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Kim IY, Cho MY, Kim YW. Synchronous multiple colonic adenocarcinomas arising in patient with neurofibromatosis type 1. Ann Surg Treat Res 2014; 87:156-60. [PMID: 25247170 PMCID: PMC4170576 DOI: 10.4174/astr.2014.87.3.156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/24/2013] [Accepted: 01/13/2014] [Indexed: 11/30/2022] Open
Abstract
We report a case of synchronous multiple colon adenocarcinomas in a patient with neurofibromatosis type 1 (NF1). NF1 is an autosomal dominant inherited disorder and patients with NF1 have high risk for both benign and malignant tumors. However, adenocarcinomas involving the colon have rarely been reported in patients with NF1. A 61-year-old man was referred for generalized peritonitis due to descending colon perforation. Left hemicolectomy was performed and pathologic examination showed four adenocarcinomas. Peritoneal nodules were confirmed as metastatic adenocarcinoma (pT4N1M1). The patient also had clinical features compatible with NF1 such as café au lait macules, axillary freckles, neurofibromas across the body, and Lisch nodules. Upon review of the literature, colon adenocarcinoma in patients with NF1 tends to occur in males and relatively young age groups, and is associated with advanced tumor stages and multiple colon cancers. To improve treatment outcome, early colonoscopic surveillance should be considered in patients with NF1.
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Affiliation(s)
- Ik Yong Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Mee Yon Cho
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Wan Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
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Abstract
INTRODUCTION Neurofibromatosis 1 is a tumor predisposition genetic syndrome with autosomal dominant inheritance and virtually 100% penetrance by the age of 5 years. NF1 results from a loss-of-function mutation in the NF1 gene, resulting in decreased levels of neurofibromin in the cell. Neurofibromin is a negative regulator of various intracellular signaling pathways involved in the cellular proliferation. Although the loss of heterozygosity in the NF1 gene may predispose NF1 patients to certain malignancies, additional genetic alterations are a prerequisite for their development. The precise nature of these additional genetic alterations is not well defined, and genetic testing of all malignancies in NF1 patients becomes an essential component of future research in this subset of patients. In addition to germline NF1 mutations, alteration of the somatic NF1 gene is associated with sporadic malignancies such as adenocarcinoma of the colon, myelodysplastic syndrome, and anaplastic astrocytoma. MATERIALS AND METHODS A comprehensive English and non-English language search for all articles pertinent to malignancies associated with NF1 was conducted using PubMed, a search engine provided by the U.S. National Library of Medicine and the National Institutes of Health. Key words searched included the following: "malignancies associated with NF1", "tumors associated with NF1", and "NF1 and malignancies". A comprehensive analysis in terms age and mode of presentation, investigation and therapeutic modalities, and outcome of the published data was performed and compared with similar information on the sporadic cases. RESULTS Malignancies in NF1 patients typically occur at an earlier age and, with an exception of optic pathway gliomas, certain types of malignancies carry a poor prognosis compared with their sporadic counterparts. Malignancies are the leading cause of death in NF1 patients, resulting in a 10- to 15-year decreased life expectancy compared with the general population. CONCLUSIONS The lack of well-defined screening tests for early detection and the nonspecific clinical presentation contributes to a poorer outcome in malignancies associated with NF1. Small study group size, mixed patient population, and a lack of uniformity in reporting research results make comparison of treatment outcome for this group difficult. An International Consensus Meeting to address and recommend best practices for screening, diagnosis, management, and follow-up of malignancies associated with NF1 is needed.
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Affiliation(s)
- Sachin Patil
- Department of Surgery, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, New Jersey 07039, USA
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Kato K, Nagase A, Onodera K, Matsuda M, Iwasaki Y, Kato Y, Kato K, Kawakami T, Taniguchi M, Furukawa H. Primary adenocarcinoma of the stomach in von Recklinghausen's disease with high serum levels of multiple tumor markers: a case report. J Med Case Rep 2011; 5:521. [PMID: 22018031 PMCID: PMC3212996 DOI: 10.1186/1752-1947-5-521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 10/23/2011] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Gastric tumors in patients affected by neurofibromatosis type 1 are usually carcinoids or stromal tumors, and rarely adenocarcinomas. CASE PRESENTATION We report a case of an adenocarcinoma of the stomach in a 53-year-old Japanese man with neurofibromatosis type 1. An abdominal computed tomography scan and ultrasonography showed tumors in his liver. Gastric fibroscopy revealed a Borrmann type III tumor on his cardia that had spread to his esophagus and was highly suspicious for malignancy. Multiple biopsies showed an adenocarcinoma of the stomach, which was evaluated as gastric cancer, stage IV. Chemotherapy with TS-1 was performed. Our patient died four weeks after initial admission. Histological examination of a liver needle biopsy showed metastatic adenocarcinoma in his liver. CONCLUSION To the best of our knowledge, high serum levels of α-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 72-4, resulting from gastric adenocarcinoma, have not been reported previously in a patient with neurofibromatosis type 1. We report this rare case along with a review of the literature.
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Affiliation(s)
- Kazuya Kato
- Department of Surgery, Pippu Clinic, 2-10, 1 Cyome Nakamachi, Pippu Town Kamikawa-gun, Hokkaido, 078-0343, Japan
| | - Atsushi Nagase
- Department of Surgery, Asahikawa Medical Center, 4048, 7 Cyome Hanasaki-cyou, Asahikawa, 070-8644, Japan
| | - Kazuhiko Onodera
- Department of Surgery, Hokuyu Hospital, 5-1, 6-6 Higashi-Sappro, Shiroishi-ku Sapporo, 003-0006, Japan
| | - Minoru Matsuda
- Department of Surgery, Nihon University, 1-8-13 Surugadai Kanda, Chiyoda-ku Tokyo, 010-8309, Japan
| | - Yoshiaki Iwasaki
- Department of Digestive Internal Medicine, Okayama University, 2-5-1 Shikata Town, Okayama City, Okayama, 700-8558, Japan
| | - Yurina Kato
- Department of Surgery, Pippu Clinic, 2-10, 1 Cyome Nakamachi, Pippu Town Kamikawa-gun, Hokkaido, 078-0343, Japan
| | - Kimitaka Kato
- Department of Surgery, Pippu Clinic, 2-10, 1 Cyome Nakamachi, Pippu Town Kamikawa-gun, Hokkaido, 078-0343, Japan
| | - Takako Kawakami
- Department of Surgery, Pippu Clinic, 2-10, 1 Cyome Nakamachi, Pippu Town Kamikawa-gun, Hokkaido, 078-0343, Japan
| | - Masahiko Taniguchi
- Department of Surgery, Asahikwa Medical College, 1-1, 2-1 Midorigaoka, Asahikawa, 078-8510, Japan
| | - Hiroyuki Furukawa
- Department of Surgery, Asahikwa Medical College, 1-1, 2-1 Midorigaoka, Asahikawa, 078-8510, Japan
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Verma M, Loughrey MB. Hepatoid gastric adenocarcinoma in a patient with type 1 neurofibromatosis. Histopathology 2011; 58:799-801. [PMID: 21434978 DOI: 10.1111/j.1365-2559.2011.03828.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Totally Laparoscopic Gastrectomy for Gastric Cancer Associated with Recklinghausen's Disease. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2010; 2010:682401. [PMID: 20672006 PMCID: PMC2905906 DOI: 10.1155/2010/682401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 05/06/2010] [Indexed: 01/18/2023]
Abstract
This paper documents the first case of gastric cancer associated with Recklinghausen's disease, which was successfully treated by a totally laparoscopic operation. A 67-year-old woman with Recklinghausen's disease was referred to this department to undergo surgical treatment for early gastric cancer. The physical examination showed multiple cutaneous neurofibromas throughout the body surface, which made an upper abdominal incision impossible. Laparoscopic surgery requiring only small incisions was well indicated, and a totally laparoscopic distal gastrectomy with lymph node dissection was performed. Billroth I reconstruction was done intra-abdominally using a delta-shaped anastomosis. The patient followed a satisfactory postoperative course with no complications. Since the totally laparoscopic gastrectomy has many advantages over open surgery, it should therefore be preferentially used as a less invasive treatment in the field of gastric cancer.
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Wood JJ, Longman RJ, Rooney N, Loveday EJ, Roe AM. Colonic vascular anomalies and colon cancer in neurofibromatosis: report of a case. Dis Colon Rectum 2008; 51:360-2. [PMID: 18183464 DOI: 10.1007/s10350-007-9089-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2005] [Revised: 02/28/2006] [Accepted: 04/06/2006] [Indexed: 02/08/2023]
Abstract
We report a case of neurofibromatosis with synchronous adenocarcinomas in the sigmoid and transverse colon. There was widespread intimal proliferation in arteries in the region of the tumors and also in the cecum. Such vascular lesions are associated with von Recklinghausen's disease. The cecal lesion produced mural thickening visible on computed tomography. This case supports a possible genetic link between neurofibromatosis and adenocarcinoma of the colon.
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Affiliation(s)
- James J Wood
- Department of General Surgery, Southmead Hospital, Bristol, BS2 5NB, United Kingdom.
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From the archives of the AFIP: abdominal neoplasms in patients with neurofibromatosis type 1: radiologic-pathologic correlation. Radiographics 2006; 25:455-80. [PMID: 15798063 DOI: 10.1148/rg.252045176] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Neurofibromatosis type 1 (NF1) is one of the most common genetic disorders. NF1 is a complex disease resulting from a spectrum of mutations that may occur at many locations along the large, complex NF1 gene, which is located on chromosome 17. Mutations of the NF1 gene lead to abnormal tumor suppression. Consequently, patients with NF1 have an increased prevalence of benign and malignant neoplasms throughout the body. There are five categories of NF1 tumors that occur in the abdomen: neurogenic, neuroendocrine, nonneurogenic gastrointestinal mesenchymal, embryonal, and miscellaneous. Many of these tumors are age related, occur at specific anatomic locations, and have unique imaging features. Notably, many patients have a variety of organs affected because there is a high prevalence of multiple tumors occurring in the same patient. Neurofibromas are the most common benign neoplasms and may occur in the retroperitoneum or visceral organs. Malignant peripheral nerve sheath tumor is an aggressive malignancy that is the most common malignant tumor of the abdomen in patients with NF1. Interpreting abdominal imaging studies in patients with NF1 can be challenging because of the wide spectrum and diverse nature of tumors that occur in this disease.
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Kim SE, Heo EP, Yoon TJ, Kim TH. Segmentally distributed neurofibromatosis associated with adenocarcinoma of the colon. J Dermatol 2002; 29:350-3. [PMID: 12126071 DOI: 10.1111/j.1346-8138.2002.tb00279.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Neurofibromatosis can be associated with various malignancies, but an association with adenocarcinoma is extremely rare. A 61-year-old man who had been diagnosed with adenocarcinoma of the hepatic flexure of the colon was referred for segmentally located, multiple café-au-lait spots and tumors on his back and axillary freckles for 40 years. Histopathologic examination of the tumor was consistent with the neurofibromatosis. We report an unusual case of type I neurofibromatosis associated with adenocarcinoma of the colon that was clinically similar to segmental neurofibromatosis.
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Affiliation(s)
- Seong Eon Kim
- Department of Dermatology, College of Medicine, Gyeongsang National University, Chinju, Korea
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9
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Costi R, Caruana P, Sarli L, Violi V, Roncoroni L, Bordi C. Ampullary adenocarcinoma in neurofibromatosis type 1. Case report and literature review. Mod Pathol 2001; 14:1169-74. [PMID: 11706080 DOI: 10.1038/modpathol.3880454] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Periampullary tumors in patients affected by Neurofibromatosis Type 1 (NF-1) are usually carcinoids or stromal tumors and, rarely, adenocarcinomas. We report a case of an adenocarcinoma of the ampulla of Vater in a 54-year-old woman with NF-1 admitted to the hospital with jaundice and undergoing pancreato-duodenectomy. Histologically, the resected specimen showed an adenocarcinoma of the ampulla as being a part of a complex atypical epithelial proliferation extended from the papilla to the mucosa of the duodenum and distal choledochus, islet-cell adenomatosis of the pancreas and multiple gastric, duodenal, jejunal stromal tumors. The ampullary and periampullary adenocarcinomas in NF-1 patients have peculiar features, suggesting a widespread predisposition to cancer development in periampullary tissues and requiring widely demolitive surgery. Moreover, they occur at a younger age than those occurring in non-NF-1 patients, may be associated with additional periampullary epithelial tumors, are often operable and may present long survival.
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Affiliation(s)
- R Costi
- Department of Surgery, Institute of General Surgery, University of Parma School of Medicine, Via Gramsci 14, 43100 Parma, Italy
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Basu S, Majumdar J, Mitra R, Chowdhury JR. Primary adenocarcinoma of the stomach associated with peripheral neurofibromatosis: report of a case. Surg Today 1997; 27:57-9. [PMID: 9035301 DOI: 10.1007/bf01366940] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 55-year old man with von Recklinghausen's disease was admitted to our hospital for investigation of weight loss, anorexia, and abdominal discomfort. Endoscopy findings revealed impairment in the extendability of the stomach by air, and barium meal studies showed a well-contracted stomach. On exploratory laparotomy, the whole of the stomach was found to be grossly shrunken with thickening of the walls suggesting a "linitis plastica" stomach. Histological findings confirmed stage III poorly differentiated diffuse infiltrative adenocarcinoma of the stomach. This report describes a rare case of "linitis plastica" stomach in a patient with peripheral neurofibromatosis (NF-1) indicating that the NF-1 disorder does not spare an individual from other common neoplastic disorders.
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Affiliation(s)
- S Basu
- Department of Medical Oncology, Chittaranjan National Cancer Institute, Calcutta, India
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Abstract
Peripheral neurofibromatosis (Von Recklinghausen's disease) has been previously reported in association with a number of tumours and recently with aqueductal stenosis. We report a case which had both aqueductal stenosis and a testicular teratoma, which has not previously been reported in this condition.
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Affiliation(s)
- D A Hilton
- Department of Histopathology, Glenfield General Hospital, Leicester, UK
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12
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Williams DJ. Metastatic oesophageal squamous carcinoma in a small bowel neurofibroma. THE JAPANESE JOURNAL OF SURGERY 1988; 18:110-3. [PMID: 3133513 DOI: 10.1007/bf02470856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Metastatic oesophageal carcinoma in a jejunal neurofibroma is described. This case contributes to the current evidence linking carcinomas of the gastro-intestinal tract with von Recklinghausen's disease and also illustrates an unusual method of spread for oesophageal squamous carcinoma.
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Affiliation(s)
- D J Williams
- University Department of Pathology, Western Infirmary, Glasgow, Scotland
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Abstract
We present a review of the reported cases and describe a fifth of neurofibromatosis with small bowel adenocarcinoma and concurrent leiomyomas, indicating a previously unrecognised association.
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Affiliation(s)
- T J Jones
- Department of Morbid Anatomy, London Hospital Medical College
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15
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Sørensen SA, Mulvihill JJ, Nielsen A. Long-term follow-up of von Recklinghausen neurofibromatosis. Survival and malignant neoplasms. N Engl J Med 1986; 314:1010-5. [PMID: 3083258 DOI: 10.1056/nejm198604173141603] [Citation(s) in RCA: 373] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To document the natural history of von Recklinghausen neurofibromatosis, we followed up a nationwide cohort of 212 affected patients and families identified in Denmark 42 years ago. We obtained follow-up information on 99 percent. Because all 76 probands were identified through hospitals, they may include a disproportionate number of severe cases of neurofibromatosis. To diminish this effect of selection bias, we distinguished between the probands and their affected relatives. In a comparison with the general population, survival rates were significantly impaired in relatives with neurofibromatosis, worse in probands, and worst in female probands. Malignant neoplasms or benign central nervous system tumors occurred in 45 percent of the probands, giving a relative risk of 4.0 (95 percent confidence limits, 2.8 to 5.6) as compared with expected numbers. Multiple primary neoplasms were found in 15 probands, but only 1 relative. Compared with the general population, male relatives with neurofibromatosis had the same rate of neoplasms, whereas female relatives had a nearly twofold higher rate (relative risk, 1.9; 1.1 to 3.1). Nervous system tumors were disproportionately represented. We conclude that patients with severe neurofibromatosis requiring hospitalization often have a poor prognosis, but incidentally diagnosed relatives may have a considerably better outcome.
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McGlinchey JJ, Santer GJ, Haqqani MT. Primary adenocarcinoma of the duodenum associated with cutaneous neurofibromatosis (von Recklinghausen's disease). Postgrad Med J 1982; 58:115-6. [PMID: 6808470 PMCID: PMC2426319 DOI: 10.1136/pgmj.58.676.115] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A case of primary adenocarcinoma of the duodenum in a 29-year-old man with neurofibromatosis (von Recklinghausen's disease) is described. As far as can be ascertained, such an association has not been described before.
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Okudaira Y, Sugimachi K, Mayumi H, Ikeda M, Tamada R, Inokuchi K, Kuwano H, Enjoji M. Esophageal carcinoma associated with neurofibromatosis-a case report. THE JAPANESE JOURNAL OF SURGERY 1981; 11:189-92. [PMID: 6792411 DOI: 10.1007/bf02468836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Rutgeerts P, Hendrickx H, Geboes K, Ponette E, Broeckaert L, Vantrappen G. Involvement of the upper digestive tract by systemic neurofibromatosis. Gastrointest Endosc 1981; 27:22-5. [PMID: 6783470 DOI: 10.1016/s0016-5107(81)73137-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
A case of adenocarcinoma of the pancreas in a 27-year-old woman with neurofibromatosis (von Recklinghausen's disease) is presented.
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