Case of complex craniofacial anomalies, bilateral nasal proboscides, palatal pituitary, upper limbs reduction, and amnion rupture sequence: disorganization phenotype?

Rhabdomyomatous mesenchymal hamartoma presenting as telangiectasia in a 57-year-old man

Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare congenital malformation of the dermis and subcutaneous tissue. Usually, RMH occurs in the midline of the face and neck region. We described a case of RMH presenting as telangiectasia in a 57-year-old man with a history of pityriasis lichenoides chronicus. Histopathological examination revealed a subepidermal haphazard proliferation of striated muscular tissue perpendicular to the epidermis. These bundles of striated muscular tissue were admixed with adnexal structures. The diagnosis was consistent with RMH. RMH is more common in the neonatal period or in young children, but we should consider it as part of a differential diagnosis in older adults as well.

The Orthopaedic Management of Human Disorganization Syndrome

Human disorganization syndrome (HDS) is an extremely rare congenital syndrome characterized by a seemingly random distribution of multiple developmental anomalies involving all three germinal layers.

[Ectopia of the pituitary]

The adenohypophysis has a large intrasellar part and two small parts at the pituitary stalk and the pharynx. Near this extrasellar pituitary tissue, and also in sinus sphenoidalis and sinus cavernosus, ectopic pituitary adenomas can develop. They are indistinguishable in structure and function from usual intrasellar adenomas. The neurohypophysis can show dystopias within complex malformations. In so-called pituitary stalk interruption syndrome, a real ectopia of the neurohypophysis is found at the eminentia mediana of the hypothalamus. Ectopic tissue in the pituitary is extremely rare: foci of ganglionic cells were found in the neurohypophysis and adrenocortical tissue in the adenohypophysis. Focal squamous epithelia in the anterior pituitary are a common finding but they are rather metaplastic from parenchymal cells than ectopic tissue. Small foci of ectopic salivary gland tissue are not rare in the intermediate zone.

A case of optic-nerve hypoplasia and anterior segment abnormality associated with facial cleft

Introduction

The incidence of facial cleft is rare and ranges between 1.43 and 4.85 per 100,000 births. To date, there have been few reports of detailed ophthalmologic examinations performed in cases of facial cleft. Here, we report a case of optic-nerve hypoplasia and anterior segment abnormality associated with facial cleft.

Case report

A 9-day-old female infant was delivered by cesarian section at 34 weeks of gestational age (the second baby of twins) and weighed 2,276 g upon presentation. She had a facial cleft and ectrodactyly at birth. Right eye-dominant blepharophimosis was obvious. Examination of the right eye revealed inferior corneal opacity with vascularization, downward corectopia, and optic-nerve hypoplasia. The corneal diameter was 8 mm in both eyes, and tonometry by use of a Tono-Pen^® XL (Reichert Technologies, Depew, NY, USA) handheld applanation tonometer revealed that her intraocular pressure was 11–22 mmHg (Oculus Dexter) and 8 mmHg (Oculus Sinister). B-mode echo revealed no differences in axial length between her right and left eyes. When she was 15–16 months old, we attempted to examine her eyes before she underwent plastic surgery under general anesthesia. She had a small optic disc in both eyes and the right-eye disc was tilted. After undergoing canthotomy, gonioscopy and ultrasound biomicroscopy revealed that almost all directions were open except for the peripheral anterior synechia. Since magnetic resonance imaging revealed ventriculomegaly associated with an interhemispheric cyst at birth, a ventriculoperitoneal shunt was inserted at 12 days of age. At 25 months of age, her condition suddenly deteriorated due to occlusion of the ventricular shunt catheter, and she died 5 days later. In this patient, amniotic band syndrome was presumed to be the primary cause due to the clinical findings.

Conclusion

We experienced a case of optic-nerve hypoplasia and anterior segment abnormality that occurred with facial cleft. The cause of these abnormalities is unclear, yet amniotic band syndrome is a possible candidate.

MR imaging of fetal head and neck anomalies

This article describes an approach to imaging of fetal head and neck anomalies. Topics include cleft lip and palate, facial clefts, amniotic band sequence, micrognathia and retrognathia, ocular and orbital abnormalities, craniosynostosis, posterior nuchal translucency, cephaloceles, vascular anomalies, and tumors. Some of the more common syndromes are also described.

Rhabdomyomatous mesenchymal hamartoma: an unusual dermal entity with a report of two cases and a review of the literature

BACKGROUND

Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare congenital lesion of the dermis and soft tissues consisting of a disordered and varied collection of mature adipose tissue, skeletal muscle, adnexal elements and nerve bundles. This entity exists under various names including striated muscle hamartoma, congenital midline hamartoma, and hamartoma of cutaneous adnexa and mesenchyme. Several published cases report the occurrence of RMH within the setting of other uncommon congenital abnormalities.

METHODS

We report the clinical and pathologic features of two cases of rhabdomyomatous mesenchymal hamartoma. Patient 1 is a 71-year-old man who presented for removal of a nodule located on his temple that had been traumatized during a recent haircut. Patient 2 is a 4-month-old infant with amnion rupture sequence and rare craniofacial abnormalities including facial clefts, microphthalmia, bilateral colobomas, and a mobile fingerlike projection above the left medial canthus.

RESULTS

Histological examination in both cases showed a deep dermal and subcutaneous fat collection of disorganized skeletal muscle fibers, adipose and neural tissue, and adnexal structures. Characteristically, the skeletal muscle approximated folliculosebaceous structures in a haphazard manner.

CONCLUSIONS

RMH is a rare benign condition of the deep dermis and subcutaneous fat with only 22 cases existing in the English literature. To our knowledge, this is the first report of an elderly man presenting with RMH, presumptively present since birth. There was no evidence of cellular or malignant degeneration. While the etiology of RMH is unknown, possible explanations include aberrancy in the embryonic migration of mesodermally derived tissues or a genetic defect predisposing to the formation of hamartomas.