1
|
Abdelrahman A, Abass SM, Abdalla EM, Elamin S, Zaki HA, Fadul KY, Abugabala M, Elgassim M. Lhermitte-Duclos disease in a 51-year old patient. Radiol Case Rep 2024; 19:2820-2825. [PMID: 38689816 PMCID: PMC11059306 DOI: 10.1016/j.radcr.2024.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/22/2024] [Indexed: 05/02/2024] Open
Abstract
Lhermitte-Duclos disease (LDD) is a rare, slow-growing neoplasm that develops in the brain's posterior fossa. It can appear as a single lesion or as part of Cowden's syndrome. We report the case of a 51-year-old female with a history of diabetes, hypertension, and a previously treated neuroendocrine tumor, who presented to the hospital after experiencing a generalized tonic-clonic seizure. Except for a tongue laceration, the neurological examination was unremarkable. Brain magnetic resonance imaging (MRI) showed a T2 left cerebellar hemisphere pseudomass lesion with iso-hyperintense signals suggestive of Lhermitte-Duclos disease. This case describes a unique presentation of LDD and its various radiological manifestations, emphasizing the importance of neuroimaging in its diagnosis. Additionally, it contributes to the expanding literature on the varied manifestations of LDD.
Collapse
Affiliation(s)
| | - Shahd M. Abass
- Department: Medical Education department, HMC, Doha, Qatar
| | | | - Shuhal Elamin
- Department: Khartoum State Ministry Of Health, Khartoum, Sudan
| | - Hany A. Zaki
- Department: Medical Education department, HMC, Doha, Qatar
| | | | | | | |
Collapse
|
2
|
Dhamija R, Hoxworth JM. Imaging of PTEN-related abnormalities in the central nervous system. Clin Imaging 2019; 60:180-185. [PMID: 31927175 DOI: 10.1016/j.clinimag.2019.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/04/2019] [Accepted: 12/09/2019] [Indexed: 11/16/2022]
Abstract
The phosphatase and tensin homolog (PTEN) located at 10q23.31 is a tumor suppressor gene expressed ubiquitously, and loss of function mutations lead to aberrant growth, angiogenesis, and an increased risk for a variety of tumors. PTEN mutations have been associated with multiple abnormalities in the central nervous system, and a number of clinical phenotypes are now attributed to germline PTEN mutations, collectively referred to as PTEN hamartoma tumor syndrome (PHTS). Most notably, these include Cowden syndrome (CS), Bannayan-Riley-Ruvalcaba syndrome (BRRS), and autism spectrum disorders with macrocephaly. It is important to recognize the neuroimaging features associated with PTEN mutations to not only avoid misdiagnosis in cases of known PHTS but also to guide genetic testing in patients who do not yet have an established diagnosis. In this review, the central nervous system imaging features of PTEN-related disorders are discussed.
Collapse
Affiliation(s)
- Radhika Dhamija
- Departments of Clinical Genomics and Neurology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
| | - Joseph M Hoxworth
- Divison of Neuroradiology, Department of Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
| |
Collapse
|
3
|
|
4
|
Uchida D, Nakatogawa H, Inenaga C, Tanaka T. An Unusual Case of Lhermitte-Duclos Disease Manifesting with Intratumoral Hemorrhage. World Neurosurg 2018; 114:326-329. [DOI: 10.1016/j.wneu.2018.03.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 11/26/2022]
|
5
|
Lhermitte-Duclos Disease (Dysplastic Gangliocytoma of the Cerebellum) and Cowden Syndrome: Clinical Experience From a Single Institution with Long-Term Follow-Up. World Neurosurg 2017; 104:398-406. [DOI: 10.1016/j.wneu.2017.04.147] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/21/2017] [Accepted: 04/22/2017] [Indexed: 11/24/2022]
|
6
|
Gama I, Almeida L. Lhermitte-Duclos disease associated to Cowden syndrome: de novo diagnosis and management of these extremely rare syndromes in a patient. BMJ Case Rep 2017; 2017:bcr-2016-217974. [PMID: 28137902 DOI: 10.1136/bcr-2016-217974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 36-year-old woman, with history of cutaneous papilomatosis and thyroid carcinoma presented with headache, transitory visual blurring and nausea. Funduscopy showed papilloedema. MRI showed a tumour of the right cerebellar hemisphere with a striated, tigroid pattern, typical of Lhermitte-Duclos disease (LDD). Significant clinical and perimetric improvements were noted after surgery and the follow-up did not reveal recurrences of the tumour. LDD is an extremely rare differential diagnosis of posterior fossa tumours. LDD and the history of thyroid carcinoma permitted us to diagnose Cowden syndrome (CS). We present a clinical case that supports the possibility of performing a preoperative diagnosis of LDD based on MRI features. We review the diagnosis and management of LDD and CS. This report highlights the importance of excluding CS after LDD diagnosis, of monitoring the optic nerve postoperatively using optical coherence tomography and of prompt treatment that can potentially prevent visual function loss.
Collapse
Affiliation(s)
- Ivo Gama
- Ophthalmology Department, University Hospital Santa Maria, North Lisbon Hospital Center, Lisbon, Portugal.,Medical Faculty of Lisbon, University of Lisbon, Lisbon, Portugal
| | - Leonor Almeida
- Ophthalmology Department, University Hospital Santa Maria, North Lisbon Hospital Center, Lisbon, Portugal.,Medical Faculty of Lisbon, University of Lisbon, Lisbon, Portugal
| |
Collapse
|
7
|
Prabhu SS, Aldape KD, Bruner JM, Weinberg JS. Cowden Disease with Lhermitte-Duclos Disease: Case Report. Can J Neurol Sci 2014; 31:542-9. [PMID: 15595264 DOI: 10.1017/s0317167100003784] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background:We report a case and review the recent literature describing 36 patients with both Lhermitte-Duclos disease (LDD) and Cowden disease (CD). Lhermitte-Duclos disease, or dysplastic gangliocytoma, is a benign hamartomatous condition involving the cerebellum. The presenting symptoms are usually headaches, gait ataxia, and symptoms of lower cranial nerve involvement. Cowden disease is a rare autosomal dominant disease that usually presents with multiple mucocutaneous lesions. Patients with CD are prone to multiple systemic malignancies, the most common of which is breast cancer. Recent studies have demonstrated an association between LDD and CD.Methods:A 44-year-old woman with a previous history of breast cancer, multiple benign skin lesions, Hashimoto's thyroiditis, and chronic headaches presented with exacerbation of her headaches during the previous year. Magnetic resonance imaging of the brain revealed a right cerebellar nonenhancing mass and an acquired tonsillar herniation.Results:The patient underwent resection of the right cerebellar mass, posterior fossa decompression, C1 and C2 laminectomies, and a duraplasty. Pathologic examination confirmed LDD. The patient recovered well after surgery, with immediate improvement of her headaches.Conclusion:The association between LDD and CD has been under-recognized and under-reported. Recognition of this association has direct clinical relevance, because diligent monitoring of individuals with LDD and CD may lead to the early detection of systemic malignancies.
Collapse
Affiliation(s)
- Sujit S Prabhu
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, The Brain Tumor Center, Houston, Texas, USA
| | | | | | | |
Collapse
|
8
|
Abi Lahoud G, Chalouhi N, Zanaty M, Rizk T, Jabbour P. Association of Lhermitte-Duclos disease and split cord malformation in a child. J Clin Neurosci 2014; 21:1999-2002. [PMID: 24938384 DOI: 10.1016/j.jocn.2014.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/11/2014] [Indexed: 11/16/2022]
Abstract
Lhermitte-Duclos disease (LDD) or cerebellar gangliocytoma is a rare pathological entity, the etiology of which remains controversial. Numerous developmental anomalies are known to be associated with LDD, but the association between LDD and split cord malformation (SCM) has not been reported to our knowledge. We report LDD in a 3-year-old girl in whom repetitive urinary tract infections led to the diagnosis of a neurogenic bladder. Thorough screening revealed a SCM at the thoracic level which was surgically repaired. The pathogenesis of this entity and management strategies are discussed in this paper.
Collapse
Affiliation(s)
- Georges Abi Lahoud
- Department of Neurosurgery, Division of Spine Surgery, Paris Descartes University and Sainte-Anne University Hospital, Paris, France
| | - Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, 901 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA
| | - Mario Zanaty
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, 901 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA
| | - Tony Rizk
- Department of Neurosurgery, Hotel Dieu de France, Beirut, Lebanon
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, 901 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA.
| |
Collapse
|
9
|
Shinagare AB, Patil NK, Sorte SZ. Case 144: Dysplastic cerebellar gangliocytoma (Lhermitte-Duclos disease). Radiology 2009; 251:298-303. [PMID: 19332858 DOI: 10.1148/radiol.2511071390] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Atul B Shinagare
- Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India.
| | | | | |
Collapse
|
10
|
Nakagawa T, Maeda M, Kato M, Terada N, Shimizu S, Morooka Y, Nakano H, Takeda K. A case of Lhermitte-Duclos disease presenting high FDG uptake on FDG-PET/CT. J Neurooncol 2007; 84:185-8. [PMID: 17332944 DOI: 10.1007/s11060-007-9355-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Accepted: 02/07/2007] [Indexed: 10/23/2022]
Abstract
Lhermitte-Duclos Disease (LDD) is a rare cerebellar lesion that has long been controversial as to whether the entity is a hamartoma, a malformation, or a neoplasm. Recent advances in metabolic imaging and molecular biology have unveiled biological features of LDD and a close relationship between LDD and Cowden disease. Adult onset LDD is now considered identical to Cowden disease in a US guideline. We present a case of LDD, in which high fluorodeoxy glucose (FDG) uptake was shown on PET/CT. We performed dual time point scans, in which a delayed scan exhibited more intense FDG uptake by the hamartomatous lesion than an early scan. We must remain aware of the possibility of LDD when intense accumulation is observed in a cerebellar lesion on FDG-PET/CT imaging.
Collapse
Affiliation(s)
- Toshio Nakagawa
- Department of Radiology, Saiseikai Matsusaka General Hospital, Matsusaka, Japan
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
Lhermitte-Duclos disease is a rare disorder with an unknown pathogenesis. A single report of a pathological proven case of Lhermitte-Duclos disease is presented with clinical, imaging, and histopathological findings. A brief review of the condition is provided with an emphasis on imaging description.
Collapse
Affiliation(s)
- Jeffrey J Carlson
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA.
| | | | | |
Collapse
|
12
|
Robinson S, Cohen AR. Cowden disease and Lhermitte-Duclos disease: an update. Case report and review of the literature. Neurosurg Focus 2006; 20:E6. [PMID: 16459996 DOI: 10.3171/foc.2006.20.1.7] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECT Cowden disease is a rare autosomal-dominant phacomatosis and cancer syndrome that is associated with Lhermitte-Duclos disease (LDD), also called dysplastic cerebellar gangliocytoma. METHODS In this review the authors summarize the additions to the literature during the past 5 years, with emphasis on new case reports and advances in imaging and molecular biology. Adult-onset LDD is now considered pathognomonic for Cowden disease. Approximately 220 cases of LDD have been reported. Magnetic resonance imaging in patients with LDD is often diagnostic, and imaging studies have facilitated accurate diagnosis and contributed to the improved outcome in affected patients. Cowden disease and other rare, related disorders, such as Bannayan-Riley-Ruvalcaba, Proteus, and Proteus- like syndromes, are often caused by mutations of the PTEN gene. CONCLUSIONS Because of the high incidence of systemic cancer in patients with Cowden disease, it is important for neurosurgeons to recognize the association between this disease and LDD and to refer affected patients for appropriate cancer screenings and interventions.
Collapse
Affiliation(s)
- Shenandoah Robinson
- Division of Pediatric Neurosurgery, Rainbow Babies and Children's Hospital, Case Research Institute, Case School of Medicine, Cleveland, Ohio 44120, USA.
| | | |
Collapse
|
13
|
Lok C, Viseux V, Avril MF, Richard MA, Gondry-Jouet C, Deramond H, Desfossez-Tribout C, Courtade S, Delaunay M, Piette F, Legars D, Dreno B, Saïag P, Longy M, Lorette G, Laroche L, Caux F. Brain magnetic resonance imaging in patients with Cowden syndrome. Medicine (Baltimore) 2005; 84:129-136. [PMID: 15758842 DOI: 10.1097/01.md.0000158792.24888.d2] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cowden syndrome (CS) is a rare autosomal dominant genodermatosis, characterized by multiple hamartomas, particularly of the skin, associated with high frequencies of breast, thyroid, and genitourinary malignancies. Although Lhermitte-Duclos disease (LDD) or dysplastic gangliocytoma of the cerebellum, a slowly progressive unilateral tumor, is a major criterion of CS, its frequency in patients with CS is unknown. Other cerebral abnormalities, especially meningioma and vascular malformations, have also been described, albeit rarely, in these patients. The aim of the current study was to use cerebral magnetic resonance imaging (MRI) to evaluate LDD frequency and to investigate other brain abnormalities in CS patients recruited by dermatologists. A multicenter study was conducted in 8 hospital dermatology departments between January 2000 and December 2003. Twenty patients with CS were included; specific cerebral MRI abnormalities were found in 35% (7/20) of them. Cerebral MRI revealed LDD in 3 patients, a meningioma in 1, and numerous vascular malformations in 6 patients. Five patients had venous angiomas (3 associated with LDD) and 2 patients had cavernous angiomas (1 associated with LDD and a venous angioma). The discovery of asymptomatic LDD in 3 patients and a cavernous angioma in another prompted us to perform neurologic examinations regularly and MRI to estimate the size and the extension of the tumor, and to assess the need for surgery. CS similarities with Bannayan-Riley-Ruvalcaba (BRR) are discussed because some patients could also have the BRR phenotype (for example, genital lentigines, macrocephaly, multiple lipomas) and because BRR seems to have more central nervous system vascular anomalies. Because CS signs can involve numerous systems, all physicians who might encounter this disease should be aware of its neurologic manifestations. Our findings confirm the contribution of brain MRI to detecting asymptomatic LDD, vascular malformations, and meningiomas in patients with CS.
Collapse
Affiliation(s)
- Catherine Lok
- From Department of Dermatology (CL, VV, CD-T, SC), CHU Sud, Amiens; Department of Dermatology (MFA), Institut Gustave-Roussy, Villejuif; Department of Dermatology (MAR), CHU Sainte-Marguerite, Marseille; Department of Radiology A (CG-J, HD), Department of Neurosurgery (DL), CHU Nord, Amiens; Department of Dermatology (MD), CHU Saint-André, Bordeaux; Department of Dermatology (FP), CHU de Lille, Lille; Department of Dermatology (BD), CHU de Nantes, Nantes; Department of Dermatology (PS), CHU Ambroise-Paré, Boulogne-Billancourt; Molecular Genetics Laboratory (ML), Bergonié Institute, Bordeaux; Department of Dermatology (GL), CHU Tours, Tours; Department of Dermatology (LL, FC), CHU Avicenne, Bobigny, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Derrey S, Proust F, Debono B, Langlois O, Layet A, Layet V, Longy M, Fréger P, Laquerrière A. Association between Cowden syndrome and Lhermitte-Duclos disease. ACTA ACUST UNITED AC 2004; 61:447-54; discussion 454. [PMID: 15120218 DOI: 10.1016/s0090-3019(03)00576-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2002] [Accepted: 06/30/2003] [Indexed: 11/22/2022]
Abstract
BACKGROUND The authors describe 2 cases of dysplasic gangliocytoma of the cerebellum or Lhermitte-Duclos disease revealing Cowden disease or multiple hamartoma neoplasia syndrome. Cowden disease is a rare autosomal dominant disorder, now considered as a phakomatosis. Nevertheless, relationships between both conditions still remain unclear, since Lhermitte-Duclos disease can also be sporadic. CASE REPORTS Two patients, 25 and 27 years old, were admitted to the emergency department for an acute intracranial hypertension. In both cases, magnetic resonance imaging (MRI) scan showed a mass in the cerebellar hemisphere. Pathological examination of surgical resection specimens concluded Lhermitte-Duclos disease. Because of the patients' previous personal and familial medical history, Cowden disease was suspected and confirmed by mutational analysis of the phosphatase and tensin homolog (PTEN) gene. In the first case, a nonsense punctual mutation in exon 8 was found. In the second one, a mutation was revealed in the exon 5, a mutational hot spot encoding the phosphatase catalytic core motif. CONCLUSION Lhermitte-Duclos disease and Cowden disease can be associated. Germline mutations of PTEN gene are known to be implicated in Cowden disease. This gene, located at chromosome 10q23-3, is a tumor suppressor gene that encodes a protein with phosphatase activity. To date, more than 80 mutations have been reported in Cowden disease. When the diagnosis of either one of these two disorders is established, it is imperative to search for the other one to detect early malignant lesions that occur in Cowden disease. Finally, a long-term follow up of the patient is required and a thorough familial screening is necessary.
Collapse
Affiliation(s)
- Stéphane Derrey
- Department of Neurosurgery, Rouen University Hospital, Rouen Cedex, France
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Koeller KK, Henry JM. From the archives of the AFIP: superficial gliomas: radiologic-pathologic correlation. Armed Forces Institute of Pathology. Radiographics 2001; 21:1533-56. [PMID: 11706224 DOI: 10.1148/radiographics.21.6.g01nv051533] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Glial neoplasms that are peripherally located and involve the cortical gray matter are noteworthy because of their predilection to serve as a seizure locus, their amenability to surgical resection, their generally favorable prognosis, and their characteristic imaging features, which facilitate diagnosis before surgery. The smaller lesions include ganglioglioma and dysembryoplastic neuroepithelial tumor. Gangliogliomas contain both neuronal and glial components and occur most commonly in the temporal lobe. Variant forms of gangliogliomas may occur and are related to the different compositions of the underlying cellular population. Gangliocytomas lack glial cells and are located both in the cerebral hemispheres and the cerebellum. Lhermitte-Duclos disease represents a specific type of cerebellar gangliocytoma with dysplastic features and is characterized by a laminar pattern at imaging. Dysembryoplastic neuroepithelial tumors occur predominantly in children and young adults with partial seizures and most commonly arise in the temporal lobe, frequently in combination with cortical dysplasia. Surrounding vasogenic edema is conspicuously absent in both gangliogliomas and dysembryoplastic neuroepithelial tumors. The larger masses in this group include desmoplastic infantile ganglioglioma and pleomorphic xanthoastrocytoma and tend to involve the leptomeninges and cortical territory. Both invoke an intense desmoplastic reaction, which appears as an enhancing soft-tissue component at imaging.
Collapse
Affiliation(s)
- K K Koeller
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, Bldg 54, Rm M-121, 14th St at Alaska Ave, Washington, DC 20306-6000, USA.
| | | |
Collapse
|
16
|
Vantomme N, Van Calenbergh F, Goffin J, Sciot R, Demaerel P, Plets C. Lhermitte-Duclos disease is a clinical manifestation of Cowden's syndrome. SURGICAL NEUROLOGY 2001; 56:201-4; discussion 204-5. [PMID: 11597654 DOI: 10.1016/s0090-3019(01)00552-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lhermitte-Duclos disease (LDD) is a hamartomatous overgrowth of cerebellar ganglion cells, which replace granular cells and Purkinje cells. In recent years several cases involving the association between LDD and Cowden's syndrome (CS), an autosomal dominant condition characterized by multiple hamartomas and neoplastic lesions in skin and internal organs, have been reported. METHODS We reviewed the medical records and imaging studies of six patients with LDD who were treated at our institution, and we looked at other possible symptoms of CS. RESULTS Other clinical findings suggestive of CS were apparent in five patients: These included mucocutaneous lesions, acral keratosis, thyroid adenoma, fibrocystic disease, ovarian cyst, intestinal polyposis, and arteriovenous malformation. Only in the youngest patient, a 5-year-old boy, were no cutaneous or other signs found, despite extensive clinical and ultrasound examination. CONCLUSION Our observations strengthen the hypothesis that LDD is a neurological manifestation of CS. Patients with LDD should receive a thorough dermatological and systemic screening, because some of the lesions (breast, etc...) can develop into malignant tumors.
Collapse
Affiliation(s)
- N Vantomme
- Department of Neurosurgery, University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
17
|
Robinson S, Cohen AR. Cowden disease and Lhermitte-Duclos disease: characterization of a new phakomatosis. Neurosurgery 2000; 46:371-83. [PMID: 10690726 DOI: 10.1097/00006123-200002000-00021] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Lhermitte-Duclos disease, or dysplastic gangliocytoma of the cerebellum, is an unusual hamartomatous lesion that can cause progressive mass effects in the posterior fossa. Cowden disease, or multiple hamartoma-neoplasia syndrome, is a rare autosomal dominant disorder characterized by mucocutaneous hamartomas and high incidences of systemic malignancies. We recently treated a patient with manifestations of both Lhermitte-Duclos disease and Cowden disease, and we were intrigued by the occurrence of these two rare disorders in the same patient. The purpose of the present study was to examine the nature of the association between Lhermitte-Duclos disease and Cowden disease. METHODS The records for all patients who had been diagnosed at our institution as having Lhermitte-Duclos disease were reviewed, to determine whether these patients also exhibited manifestations of Cowden disease. Data were obtained from multiple sources, including patient interviews, correspondence with treating physicians, and chart reviews. RESULTS During the past 40 years, five patients were diagnosed at Case Western Reserve University as having Lhermitte-Duclos disease. All five patients exhibited manifestations of Cowden disease. Before this review, Cowden disease had not been diagnosed for three of the patients. In our most recent case, the diagnoses of both disorders were established preoperatively. That patient was observed to have a deletion in the critical portion of Exon 5 of the PTEN gene, the gene associated with Cowden disease. CONCLUSION Inclusion of Lhermitte-Duclos disease in the Cowden disease spectrum suggests that Cowden disease is a true phakomatosis, with hamartomas arising from cutaneous and neural ectoderm. Recent advances in molecular genetics may help to refine the current descriptive classification of the phakomatoses. The association between Lhermitte-Duclos disease and Cowden disease has been under-recognized and under-reported. Recognition of this association has direct clinical relevance, because diligent long-term follow-up monitoring of individuals with Lhermitte-Duclos disease and Cowden disease may lead to the early detection of malignancy.
Collapse
Affiliation(s)
- S Robinson
- Division of Pediatric Neurological Surgery, Rainbow Babies and Childrens Hospital, and Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA
| | | |
Collapse
|
18
|
Murata J, Tada M, Sawamura Y, Mitsumori K, Abe H, Nagashima K. Dysplastic gangliocytoma (Lhermitte-Duclos disease) associated with Cowden disease: report of a case and review of the literature for the genetic relationship between the two diseases. J Neurooncol 1999; 41:129-36. [PMID: 10222433 DOI: 10.1023/a:1006167421100] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report a case of dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease, LDD). The patient also had cutaneous and mucosal hamartomas, adenomatous goiter, bilateral breast tumors, and gastrointestinal polyposis, indicating the diagnosis of Cowden disease (CD), the familial hamartoma syndrome. This was a rare sporadic case without any family history of CD, though CD is considered to be an autosomal dominant hereditary disease. Based on a thorough review of the previously reported cases, it is reasonable to consider that CD is inherited in autosomal dominant fashion through a CD gene (PTEN) containing a germline mutation, and that the occurrence of LDD is predicted on an additional somatic hit on the remaining normal CD allele or another unknown gene.
Collapse
Affiliation(s)
- J Murata
- Department of Neurosurgery, Hokkaido University School of Medicine, Sapporo, Japan
| | | | | | | | | | | |
Collapse
|
19
|
Dörfler A, Forsting M, Egelhof T, Albert FK, Sommer C, Sartor K. Atypical MR presentation of Lhermitte-Duclos disease (Dysplastic gangliocytoma of the cerebellum). Clin Neuroradiol 1997. [DOI: 10.1007/bf03043994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
20
|
Luzzani F, Morisetti A, Bussi S, Tirone P, de Haën C. Neurotolerability of nonionic X-ray contrast media. The role of chemotoxicity. Invest Radiol 1996; 31:338-44. [PMID: 8761866 DOI: 10.1097/00004424-199606000-00005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
RATIONALE AND OBJECTIVES Because small quantities of x-ray contrast agents can cross the blood-brain barrier, the authors evaluate the properties that contribute to neurotoxicity. METHODS The acute toxicity of various monomer and dimer contrast media was assessed after intracerebroventricular (ICV) injection to mice and intracisternal (ICI) injection to rats. RESULTS In mice, median lethal dose (LD50) values for monomer contrast media apart from iohexol were higher than those for dimer contrast media. In rats, iopentol and iopromide were more neurotoxic than all other contrast media. The signs of toxicity for all contrast media included convulsions, dyspnea, hypoactivity, and sedation. Hypertonic D-mannitol solution was tolerated as well as artificial cerebrospinal fluid. Neither the hydrophilicity of the molecules nor the physicochemical properties of their solutions explain the toxicities satisfactorily. CONCLUSIONS Neurotoxicity of monomer or dimer contrast media depends more on chemical structure characteristics other than hydrophilicity than on the physicochemical characteristics of their solutions.
Collapse
Affiliation(s)
- F Luzzani
- Milano Research Centre, Bracco Spa, Italy
| | | | | | | | | |
Collapse
|