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Almesned R, Alhagbani M, Sultan M, Alshayie M, Alqarni N, Alshammari A. Neurofibroma of the external genitalia, extreme enlargement of the clitoris. Urol Ann 2023; 15:328-330. [PMID: 37664088 PMCID: PMC10471813 DOI: 10.4103/ua.ua_86_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/12/2022] [Indexed: 09/05/2023] Open
Abstract
Neurofibromatosis of the genitourinary tract is rare, with a prevalence of 0.65%, and it is exceedingly rare to involve the external genitalia. Involvement of the clitoris, labia majora, and prepuce was reported with clitoromegaly being the most frequently occurring. Herein, we are reporting the case of a 6-year-old girl who was diagnosed with a neurofibroma of the clitoris; measuring 9.4 cm in its largest dimension. To the best of our knowledge, this is the largest clitoral neurofibroma reported in the literature. Due to the rarity of such cases and reports limitations in the literature, the diagnosis of neurofibroma of the external genitalia requires a high index of suspicion by health-care providers. Surgical excision and postoperative follow-up for possible recurrence remain the gold standard of management.
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Affiliation(s)
- Razan Almesned
- Department of Urology, Pediatric Urology Division, King Faisal Specialists Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohamed Alhagbani
- Department of Urology, Pediatric Urology Division, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed Sultan
- Department of Urology, Pediatric Urology Division, King Faisal Specialists Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammed Alshayie
- Department of Urology, Pediatric Urology Division, King Faisal Specialists Hospital and Research Center, Riyadh, Saudi Arabia
| | - Naif Alqarni
- Department of Urology, Pediatric Urology Division, King Faisal Specialists Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Alshammari
- Department of Urology, Pediatric Urology Division, King Faisal Specialists Hospital and Research Center, Riyadh, Saudi Arabia
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2
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Ahmad MS, Mahalik SK, Sahoo B, Sable MN, Pati AB, Das K. Primary solitary neurofibroma of penis in a child: case report and review. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Genital involvement in neurofibromas is rare and can involve both the clitoris and penis; in the latter, it usually accompanies a systemic pathology. Isolated penile neurofibroma is anecdotal. This report presents an unusual solitary penile neurofibroma in a child, discusses its surgical management and reviews the literature.
Case presentation
A 6-year child presented with history of swelling on the undersurface of his penis and obstructive voiding symptoms since 18 months of age. He underwent a partial excision at 5 years of age elsewhere which recurred. The swelling was a 3 × 2 cm, firm, midline, smooth surfaced, longitudinally oblong mass over the ventral penis extending from root to mid shaft with restricted mobility. There was no inguinal lymphadenopathy. Ultrasonography and cystoscopy characterized it to be a corpus spongiosal soft tissue mass encasing and indenting the contained penile urethra. The mass was completely excised along with involved urethra and corpus spongiosa and a penoscrotal urethrostomy created. Histopathological analysis revealed it to be a benign nerve sheath tumor/neurofibroma. He had no stigmata of neurofibromatosis and the ophthalmologic examination was unremarkable. At 2-year follow-up, he is well, has normal glanular sensation and erectile function and awaits urethral reconstruction.
Conclusion
Primary solitary penile neurofibroma in children is extremely rare. This report details the presentation and management of a ventral penile neurofibroma involving the adjacent urethra/corpora spongiosa.
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3
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Khushaim A, Albaradi A, Alsalim A. Early presentation of neurofibromatosis type I patient with clitoromegaly and café au lait spots: A case report. Radiol Case Rep 2022; 17:667-669. [PMID: 35003457 PMCID: PMC8715292 DOI: 10.1016/j.radcr.2021.11.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 11/01/2022] Open
Abstract
Neurofibromatosis is a rare genetic disorder that typically affects the nerves and causes benign tumors. It also affects different parts of the body, including the bone, skin, and genitourinary system. We report a case of a 6-year-old girl medically free who was referred to our institute with clitoromegaly and multiple café au lait spots on the skin. Clitoral mass excision was performed, and histopathology confirmed the diagnosis of clitoral plexiform neurofibroma as a primary presentation of Neurofibromatosis type I.
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Issa B, Mansour E, Jabbour G, Chikhani C, Mansour H, Jabbour M. Plexiform Penile Neurofibroma: A Case Report of a Rare Entity in a Pre-Pubertal Child. Urology 2021; 156:e124-e126. [PMID: 34129894 DOI: 10.1016/j.urology.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/24/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
Neurofibromatosis is a group of genetic disorders and consists of 2 forms: Neurofibromatosis type 1 (NF-1) and Neurofibromatosis type 2. The most common is the NF-1 which is also known as von Recklinghausen's disease. The presentation and clinical manifestations of this condition vary greatly. It is usually characterized by café-au-lait spots and neurofibromas. In this report, the case of a 12-year-old boy with NF-1 is presented. The boy has several café-au-lait spots along with inguinal and axillary freckles. He was found to have a rare and unusual neurofibroma of the penis.
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Affiliation(s)
- Bassim Issa
- Department of Urology, Saint George hospital university hospital, Beirut, Lebanon
| | - Elias Mansour
- Department of Urology, Saint George hospital university hospital, Beirut, Lebanon
| | | | - Carla Chikhani
- Department of Pediatrics, Saint George hospital university hospital, Beirut, Lebanon
| | - Hicham Mansour
- Department of Pediatrics, Saint George hospital university hospital, Beirut, Lebanon
| | - Michel Jabbour
- Department of Urology, Saint George hospital university hospital, Beirut, Lebanon.
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Xie H, Ansar S, Anderson L, Saidi S, Kitzing YX, Anand S. Glomangiomyoma of the clitoris: A case report and literature review. Case Rep Womens Health 2020; 29:e00269. [PMID: 33294388 PMCID: PMC7691537 DOI: 10.1016/j.crwh.2020.e00269] [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: 10/10/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022] Open
Abstract
Glomus tumor is an uncommon, benign, soft-tissue lesion in which the cells recapitulate the structure of the normal modified smooth muscle cells of the glomus body. Glomus tumors usually occur in tissues that normally contain glomus bodies; only rarely can they develop in sites where glomus bodies are normally sparse or absent. There are three subtypes of glomus tumor, with glomangiomyoma being the rarest. No more than 10 cases of glomus tumor in female genitalia have previously been reported, involving the vulva, vaginal area, periurethral area and clitoris. A clitoral glomangiomyoma is extremely rare. This is a case report of a glomangiomyoma in the clitoral area. Published reports of glomus tumor in the female external genitalia are reviewed. We report a rare case of glomangiomyoma of the clitoris. Magnetic resonance imaging is valuable in characterizing the soft-tissue mass of the clitoris and assisting surgical planning. Excision of a clitoral lesion entails consideration of the risk of bleeding, cosmetic results, and potential sexual dysfunction.
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Affiliation(s)
- Huan Xie
- Sydney Gynaecologic Oncology Group, Chris O'Brien Lifehouse Comprehensive Cancer Centre and Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
- Corresponding author at: Level 5 Gynaecologic Oncology Department, Chris O Brien Lifehouse Comprehensive Cancer Centre and Royal Prince Alfred Hospital, Camperdown, Sydney 2050, Australia.
| | - Sameera Ansar
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Lyndal Anderson
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
- The University of Sydney School of Medicine, Sydney, Australia
| | - Samir Saidi
- Sydney Gynaecologic Oncology Group, Chris O'Brien Lifehouse Comprehensive Cancer Centre and Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
- The University of Sydney School of Medicine, Sydney, Australia
| | - Yu Xuan Kitzing
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sunaina Anand
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
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Chapel DB, Cipriani NA, Bennett JA. Mesenchymal lesions of the vulva. Semin Diagn Pathol 2020; 38:85-98. [PMID: 32958293 DOI: 10.1053/j.semdp.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 02/01/2023]
Abstract
Mesenchymal lesions of the vulva include site-specific entities limited to the lower genital tract, as well as a range of non-site-specific tumors that are more common at extragenital sites. Site-specific lesions include fibroepithelial stromal polyp, cellular angiofibroma, angiomyofibroblastoma, and aggressive angiomyxoma. Non-site-specific tumors that may occur in the vulva include those of smooth muscle, skeletal muscle, vascular, neural, adipocytic, and uncertain differentiation. This review discusses both site-specific and non-site-specific vulvar mesenchymal lesions including non-neoplastic proliferations, benign neoplasms, locally aggressive neoplasms with a predilection for local recurrence, neoplasms of indeterminate biologic potential, and frankly malignant neoplasms with a high risk of distant metastasis and death. Accurate diagnosis is essential for proper management, and is facilitated by correlation with clinical findings and targeted application of immunohistochemical and molecular studies.
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Affiliation(s)
- David B Chapel
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA
| | - Jennifer A Bennett
- Department of Pathology, The University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA.
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Waldner RC, Rojas-Vasquez M, Metcalfe PD, Haqq AM. Extensive Pelvic Plexiform Neurofibroma Presenting As Clitoromegaly in a 3-Year-Old Female: Presentation and Management with MEK Inhibitor. J Pediatr Genet 2020; 11:139-143. [DOI: 10.1055/s-0040-1715638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
AbstractPlexiform neurofibroma (PN) involvement of the external genitalia in patients with neurofibromatosis type I (NF1) is a rare cause of nonhormonal clitoromegaly. We present a 3-year-old female with known NF1 who presented with clitoromegaly. She was identified with an extensive pelvic mass involving the bladder wall, perineum, labia, clitoris, rectum, and sacral foramina. A partial cystectomy was performed, and histopathology was consistent with PN. She has been initiated on a mitogen activated protein kinase enzyme kinase inhibitor, trametinib, which has been effective in achieving partial radiographic response of the bladder mass over 5 months. Additionally, she has experienced clinical response to trematinib with resolution of urinary urgency and frequency since initiating treatment.
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Affiliation(s)
- Richelle C. Waldner
- Department of Pediatrics, Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Alberta, Canada
| | - Marta Rojas-Vasquez
- Department of Pediatrics, Division of Immunology, Hematology, Oncology and Palliative Care, University of Alberta, Edmonton, Alberta, Canada
| | - Peter D. Metcalfe
- Department of Surgery, Division of Urology, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea M. Haqq
- Department of Pediatrics, Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Alberta, Canada
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Giotta Lucifero A, Luzzi S, Brambilla I, Schena L, Mosconi M, Foiadelli T, Savasta S. Potential roads for reaching the summit: an overview on target therapies for high-grade gliomas. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:61-78. [PMID: 32608376 PMCID: PMC7975828 DOI: 10.23750/abm.v91i7-s.9956] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/14/2022]
Abstract
Background: The tailored targeting of specific oncogenes represents a new frontier in the treatment of high-grade glioma in the pursuit of innovative and personalized approaches. The present study consists in a wide-ranging overview of the target therapies and related translational challenges in neuro-oncology. Methods: A review of the literature on PubMed/MEDLINE on recent advances concerning the target therapies for treatment of central nervous system malignancies was carried out. In the Medical Subject Headings, the terms “Target Therapy”, “Target drug” and “Tailored Therapy” were combined with the terms “High-grade gliomas”, “Malignant brain tumor” and “Glioblastoma”. Articles published in the last five years were further sorted, based on the best match and relevance. The ClinicalTrials.gov website was used as a source of the main trials, where the search terms were “Central Nervous System Tumor”, “Malignant Brain Tumor”, “Brain Cancer”, “Brain Neoplasms” and “High-grade gliomas”. Results: A total of 137 relevant articles and 79 trials were selected. Target therapies entailed inhibitors of tyrosine kinases, PI3K/AKT/mTOR pathway, farnesyl transferase enzymes, p53 and pRB proteins, isocitrate dehydrogenases, histone deacetylases, integrins and proteasome complexes. The clinical trials mostly involved combined approaches. They were phase I, II, I/II and III in 33%, 42%, 16%, and 9% of the cases, respectively. Conclusion: Tyrosine kinase and angiogenesis inhibitors, in combination with standard of care, have shown most evidence of the effectiveness in glioblastoma. Resistance remains an issue. A deeper understanding of the molecular pathways involved in gliomagenesis is the key aspect on which the translational research is focusing, in order to optimize the target therapies of newly diagnosed and recurrent brain gliomas. (www.actabiomedica.it)
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Affiliation(s)
- Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Ilaria Brambilla
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
| | - Lucia Schena
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
| | - Mario Mosconi
- Orthopaedic and Traumatology Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Thomas Foiadelli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
| | - Salvatore Savasta
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
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Luzzi S, Giotta Lucifero A, Brambilla I, Magistrali M, Mosconi M, Savasta S, Foiadelli T. Adoptive immunotherapies in neuro-oncology: classification, recent advances, and translational challenges. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:18-31. [PMID: 32608373 PMCID: PMC7975830 DOI: 10.23750/abm.v91i7-s.9952] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/04/2020] [Indexed: 12/16/2022]
Abstract
Background: Adoptive immunotherapies are among the pillars of ongoing biological breakthroughs in neuro-oncology, as their potential applications are tremendously wide. The present literature review comprehensively classified adoptive immunotherapies in neuro-oncology, provides an update, and overviews the main translational challenges of this approach. Methods: The PubMed/MEDLINE platform, Medical Subject Heading (MeSH) database, and ClinicalTrials.gov website were the sources. The MeSH terms “Immunotherapy, Adoptive,” “Cell- and Tissue-Based Therapy,” “Tissue Engineering,” and “Cell Engineering” were combined with “Central Nervous System,” and “Brain.” “Brain tumors” and “adoptive immunotherapy” were used for a further unrestricted search. Only articles published in the last 5 years were selected and further sorted based on the best match and relevance. The search terms “Central Nervous System Tumor,” “Malignant Brain Tumor,” “Brain Cancer,” “Brain Neoplasms,” and “Brain Tumor” were used on the ClinicalTrials.gov website. Results: A total of 79 relevant articles and 16 trials were selected. T therapies include chimeric antigen receptor T (CAR T) cell therapy and T cell receptor (TCR) transgenic therapy. Natural killer (NK) cell-based therapies are another approach; combinations are also possible. Trials in phase 1 and 2 comprised 69% and 31% of the studies, respectively, 8 of which were concluded. CAR T cell therapy targeting epidermal growth factor receptor variant III (EGFRvIII) was demonstrated to reduce the recurrence rate of glioblastoma after standard-of-care treatment. Conclusion: Adoptive immunotherapies can be classified as T, NK, and NKT cell-based. CAR T cell therapy redirected against EGFRvIII has been shown to be the most promising treatment for glioblastoma. Overcoming immune tolerance and immune escape are the main translational challenges in the near future of neuro-oncology. (www.actabiomedica.it)
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Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Ilaria Brambilla
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
| | - Mariasole Magistrali
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
| | - Mario Mosconi
- Orthopaedic and Traumatology Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Salvatore Savasta
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
| | - Thomas Foiadelli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
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Giotta Lucifero A, Luzzi S, Brambilla I, Trabatti C, Mosconi M, Savasta S, Foiadelli T. Innovative therapies for malignant brain tumors: the road to a tailored cure. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:5-17. [PMID: 32608372 PMCID: PMC7975829 DOI: 10.23750/abm.v91i7-s.9951] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/17/2022]
Abstract
Background: Immune tolerance, immune escape, neoangiogenesis, phenotypic changes, and glioma stem cells are all responsible for the resistance of malignant brain tumors to current therapies and persistent recurrence. The present study provides a panoramic view of innovative therapies for malignant brain tumors, especially glioblastoma, aimed at achieving a tailored approach. Methods: PubMed/Medline and ClinicalTrials.gov were the main sources of an extensive literature review in which “Regenerative Medicine,” “Cell-Based Therapy,” “Chemotherapy,” “Vaccine,” “Cell Engineering,” “Immunotherapy, Active,” “Immunotherapy, Adoptive,” “Stem Cells,” “Gene Therapy,” “Target Therapy,” “Brain Cancer,” “Glioblastoma,” and “Malignant Brain Tumor” were the search terms. Only articles in English published in the last 5 years were included. A further selection was made according to the quality of the studies and level of evidence. Results: Cell-based and targeted therapies represent the newest frontiers of brain cancer treatment. Active and adoptive immunotherapies, stem cell therapies, and gene therapies represent a tremendous evolution in recent years due to many preclinical and clinical studies. Clinical trials have validated the effectiveness of antibody-based immunotherapies, including an in-depth study of bevacizumab, in combination with standard of care. Preclinical data highlights the role of vaccines, stem cells, and gene therapies to prevent recurrence. Conclusion: Monoclonal antibodies strengthen the first-line therapy for high grade gliomas. Vaccines, engineered cells, stem cells, and gene and targeted therapies are good candidates for second-line treatment of both newly diagnosed and recurrent gliomas. Further data are necessary to validate this tailored approach at the bedside. (www.actabiomedica.it)
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Affiliation(s)
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Ilaria Brambilla
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
| | - Chiara Trabatti
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
| | - Mario Mosconi
- Orthopaedic and Traumatology Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Salvatore Savasta
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
| | - Thomas Foiadelli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
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11
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Luzzi S, Giotta Lucifero A, Brambilla I, Trabatti C, Mosconi M, Savasta S, Foiadelli T. The impact of stem cells in neuro-oncology: applications, evidence, limitations and challenges. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:51-60. [PMID: 32608375 PMCID: PMC7975826 DOI: 10.23750/abm.v91i7-s.9955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/19/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Stem cells (SCs) represent a recent and attractive therapeutic option for neuro-oncology, as well as for treating degenerative, ischemic and traumatic pathologies of the central nervous system. This is mainly because of their homing capacity, which makes them capable of reaching the inaccessible SC niches of the tumor, therefore, acting as living drugs. The target of the study is a comprehensive overview of the SC-based therapies in neuro-oncology, also highlighting the current translational challenges of this type of approach. METHODS An online search of the literature was carried out on the PubMed/MEDLINE and ClinicalTrials.gov websites, restricting it to the most pertinent keywords regarding the systematization of the SCs and their therapeutic use for malignant brain tumors. A large part of the search was dedicated to clinical trials. Only preclinical and clinical data belonging to the last 5 years were shortlisted. A further sorting was implemented based on the best match and relevance. RESULTS The results consisted in 96 relevant articles and 31 trials. Systematization involves a distinction between human embryonic, fetal and adult, but also totipotent, pluripotent or multipotent SCs. Mesenchymal and neuronal SCs were the most studied for neuro-oncological illnesses. 30% and 50% of the trials were phase I and II, respectively. CONCLUSION Mesenchymal and neuronal SCs are ideal candidates for SCs-based therapy of malignant brain tumors. The spectrum of their possible applications is vast and is mainly based on the homing capacity toward the tumor microenvironment. Availability, delivery route, oncogenicity and ethical issues are the main translational challenges concerning the use of SCs in neuro-oncology.
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Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Ilaria Brambilla
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
| | - Chiara Trabatti
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
| | - Mario Mosconi
- c and Traumatology Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Salvatore Savasta
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
| | - Thomas Foiadelli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
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12
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Luzzi S, Giotta Lucifero A, Brambilla I, Semeria Mantelli S, Mosconi M, Foiadelli T, Savasta S. Targeting the medulloblastoma: a molecular-based approach. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:79-100. [PMID: 32608377 PMCID: PMC7975825 DOI: 10.23750/abm.v91i7-s.9958] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The lack of success of standard therapies for medulloblastoma has highlighted the need to plan a new therapeutic approach. The purpose of this article is to provide an overview of the novel treatment strategies based on the molecular characterization and risk categories of the medulloblastoma, also focusing on up-to-date relevant clinical trials and the challenges in translating tailored approaches into clinical practice. METHODS An online search of the literature was carried out on the PubMed/MEDLINE and ClinicalTrials.gov websites about molecular classification of medulloblastomas, ongoing clinical trials and new treatment strategies. Only articles in the English language and published in the last five years were selected. The research was refined based on the best match and relevance. RESULTS A total 58 articles and 51 clinical trials were analyzed. Trials were of phase I, II, and I/II in 55%, 33% and 12% of the cases, respectively. Target and adoptive immunotherapies were the treatment strategies for newly diagnosed and recurrent medulloblastoma in 71% and 29% of the cases, respectively. CONCLUSION Efforts are focused on the fine-tuning of target therapies and immunotherapies, including agents directed to specific pathways, engineered T-cells and oncoviruses. The blood-brain barrier, chemoresistance, the tumor microenvironment and cancer stem cells are the main translational challenges to be overcome in order to optimize medulloblastoma treatment, reduce the long-term morbidity and increase the overall survival.
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Affiliation(s)
- Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Ilaria Brambilla
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
| | - Simona Semeria Mantelli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
| | - Mario Mosconi
- Orthopaedic and Traumatology Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Thomas Foiadelli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
| | - Salvatore Savasta
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Uni-versity of Pavia, Pavia, Italy.
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Foiadelli T, Naso M, Licari A, Orsini A, Magistrali M, Trabatti C, Luzzi S, Mosconi M, Savasta S, Marseglia GL. Advanced pharmacological therapies for neurofibromatosis type 1-related tumors. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:101-114. [PMID: 32608378 PMCID: PMC7975824 DOI: 10.23750/abm.v91i7-s.9961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/23/2020] [Indexed: 11/23/2022]
Abstract
Neurofibromatosis Type 1 (NF1) is an autosomal dominant tumor-predisposition disorder that is caused by a heterozygous loss of function variant in the NF1 gene, which encodes a protein called neurofibromin. The absence of neurofibromin causes increased activity in the Rat sarcoma protein (RAS) signalling pathway, which results in an increased growth and cell proliferation. As a result, both oncological and non-oncological comorbidities contribute to a high morbidity and mortality in these patients. Optic pathways gliomas, plexiform neurofibromas and malignant peripheral nerve sheath tumor (MPNST) are the most frequent NF1-associated tumors. The treatment of these complications is often challenging, since surgery may not be feasible due to the location, size, and infiltrative nature of these tumors, and standard chemotherapy or radiotherapy are burdened by significant toxicity and risk for secondary malignancies. For these reasons, following the novel discoveries of the pathophysiological mechanisms that lead to cell proliferation and tumorigenesis in NF1 patients, emerging drugs targeting specific signalling pathways (i.e. the MEK/ERK cascade), have been developed with promising results.
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Affiliation(s)
- Thomas Foiadelli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Matteo Naso
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Amelia Licari
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric Department, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy.
| | - Mariasole Magistrali
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Chiara Trabatti
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Mario Mosconi
- Orthopaedic and Traumatology Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Salvatore Savasta
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Gian Luigi Marseglia
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
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14
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Genital Neurofibromatosis Presenting as Painful Clitoromegaly. Urology 2019; 133:219-221. [DOI: 10.1016/j.urology.2019.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 06/18/2019] [Accepted: 07/15/2019] [Indexed: 11/22/2022]
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15
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Happle R. The concept of type 2 segmental mosaicism, expanding from dermatology to general medicine. J Eur Acad Dermatol Venereol 2018; 32:1075-1088. [PMID: 29405433 DOI: 10.1111/jdv.14838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022]
Abstract
In autosomal dominant skin disorders, the well-known type 1 segmental mosaicism reflects heterozygosity for a postzygotic new mutation. By contrast, type 2 segmental mosaicism originates in a heterozygous embryo from an early postzygotic mutational event giving rise to loss of the corresponding wild-type allele, which results in a pronounced segmental involvement being superimposed on the ordinary, non-segmental phenotype. Today, this concept has been proven by molecular analysis in many cutaneous traits. The purpose of this review was to seek publications of cases suggesting an extracutaneous manifestation of type 2 segmental mosaicism. Case reports documenting a pronounced extracutaneous segmental involvement were collected from the literature available in PubMed and from personal communications to the author. Pertinent cases are compared to the description of cutaneous segmental mosaicism of type 1 or type 2 as reported in a given trait. In total, reports suggesting extracutaneous type 2 segmental mosaicism were found in 14 different autosomal dominant skin disorders. In this way, clinical evidence is accumulated that extracutaneous type 2 segmental mosaicism does likewise occur in many autosomal dominant skin disorders. So far, however, molecular proof of this particular form of mosaicism is lacking. The present review may stimulate readers to inform colleagues of other specialties on this new concept, in order to initiate further research in this particular field of knowledge that has important implications for diagnosis, treatment and genetic counselling.
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Affiliation(s)
- R Happle
- Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany
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16
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Bouty A, Dobremez E, Harper L, Harambat J, Bouteiller C, Zaghet B, Wolkenstein P, Ducassou S, Lefevre Y. Bladder Dysfunction in Children with Neurofibromatosis Type I: Report of Four Cases and Review of the Literature. Urol Int 2018. [DOI: 10.1159/000487193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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17
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Yesodharan D, Sudarsanan B, Jojo A, Abraham M, Bhavani N, Mathews H, Nampoothiri S. Plexiform Neurofibroma of Clitoris. J Pediatr Genet 2017; 6:244-246. [PMID: 29142769 DOI: 10.1055/s-0037-1602789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
Abstract
The most frequent genital presentation of neurofibromatosis in females is clitoromegaly. We report a case of a 5-year-old girl with neurofibromatosis type 1 with clitoral plexiform neurofibromatosis. Clitoroplasty was done, and the histopathology confirmed the diagnosis. Though rare, plexiform neurofibroma of clitoris should always be considered as a differential diagnosis in children with clitoromegaly before embarking on detailed investigations.
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Affiliation(s)
- Dhanya Yesodharan
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences & Research Center, Cochin, Kerala, India
| | - Bindu Sudarsanan
- Department of Pediatric Surgery, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Annie Jojo
- Department of Clinical Pathology, Amrita Institute of Medical Sciences & Research Center, Cochin, Kerala, India
| | - Mohan Abraham
- Department of Pediatric Surgery, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Nisha Bhavani
- Department of Endocrinology, Amrita Institute of Medical Sciences & Research Center, Cochin, Kerala, India
| | - Hima Mathews
- Department of Pediatrics, Amrita Institute of Medical Sciences & Research Center, Cochin, Kerala, India
| | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences & Research Center, Cochin, Kerala, India
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18
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Nelson KL, McQuillan SK, Brain P. Literature Review of Periclitoral Cysts in the Prepubertal Population. J Pediatr Adolesc Gynecol 2016; 29:558-561. [PMID: 27239014 DOI: 10.1016/j.jpag.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 05/06/2016] [Accepted: 05/06/2016] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE Clitoral cysts in the pediatric population are rare conditions that require careful evaluation. In this review of the literature we discuss the evaluation of clitoral abnormalities in the pediatric population, the development of clitoral cysts, and how to differentiate benign from malignant tumors. In addition, a summary of relevant cases of clitoral tumors in the literature are discussed. DESIGN Literature review. DATA SOURCE A MedLine and advanced PubMed search was conducted of all English language articles published using the search terms "clitoris" and "cyst" until February 2015. Reference tracing was completed for all articles for completeness. MAIN OUTCOME Literature review of clitoral cysts in the prepubertal population. RESULTS In total, we found 15 cases of benign, spontaneously forming clitoral cysts reported. Eleven of those cases document symptom onset before puberty. Reports of other benign clitoral lesions in the pediatric population include 1 angiokeratoma, 1 hemangiopericytoma, 1 granular cell tumor, 6 hemangiomas, and approximately 30 neurofibromas. Clitoral malignancies in the pediatric population are even more rare with only 3 cases of clitoral schwannomas, 2 rhabdomyosarcomas, 1 lymphoma, and 1 endodermal sinus tumor documented in the literature. CONCLUSION Clitoral cysts must be considered as a possible cause of clitoral enlargement in the prepubertal population. Clitoral tumors are distinguished clinically from hormonal abnormalities and intersex disorders by their hormonal profile, and the presence of an underlying mass. Ultrasound and magnetic resonance imaging might be useful imaging modalities to further characterize the clitoral enlargement. When confirmed as the most likely diagnosis, surgical resection is the mainstay of treatment for clitoral cysts.
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Affiliation(s)
- Kayla L Nelson
- Obstetrics and Gynecology, University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada.
| | - Sarah K McQuillan
- Obstetrics and Gynecology, Pediatric Gynecology, University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Philippa Brain
- Obstetrics and Gynecology, Pediatric Gynecology, University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada
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19
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Kumar I, Verma A, Ojha R, Aggarwal P, Shukla RC, Srivastava A. Magnetic resonance neurographic confirmation of extensive Plexiform neurofibroma in neurofibromatosis-1 presenting as ambiguous genitalia. Indian J Radiol Imaging 2016; 26:332-336. [PMID: 27857458 PMCID: PMC5036330 DOI: 10.4103/0971-3026.190423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Genitourinary involvement of neurofibromatosis is uncommon and genital neurofibromatosis is even rarer. Involvement of clitoris by neurofibroma can lead to clitoromegaly masquerading as a male penis. We report such a case of ambiguous genitalia in a 7-year-old female child presenting with clitoromegaly since birth, in which magnetic resonance imaging (MRI) revealed the presence of extensive neurofibromatosis in the clitoris and lumbosacral regions. We emphasize the central role of MRI in evaluation of hormonal and non-hormonal causes of ambiguous genitalia. We further discuss the merits of including MR neurography in the imaging protocol for comprehensive delineation of neurofibromatosis.
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Affiliation(s)
- Ishan Kumar
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashish Verma
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ritu Ojha
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Priyanka Aggarwal
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ram C Shukla
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Arvind Srivastava
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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20
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Dutta D, Roy A, Mukhopadhyay S, Chowdhury S. Labial neurofibroma as the presenting feature of genital and orbitotemporal neurofibromatosis. Indian J Pediatr 2014; 81:829-30. [PMID: 24374492 DOI: 10.1007/s12098-013-1287-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/28/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Deep Dutta
- Department of Endocrinology & Metabolism, Institute of Post-Graduate Medical Education & Research (IPGMER) and Seth Sukhlal Karnani Memorial (SSKM) Hospital, 244 AJC Bose Road, Calcutta, 700020, India,
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21
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Gomes AL, Onofre LS, Leão JQDS, Leão FG, Amaral Cruz TM, Sircilli MHP, Carnevale J. Clitoral anomalies not associated with disorders of sex development. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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22
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Ballouhey Q, Longis B, Couvrat-Carcauzon V, Gardic S, Piguet C, Berenguer D, Fourcade L. Neurofibroma and epidermoid cyst: unexpected findings after first foreskin retraction. Urology 2013; 82:1419-20. [PMID: 23958511 DOI: 10.1016/j.urology.2013.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/04/2013] [Accepted: 06/07/2013] [Indexed: 11/16/2022]
Abstract
We report here 2 unusual cases of tumor of the glans penis in children. Abnormal findings were found on a 12-year-old and a 13-year-old boy soon after their first foreskin retraction. Initial medical examination suggested inclusions of smegma and they were referred to our Department of Pediatric Urology. Complete resection was performed under general anesthesia. Histologic examination revealed an epidermoid cyst in the first patient and a solitary neurofibroma in the second. These patients represent respectively the third and the second cases of such entities described in the pediatric age group. Cautious examination is required for persistent inclusions of smegma.
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Affiliation(s)
- Quentin Ballouhey
- Department of Pediatric Surgery, Children Hospital, University of Limoges, France.
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23
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Pascual-Castroviejo I, Pascual-Pascual SI, Viaño J, Velazquez-Fragua R, López-Gutierrez JC. Bilateral spinal neurofibromas in patients with neurofibromatosis 1. Brain Dev 2012; 34:563-9. [PMID: 21999966 DOI: 10.1016/j.braindev.2011.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 09/19/2011] [Accepted: 09/20/2011] [Indexed: 11/26/2022]
Abstract
Neurofibromatosis 1 (NF1) is a neurocutaneous syndrome that can be inherited as autosomal dominant or may appear due to a de novo mutation. We present 8 patients (5 M and 3 F) with sporadic or non-familial spinal neurofibromatosis 1 (non-FSNF1) associated with bilateral spinal neurofibromas involving all of the paraspinal nerves. To our knowledge, this is the first series of such association described in the literature. Their ages ranged from 6 months to 20 years (average 9.8 years) at the time of radiological diagnosis. This presentation appears to be earlier than in familial spinal neurofibromas in NF1 (FSNF1). Predisposition to malignancy probably is greater in the non-FSNF1 type. MRI studies were performed routinely in all patients with NF1 and these were complemented with MRI enhanced with gadolinium and repeated at different ages in cases with paraspinal tumors. Coronal views provided the best evidence for the presence of neurofibromas in every spinal nerve. The size of the tumors and the clinical complications increased with advancing age in most patients. Giant plexiform tumors were often seen in the cervico-thoracic region. Malignant peripheral nerve sheath tumors (MPNST) were found in one patient with a sciatic tumor and another patient died suddenly at home without necropsy or pathological study. Voluminous paraspinal neurofibromas can be at risk for malignancy. More frequent neuroimaging studies may be necessary for an earlier detection. Early surgical treatment to anticipate the occurrence of MPNST during surveillance could be an option. Bilateral spinal neurofibromas are found in both patients who inherited the NF1 and in those due to de novo mutations.
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24
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Skorupski JC, Hafener HK, Smith YR, Quint EH. A rare vulvar manifestation of neurofibromatosis 1 in a teen. J Pediatr Adolesc Gynecol 2011; 24:e103-5. [PMID: 21715194 DOI: 10.1016/j.jpag.2011.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 04/27/2011] [Accepted: 05/17/2011] [Indexed: 11/28/2022]
Abstract
Neurofibromatosis 1 is an autosomal dominant disorder with cutaneous findings that include multiple café-au-lait spots, axillary/inguinal freckling, dermal, and plexiform neurofibromas. Skin manifestations, including involvement of the vulva, are often the most troubling physical finding to patients. Hormonal and growth factor changes during puberty have been implicated in neurofibroma growth. In the case presented here, an exceedingly rare isolated vulvar neurofibroma without clitoral involvement became enlarged and symptomatic, requiring excisional surgery after puberty. The diffuse involvement of these tumors makes complete resection very difficult and recurrence is common.
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Affiliation(s)
- Josh C Skorupski
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA.
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25
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Ji YH, Cheon SH, Lee JH, Moon KH, Kim YM, Park S, Park S. Solitary penile neurofibroma with erectile dysfunction. Korean J Urol 2011; 52:428-30. [PMID: 21750756 PMCID: PMC3123822 DOI: 10.4111/kju.2011.52.6.428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 04/01/2011] [Indexed: 11/18/2022] Open
Abstract
Neurofibromas of the penis, although very rare, are often associated with neurofibromatosis type 1. Primary solitary neurofibromas of the penis are extremely rare. We describe a 37-year-old man with a solitary neurofibroma in the dorsum of the penis. The patient reported difficulty with sexual intercourse owing to a penile mass and erectile dysfunction. After surgical excision of the neurofibroma, he had no pain and a normal sensation of the penile glans, and his erectile dysfunction improved. At the present time, 26 months after surgery, there has been no evidence of tumor recurrence.
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Affiliation(s)
- Young Hwan Ji
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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26
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El Ounani F, Dafiri R. [Imaging features of neurofibromatosis involving the urinary bladder]. JOURNAL DE RADIOLOGIE 2010; 91:567-9. [PMID: 20657356 DOI: 10.1016/s0221-0363(10)70089-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neurofibromatosis type 1 is a phacomatosis with neurocutaneous involvement. Urinary bladder involvement is rare and the imaging features are seldom reported. Involvement of the urinary bladder may be isolated or associated with more diffuse disease. The imaging features of neurofibromas are fairly characteristic and may often suggest the correct diagnosis, especially in patients with known NF1. We report the imaging features of bladder involvement in 3 patients with known NF1.
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Affiliation(s)
- F El Ounani
- Service de Radiologie, hôpital d'enfant-maternité, Rabat, Maroc.
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27
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Chronic renal failure and macrogenitalia associated with genitourinary neurofibromatosis. Pediatr Nephrol 2010; 25:353-6. [PMID: 19826840 DOI: 10.1007/s00467-009-1308-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 07/13/2009] [Accepted: 08/05/2009] [Indexed: 10/20/2022]
Abstract
Neurofibromatosis (NF) is a genetic disorder of the nervous system that primarily affects the development and growth of neural cell tissues. This disorder is characterized by the development of various tumors, including neurofibromas, neuroniomas, malignant and benign peripheral nerve sheath tumors, and meningiomas. Accompanying skin changes and bone deformities are also common in NF. However, genitourinary involvement in NF is a rare condition, and penile enlargement has been reported only in a few males with plexiform NF. We report a 6-year-old boy with chronic renal failure associated with plexiform neurofibromas of the bladder and prostatic urethra which led to urinary obstruction and macrogenitalia due to genitourinary NF.
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28
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Miscellaneous Pseudotumors and Mesenchymal Tumors of the Female Genital Tract. Surg Pathol Clin 2009; 2:755-83. [PMID: 26838778 DOI: 10.1016/j.path.2009.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Benign and malignant soft tissue tumors and pseudotumors can rarely arise anywhere in the female genital tract. Their pathologic features as well as behavior typically overlap with those described in tumors involving typical locations. However, due to their rarity, not infrequently these tumors represent a diagnostic challenge. Their diagnosis should be based on careful gross examination, thorough sampling, and morphologic evaluation, applying a selected immunohistochemical panel and molecular studies. Accurate classification of these tumors is important because their clinical behavior, prognosis, and therapy differ markedly. This article outlines several mesenchymal lesions reported in the female genital tract, encompassing recent histologic, immunohistochemical, and molecular findings, with special emphasis on problems in the differential diagnosis.
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