Oral-facial manifestations of the multiple endocrine neoplasia syndrome

Multiple endocrine neoplasia syndrome — type 2b

The multiple endocrine neoplasia syndromes are an association of tumours of 2 or more endocrine glands. Multiple endocrine neoplasia type 2b (MEN 2b) patients develop medullary thyroid carcinoma and pheochromocytomas as well as unique physical characteristics. Most commonly, MEN2b is inherited with an autosomal dominant pattern although sporadic cases are not uncommon. If untreated the disease may be lethal. The facial, oral and ocular characteristics are reliable markers of the disease. These patients give a history most commonly of slipped capital femoral epiphysis, hypertension and life-long diarrhoea and/or constipation. MEN2b is most commonly characterised by nodules on the anterior aspect of the tongue, thickened lips with nodules, thickened upper eyelids, broadened nasal bridge, thickened corneal nerves and dilated, symmetrical, pedunculated nodules on the cheek mucosa. The patient described has most of these characteristics. Radiographic features of the jaws which have not been previously described are reported. These include a markedly enlarged and bifurcated inferior alveolar canal and shortened roots of the lower incisor teeth. Due to the lethality of the disease, patients who present with the above physical characteristics must be further investigated to exclude MEN2b.

Multiple endocrine neoplasia type IIb: a clinicopathological report

The clinicopathological findings in a 12-year-old boy with multiple endocrine neoplasia type IIb (MEN-IIb) are presented. He demonstrated the characteristics of a Marfanoid habitus and had mucosal neuromas of the lips, tongue, eyelids, and cornea. The enlarged right thyroid lobe showed an increased thallium-201 chloride uptake, and the serum calcitonin level was markedly raised. A total thyroidectomy was performed. Histopathological examination showed an infiltrating medullary carcinoma of the thyroid (MCT) and metastatic spread to supraclavicular lymph nodes. Special stains, immunocytochemistry, and electron microscopy revealed mucin-containing follicular structures lined by calcitonin-positive and thyroglobulin-negative tumour cells. Ultrastructurally the mucosal neuromas consisted of proliferating perineurial and Schwann cells. The serum calcitonin level fell below 300 pmol/L, and his stools returned to normal postoperatively. Because the incidence of MCT in MEN-IIb is virtually 100%, a total thyroidectomy in high risk patients--even before clinical evidence of malignant tumours--may be the only hope of cure.

Multiple endocrine neoplasia type 3: three cases with mucosal neuromata

Three female patients (ages 10, 18 & 25 years) with multiple endocrine neoplasia type 3 are reported. They had all characteristic facial appearances, with mucosal neuromata, rubbery swollen lips, tubercles on the tongue and eversion of the eye lids. Clinical signs and symptoms appeared to be progressive with increase in age, suggesting the importance of the correct diagnosis and early evaluation of endocrine function leading to a better prognosis for the patient.

Mucosal neuromata syndrome (MEN type IIb (III))

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The occurrence of multiple endocrine neoplasia type IIb, in two children of an affected mother

Two children with multiple endocrine neoplasia syndrome, Type IIb, (MEN IIb), whose natural mother died from complications of general anesthesia, due to undiagnosed bilateral pheochromocytomas, are described. Of particular interest is the fact that the daughter presented with many stigmata of the syndrome, including the typical facies, while her brother had no obvious clinical manifestations of the syndrome. Both children to date have undergone total thyroidectomy, and pathology reports have confirmed the presence of medullary thyroid carcinoma.

Multiple endocrine neoplasia, type III

Multiple oral plexiform neuromas in a 14-year-old white girl prompting screening of the patient with respect to the multiple endocrine neoplasia (MEN) type-III syndrome, verified the existence of a thyroid medullary carcinoma and the diagnosis MEN-type III. Total thyroidectomy was performed, but extensive tumour infiltration prevented radical tumour excision. The condition being relatively infrequent, the important life-saving role of dental practitioners and oral surgeons in its recognition and early diagnosis is emphasized.