with NF1 microdeletions than in the general NF1 population. CONCLUSION Our findings indicate that already at a very young age, NF1 microdeletions patients frequently exhibit a severe disease manifestation which requires specialized long-term clinical care.
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Affiliation(s)
- Hildegard Kehrer-Sawatzki
- Institute of Human Genetics, University of Ulm and University of Ulm Medical Center, Albert-Einstein-Allee 11, 89081, Ulm, Germany.
| | - Lan Kluwe
- Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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25
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Toledano-Alhadef H, Mautner VF, Gugel I, Zipfel J, Haas-Lude K, Constantini S, Schuhmann MU. Role, function and challenges of multidisciplinary centres for rare diseases exemplified for neurofibromatosis type 1 syndrome. Childs Nerv Syst 2020; 36:2279-2284. [PMID: 32514759 PMCID: PMC7276654 DOI: 10.1007/s00381-020-04708-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/26/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Neurofibromatosis type 1 (NF1) syndrome is a common rare/orphan disease that manifests itself early in the paediatric age. It imposes a considerable burden upon patients as well as on caregivers. Decisions regarding optimal care often rely on several medical instances working together as a team. METHODS The authors reviewed the literature and supplied a description of their own clinical work at the NF1 centres. RESULTS The experience of a multidisciplinary teamwork of three NF centres was summarized in order to enhance awareness for possible multidisciplinary ways of delivery of health and health-related aspects of care to NF1 patients. Both population-focused research centres and family-focused centres were reviewed. CONCLUSIONS Chronic rare diseases that start in the paediatric age mandate long-term follow-up most often by several disciplines. NF1 syndrome is an example of a multidisciplinary centre in order to enhance the quality of care.
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Affiliation(s)
- Hagit Toledano-Alhadef
- Gilbert Israeli and International Neurofibromatosis Centre, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
- Paediatric Neurology and Child Development Center, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor-Felix Mautner
- International Neurofibromatosis Centre, Department of Neurology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Isabel Gugel
- Centre of Neurofibromatosis at the Centre of Rare Diseases, Tuebingen University Hospital, Tuebingen, Germany
- Department of Neurosurgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Julian Zipfel
- Centre of Neurofibromatosis at the Centre of Rare Diseases, Tuebingen University Hospital, Tuebingen, Germany
- Department of Neurosurgery, Tuebingen University Hospital, Tuebingen, Germany
- Division of Paediatric Neurosurgery, Department of Neurosurgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Karin Haas-Lude
- Centre of Neurofibromatosis at the Centre of Rare Diseases, Tuebingen University Hospital, Tuebingen, Germany
- Department of Paediatric Neurology and Developmental Medicine, University Children's Hospital, Tuebingen, Germany
| | - Shlomi Constantini
- Gilbert Israeli and International Neurofibromatosis Centre, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Paediatric Neurosurgery, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel.
| | - Martin U Schuhmann
- Centre of Neurofibromatosis at the Centre of Rare Diseases, Tuebingen University Hospital, Tuebingen, Germany
- Department of Neurosurgery, Tuebingen University Hospital, Tuebingen, Germany
- Division of Paediatric Neurosurgery, Department of Neurosurgery, Tuebingen University Hospital, Tuebingen, Germany
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26
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Evans DGR, Kallionpää RA, Clementi M, Trevisson E, Mautner VF, Howell SJ, Lewis L, Zehou O, Peltonen S, Brunello A, Harkness EF, Wolkenstein P, Peltonen J. Correction: Breast cancer in neurofibromatosis 1: survival and risk of contralateral breast cancer in a five country cohort study. Genet Med 2020; 22:242. [PMID: 31591510 PMCID: PMC6944643 DOI: 10.1038/s41436-019-0671-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Gareth R Evans
- The Christie NHS Foundation Trust, Manchester, UK.,Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Genesis Breast Cancer Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Maurizio Clementi
- Clinical Genetics Unit, Deparment of Women's and Children's Health, University of Padova, Padova, Italy
| | - Eva Trevisson
- Clinical Genetics Unit, Deparment of Women's and Children's Health, University of Padova, Padova, Italy
| | - Victor-Felix Mautner
- Phacomatoses Department, Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sacha J Howell
- The Christie NHS Foundation Trust, Manchester, UK.,Genesis Breast Cancer Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Lauren Lewis
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ouidad Zehou
- Referral Centre for Neurofibromatoses Dermatology, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Sirkku Peltonen
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland
| | - Antonella Brunello
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Elaine F Harkness
- Genesis Breast Cancer Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Pierre Wolkenstein
- Referral Centre for Neurofibromatoses Dermatology, Hôpital Henri Mondor, APHP, UPEC, Créteil, France
| | - Juha Peltonen
- Institute of Biomedicine, University of Turku, Turku, Finland.
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27
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Gugel I, Zipfel J, Hartjen P, Kluwe L, Tatagiba M, Mautner VF, Schuhmann MU. Managing NF2-associated vestibular schwannomas in children and young adults: review of an institutional series regarding effects of surgery and bevacizumab on growth rates, tumor volume, and hearing quality. Childs Nerv Syst 2020; 36:2471-2480. [PMID: 32548671 PMCID: PMC7575489 DOI: 10.1007/s00381-020-04728-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/04/2020] [Indexed: 11/27/2022]
Abstract
We reviewed our experience in managing of NF2-associated vestibular schwannoma (VS) in children and young adults regarding the effect of surgery and postoperative bevacizumab treatment. A total of 579 volumetric and hearing data sets were analyzed. The effect of surgery on tumor volume and growth rate was investigated in 46 tumors and on hearing function in 39 tumors. Long-term hearing follow-up behavior was compared with 20 non-operated ears in additional 15 patients. Sixteen operated VS were treated with bevacizumab. Mutation analysis of the NF2 gene was performed in 25 patients. Surgery significantly slowed down VS growth rate. Factors associated with a higher growth rate were increasing patient age, tumor volume, and constitutional truncating mutations. Immediately after surgery, functional hearing was maintained in 82% of ears. Deterioration of hearing was associated with initial hearing quality, larger tumor volumes, and larger resection amounts. Average hearing scores were initially better in the group of non-operated VS. Over time, hearing scores in both groups worsened with a similar dynamic. During bevacizumab treatment of residual tumors, four different patterns of growth were observed. Decompression of the internal auditory canal with various degrees of tumor resection decreases the postoperative tumor growth rates. Carefully tailored BAEP-guided surgery does not cause additional hearing deterioration. Secondary bevacizumab treatment showed heterogenous effects both regarding tumor size and hearing preservation. It seems that postoperative tumor residuals, that grow slower, behave differently to bevacizumab than reported for not-operated faster growing VS.
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Affiliation(s)
- Isabel Gugel
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany.
- Centre of Neurofibromatosis, Centre of Rare Disease, University Hospital Tübingen, Tübingen, Germany.
| | - Julian Zipfel
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
- Centre of Neurofibromatosis, Centre of Rare Disease, University Hospital Tübingen, Tübingen, Germany
- Division of Pediatric Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - Philip Hartjen
- Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lan Kluwe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
- Centre of Neurofibromatosis, Centre of Rare Disease, University Hospital Tübingen, Tübingen, Germany
| | - Victor-Felix Mautner
- Centre of Neurofibromatosis, Centre of Rare Disease, University Hospital Tübingen, Tübingen, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Ulrich Schuhmann
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
- Centre of Neurofibromatosis, Centre of Rare Disease, University Hospital Tübingen, Tübingen, Germany
- Division of Pediatric Neurosurgery, University Hospital Tübingen, Tübingen, Germany
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28
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Zipfel J, Al-Hariri M, Gugel I, Haas-Lude K, Grimm A, Warmann S, Krimmel M, Mautner VF, Tatagiba M, Schuhmann MU. Surgical management of peripheral nerve sheath tumours in children, with special consideration of neurofibromatoses. Childs Nerv Syst 2020; 36:2433-2442. [PMID: 32506255 PMCID: PMC8272701 DOI: 10.1007/s00381-020-04703-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/25/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Peripheral nerve sheath tumours in children are a rare and heterogeneous group, consisting mostly of benign tumours as well as malignant neoplasms. Especially in the paediatric population, diagnostics and indication for therapy pose relevant challenges for neurosurgeons and paediatric neurologists alike. Most paediatric cases that need surgical intervention are associated to neurofibromatosis type 1 (NF1). METHODS We retrospectively reviewed all paediatric cases treated at the Department of Neurosurgery in Tübingen between 2006 and 2017 for peripheral nerve sheath tumours. We analysed clinical signs, symptoms, histology, association to an underlying phacomatosis and sensory/motor function. RESULTS Of the 82 identified patients, the majority had NF1 (76.8%). Nine children bore a sporadic tumour without underlying phacomatosis (11%), 8 had NF2 (9.8%) and 2 schwannomatosis (2.4%), A total of 168 surgical interventions were performed, and 206 tumours were removed. Indication for surgery was in most instances significant tumour growth (45.2%) followed by pain (33.9%). New deficits led to surgery in 12.5% of interventions; malignancy was suspected in 8.3%. Histopathology revealed mostly neurofibromas (82.5%), divided into cutaneous neurofibromas (10.7%), infiltrating plexiform neurofibromas (25.7%) and peripheral nerve-born neurofibromas (46.1%). 12.1% of tumours were schwannomas, 2.9% MPNST, 1.5% ganglioneuroma (n = 3) and 1 hybrid-neurofibroma and perineurinoma each. Leading symptoms, such as pain and motor and sensory deficits, improved after 125/166 interventions (74.4%), remained unchanged following 39 interventions (23.2%) and worsened in 4 occasions (2.4%). CONCLUSION Surgery is safe and effective for (neurofibromatosis associated) peripheral nerve sheath tumours in the paediatric population; however, management needs a multidisciplinary setting. We propose early surgical resection in paediatric patients with peripheral nerve sheath tumours with significant growth, or pain, or motor deficit, or suspected malignancy.
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Affiliation(s)
- Julian Zipfel
- Division of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany. .,Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany. .,Centre for Neurofibromatosis at the Centre of Rare Diseases, University Hospital and University of Tübingen, Tübingen, Germany.
| | - Meizer Al-Hariri
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - Isabel Gugel
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany ,Centre for Neurofibromatosis at the Centre of Rare Diseases, University Hospital and University of Tübingen, Tübingen, Germany
| | - Karin Haas-Lude
- Centre for Neurofibromatosis at the Centre of Rare Diseases, University Hospital and University of Tübingen, Tübingen, Germany ,Department of Paediatric Neurology, University Children’s Hospital Tübingen, Tübingen, Germany
| | - Alexander Grimm
- Department of Neurology, University Hospital Tübingen, Tübingen, Germany
| | - Steven Warmann
- Department of Paediatric Surgery, University Children’s Hospital Tübingen, Tübingen, Germany
| | - Michael Krimmel
- Department of Maxillofacial Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Victor-Felix Mautner
- Neurofibromatosis Centre Hamburg, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcos Tatagiba
- Division of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany ,Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany ,Centre for Neurofibromatosis at the Centre of Rare Diseases, University Hospital and University of Tübingen, Tübingen, Germany
| | - Martin U. Schuhmann
- Division of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany ,Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany ,Centre for Neurofibromatosis at the Centre of Rare Diseases, University Hospital and University of Tübingen, Tübingen, Germany
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29
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Gugel I, Kluwe L, Zipfel J, Teuber C, Tatagiba M, Mautner VF, Schuhmann MU, Grimm F. Minimal Effect of Bevacizumab Treatment on Residual Vestibular Schwannomas after Partial Resection in Young Neurofibromatosis Type 2 Patients. Cancers (Basel) 2019; 11:cancers11121862. [PMID: 31769423 PMCID: PMC6966588 DOI: 10.3390/cancers11121862] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 09/13/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
Hearing-preserving partial resection of neurofibromatosis type 2 (NF2) associated vestibular schwannomas (VS) is a preferred treatment strategy, particularly for children and adolescents. However, the residual tumors do grow and lead at some point to continued hearing deterioration. An adjuvant bevacizumab treatment may provide an option for slowing down this process. In this retrospective study, we reviewed tumor volume and hearing data of 16 operated VS in nine patients younger than 30 years over a period of 63 to 142 months. All these patients had one or more bevacizumab treatment periods and most of them had a non-treatment period after surgery. Four different patterns of growth were observed for the residual tumors: (1) growth in the non-treatment periods, which slowed down in the treatment periods; (2) growth slowed down in one but not in another on-period; (3) unaffected growth; (4) no or minimal growth regardless of the treatment. Neither radiological regression of tumor volume nor hearing improvement were observed in the treatment periods. Accelerated hearing deterioration was observed in several non-treatment periods, but also in some treatment periods. No straightforward correlation can be drawn between tumor growth and hearing scores. Tumor growth and worsening of hearing between two measurement points were slightly less in the treatment periods; however, the differences were not significant, because variations were large. In conclusion, our comprehensive follow-up on 16 VS in nine NF2 patients did show heterogenous effects of bevacizumab on small residual vestibular schwannomas after surgery both regarding tumor size and hearing preservation. Thus, smaller and slower growing tumor residuals seem to behave differently to bevacizumab than reported for not-operated faster growing VS.
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Affiliation(s)
- Isabel Gugel
- Department of Neurosurgery, University Hospital Tübingen, BW 72076 Tübingen, Germany
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, BW 72076 Tübingen, Germany
| | - Lan Kluwe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, HH 20251 Hamburg, Germany
- Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, HH 20251 Hamburg, Germany
| | - Julian Zipfel
- Department of Neurosurgery, University Hospital Tübingen, BW 72076 Tübingen, Germany
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, BW 72076 Tübingen, Germany
- Division of Pediatric Neurosurgery, University Hospital Tübingen, BW 72076 Tübingen, Germany
| | - Christian Teuber
- Department of Neurosurgery, University Hospital Tübingen, BW 72076 Tübingen, Germany
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, BW 72076 Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, BW 72076 Tübingen, Germany
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, BW 72076 Tübingen, Germany
| | - Victor-Felix Mautner
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, BW 72076 Tübingen, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, HH 20251 Hamburg, Germany
| | - Martin Ulrich Schuhmann
- Department of Neurosurgery, University Hospital Tübingen, BW 72076 Tübingen, Germany
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, BW 72076 Tübingen, Germany
- Division of Pediatric Neurosurgery, University Hospital Tübingen, BW 72076 Tübingen, Germany
| | - Florian Grimm
- Department of Neurosurgery, University Hospital Tübingen, BW 72076 Tübingen, Germany
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30
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Farschtschi SC, Kluwe L, Schön G, Friedrich RE, Matschke J, Glatzel M, Weis J, Hagel C, Mautner VF. Distinctive low epidermal nerve fiber density in schwannomatosis patients provides a major parameter for diagnosis and differential diagnosis. Brain Pathol 2019; 30:386-391. [PMID: 31424590 PMCID: PMC8018006 DOI: 10.1111/bpa.12780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 06/20/2019] [Accepted: 08/14/2019] [Indexed: 12/12/2022] Open
Abstract
Schwannomatosis and neurofibromatosis type 2 (NF2) are two distinct neuro‐genetic tumor predisposition disorders, which, however, share some clinical and genetic features. While germline mutations in the NF2 gene are only found in NF2, a majority of schwannomatosis patients have germline mutations in the SMARCB1 or LZTR1 genes. The overlapping clinical phenotypes pose a serious challenge in differential diagnosis and in risk stratification of these two entities which is further complicated by frequent mosaicism in both disorders. Chronic neuropathic pain which is a typical consequence of small fiber neuropathy, is characteristic for schwannomatosis. By contrast, NF2 patients do not have chronic pain but may have moderate to severe sensory deficits and paresis which are not characteristic for schwannomatosis. In the present study, we determined intraepidermal nerve fiber density (IEND) in skin biopsies of 34 clinically ascertained schwannomatosis and 25 NF2 patients. In the NF2 group, 11/25 (44%) presented with IEND below the age‐ and gender‐matched bottom 5% normative reference IEND. In contrast, nearly all (33/34 = 97%) schwannomatosis patients showed IEND below or on the bottom 5% normative reference. The reduction of IEND in schwannomatosis patients was age‐independent. Paired t‐test revealed no difference between the NF2‐IEND and the corresponding bottom 5% normative reference (P = 0.98). By contrast, IEND in the schwannomatosis patients were highly significantly lower than the corresponding 5% normative reference IEND (P < 0.0001). In addition, the difference between the IEND of our patients and the 5% lowest normative reference IEND was highly significantly larger in schwannomatosis patients than in NF2 patients (P < 0.0001). IEND of our patients did not correlate with neither the presence nor types of germline mutations in neither the NF2 nor the LZTR1 gene. In conclusion, schwannomatosis patients have marked low IEND which provides a major parameter for diagnosis and differential diagnosis.
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Affiliation(s)
- Said C Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lan Kluwe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhard E Friedrich
- Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Matschke
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Glatzel
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Weis
- Department of Neuropathology, University Medical Center Aachen, Aachen, Germany
| | - Christian Hagel
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Gugel I, Grimm F, Teuber C, Kluwe L, Mautner VF, Tatagiba M, Schuhmann MU. Management of NF2-associated vestibular schwannomas in children and young adults: influence of surgery and clinical factors on tumor volume and growth rate. J Neurosurg Pediatr 2019; 24:584-592. [PMID: 31443078 DOI: 10.3171/2019.6.peds1947] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/06/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' aim was to evaluate the tumor volume and growth rate of neurofibromatosis type 2 (NF2)-associated vestibular schwannomas (VSs) and the clinical factors or type of mutations before and after surgery in children and adults younger than 25 years at the time of diagnosis. METHODS A total of 579 volumetric measurements were performed in 46 operated tumors in 28 NF2 patients, using thin-slice (< 3 mm) T1-weighted contrast-enhanced MRI. The follow-up period ranged from 21 to 167 months (mean 75 months). Growth rate was calculated using a multilinear regression model. Mutation analysis of the NF2 gene was performed in 25 patients. RESULTS Surgery significantly (p = 0.013) slowed the VS growth rate from 0.69 ± 1.30 cm3/yr to 0.23 ± 0.42 cm3/yr. Factors significantly associated with a higher growth rate of VSs were increasing patient age (p < 0.0005), tumor volume (p = 0.006), tumor size (p = 0.001), and constitutional truncating mutations in the NF2 gene (p = 0.018). VS growth rates tended to be higher in patients with spinal ependymomas and in right-sided tumors and lower in the presence of peripheral schwannomas; however, no statistical significance was achieved. CONCLUSIONS Decompression of the internal auditory canal with various degrees of tumor resection decreases the postoperative tumor growth rate in children and young adults with NF2-associated VS. Patients with potential risk factors for accelerated growth (e.g., large volume, truncating mutations) and with increasing age should be monitored more closely before and after surgery.
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Affiliation(s)
- Isabel Gugel
- 1Department of Neurosurgery
- 2Centre of Neurofibromatosis, Centre of Rare Disease, and
| | | | | | - Lan Kluwe
- Departments of3Neurology and
- 4Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor-Felix Mautner
- 2Centre of Neurofibromatosis, Centre of Rare Disease, and
- Departments of3Neurology and
| | - Marcos Tatagiba
- 1Department of Neurosurgery
- 2Centre of Neurofibromatosis, Centre of Rare Disease, and
| | - Martin Ulrich Schuhmann
- 1Department of Neurosurgery
- 2Centre of Neurofibromatosis, Centre of Rare Disease, and
- 5Division of Pediatric Neurosurgery, University Hospital Tübingen; and
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Godel T, Bäumer P, Farschtschi S, Gugel I, Kronlage M, Hofstadler B, Heiland S, Gelderblom M, Bendszus M, Mautner VF. Peripheral nervous system alterations in infant and adult neurofibromatosis type 2. Neurology 2019; 93:e590-e598. [PMID: 31300546 DOI: 10.1212/wnl.0000000000007898] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/18/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To examine the involvement of dorsal root ganglia and peripheral nerves in children with neurofibromatosis type 2 compared to healthy controls and symptomatic adults by in vivo high-resolution magnetic resonance neurography. METHODS In this prospective multicenter study, the lumbosacral dorsal root ganglia and sciatic, tibial, and peroneal nerves were examined in 9 polyneuropathy-negative children diagnosed with neurofibromatosis type 2 by a standardized magnetic resonance neurography protocol at 3T. Volumes of dorsal root ganglia L3 to S2 and peripheral nerve lesions were assessed and compared to those of 29 healthy children. Moreover, dorsal root ganglia volumes and peripheral nerve lesions were compared to those of 14 adults with neurofibromatosis type 2. RESULTS Compared to healthy controls, dorsal root ganglia hypertrophy was a consistent finding in children with neurofibromatosis type 2 (L3 +255%, L4 +289%, L5 +250%, S1 +257%, and S2 +218%, p < 0.001) with an excellent diagnostic accuracy. Moreover, peripheral nerve lesions occurred with a high frequency in those children compared to healthy controls (18.89 ± 11.11 vs 0.90 ± 1.08, p < 0.001). Children and adults with neurofibromatosis type 2 showed nonsignificant differences in relative dorsal root ganglia hypertrophy rates (p = 0.85) and peripheral nerve lesions (p = 0.28). CONCLUSIONS Alterations of peripheral nerve segments occur early in the course of neurofibromatosis type 2 and are evident even in children not clinically affected by peripheral polyneuropathy. While those early alterations show similar characteristics compared to adults with neurofibromatosis type 2, the findings of this study suggest that secondary processes might be responsible for the development and severity of associated polyneuropathy.
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Affiliation(s)
- Tim Godel
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany.
| | - Philipp Bäumer
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Said Farschtschi
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Isabel Gugel
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Moritz Kronlage
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Barbara Hofstadler
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Sabine Heiland
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Mathias Gelderblom
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Martin Bendszus
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
| | - Victor-Felix Mautner
- From the Department of Neuroradiology (T.G., P.B., M.K., B.H., S.H., M.B.), Neurological University Clinic, Heidelberg University Hospital; Center for Radiology dia.log (P.B.),Altötting; Department of Neurology (S.F., M.G., V.-F.M.), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Neurosurgery (I.G.), Tübingen University Hospital, Germany
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Mehlan J, Schüttauf F, Salamon JM, Kordes U, Friedrich RE, Mautner VF. Manifestations and Treatment of Adult-onset Symptomatic Optic Pathway Glioma in Neurofibromatosis Type 1. Anticancer Res 2019; 39:827-831. [PMID: 30711963 DOI: 10.21873/anticanres.13181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 12/27/2018] [Accepted: 01/07/2019] [Indexed: 11/10/2022]
Abstract
This report describes the diagnosis and treatment of a 27-year-old patient with neurofibromatosis 1 (NF1) and late progression of a pre-existing optic pathway glioma (OPG) that caused significant reduction in vision. OPG is one of the diagnostic criteria for establishing the diagnosis of NF1. Most common findings of NF1 are café-au-lait spots, axillary and inguinal freckling of the skin, iris hamartoma (Lisch nodules), and tumors of the central nervous system and peripheral nerves. We successfully applied a modified International Society of Paediatric Oncology chemotherapy regimen for low-grade glioma in children with carboplatin dose adjustment according to the area under the plasma drug concentration-time curve calculation. During and after the chemotherapy, a clear improvement of the visual capacity was achieved. Age-adapted chemotherapy for symptomatic adult-onset OPG in patients with NF1 should be considered in individual cases.
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Affiliation(s)
- Juliane Mehlan
- Clinic of Ophthalmology, Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Frank Schüttauf
- Clinic of Ophthalmology, Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Johannes M Salamon
- Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Kordes
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhard E Friedrich
- Department of Oral and Craniomaxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Frayling IM, Mautner VF, van Minkelen R, Kallionpaa RA, Aktaş S, Baralle D, Ben-Shachar S, Callaway A, Cox H, Eccles DM, Ferkal S, LaDuca H, Lázaro C, Rogers MT, Stuenkel AJ, Summerour P, Varan A, Yap YS, Zehou O, Peltonen J, Evans DG, Wolkenstein P, Upadhyaya M. Breast cancer risk in neurofibromatosis type 1 is a function of the type of NF1 gene mutation: a new genotype-phenotype correlation. J Med Genet 2018; 56:209-219. [DOI: 10.1136/jmedgenet-2018-105599] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/30/2018] [Accepted: 11/15/2018] [Indexed: 01/19/2023]
Abstract
BackgroundNeurofibromatosis type 1 (NF1) predisposes to breast cancer (BC), but no genotype-phenotype correlations have been described.MethodsConstitutional NF1 mutations in 78 patients with NF1 with BC (NF1-BC) were compared with the NF1 Leiden Open Variation Database (n=3432).ResultsNo cases were observed with whole or partial gene deletions (HR 0.10; 95% CI 0.006 to 1.63; p=0.014, Fisher’s exact test). There were no gross relationships with mutation position. Forty-five (64.3%; HR 6.4–83) of the 70 different mutations were more frequent than expected (p<0.05), while 52 (74.3%; HR 5.3–83) were significant when adjusted for multiple comparisons (adjusted p≤0.125; Benjamini-Hochberg). Higher proportions of both nonsense and missense mutations were also observed (adjusted p=0.254; Benjamini-Hochberg). Ten of the 11 missense cases with known age of BC occurred at <50 years (p=0.041). Eighteen cases had BRCA1/2 testing, revealing one BRCA2 mutation.DiscussionThese data strongly support the hypothesis that certain constitutional mutation types, and indeed certain specific variants in NF1 confer different risks of BC. The lack of large deletions and excess of nonsenses and missenses is consistent with gain of function mutations conferring risk of BC, and also that neurofibromin may function as a dimer. The observation that somatic NF1 amplification can occur independently of ERBB2 amplification in sporadic BC supports this concept. A prospective clinical-molecular study of NF1-BC needs to be established to confirm and build on these findings, but regardless of NF1 mutation status patients with NF1-BC warrant testing of other BC-predisposing genes.
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Summerer A, Schäfer E, Mautner VF, Messiaen L, Cooper DN, Kehrer-Sawatzki H. Ultra-deep amplicon sequencing indicates absence of low-grade mosaicism with normal cells in patients with type-1 NF1 deletions. Hum Genet 2018; 138:73-81. [PMID: 30478644 DOI: 10.1007/s00439-018-1961-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Received: 09/21/2018] [Accepted: 11/20/2018] [Indexed: 11/26/2022]
Abstract
Different types of large NF1 deletion are distinguishable by breakpoint location and potentially also by the frequency of mosaicism with normal cells lacking the deletion. However, low-grade mosaicism with fewer than 10% normal cells has not yet been excluded for all NF1 deletion types since it is impossible to assess by the standard techniques used to identify such deletions, including MLPA and array analysis. Here, we used ultra-deep amplicon sequencing to investigate the presence of normal cells in the blood of 20 patients with type-1 NF1 deletions lacking mosaicism according to MLPA. The ultra-deep sequencing entailed the screening of 96 amplicons for heterozygous SNVs located within the NF1 deletion region. DNA samples from three previously identified patients with type-2 NF1 deletions and low-grade mosaicism with normal cells as determined by FISH or microsatellite marker analysis were used to validate our methodology. In these type-2 NF1 deletion samples, proportions of 5.3%, 6.6% and 15.0% normal cells, respectively, were detected by ultra-deep amplicon sequencing. However, using this highly sensitive method, none of the 20 patients with type-1 NF1 deletions included in our analysis exhibited low-grade mosaicism with normal cells in blood, thereby supporting the view that the vast majority of type-1 deletions are germline deletions.
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Affiliation(s)
- Anna Summerer
- Institute of Human Genetics, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Eleonora Schäfer
- Institute of Human Genetics, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Hospital Hamburg Eppendorf, 20246, Hamburg, Germany
| | - Ludwine Messiaen
- Department of Genetics, University of Alabama at Birmingham, Birmingham, USA
| | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK
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Gugel I, Mautner VF, Kluwe L, Tatagiba MS, Schuhmann MU. Cerebrovascular Insult as Presenting Symptom of Neurofibromatosis Type 2 in Children, Adolescents, and Young Adults. Front Neurol 2018; 9:733. [PMID: 30250447 PMCID: PMC6139325 DOI: 10.3389/fneur.2018.00733] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 06/17/2018] [Accepted: 08/13/2018] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Neurofibromatosis Type 2 (NF2) is an autosomal-dominant tumor-prone disorder characterized by the manifestations of central nervous system lesions. However, the first clinical signs of disease are often non-tumorous. Cerebrovascular insults are known in NF2, however, not yet described as first symptom in young NF2 patients. Methods: Magnetic resonance image scans of 298 NF2 patients treated in our neurofibromatosis center in Tübingen from 2003 to 2017 were retrospectively evaluated focusing on presence of aneurysms and ischemic stroke. Clinical data were used to clarify whether or not ischemic stroke or aneurysm rupture were the first presentation of disease. Blood of the patients were subjected to genetic screening for constitutional NF2 mutations. Results: We identified 5 cases under age of 25 years with aneurysms or ischemic stroke. Among them three had ischemic strokes of the brain stem and one aneurysmal subarachnoid hemorrhage as the first symptom of the disease. Incidental finding of 2 intracranial aneurysm occurred in one patient. All aneurysms were clipped. Patients with ischemia suffered from dysarthria, gait disturbances, dizziness, and hemiparesis. Residual signs of hemiparesis and dysarthria persisted in one patient. All others fully recovered from the cerebrovascular insult. Bilateral vestibular schwannomas and intracranial meningiomas were found in all five patients. Conclusions: A cerebrovascular insult in the vertebrobasilar territory may occur as first symptom of disease in young NF2 patients. The brain stem seems to be especially prone to ischemic stroke. Multicenter studies on large NF2 cohorts are needed to determine the prevalence and pattern of cerebrovascular insults and disease in NF2 patients.
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Affiliation(s)
- Isabel Gugel
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Victor-Felix Mautner
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, Tübingen, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lan Kluwe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcos Soares Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Martin Ulrich Schuhmann
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
- Centre of Neurofibromatosis and Rare Diseases, University Hospital Tübingen, Tübingen, Germany
- Division of Pediatric Neurosurgery, University Hospital Tübingen, Tübingen, Germany
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Kehrer-Sawatzki H, Kluwe L, Friedrich RE, Summerer A, Schäfer E, Wahlländer U, Matthies C, Gugel I, Farschtschi S, Hagel C, Cooper DN, Mautner VF. Phenotypic and genotypic overlap between mosaic NF2 and schwannomatosis in patients with multiple non-intradermal schwannomas. Hum Genet 2018; 137:543-552. [DOI: 10.1007/s00439-018-1909-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
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Sellmer L, Farschtschi S, Marangoni M, Heran MKS, Birch P, Wenzel R, Mautner VF, Friedman JM. Serial MRIs provide novel insight into natural history of optic pathway gliomas in patients with neurofibromatosis 1. Orphanet J Rare Dis 2018; 13:62. [PMID: 29685181 PMCID: PMC5913802 DOI: 10.1186/s13023-018-0811-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 04/17/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Optic pathway gliomas (OPGs) are present in 20% of children with neurofibromatosis 1 (NF1) but are less frequently observed in adults. Our goal was to determine the natural history of OPGs in children and adults with NF1. RESULTS We analyzed the features of OPGs and other intracranial lesions on 1775 head MRI scans of 562 unselected adults and children with NF1 collected between 2003 and 2015. 52 (9.3%) of 562 patients in this study had an OPG diagnosed on their MRI. The median age at first scan with an OPG present was 12.7 years. Of the 52 OPG patients, the intraorbital optic nerves were affected in 29 patients (56%), the prechiasmatic optic nerves were affected in 32 patients (62%), the optic chiasm was affected in 17 patients (33%) and the optic radiations were affected in 19 patients (37%). 29 patients had two or more areas affected. One patient had a newly-appearing OPG, and 1 patient showed progression. The rate of progression over 5 years was 2.4% (95% CI: 0.4% to 16%). Four patients showed partial regression of their OPGs, but we observed no case of complete regression during this study. The rate of regression over 5 years was 8.9% (95% confidence intervals: 2.8% to 26%). We found the presence of UBOs and the presence of OPGs in individual patients to be highly associated (p = 0.0061). CONCLUSION OPGs are more common in older adults with NF1 than previously thought. The occurrences of unidentified bright objects (UBOs) and asymptomatic OPGs are associated with each other. This suggests the possibility that OPGs that remain asymptomatic may differ pathogenically from those that become symptomatic.
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Affiliation(s)
- Laura Sellmer
- Department of Medical Genetics, BC Children's Hospital, University of British Columbia, 4480 Oak Street, Vancouver, Canada.
| | - Said Farschtschi
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Marco Marangoni
- Diagnostic and Therapeutic Neuroradiology, University of British Columbia, Vancouver, Canada
| | - Manraj K S Heran
- Diagnostic and Therapeutic Neuroradiology, University of British Columbia, Vancouver, Canada
| | - Patricia Birch
- Department of Medical Genetics, BC Children's Hospital, University of British Columbia, 4480 Oak Street, Vancouver, Canada
| | - Ralph Wenzel
- Department of Radiology, MRI Institute Altona, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jan M Friedman
- Department of Medical Genetics, BC Children's Hospital, University of British Columbia, 4480 Oak Street, Vancouver, Canada
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Godel T, Mautner VF, Farschtschi S, Pham M, Schwarz D, Kronlage M, Gugel I, Heiland S, Bendszus M, Bäumer P. Dorsal root ganglia volume differentiates schwannomatosis and neurofibromatosis 2. Ann Neurol 2018; 83:854-857. [PMID: 29469988 DOI: 10.1002/ana.25191] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/20/2018] [Accepted: 02/21/2018] [Indexed: 12/13/2022]
Abstract
Schwannomatosis and neurofibromatosis type 2 are hereditary tumor syndromes, and peripheral neuropathy has been reported in both. We prospectively applied in vivo morphometric measurement of dorsal root ganglia volume in 16 schwannomatosis patients, 14 neurofibromatosis type 2 patients, and 26 healthy controls by magnetic resonance neurography. Compared to healthy controls, dorsal root ganglia hypertrophy was a consistent finding in neurofibromatosis type 2 (L3, + 267%; L4, + 235%; L5, + 241%; S1, + 300%; S2, + 242%; Bonferroni-adjusted p < 0.001) but not in schwannomatosis. Dorsal root ganglia may be a vulnerable site in origination of areflexia and sensory loss and a useful diagnostic marker in neurofibromatosis type 2. Ann Neurol 2018;83:854-857.
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Affiliation(s)
- Tim Godel
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg
| | | | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Mirko Pham
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg.,Department of Neuroradiology, Würzburg University Hospital, Würzburg
| | - Daniel Schwarz
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg
| | - Moritz Kronlage
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg
| | - Isabel Gugel
- Department of Neurosurgery, Tübingen University Hospital, Tübingen
| | - Sabine Heiland
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg
| | - Martin Bendszus
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg
| | - Philipp Bäumer
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg.,Department of Radiology, German Cancer Research Institute, Heidelberg, Germany
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Haas-Lude K, Heimgärtner M, Winter S, Mautner VF, Krägeloh-Mann I, Lidzba K. Motor dysfunction in NF1: Mediated by attention deficit or inherent to the disorder? Eur J Paediatr Neurol 2018; 22:164-169. [PMID: 29111114 DOI: 10.1016/j.ejpn.2017.10.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/29/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
AIM Attention deficit and compromised motor skills are both prevalent in Neurofibromatosis type 1 (NF1), but the relationship is unclear. We investigated motor function in children with NF1 and in children with Attention Deficit/Hyperactivity Disorder (ADHD), and explored if, in patients with NF1, attention deficit influences motor performance. METHODS Motor performance was measured using the Movement Assessment Battery for Children (M-ABC) in 71 children (26 with NF1 plus ADHD, 14 with NF1 without ADHD, and 31 with ADHD without NF1) aged 6-12 years. RESULTS There was a significant effect of group on motor performance. Both NF1 groups scored below children with ADHD without NF1. Attention performance mediated motor performance in children with ADHD without NF1, but not in children with NF1. CONCLUSIONS Motor function is not mediated by attention performance in children with NF1. While in ADHD, attention deficit influences motor performance, motor problems in NF1 seem to be independent from attention deficit. This argues for different pathomechanisms in these two groups of developmental disorders.
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Affiliation(s)
- Karin Haas-Lude
- University Children's Hospital Tübingen, Department of Pediatric Neurology and Developmental Medicine, Hoppe-Seyler-Straße 1, 72076, Tübingen, Germany.
| | - Magdalena Heimgärtner
- University Children's Hospital Tübingen, Department of Pediatric Neurology and Developmental Medicine, Hoppe-Seyler-Straße 1, 72076, Tübingen, Germany
| | - Sarah Winter
- University Children's Hospital Tübingen, Department of Pediatric Neurology and Developmental Medicine, Hoppe-Seyler-Straße 1, 72076, Tübingen, Germany
| | - Victor-Felix Mautner
- University Hospital Hamburg-Eppendorf, Neurofibromatosis Outpatient Department, Martinistraße 52, 20246, Hamburg, Germany
| | - Ingeborg Krägeloh-Mann
- University Children's Hospital Tübingen, Department of Pediatric Neurology and Developmental Medicine, Hoppe-Seyler-Straße 1, 72076, Tübingen, Germany
| | - Karen Lidzba
- University Children's Hospital Tübingen, Department of Pediatric Neurology and Developmental Medicine, Hoppe-Seyler-Straße 1, 72076, Tübingen, Germany
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Hillmer M, Summerer A, Mautner VF, Högel J, Cooper DN, Kehrer-Sawatzki H. Consideration of the haplotype diversity at nonallelic homologous recombination hotspots improves the precision of rearrangement breakpoint identification. Hum Mutat 2017; 38:1711-1722. [PMID: 28862369 DOI: 10.1002/humu.23319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/07/2017] [Accepted: 08/26/2017] [Indexed: 01/30/2023]
Abstract
Precise characterization of nonallelic homologous recombination (NAHR) breakpoints is key to identifying those features that influence NAHR frequency. Until now, analysis of NAHR-mediated rearrangements has generally been performed by comparison of the breakpoint-spanning sequences with the human genome reference sequence. We show here that the haplotype diversity of NAHR hotspots may interfere with breakpoint-mapping. We studied the transmitting parents of individuals with germline type-1 NF1 deletions mediated by NAHR within the paralogous recombination site 1 (PRS1) or paralogous recombination site 2 (PRS2) hotspots. Several parental wild-type PRS1 and PRS2 haplotypes were identified that exhibited considerable sequence differences with respect to the reference sequence, which also affected the number of predicted PRDM9-binding sites. Sequence comparisons between the parental wild-type PRS1 or PRS2 haplotypes and the deletion breakpoint-spanning sequences from the patients (method #2) turned out to be an accurate means to assign NF1 deletion breakpoints and proved superior to crude reference sequence comparisons that neglect to consider haplotype diversity (method #1). The mean length of the deletion breakpoint regions assigned by method #2 was 269-bp in contrast to 502-bp by method #1. Our findings imply that paralog-specific haplotype diversity of NAHR hotspots (such as PRS2) and population-specific haplotype diversity must be taken into account in order to accurately ascertain NAHR-mediated rearrangement breakpoints.
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Affiliation(s)
- Morten Hillmer
- Institute of Human Genetics, University of Ulm, Ulm, Germany
| | - Anna Summerer
- Institute of Human Genetics, University of Ulm, Ulm, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Josef Högel
- Institute of Human Genetics, University of Ulm, Ulm, Germany
| | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, UK
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Godel T, Bäumer P, Pham M, Köhn A, Muschol N, Kronlage M, Kollmer J, Heiland S, Bendszus M, Mautner VF. Human dorsal root ganglion in vivo morphometry and perfusion in Fabry painful neuropathy. Neurology 2017; 89:1274-1282. [DOI: 10.1212/wnl.0000000000004396] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/30/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:To evaluate functional and morphometric magnetic resonance neurography of the dorsal root ganglion and peripheral nerve segments in patients with Fabry painful neuropathy.Methods:In this prospective study, the lumbosacral dorsal root ganglia and proximal peripheral nerve segments of the lower extremity were examined in 11 male patients with Fabry disease by a standardized 3T magnetic resonance neurography protocol. Volumes of L3 to S2 dorsal root ganglia, perfusion parameters of L5-S1 dorsal root ganglia and the spinal nerve L5, and the cross-sectional area of the proximal sciatic nerve were compared to healthy controls.Results:Dorsal root ganglia of patients with Fabry disease were symmetrically enlarged by 78% (L3), 94% (L4), 122% (L5), 115% (S1), and 119% (S2) (p < 0.001). In addition, permeability of the blood-tissue interface was decreased by 53% (p < 0.001). This finding was most pronounced in the peripheral zone of the dorsal root ganglion containing the cell bodies of the primary sensory neurons (p < 0.001). Spinal nerve permeability showed no difference between patients with Fabry disease and controls (p = 0.7). The sciatic nerve of patients with Fabry disease at the thigh level showed an increase in cross-sectional area by 48% (p < 0.001).Conclusions:Patients with Fabry disease have severely enlarged dorsal root ganglia with dysfunctional perfusion. This may be due to glycolipid accumulation in the dorsal root ganglia mediating direct neurotoxic effects and decreased neuronal blood supply. These alterations were less pronounced in peripheral nerve segments. Thus, the dorsal root ganglion might play a key pathophysiologic role in the development of neuropathy and pain in Fabry disease.
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Sellmer L, Farschtschi S, Marangoni M, Heran MKS, Birch P, Wenzel R, Friedman JM, Mautner VF. Non-optic glioma in adults and children with neurofibromatosis 1. Orphanet J Rare Dis 2017; 12:34. [PMID: 28202035 PMCID: PMC5312522 DOI: 10.1186/s13023-017-0588-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 12/07/2016] [Accepted: 02/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-optic gliomas occur in 5% of children with NF1, but little is known about these tumours in adults. We aimed to investigate progression, spontaneous regression and the natural history of non-optic gliomas in adults and compare these findings to the results found in children. RESULTS One thousand seven hundred twenty-two brain MRI scans of 562 unselected individuals with NF1 were collected at the NF outpatient department of the University Hospital Hamburg-Eppendorf between 2003 and 2015. The number of scans per patient ranged from one to 12; patients were followed for a median of 3.7 years. We identified 24 patients (4.3%) with non-optic gliomas. Median age at first scan with glioma was 21.2 years, much higher than in previous publications. Only seven of the 24 non-optic glioma patients were symptomatic. Five of 24 patients had multiple non-optic gliomas. Four individuals developed a new tumour, and 4 cases showed progression. The risk of new tumour development was 0.19% (95% confidence interval 0.06% to 0.52%) per patient year of follow-up for patients over 10 years. The rate of progressing non-optic gliomas per patient year of follow-up in the first 5 years after tumour diagnosis was 4.7% (95% confidence interval 1.5% to 12%). CONCLUSIONS Non-optic gliomas are twice as common in an unselected cohort of NF1 patients as previously reported. This is likely due to increased frequency of diagnosis of asymptomatic tumours when routine MRIs are performed and a higher prevalence in older individuals.
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Affiliation(s)
- Laura Sellmer
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada.
| | - Said Farschtschi
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Marco Marangoni
- Diagnostic and Therapeutic Neuroradiology, University of British Columbia, Vancouver, Canada
| | - Manraj K S Heran
- Diagnostic and Therapeutic Neuroradiology, University of British Columbia, Vancouver, Canada
| | - Patricia Birch
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Ralph Wenzel
- Department of Radiology, MRI Institute Altona, Hamburg, Germany
| | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Victor-Felix Mautner
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Kehrer-Sawatzki H, Farschtschi S, Mautner VF, Cooper DN. The molecular pathogenesis of schwannomatosis, a paradigm for the co-involvement of multiple tumour suppressor genes in tumorigenesis. Hum Genet 2016; 136:129-148. [PMID: 27921248 PMCID: PMC5258795 DOI: 10.1007/s00439-016-1753-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/27/2016] [Indexed: 12/20/2022]
Abstract
Schwannomatosis is characterized by the predisposition to develop multiple schwannomas and, less commonly, meningiomas. Despite the clinical overlap with neurofibromatosis type 2 (NF2), schwannomatosis is not caused by germline NF2 gene mutations. Instead, germline mutations of either the SMARCB1 or LZTR1 tumour suppressor genes have been identified in 86% of familial and 40% of sporadic schwannomatosis patients. In contrast to patients with rhabdoid tumours, which are due to complete loss-of-function SMARCB1 mutations, individuals with schwannomatosis harbour predominantly hypomorphic SMARCB1 mutations which give rise to the synthesis of mutant proteins with residual function that do not cause rhabdoid tumours. Although biallelic mutations of SMARCB1 or LZTR1 have been detected in the tumours of patients with schwannomatosis, the classical two-hit model of tumorigenesis is insufficient to account for schwannoma growth, since NF2 is also frequently inactivated in these tumours. Consequently, tumorigenesis in schwannomatosis must involve the mutation of at least two different tumour suppressor genes, an occurrence frequently mediated by loss of heterozygosity of large parts of chromosome 22q harbouring not only SMARCB1 and LZTR1 but also NF2. Thus, schwannomatosis is paradigmatic for a tumour predisposition syndrome caused by the concomitant mutational inactivation of two or more tumour suppressor genes. This review provides an overview of current models of tumorigenesis and mutational patterns underlying schwannomatosis that will ultimately help to explain the complex clinical presentation of this rare disease.
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Affiliation(s)
| | - Said Farschtschi
- Department of Neurology, University Hospital Hamburg Eppendorf, 20246, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Hospital Hamburg Eppendorf, 20246, Hamburg, Germany
| | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK
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Farschtschi S, Mautner VF, Pham M, Nguyen R, Kehrer-Sawatzki H, Hutter S, Friedrich RE, Schulz A, Morrison H, Jones DTW, Bendszus M, Bäumer P. Multifocal nerve lesions andLZTR1germline mutations in segmental schwannomatosis. Ann Neurol 2016; 80:625-8. [DOI: 10.1002/ana.24753] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Said Farschtschi
- Department of Neurology; University Medical Center Hamburg-Eppendorf, University of Hamburg; Hamburg Germany
| | - Victor-Felix Mautner
- Department of Neurology; University Medical Center Hamburg-Eppendorf, University of Hamburg; Hamburg Germany
| | - Mirko Pham
- Department of Neuroradiology; Heidelberg University Hospital; Heidelberg Germany
| | - Rosa Nguyen
- Department of Oncology; St Jude Children's Research Hospital; Memphis TN
| | | | - Sonja Hutter
- Division of Pediatric Neuro-oncology; German Cancer Research Center; Heidelberg Germany
| | - Reinhard E. Friedrich
- Department of Maxillofacial Surgery; University Medical Center Hamburg-Eppendorf, University of Hamburg; Hamburg Germany
| | - Alexander Schulz
- Leibniz Institute on Aging; Fritz Lipmann Institute; Jena Germany
| | - Helen Morrison
- Leibniz Institute on Aging; Fritz Lipmann Institute; Jena Germany
| | - David T. W. Jones
- Division of Pediatric Neuro-oncology; German Cancer Research Center; Heidelberg Germany
| | - Martin Bendszus
- Department of Neuroradiology; Heidelberg University Hospital; Heidelberg Germany
| | - Philipp Bäumer
- Department of Neuroradiology; Heidelberg University Hospital; Heidelberg Germany
- Department of Radiology; German Cancer Research Center; Heidelberg Germany
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46
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Schulz A, Büttner R, Hagel C, Baader SL, Kluwe L, Salamon J, Mautner VF, Mindos T, Parkinson DB, Gehlhausen JR, Clapp DW, Morrison H. The importance of nerve microenvironment for schwannoma development. Acta Neuropathol 2016; 132:289-307. [PMID: 27236462 PMCID: PMC4947119 DOI: 10.1007/s00401-016-1583-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 05/18/2016] [Accepted: 05/21/2016] [Indexed: 11/22/2022]
Abstract
Schwannomas are predominantly benign nerve sheath neoplasms caused by Nf2 gene inactivation. Presently, treatment options are mainly limited to surgical tumor resection due to the lack of effective pharmacological drugs. Although the mechanistic understanding of Nf2 gene function has advanced, it has so far been primarily restricted to Schwann cell-intrinsic events. Extracellular cues determining Schwann cell behavior with regard to schwannoma development remain unknown. Here we show pro-tumourigenic microenvironmental effects on Schwann cells where an altered axonal microenvironment in cooperation with injury signals contribute to a persistent regenerative Schwann cell response promoting schwannoma development. Specifically in genetically engineered mice following crush injuries on sciatic nerves, we found macroscopic nerve swellings in mice with homozygous nf2 gene deletion in Schwann cells and in animals with heterozygous nf2 knockout in both Schwann cells and axons. However, patient-mimicking schwannomas could only be provoked in animals with combined heterozygous nf2 knockout in Schwann cells and axons. We identified a severe re-myelination defect and sustained macrophage presence in the tumor tissue as major abnormalities. Strikingly, treatment of tumor-developing mice after nerve crush injury with medium-dose aspirin significantly decreased schwannoma progression in this disease model. Our results suggest a multifactorial concept for schwannoma formation—emphasizing axonal factors and mechanical nerve irritation as predilection site for schwannoma development. Furthermore, we provide evidence supporting the potential efficacy of anti-inflammatory drugs in the treatment of schwannomas.
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Röhrich M, Koelsche C, Schrimpf D, Capper D, Sahm F, Kratz A, Reuss J, Hovestadt V, Jones DTW, Bewerunge-Hudler M, Becker A, Weis J, Mawrin C, Mittelbronn M, Perry A, Mautner VF, Mechtersheimer G, Hartmann C, Okuducu AF, Arp M, Seiz-Rosenhagen M, Hänggi D, Heim S, Paulus W, Schittenhelm J, Ahmadi R, Herold-Mende C, Unterberg A, Pfister SM, von Deimling A, Reuss DE. Methylation-based classification of benign and malignant peripheral nerve sheath tumors. Acta Neuropathol 2016; 131:877-87. [PMID: 26857854 DOI: 10.1007/s00401-016-1540-6] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [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] [Received: 12/23/2015] [Revised: 01/22/2016] [Accepted: 01/24/2016] [Indexed: 12/20/2022]
Abstract
The vast majority of peripheral nerve sheath tumors derive from the Schwann cell lineage and comprise diverse histological entities ranging from benign schwannomas and neurofibromas to high-grade malignant peripheral nerve sheath tumors (MPNST), each with several variants. There is increasing evidence for methylation profiling being able to delineate biologically relevant tumor groups even within the same cellular lineage. Therefore, we used DNA methylation arrays for methylome- and chromosomal profile-based characterization of 171 peripheral nerve sheath tumors. We analyzed 28 conventional high-grade MPNST, three malignant Triton tumors, six low-grade MPNST, four epithelioid MPNST, 33 neurofibromas (15 dermal, 8 intraneural, 10 plexiform), six atypical neurofibromas, 43 schwannomas (including 5 NF2 and 5 schwannomatosis associated cases), 11 cellular schwannomas, 10 melanotic schwannomas, 7 neurofibroma/schwannoma hybrid tumors, 10 nerve sheath myxomas and 10 ganglioneuromas. Schwannomas formed different epigenomic subgroups including a vestibular schwannoma subgroup. Cellular schwannomas were not distinct from conventional schwannomas. Nerve sheath myxomas and neurofibroma/schwannoma hybrid tumors were most similar to schwannomas. Dermal, intraneural and plexiform neurofibromas as well as ganglioneuromas all showed distinct methylation profiles. Atypical neurofibromas and low-grade MPNST were indistinguishable with a common methylation profile and frequent losses of CDKN2A. Epigenomic analysis finds two groups of conventional high-grade MPNST sharing a frequent loss of neurofibromin. The larger of the two groups shows an additional loss of trimethylation of histone H3 at lysine 27 (H3K27me3). The smaller one retains H3K27me3 and is found in spinal locations. Sporadic MPNST with retained neurofibromin expression did not form an epigenetic group and most cases could be reclassified as cellular schwannomas or soft tissue sarcomas. Widespread immunohistochemical loss of H3K27me3 was exclusively seen in MPNST of the main methylation cluster, which defines it as an additional useful marker for the differentiation of cellular schwannoma and MPNST.
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Affiliation(s)
- Manuel Röhrich
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Koelsche
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Schrimpf
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Capper
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annekathrin Kratz
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jana Reuss
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Hovestadt
- Division of Molecular Genetics, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melanie Bewerunge-Hudler
- Genomics and Proteomics Core Facility, Microarray Unit, German Cancer Research Center (DKFZ), INF 580, Heidelberg, Germany
| | - Albert Becker
- Institute of Neuropathology, University Medical Center, Bonn, Germany
| | - Joachim Weis
- Institute of Neuropathology, Rheinisch-Westfälische Technische Hochschule, Aachen University Hospital, Aachen, Germany
| | - Christian Mawrin
- Department of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany
| | - Michel Mittelbronn
- Institute of Neurology (Edinger Institute), Goethe University, Frankfurt, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Arie Perry
- Division of Neuropathology, University of California, San Francisco, USA
| | - Victor-Felix Mautner
- Department of Neurology, University Hospital Hamburg Eppendorf, 20246, Hamburg, Germany
| | - Gunhild Mechtersheimer
- Department of General Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Christian Hartmann
- Department of Neuropathology, Hannover Medical School, Hannover, Germany
| | - Ali Fuat Okuducu
- Department of Pathology, Municipal Hospital Nürnberg, Nuremberg, Germany
| | - Mirko Arp
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefanie Heim
- Institute of Neuropathology, University Hospital, Muenster, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital, Muenster, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, University Hospital, Tuebingen, Germany
| | - Rezvan Ahmadi
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | | | - Andreas Unterberg
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Medical Center, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David E Reuss
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany.
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
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48
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Friedrich RE, Hagel C, Mautner VF. Unilateral gynaecomastia in a 16-month-old boy with neurofibromatosis type 1 - case report and brief review of the literature. GMS Interdiscip Plast Reconstr Surg DGPW 2015; 4:Doc11. [PMID: 26668786 PMCID: PMC4670967 DOI: 10.3205/iprs000070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant disease that shows high penetrance with a wide variability in the phenotype. Prepubertal enlargement of the breast in male subjects affected by this condition is well known, but rarely reported. The present case report describes diagnosis and therapy of unilateral gynaecomastia in a toddler showing integumental stigmata of NF1. Furthermore, the report provides a brief review of the literature concerning this finding in NF1. According to this review, the present case appears to be one of the youngest NF1-affected males affected by gynaecomastia that has been reported.
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Affiliation(s)
- Reinhard E Friedrich
- Department of Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Christian Hagel
- Institute of Neuropathology, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
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49
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Friedrich RE, Hagel C, Mautner VF. Ipsilateral Sphenoid Wing Dysplasia, Orbital Plexiform Neurofibroma and Fronto-Parietal Dermal Cylindroma in a Patient with Segmental Neurofibromatosis. Anticancer Res 2015; 35:6813-6818. [PMID: 26637901] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal-dominant inherited disease affecting various parts of the body. Penetrance is almost complete but the phenotype varies considerably. Recently, mosaicism in NF1 has come into the focus of scientific interest. This report refers to a patient with orbitotemporal-confined neurofibromatosis who developed a rare skin tumor in the region.
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Affiliation(s)
- Reinhard E Friedrich
- Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Christian Hagel
- Neuropathology, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Victor-Felix Mautner
- Neurology, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
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50
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Hillmer M, Wagner D, Summerer A, Daiber M, Mautner VF, Messiaen L, Cooper DN, Kehrer-Sawatzki H. Fine mapping of meiotic NAHR-associated crossovers causing large NF1 deletions. Hum Mol Genet 2015; 25:484-96. [PMID: 26614388 DOI: 10.1093/hmg/ddv487] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023] Open
Abstract
Large deletions encompassing the NF1 gene and its flanking regions belong to the group of genomic disorders caused by copy number changes that are mediated by the local genomic architecture. Although nonallelic homologous recombination (NAHR) is known to be a major mutational mechanism underlying such genomic copy number changes, the sequence determinants of NAHR location and frequency are still poorly understood since few high-resolution mapping studies of NAHR hotspots have been performed to date. Here, we have characterized two NAHR hotspots, PRS1 and PRS2, separated by 20 kb and located within the low-copy repeats NF1-REPa and NF1-REPc, which flank the human NF1 gene region. High-resolution mapping of the crossover sites identified in 78 type 1 NF1 deletions mediated by NAHR indicated that PRS2 is a much stronger NAHR hotspot than PRS1 since 80% of these deletions exhibited crossovers within PRS2, whereas 20% had crossovers within PRS1. The identification of the most common strand exchange regions of these 78 deletions served to demarcate the cores of the PRS1 and PRS2 hotspots encompassing 1026 and 1976 bp, respectively. Several sequence features were identified that may influence hotspot intensity and direct the positional preference of NAHR to the hotspot cores. These features include regions of perfect sequence identity encompassing 700 bp at the hotspot core, the presence of PRDM9 binding sites perfectly matching the consensus motif for the most common PRDM9 variant, specific pre-existing patterns of histone modification and open chromatin conformations that are likely to facilitate PRDM9 binding.
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Affiliation(s)
- Morten Hillmer
- Institute of Human Genetics, University of Ulm, 89081 Ulm, Germany
| | - David Wagner
- Institute of Human Genetics, University of Ulm, 89081 Ulm, Germany
| | - Anna Summerer
- Institute of Human Genetics, University of Ulm, 89081 Ulm, Germany
| | - Michaela Daiber
- Institute of Human Genetics, University of Ulm, 89081 Ulm, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany
| | - Ludwine Messiaen
- Medical Genomics Laboratory, Department of Genetics, University of Alabama at Birmingham, Birmingham, AL 35242, USA and
| | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
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