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Erginoz E, Taskin HE, Cavus GH, Zengin AK. Leiomyomatosis-like lymphangioleiomyomatosis: A case report of the colonic manifestation of tuberous sclerosis. Medicine (Baltimore) 2021; 100:e27723. [PMID: 34918628 PMCID: PMC8677895 DOI: 10.1097/md.0000000000027723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/22/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Tuberous sclerosis complex is an inherited multisystemic disorder with manifestations in various organ systems as a result of a mutation of 1 of 2 tumor suppressor genes, tuberous sclerosis complex-1 or tuberous sclerosis complex-2. Perivascular epithelioid cell tumors have been shown to be associated with these gene mutations and include a variety of tumors such as angiomyolipomas and lymphangioleiomyomatosis. PATIENT CONCERNS In this report, we present a case of a 28-year-old woman presenting with symptoms of severe abdominal pain and nausea with a medical history of cardiac rhabdomyoma, adenoma sebaceum, Ash leaf spots, bilateral renal angiomyolipomas, and retinal hamartoma, which are manifestations of tuberous sclerosis complex. The patient was operated twice for colonic perforations in the rectosigmoid and ileocecal regions where the pathologic examination revealed multiple tumoral lesions in both specimens. DIAGNOSIS The tumor consisted of a myomatous component where the nodules were composed of spindle cells with fascicular array, and a lymphangiomatous component where epithelioid cells could be observed. Immunohistochemically, smooth muscle markers (desmin and SMA) were positive and the epithelioid component showed HMB-45 positivity. A diagnosis of leiomyomatosis-like lymphangioleiomyomatosis was established due to its morphological and immunohistochemical features, the presence of the tumor in multiple foci, and widespread lymphovascular invasion. INTERVENTIONS The patient had a perforation in her bowel twice during the hospital stay and underwent Hartmann operation and ileocecal resection in 2 different surgical operations. OUTCOMES After the second operation the patient developed fever and was diagnosed with SARS-CoV-2 infection. No other complication was observed during her stay and the patient's follow-up was unremarkable. CONCLUSION Perivascular epithelioid cell tumors are associated with tuberous sclerosis and can rarely appear in the colon. Therefore, lymphangioleiomyomatosis should be in the differential diagnosis in a tuberous sclerosis patient presenting with a colonic tumor.
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Affiliation(s)
- Ergin Erginoz
- Department of General Surgery, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Halit Eren Taskin
- Department of General Surgery, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Gokce Hande Cavus
- Department of Pathology, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Abdullah Kagan Zengin
- Department of General Surgery, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
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A second hit somatic (p.R905W) and a novel germline intron-mutation of TSC2 gene is found in intestinal lymphangioleiomyomatosis: a case report with literature review. Diagn Pathol 2021; 16:83. [PMID: 34465349 PMCID: PMC8406734 DOI: 10.1186/s13000-021-01138-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/11/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by hamartomas in multiple organs associated with germline mutations in TSC1 and TSC2, including exonic, intronic, or mosaic mutations. Gastrointestinal (GI) tract Lymphangioleiomyomatosis (LAM) is an extremely rare manifestation of TSC, with few reported cases. Herein, we aimed to determine the driver mutation, pathogenesis, and relationship of germline and somatic mutations of LAM through whole-genome sequencing (WGS) of the tumor and blood samples and whole transcriptome sequencing (WTS) analysis. CASE PRESENTATION A nine-year-old girl with a full-blown TSC presented with abdominal masses detected during a routine check-up. Resected intestinal masses were diagnosed as LAM by thorough pathological examination. Interestingly, the LAM presented a somatic TSC2 gene mutation in exon 24 (p.R905W, c.C2713T), and the patient had intron retention by a novel germline mutation in the intron region of TSC2 (chr16:2126489, C > G). CONCLUSION Our case suggests that intron retention by a single nucleotide intronic mutation of TSC2 is sufficient to develop severe manifestations of TSC, but the development of LAM requires an additional somatic oncogenic mutation of TSC2.
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Kolin DL, Duan K, Ngan B, Gerstle JT, Krzyzanowska MK, Somers GR, Mete O. Expanding the Spectrum of Colonic Manifestations in Tuberous Sclerosis: L-Cell Neuroendocrine Tumor Arising in the Background of Rectal PEComa. Endocr Pathol 2018; 29:21-26. [PMID: 28733877 DOI: 10.1007/s12022-017-9497-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous condition that predisposes to numerous proliferative lesions, including perivascular epithelioid cell tumors (PEComas), such as lymphangioleiomyomatosis (LAM) and angiomyolipomas, and rare neuroendocrine neoplasms. We describe herein a TSC2-harboring tuberous sclerosis patient manifesting with a synchronous well-differentiated L-cell rectal neuroendocrine tumor and leiomyomatosis-like LAM of the rectum. The background large bowel wall was thickened by confluent nodular areas comprising vessels and spindle-to-epithelioid cells, which are immunoreactive for myoid (smooth muscle actin, muscle specific actin, and desmin) and melanocytic markers (HMB45, Melan-A, microphthalmia transcription factor, and CD117). With the exception of TSC-related pancreatic neuroendocrine tumors, the association between tuberous sclerosis and neuroendocrine neoplasms remains largely unknown in the gastrointestinal tract. Neuroendocrine tumorigenesis in tuberous sclerosis is often linked to inactivating mutations of TSC2 leading to aberrant activation of mammalian target of rapamycin (mTOR) pathway. In this report, we document, for the first time, two foci of L-cell rectal neuroendocrine tumor arising in the setting of tuberous sclerosis, thus broadening the spectrum of TSC-associated endocrine disorders. Moreover, to our knowledge, this is only the second documented case of gastrointestinal leiomyomatosis-like LAM in a patient with tuberous sclerosis. The current case provides further evidence that, similar to pancreatic neuroendocrine tumors, neuroendocrine tumors of the luminal gastrointestinal tract may also be a feature of tuberous sclerosis and can be seen in association with PEComas.
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Affiliation(s)
- David L Kolin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Kai Duan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Bo Ngan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Pathology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - J Ted Gerstle
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Department of Medical Oncology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Gino R Somers
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Pathology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ozgur Mete
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
- Department of Pathology, University Health Network, 200 Elizabeth Street, 11th floor, Toronto, Ontario, M5G 2C4, Canada.
- Endocrine Oncology Site Group, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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Vascular, Gastrointestinal, and Urogenital Associations of Tuberous Sclerosis: Classic but Less Known. AJR Am J Roentgenol 2015; 205:W566. [DOI: 10.2214/ajr.15.15016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hammad TA, Alastal Y, Khan MA, Rkaine S, Sodeman TC, Nawras A. Tuberous Sclerosis Complex with Multiple Gastrointestinal Manifestations. Case Report and Literature Review. J Gastrointest Cancer 2015; 47:442-445. [PMID: 26350414 DOI: 10.1007/s12029-015-9762-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Tariq A Hammad
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH, 43614, USA.
| | - Yaseen Alastal
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH, 43614, USA
| | - Muhammad Ali Khan
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH, 43614, USA
| | - Soukayna Rkaine
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH, 43614, USA
| | - Thomas C Sodeman
- Department of Gastroenerology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA
| | - Ali Nawras
- Department of Gastroenerology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA
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Prodinger PM, Sarbia M, Massmann J, Straka C, Meyer G, Steinlein OK. Gorlin syndrome associated with small bowel carcinoma and mesenchymal proliferation of the gastrointestinal tract: case report and review of literature. BMC Cancer 2010; 10:360. [PMID: 20609239 PMCID: PMC2912266 DOI: 10.1186/1471-2407-10-360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 07/07/2010] [Indexed: 11/30/2022] Open
Abstract
Background and Case Presentation A patient with nevoid basal cell carcinoma syndrome (Gorlin syndrome) presented with two unusual clinical features, i.e. adenocarcinoma of the small bowel and extensive mesenchymal proliferation of the lower gastrointestinal tract. Conclusions We discuss the possibility that these two features are pathogenetically linked to the formerly undescribed patient's PTCH germ line mutation.
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Affiliation(s)
- Peter M Prodinger
- Institut für Humangenetik, University of Munich, University Hospital, Goethestr, 29, 80336 Munich, Germany
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Possekel AK, Katenkamp D, Brambs HJ, Pauls S. Lymphangioleiomyomatosis: solitary abdominal manifestation (2009: 9b). Eur Radiol 2009; 19:3015-8. [PMID: 19921526 DOI: 10.1007/s00330-008-1275-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 11/17/2008] [Accepted: 11/23/2008] [Indexed: 11/24/2022]
Affiliation(s)
- Anne-Kristin Possekel
- Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Germany
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Kim J, Han D, Hong CH, Lee HL, Kim JP, Sohn JH, Hahm JS. Colonic lymphangiomatosis associated with protein-losing enteropathy. Dig Dis Sci 2005; 50:1747-53. [PMID: 16133983 DOI: 10.1007/s10620-005-2929-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2004] [Accepted: 12/28/2004] [Indexed: 12/17/2022]
Affiliation(s)
- Jinbae Kim
- Department of Internal Medicine, Division of Gastroeneterology and Hepatology, Hanyang University Kuri Hospital, Kuri, Kyunggi-Do, Republic of Korea
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Chen IY, Yang SF, Chen FM, Chai CY. Abdominopelvic perivascular epithelioid cell tumor with overt malignancy: a case report. Kaohsiung J Med Sci 2005; 21:277-81. [PMID: 16035571 DOI: 10.1016/s1607-551x(09)70201-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Perivascular epithelioid cell tumor (PEComa) is a group of rare tumors composed of epithelioid cells with characteristic perivascular distribution and co-expression of the melanogenic marker HMB-45 and muscular markers. There are no documented parameters referring to the biologic behavior of PEComa. We report an abdominopelvic PEComa with overt malignancy in a 16-year-old girl. Histologically, the tumor showed the typical morphophenotypic characteristics of PEComa. Though the cytologic appearance of the tumor cells was relatively bland, the extensive necrosis, presence of lymph node metastases, and surrounding tissue invasion were all indicative of malignancy. Relapse of the tumor with multiple lymphadenopathy shortly after debulking surgery for the primary lesion, and postoperative adjuvant chemotherapy, further denoted its aggressive behavior.
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Affiliation(s)
- I-Yu Chen
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Evert M, Wardelmann E, Nestler G, Schulz HU, Roessner A, Röcken C. Abdominopelvic perivascular epithelioid cell sarcoma (malignant PEComa) mimicking gastrointestinal stromal tumour of the rectum. Histopathology 2005; 46:115-7. [PMID: 15656899 DOI: 10.1111/j.1365-2559.2005.01991.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Silva EG, Deavers MT, Bodurka DC, Malpica A. Uterine epithelioid leiomyosarcomas with clear cells: reactivity with HMB-45 and the concept of PEComa. Am J Surg Pathol 2004; 28:244-9. [PMID: 15043315 DOI: 10.1097/00000478-200402000-00013] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this study, we investigated HMB-45 expression in epithelioid uterine leiomyosarcomas with clear cell areas. From 12 epithelioid leiomyosarcomas, we selected 5 that had: 1) clear cell areas and 2) spindle cell areas that were at least focally positive for desmin and caldesmon. The patients' ages ranged from 47 to 82 years (mean 64 years). Presenting symptoms were uterine bleeding (three), abdominal pain (one), and a pelvic mass (one). There was no history of tuberous sclerosis or lymphangioleiomyomatosis. One patient had stage II disease, one stage III, and three stage IV. All were treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy. Two received radiotherapy, and three were also treated with chemotherapy. The tumors ranged in size from 4 x 3 x 3 cm to 10 x 7 x 6 cm; all had significant cellular atypia, areas of coagulative necrosis, and between 10 and 90 mitoses per 10 high power fields. Vascular invasion was seen in three cases. The epithelioid component varied from 50% to 90% in each case; and the percentage of clear cells was < 1% in one case, 5% in one case, and 10% to 80% in three cases. Smooth muscle actin and desmin were positive in all cases. Four cases were positive for HMB-45 only in the clear cell areas. The tumor with < 1% of clear cells was negative for HMB-45. All were negative for S-100 and c-kit. Three patients died of disease at 9, 30, and 32 months; one patient is alive with progressive disease at 6 months, and one patient (stage II disease) is alive with no evidence of disease at 8 months. Unequivocal uterine epithelioid leiomyosarcomas may have clear cells positive for HMB-45. These tumors might belong to the group of lesion designated as PEComas; however, it is advisable to designate them as uterine leiomyosarcomas. In uterine smooth muscle tumors, some epithelioid cells most likely undergo clear cell changes and become positive for HMB-45. It would be advisable to perform this stain in all epithelioid smooth muscle tumors of the uterus.
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Affiliation(s)
- Elvio G Silva
- Department of Pathology, Box 85, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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