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Erdin E, Bayatli E, Terzi M, Ergün E, Ozgural O. Posterior median surgical approach to anterior sacral meningocele complicated by rectothecal fistula. Childs Nerv Syst 2024; 40:1295-1299. [PMID: 38224364 DOI: 10.1007/s00381-024-06286-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
In this case report, we aimed to describe the clinical presentation, surgical approach, and follow-up of a patient with rare anterior meningocele associated with rectothecal fistula. An 17-year-old female patient was admitted to the emergency department with meningitis. On further examinations, an anterior sacral meningocele accompanied by rectothecal fistula was detected. Appropriate antibiotic treatment was arranged and surgical plan was made with the pediatric surgery clinic. The patient underwent meningocele repair via posterior approach and colostomy operation. The patient did not experience any neurological issues after the surgery. The colostomy was reversed 3 months later, and third-month follow-up MRI showed complete regression of the meningocele sac with no neurological complications. Anterior meningocele accompanied by a rectothecal fistula is a rare and complicated case. Only seven cases of coexisting ASM and RTF have been reported in literature. Although both anterior and posterior approaches have been used for the treatment of ASM, the choice of treatment is essentially based on the patient's clinical and imaging findings.
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Affiliation(s)
- Engin Erdin
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Eyup Bayatli
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Macit Terzi
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Ergun Ergün
- Department of Pediatric Surgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Onur Ozgural
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey.
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2
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Jasiewicz B, Kacki W. Caudal Regression Syndrome-A Narrative Review: An Orthopedic Point of View. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10030589. [PMID: 36980147 PMCID: PMC10047641 DOI: 10.3390/children10030589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
Abnormalities in cellular differentiation during embryo-fetal period may lead to various malformations of the spine. Caudal regression syndrome (CRS) is a group of defects with premature growth/development termination of the vertebral column. CRS can be divided into three types: sirenomelia, complete absence of the sacrum and partial absence of the sacrum. Genitourinary and gastrointestinal anomalies are common, with neurogenic bladder and bowel incontinence. Treatment of patients with CRS is complex and multidisciplinary and should be comprehensive. The most common orthopedic problems are: spinal deformity (kyphosis and scoliosis), spinopelvic instability and lower limbs deformities.
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Affiliation(s)
- Barbara Jasiewicz
- Department of Orthopedics and Rehabilitation, Jagiellonian University Collegium Medicum, Balzera 15, 34-500 Zakopane, Poland
| | - Wojciech Kacki
- Department of Orthopedics and Rehabilitation, Jagiellonian University Collegium Medicum, Balzera 15, 34-500 Zakopane, Poland
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Kamal MA, Eltayeb M, Coulter I, Jenkins A. Surgical management of anterior sacral meningoceles: an illustrated case series and review of the literature. Br J Neurosurg 2023:1-7. [PMID: 36594268 DOI: 10.1080/02688697.2022.2162852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/08/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Anterior sacral meningocele (ASM) is an uncommon variant of spinal dysraphism. Surgical correction for this condition is challenging and optimal corrective approaches are uncertain. OBJECTIVE To share our experience of managing this rare condition using the posterior trans-sacral approach and provide a contemporary review of the literature. METHODS Retrospective review of case notes, operative records, and imaging of eligible patients treated via the posterior trans-sacral approach between 2006 and 2020 at our regional neurosciences centre. RESULTS Three patients, two females and one male with a mean age of 30 years (range 16-38), were treated. Presenting symptoms included lower abdominal pain and recurrent miscarriages. Patients underwent corrective surgery using the posterior approach involving a sacral laminectomy, durotomy and closure of the communicating fistula. A single patient required reoperation due to early recurrence. Another patient proved challenging because of a very large sacral fistula and required two procedures due to the development of high-pressure headaches secondary to a recurrence. All patients improved symptomatically postoperatively and remained symptom free at the last clinic follow-up and have been discharged. Following review of the literature, only two other non-syndromic cases have been described. CONCLUSIONS ASM is an uncommon congenital abnormality, typically presenting with mass effect symptoms secondary to a presacral cystic mass. Surgical management using a posterior approach to close the meningeal sac is feasible and less invasive than an anterior approach. Long term clinical outcomes in our series were satisfactory.
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Affiliation(s)
- Muhmmad Ahmad Kamal
- Department of Neurosurgery, Royal Victoria Hospital, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Mohamed Eltayeb
- Department of Neurosurgery, Royal Victoria Hospital, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Ian Coulter
- Department of Neurosurgery, Royal Victoria Hospital, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Alistair Jenkins
- Department of Neurosurgery, Royal Victoria Hospital, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
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4
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Qudsieh H, Aborajooh E, Daradkeh A. Caudal regression syndrome: Postnatal radiological diagnosis with literature review of 83 cases. Radiol Case Rep 2022; 17:4636-4641. [PMID: 36204402 PMCID: PMC9530488 DOI: 10.1016/j.radcr.2022.09.037] [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: 08/11/2022] [Revised: 09/05/2022] [Accepted: 09/11/2022] [Indexed: 11/18/2022] Open
Abstract
Caudal regression syndrome (CRS) is a rare congenital disorder characterized by arrest of caudal spinal growth and associated with wide spectrum multisystemic anomalies. Herein, we presented a case of a newborn baby who did not pass meconium due to imperforated anus and was referred to the pediatric surgeon for urgent diverting loop colostomy. The conventional X-ray, abdominal ultrasound and abdominal pelvic magnetic resonance imaging (1.5 T) at 2-month-old age revealed right kidney agenesis, sacrococcygeal agenesis, vertebral bodies dysraphism and the spinal cord ends at D12-L1 with anterior and posterior bands of the terminating filaments. The diagnosis of CRS was confirmed. Through this case report, we hope to draw attention to this rare syndrome and the wide range of associated anomalies, also to consider this syndrome on the top of differential diagnosis list once the newborn has anorectal malformation mainly imperforated anus.
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Affiliation(s)
- Hana’ Qudsieh
- Department of Medicine and Radiology, Faculty of Medicine, Mutah University, Karak, 61710, Jordan
- Corresponding author.
| | - Emad Aborajooh
- General Surgery and Anesthesia Department, Faculty of Medicine, Mutah University, Karak, 61710, Jordan
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Naznin RA, Haq MA, Sumi SA, Ahmad R, Haque M. A Semi-quantitative Evaluation of Out-to-Out Agenesis of Posterior Wall in a Dry Human Sacrum in Bangladesh. Cureus 2022; 14:e31163. [DOI: 10.7759/cureus.31163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/07/2022] Open
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Meningitis secondary to rectothecal fistula associated with congenital anterior meningocele. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Currarino syndrome as an incidental radiologic finding in a patient with acute flank pain: A case report. Radiol Case Rep 2022; 17:2936-2939. [PMID: 35755101 PMCID: PMC9218298 DOI: 10.1016/j.radcr.2022.05.039] [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: 04/10/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 01/09/2023] Open
Abstract
Currarino syndrome is an autosomal dominant hereditary disease defined as a triad of anorectal abnormality, sacral dysgenesis, and a presacral mass, primarily an anterior sacral meningocele. It is often seen in children and considered rare in adults. It is mostly found as an incidental finding. We present a 21-year-old man who presented with acute flank pain. He had a history of Hirschsprung's disease and therefore had undergone surgery in his infancy. He also had a history of prolonged constipation and had an episode of admission due to suspected obstruction. On physical examination, he had a severe costovertebral angle tenderness. urine exam revealed microscopic hematuria. Laboratory tests were otherwise unremarkable. Computed tomography scan revealed renal stones as well as a horseshoe kidney. Incidental findings included a large simple cystic structure in the presacral area suggestive of an anterior meningocele and sacral dysgenesis associated with scimitar sacral appearance. These findings suggested a diagnosis of Currarino syndrome. Urinary complications of this disease are reported in few articles. An important takeaway note for physicians is to have a high level of suspicion when encountering patients with gastrointestinal, neurologic, or urologic signs and symptoms and consider a thorough history taking and physical examination alongside proper imaging evaluation.
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Massa DS, Montivero NA, Medina SAP. Terminal myelocystocele: Surgical management. Surg Neurol Int 2022; 13:234. [PMID: 35855164 PMCID: PMC9282762 DOI: 10.25259/sni_299_2022] [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: 03/30/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The authors describe clinical and imaging findings, surgical technique, and outcomes in myelocystocele. Methods: We describe a surgical procedure performed in six patients, four males and two females, with myelocystocele treated at our hospital. We review the images obtained at the time of diagnosis and after surgery. The patients’ age range was 12–56 months and had undergone surgery for terminal myelocystocele between 2015 and 2020. All patients had a large lumbar mass covered with healthy skin and presented spontaneous movements at birth. Two patients presented VACTERL syndrome. Results: A watertight closure of the soft tissues was performed in all cases. None of the patients presented postsurgical complications, such as cerebrospinal fluid leak or infection. All the patients had undergone excision of the meningocele sacs, the tethering bands were lysed, and the filum was detethered. The mean follow-up period was 34 (12–56) months. A motor deficit was seen in 2 patients (33.3%). Conclusion: Prenatal diagnosis and early corrective surgical intervention are recommended to prevent deterioration in neurological function. VACTERL association is a common condition and should be investigated.
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Pitsava G, Feldkamp ML, Pankratz N, Lane J, Kay DM, Conway KM, Hobbs C, Shaw GM, Reefhuis J, Jenkins MM, Almli LM, Moore C, Werler M, Browne ML, Cunniff C, Olshan AF, Pangilinan F, Brody LC, Sicko RJ, Finnell RH, Bamshad MJ, McGoldrick D, Nickerson DA, Mullikin JC, Romitti PA, Mills JL. Exome sequencing identifies variants in infants with sacral agenesis. Birth Defects Res 2022; 114:215-227. [PMID: 35274497 PMCID: PMC9338687 DOI: 10.1002/bdr2.1987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/22/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sacral agenesis (SA) consists of partial or complete absence of the caudal end of the spine and often presents with additional birth defects. Several studies have examined gene variants for syndromic forms of SA, but only one has examined exomes of children with non-syndromic SA. METHODS Using buccal cell specimens from families of children with non-syndromic SA, exomes of 28 child-parent trios (eight with and 20 without a maternal diagnosis of pregestational diabetes) and two child-father duos (neither with diagnosis of maternal pregestational diabetes) were exome sequenced. RESULTS Three children had heterozygous missense variants in ID1 (Inhibitor of DNA Binding 1), with CADD scores >20 (top 1% of deleterious variants in the genome); two children inherited the variant from their fathers and one from the child's mother. Rare missense variants were also detected in PDZD2 (PDZ Domain Containing 2; N = 1) and SPTBN5 (Spectrin Beta, Non-erythrocytic 5; N = 2), two genes previously suggested to be associated with SA etiology. Examination of variants with autosomal recessive and X-linked recessive inheritance identified five and two missense variants, respectively. Compound heterozygous variants were identified in several genes. In addition, 12 de novo variants were identified, all in different genes in different children. CONCLUSIONS To our knowledge, this is the first study reporting a possible association between ID1 and non-syndromic SA. Although maternal pregestational diabetes has been strongly associated with SA, the missense variants in ID1 identified in two of three children were paternally inherited. These findings add to the knowledge of gene variants associated with non-syndromic SA and provide data for future studies.
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Affiliation(s)
- Georgia Pitsava
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Marcia L. Feldkamp
- Division of Medical Genetics, Department of Pediatrics, 295 Chipeta Way, Suite 2S010, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nathan Pankratz
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - John Lane
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Denise M. Kay
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Kristin M. Conway
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - Charlotte Hobbs
- Rady Children’s Institute for Genomic Medicine, San Diego, California, USA
| | - Gary M. Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary M. Jenkins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lynn M. Almli
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Martha Werler
- Slone Epidemiology Center at Boston University, Boston, MA
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA
| | - Marilyn L. Browne
- New York State Department of Health, Birth Defects Registry, Albany, New York, USA
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York, USA
| | - Chris Cunniff
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Andrew F. Olshan
- Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Faith Pangilinan
- Gene and Environment Interaction Section, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Lawrence C. Brody
- Gene and Environment Interaction Section, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Robert J. Sicko
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Richard H. Finnell
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, Texas, USA
| | - Michael J. Bamshad
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Daniel McGoldrick
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Deborah A. Nickerson
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - James C. Mullikin
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul A. Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - James L. Mills
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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Nguyen BD. 18F-FDG PET/CT of Malignant Presacral Masses in Currarino Syndrome. Clin Nucl Med 2022; 47:e158-e160. [PMID: 35006115 DOI: 10.1097/rlu.0000000000003878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The Currarino syndrome is characterized by 3 main features: anorectal malformation, presacral lesion, and dysgenesis of the sacrum and coccyx. The presacral lesion is usually benign with a rare occurrence of malignant degeneration. The author presents 2 cases of Currarino syndrome with presacral mucinous adenocarcinoma and neuroendocrine tumor depicted by 18F FDG PET/CT.
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Affiliation(s)
- Ba D Nguyen
- From the Department of Radiology, Mayo Clinic, Scottsdale, AZ
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11
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Sakurai T, Nakamura M, Endo N. Postoperative complications and long-term outcomes in Currarino syndrome. Pediatr Surg Int 2021; 37:1773-1781. [PMID: 34462793 DOI: 10.1007/s00383-021-04984-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to present ten cases of Currarino syndrome, study their postoperative complications and prognosis, and analyze whether patient background and clinical factors influenced outcomes. METHODS Ten patients with Currarino syndrome who were followed up at our institution between 2004 and 2020 were enrolled. Patient records were retrospectively reviewed for clinical details, postoperative complications, and long-term outcomes. RESULTS The incidence of early postoperative complications was 80%, most of which were transient dysuria. The dysuria significantly developed in the higher normal sacral vertebra (p = 0.024) and the complete type of Currarino syndrome (p = 0.033). Later, intractable constipation requiring rectal irrigation and intractable dysuria requiring clean intermittent catheterization occurred in 40% and 30% of the patients, respectively. There was a tendency for tethered cord syndrome (p = 0.076), and the height of the normal sacral vertebra (p = 0.071) was related to intractable constipation. The height of the normal sacral vertebra (p = 0.05) and the tumor size on the image (p = 0.012) were significantly higher and larger, respectively, in the group with intractable dysuria than in the group without intractable dysuria. CONCLUSION Postoperative complications, especially early ones, occur at a high rate. Long-term intractable constipation and dysuria may be influenced by the degree of sacral dysplasia.
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Affiliation(s)
- Tsuyoshi Sakurai
- Department of Pediatric Surgery, Miyagi Children's Hospital, Sendai, 989-3126, Japan
| | - Megumi Nakamura
- Department of Pediatric Surgery, Miyagi Children's Hospital, Sendai, 989-3126, Japan
| | - Naobumi Endo
- Department of Pediatric Surgery, Miyagi Children's Hospital, Sendai, 989-3126, Japan.
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Stevens SJC, Stumpel CTRM, Diderich KEM, van Slegtenhorst MA, Abbott MA, Manning C, Balciuniene J, Pyle LC, Leonard J, Murrell JR, van de Putte R, van Rooij IALM, Hoischen A, Lasko P, Brunner HG. The broader phenotypic spectrum of congenital caudal abnormalities associated with mutations in the caudal type homeobox 2 gene. Clin Genet 2021; 101:183-189. [PMID: 34671974 PMCID: PMC9153267 DOI: 10.1111/cge.14076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/28/2022]
Abstract
The caudal type homeobox 2 (CDX2) gene encodes a developmental regulator involved in caudal body patterning. Only three pathogenic variants in human CDX2 have been described, in patients with persistent cloaca, sirenomelia and/or renal and anogenital malformations. We identified five patients with de novo or inherited pathogenic variants in CDX2 with clinical phenotypes that partially overlap with previous cases, that is, imperforate anus and renal, urogenital and limb abnormalities. However, additional clinical features were seen including vertebral agenesis and we describe considerable phenotypic variability, even in unrelated patients with the same recurrent p.(Arg237His) variant. We propose CDX2 variants as rare genetic cause for a multiple congenital anomaly syndrome that can include features of caudal regression syndrome and VACTERL. A causative role is further substantiated by the relationship between CDX2 and other proteins encoded by genes that were previously linked to caudal abnormalities in humans, for example, TBXT (sacral agenesis and other vertebral segmentation defects) and CDX1 (anorectal malformations). Our findings confirm the essential role of CDX2 in caudal morphogenesis and formation of cloacal derivatives in humans, which to date has only been well characterized in animals.
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Affiliation(s)
- Servi J C Stevens
- Department of Clinical Genetics, Maastricht University Medical Centre and GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Constance T R M Stumpel
- Department of Clinical Genetics, Maastricht University Medical Centre and GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Karin E M Diderich
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | - Mary-Alice Abbott
- Department of Pediatrics, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Courtney Manning
- Department of Pediatrics, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Jorune Balciuniene
- Division of Human Genetics and the Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Louise C Pyle
- Division of Human Genetics and the Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jacqueline Leonard
- Division of Human Genetics and the Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jill R Murrell
- Division of Human Genetics and the Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Romy van de Putte
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Iris A L M van Rooij
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alexander Hoischen
- Department of Genetics, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Paul Lasko
- Department of Genetics, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Biology, McGill University, Montréal, Québec, Canada
| | - Han G Brunner
- Department of Clinical Genetics, Maastricht University Medical Centre and GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.,Department of Genetics, Radboud University Medical Centre, Nijmegen, the Netherlands
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Di Nora A, Lena G, Giugno A, Di Mari A, Smilari P, Minardi C, Pavone P. Pure Interstitial 7q21.3-q 31.1 Duplication: A Rare Segmental Genomic Aneuploidy: Case Report and Review of Cases with Distal and Similar Segment Involved. Glob Med Genet 2021; 8:123-128. [PMID: 34430965 PMCID: PMC8378915 DOI: 10.1055/s-0041-1729546] [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] [Indexed: 11/29/2022] Open
Abstract
In children with developmental delay (DD) and neurologic impairment, diagnosis can be challenging because of the wide spectrum of causes. Since the last decade, the use of array comparative genomic hybridization (CGH) offered a great contribution to get a diagnosis in complex phenotypes. The chromosome 7 is subject of interest in medical genetics because of its frequent association with chromosome aberrations, rearrangements, and deletions involving clinical manifestations. We hereby reported a 3-year-old male child patient with severe neuro-DD, craniofacial dysmorphisms, and pulmonary stenosis, whose array CGH analysis disclosed a duplication of 14.4 Mb on chromosome 7 (7q21.3-7q31.1). By reviewing the current literature to date, we first reported on neurologic and dysmorphic anomalies related to this rearrangement which was not previously reported.
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Affiliation(s)
- Alessandra Di Nora
- Department of Clinical and Experimental Medicine, Postgraduate Training Program in Pediatrics, University of Catania, Catania, Italy
| | - Germana Lena
- Department of Clinical and Experimental Medicine, Postgraduate Training Program in Pediatrics, University of Catania, Catania, Italy
| | - Andrea Giugno
- Department of Clinical and Experimental Medicine, Postgraduate Training Program in Pediatrics, University of Catania, Catania, Italy
| | - Alessia Di Mari
- Department of Radiology, Postgraduate Training Program in Radiology, University of Catania, Catania, Italy
| | - Pierluigi Smilari
- Department of Pediatric and Pediatric Neurology, University of Catania, Catania, Italy
| | - Carmelo Minardi
- Department of Anaesthesia and Intensive Care, University Hospital “G. Rodolico” of Catania, Catania, Italy
| | - Piero Pavone
- Department of Pediatric and Pediatric Neurology, University of Catania, Catania, Italy
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The Role of De Novo Variants in Formation of Human Anorectal Malformations. Genes (Basel) 2021; 12:genes12091298. [PMID: 34573284 PMCID: PMC8466114 DOI: 10.3390/genes12091298] [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: 07/31/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022] Open
Abstract
Anorectal malformations (ARM) represent a rare birth defect of the hindgut that occur in approximately 1 in 3000 live births. Around 60% of ARM occur with associated anomalies including defined genetic syndromes and associations with chromosomal aberrations. The etiology of ARM is heterogeneous, with the individual environmental or genetic risk factors remaining unknown for the majority of cases. The occurrence of familial ARM and previous epidemiologic analysis suggest autosomal dominant inheritance in a substantial subset of ARM patients. The implicated mortality and reduced fecundity in patients with ARM would lead to allele loss. However, mutational de novo events among the affected individuals could compensate for the evolutionary pressure. With the implementation of exome sequencing, array-based molecular karyotyping and family-based rare variant analyses, the technologies are available to identify the respective factors. This review discusses the identification of disease-causing variants among individuals with ARM. It highlights the role of mutational de novo events.
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Phi JH. Sacrococcygeal Teratoma : A Tumor at the Center of Embryogenesis. J Korean Neurosurg Soc 2021; 64:406-413. [PMID: 33906346 PMCID: PMC8128526 DOI: 10.3340/jkns.2021.0015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/10/2021] [Indexed: 02/02/2023] Open
Abstract
Sacrococcygeal teratoma (SCT) is an extragonadal germ cell tumor (GCT) that develops in the fetal and neonatal periods. SCT is a type I GCT in which only teratoma and yolk sac tumors arise from extragonadal sites. SCT is the most common type I GCT and is believed to originate through epigenetic reprogramming of early primordial germ cells migrating from the yolk sac to the gonadal ridges. Fetal SCT diagnosed in utero presents many obstetrical problems. For high-risk fetuses, fetal interventions (devascularization and debulking) are under development. Most patients with SCT are operated on after birth. Complete surgical resection is the key for tumor control, and the anatomical location of the tumor determines the surgical approaches. Incomplete resection and malignant histology are risk factors for recurrence. Approximately 10-15% of patients have a tumor recurrence, which is frequently of malignant histology. Long-term surveillance with monitoring of serum alpha fetoprotein and magnetic resonance imaging is required. Survivors of SCT may suffer anorectal, urological, and sexual sequelae later in their life, and comprehensive evaluation and care are required.
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Affiliation(s)
- Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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Dworschak GC, Reutter HM, Ludwig M. Currarino syndrome: a comprehensive genetic review of a rare congenital disorder. Orphanet J Rare Dis 2021; 16:167. [PMID: 33836786 PMCID: PMC8034116 DOI: 10.1186/s13023-021-01799-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background The triad of a presacral mass, sacral agenesis and an anorectal anomaly constitutes the rare Currarino syndrome (CS), which is caused by dorsal–ventral patterning defects during embryonic development. The major causative CS gene is MNX1, encoding a homeobox protein. Main body In the majority of patients, CS occurs as an autosomal dominant trait; however, a female predominance observed, implies that CS may underlie an additional mode(s) of inheritance. Often, the diagnosis of CS is established solely by clinical findings, impacting a detailed analysis of the disease. Our combined data, evaluating more than 60 studies reporting patients with CS-associated mutations, revealed a slightly higher incidence rate in females with a female-to-male ratio of 1.39:1. Overall, MNX1 mutation analysis was successful in only 57.4% of all CS patients investigated, with no mutation detected in 7.7% of the familial and 68% of the sporadic patients. Our studies failed to detect the presence of an expressed MNX1 isoform that might explain at least some of these mutation-negative cases. Conclusion Aside from MNX1, other genes or regulatory regions may contribute to CS and we discuss several cytogenetic studies and whole-exome sequencing data that have implicated further loci/genes in its etiology. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01799-0.
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Affiliation(s)
- Gabriel C Dworschak
- Institute of Human Genetics, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany. .,Institute of Anatomy and Cell Biology, Medical Faculty, University of Bonn, 53115, Bonn, Germany. .,Department of Pediatrics, University Hospital Bonn, 53127, Bonn, Germany.
| | - Heiko M Reutter
- Institute of Human Genetics, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Department of Neonatology and Pediatric Intensive Care, University Hospital Bonn, 53127, Bonn, Germany
| | - Michael Ludwig
- Department of Clinical Chemistry and Clinical Pharmacology, University of Bonn, 53127, Bonn, Germany
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Scott AT, Tessmann JB, Braun T, Brown B, Breheny PJ, Darbro BW, Bellizzi AM, Dillon JS, O'Dorisio TM, Alderson A, Bennett B, Bernat JA, Metz DC, Howe JR. Presacral neuroendocrine tumors associated with the Currarino syndrome. Am J Med Genet A 2021; 185:1582-1588. [PMID: 33650152 DOI: 10.1002/ajmg.a.62145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 12/14/2022]
Abstract
Currarino syndrome (CS) is an autosomal dominant syndrome caused by mutations in MNX1 and characterized by anorectal abnormalities, partial sacral agenesis, and presacral masses. The presacral masses are typically benign; however, malignant degeneration can occur, and presacral neuroendocrine tumors (NETs) have been reported in six cases. We report three individuals from two families affected by CS in which multiple individuals developed presacral NETs. The first family, 491, had six members with features of CS, including two siblings who presented with presacral, Grade 2 NETs, one of which had metastasized to bone and lymph nodes. A germline c.874C>T (p.Arg292Trp) mutation was found in a highly conserved region of MNX1 in three affected members who underwent sequencing. A second somatic variant/deletion in MNX1 was not detected in either patient's tumor. In the second family, 342, the proband presented with an incidentally discovered presacral NET. The proband's father had previously undergone resection of a presacral NET, and so genetic testing was performed, which did not reveal an MNX1 mutation or copy number variants. The lack of a second, somatic mutation in the tumors from family 491 argues against MNX1 acting as a tumor suppressor, and the absence of a germline MNX1 mutation in family 342 suggests that other genetic and anatomic factors contribute to the development of presacral NETs. These cases highlight the variable presentation of CS, and the potential for malignancy in these patients.
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Affiliation(s)
- Aaron T Scott
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Jonathon B Tessmann
- Center for Bioinformatics and Computational Biology, University of Iowa College of Engineering, Iowa City, Iowa, USA
| | - Terry Braun
- Center for Bioinformatics and Computational Biology, University of Iowa College of Engineering, Iowa City, Iowa, USA
| | - Bartley Brown
- Center for Bioinformatics and Computational Biology, University of Iowa College of Engineering, Iowa City, Iowa, USA
| | - Patrick J Breheny
- Department of Biostatistics, College of Public Health, Boston, Massachusetts, USA
| | - Benjamin W Darbro
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Andrew M Bellizzi
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Joseph S Dillon
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Thomas M O'Dorisio
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Alice Alderson
- Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Bonita Bennett
- Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - John A Bernat
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - David C Metz
- Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - James R Howe
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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18
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Ferreira C, Santos AP, Fonseca J. Currarino syndrome - a pre and post natal diagnosis correlation: case report and literature review. J Matern Fetal Neonatal Med 2021; 35:5224-5226. [PMID: 33618589 DOI: 10.1080/14767058.2021.1876021] [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: 10/22/2022]
Abstract
Currarino syndrome is an uncommon genetic disease, with autosomal dominant inheritance, that is characterized by sacrococcygeal bone defect, presacral mass and anorectal malformation. There are many cases only diagnosed in adulthood, but early diagnosis is important to avoid life-threatening complications and to reduce morbidity, but it requires a high suspicion index and a multidisciplinary approach. If it is an unknown disease in the family, prenatal diagnosis is rare but possible. We discuss a case report of Currarino syndrome with an early diagnosis through fetal magnetic resonance imaging, studied during pregnancy for prenatal diagnosis purposes which showed similar defects in fetus spine and in the asymptomatic mother. We emphasize the inclusion of this rare syndrome in the differential diagnosis of fetal neural tube defects and caudal regression syndrome. The recognition of at-risk subjects should lead to better planning of pregnancies and appropriate management of affected children at birth.
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Affiliation(s)
| | | | - Joaquim Fonseca
- Hospital Prof. Doutor Fernando Fonseca, EPE, Lisbon, Portugal
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19
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Kylat RI, Bader M. Caudal Regression Syndrome. CHILDREN (BASEL, SWITZERLAND) 2020; 7:children7110211. [PMID: 33158301 PMCID: PMC7694368 DOI: 10.3390/children7110211] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/20/2020] [Accepted: 10/29/2020] [Indexed: 01/27/2023]
Abstract
Caudal Regression Syndrome (CRS) or Caudal dysgenesis syndrome (CDS) is characterized by maldevelopment of the caudal half of the body with variable involvement of the gastrointestinal, genitourinary, skeletal, and nervous systems. CRS affects 1–3 newborn infants per 100,000 live births. The prevalence in infants of diabetic mothers is reported at 1 in 350 live births which includes all the variants. A related condition is sirenomelia sequence or mermaid syndrome or symmelia and is characterized by fusion of the legs and a variable combination of the other abnormalities. The Currarino triad is a related anomaly that includes anorectal atresia, coccygeal and partial sacral agenesis, and a pre-sacral lesion such as anterior meningocele, lipoma or dermoid cyst. A multidisciplinary management approach is needed that includes rehabilitative services, and patients need a staged surgical approach.
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20
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Vitale A, Villa R, Giordano F, Napoli E, Ugga L, Manto A. Currarino syndrome in an elderly man: Multimodality imaging findings. Radiol Case Rep 2020; 15:1858-1863. [PMID: 32817777 PMCID: PMC7426326 DOI: 10.1016/j.radcr.2020.07.049] [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: 04/24/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 11/23/2022] Open
Abstract
Currarino syndrome is a rare congenital disorder characterized by the triad of anorectal anomalies, sacrococcygeal dysgenesis and presacral mass. Because of the anorectal anomalies, the extrinsic compression due to the presacral mass and neurologic deficits, patients usually present with gastrointestinal symptoms, most commonly chronic constipation. Most cases of Currarino syndromes are diagnosed in childhood, at birth or in the pre-birth period and, even if adult presentation has been reported in few sporadic case reports, the diagnosis in the late stages of life remains extremely rare. In this paper, we describe the imaging findings of an elderly man with a past medical history of megacolon surgically treated in his childhood, who was diagnosed with Currarino syndrome at the age of 72.
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Abstract
OBJECTIVES Currarino syndrome (CS) is a congenital disorder that consists of a triad of anomalies: presacral mass, sacral dysgenesis, and anorectal malformations. Few cases of CS with neuroendocrine tumors (NETs) have been reported. In this study, we sought to determine the prevalence and characteristics of NET in patients with CS. METHODS Mayo Clinic electronic medical records were searched for patients with CS. Data on demographics, CS diagnosis, family history, genetic testing, and NET diagnosis were extracted. RESULTS A total of 26 patients with CS were identified with 3 (11.5%) of them having an additional diagnosis of NET. Three patients had a family history of NET (11.53%), and 7 patients had a family history of CS (26.9%). Of the 3 NET/CS patients, 2 had a confirmed primary NET from the presacral mass, with the third patient demonstrating focal uptake on the somatostatin receptor imaging within the presacral. Two patients received octreotide, followed by peptide receptor radionuclide therapy. The other patient was not treated because of complete resection of presacral mass and is currently undergoing surveillance scans. CONCLUSIONS In our patients with CS, the prevalence of NET is 11.53%. The coexistence of 2 rare conditions, CS and presacral NET, suggests that there may be an etiological connection.
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22
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Le HK, Cardona-Grau D, Chiang G. Evaluation and Long-term Management of Neurogenic Bladder in Spinal Dysraphism. Neoreviews 2020; 20:e711-e724. [PMID: 31792158 DOI: 10.1542/neo.20-12-e711] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Spinal dysraphism, which includes conditions such as myelomeningocele and sacral agenesis, is one of the most common causes of congenital lower urinary tract dysfunction. Early evaluation of the neurogenic bladder serves to minimize renal damage, and the main goals of management include preserving renal function, achieving acceptable continence, and optimizing quality of life. The survival of patients with such conditions has improved to greater than 80% reaching adulthood, owing to advances in diagnostic and therapeutic modalities. The result is a real, and unfortunately often unmet, need for successful transitional care in this complex patient population. Clinicians must be able to identify the unique challenges encountered by patients with neurogenic bladder as they shift through different stages of their life.
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Affiliation(s)
- Hoang-Kim Le
- Division of Pediatric Urology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA
| | | | - George Chiang
- Division of Pediatric Urology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA
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23
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Yip JC, Soundappan SV, Holland AJ. Familial Currarino Syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Currarino triad: A case report of a 48-year-old patient with a neuroendocrine tumor. Radiol Case Rep 2020; 15:1555-1561. [PMID: 32670459 PMCID: PMC7341113 DOI: 10.1016/j.radcr.2020.06.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/15/2020] [Accepted: 06/21/2020] [Indexed: 01/22/2023] Open
Abstract
Currarino triad is a rare syndrome, with less than 250 cases reported, and it includes a combination of sacrococcigeal bony abnormalities, anorectal malformations and the presence of a presacral mass. Here we present a case of a 48-year-old male patient with history of severe chronic constipation, who was incidentally diagnosed with a presacral during imagiological investigation, which was histologically proven to be a neurendocrine tumor.
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25
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Han L, Zhang Z, Wang H, Song H, Gao Q, Yan Y, Tao R, Xiao P, Li L, Jiang Q, Li Q. Novel MNX1 mutations and genotype-phenotype analysis of patients with Currarino syndrome. Orphanet J Rare Dis 2020; 15:155. [PMID: 32571425 PMCID: PMC7310025 DOI: 10.1186/s13023-020-01442-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
Background Currarino syndrome (CS) is a specific complex of congenital caudal anomalies, including anorectal malformations, presacral mass and sacral anomalies. Mutations in the MNX1 gene are closely related to CS and occur in almost all familial cases and less than half of sporadic patients. We investigated the spectrum of MNX1 pathogenic variants and associated clinical features in Chinese patients with CS. Results Seventeen index patients from 16 families were recruited from 2015 to 2018. All patients were diagnosed with CS and treated at the Capital Institute of Pediatrics Affiliated Children’s Hospital. Genetic testing was applied to identify mutations in CS patients and their relatives by whole-exome sequencing and Sanger sequencing. Functional verification was performed for a recurrent noncanonical splice site variant in MNX1 with a minigene splicing assay. In 17 CS patients, 14 were complete CS and 3 were mild CS. Nine variants in MNX1 were identified in 11 patients, and these included two frameshift mutations (p.Leu223Leufs*61, p.X402Serfs*70), four nonsense mutations (p.Gly42X, p.Cys88X, p.Gln24X, p.Cys241X), one missense mutation (p.Trp288Leu), one splice region variant (c.691 + 3G > T) and one polyalanine polymorphism (p.Ala135insAlaAla). Seven of these nine variants have never been reported. Pathogenic MNX1 mutations were found in 100% (4/4) of familial and 46% (6/13) of sporadic patients. Conclusion Our study expanded the mutation spectrum of MNX1 and provided clinical and genetic analyses of seventeen CS patients from mainland China.
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Affiliation(s)
- Lu Han
- Department of Medical Genetics, Capital Institute of Pediatrics, No. 2 Yabao Rd., Chaoyang District, Beijing, 100020, China
| | - Zhen Zhang
- Department of General Surgery, Capital Institute of Pediatrics Affiliated Children's Hospital, No. 2 Yabao Rd., Chaoyang District, Beijing, 100020, China
| | - Hui Wang
- Department of Medical Genetics, Capital Institute of Pediatrics, No. 2 Yabao Rd., Chaoyang District, Beijing, 100020, China
| | - Hui Song
- Department of General Surgery, Capital Institute of Pediatrics Affiliated Children's Hospital, No. 2 Yabao Rd., Chaoyang District, Beijing, 100020, China
| | - Qing Gao
- Department of General Surgery, Capital Institute of Pediatrics Affiliated Children's Hospital, No. 2 Yabao Rd., Chaoyang District, Beijing, 100020, China
| | - Yuchun Yan
- Department of Radiology, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing, 100020, China
| | - Ran Tao
- Department of Radiology, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing, 100020, China
| | - Ping Xiao
- Department of Pathology, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing, 100020, China
| | - Long Li
- Department of General Surgery, Capital Institute of Pediatrics Affiliated Children's Hospital, No. 2 Yabao Rd., Chaoyang District, Beijing, 100020, China
| | - Qian Jiang
- Department of Medical Genetics, Capital Institute of Pediatrics, No. 2 Yabao Rd., Chaoyang District, Beijing, 100020, China.
| | - Qi Li
- Department of General Surgery, Capital Institute of Pediatrics Affiliated Children's Hospital, No. 2 Yabao Rd., Chaoyang District, Beijing, 100020, China.
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Bevanda K, Memidžan I, Boban-Raguž A. Caudal regression syndrome (Currarino syndrome) with chromosom mutation 9. Radiol Case Rep 2020; 15:1184-1188. [PMID: 32550955 PMCID: PMC7292899 DOI: 10.1016/j.radcr.2020.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 11/17/2022] Open
Abstract
Currarino syndrome is a rare set of congenital anomalies that include partial sacral agenesis, anorectal anomalies, presacral mass, urogenital malformation, and fistula between pelvic structures. We present a case of a 4-year and 10-month-old boy with incomplete Currarino syndrome, who was born with anus atresia, rectovesical fistula, and permanent perimembranous VSD. At the age of 3, he was diagnosed with neurogenic bladder and sacrococcygeal agenesis. Early psychomotor development was normal. Cytogenetic GTG-banding test confirmed a male karyotype 46, XY with high heterochromatin in chromosome 9, without mutation of the MNX 1 gene (chromosome 7q36). This genetic analysis is a result of "de novo mutation" or it is the disorder of DNA methylation. Further genetics analyses like whole-exome sequencing - WES should have been preformed if the test had been availble. The existence of Currarino syndrome should be suspected among the children born with anorectal malformation. Prompt diagnosis with multidisciplinary monitoring improves the care and quality of life of the patient, reduces morbidity and mortality.
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Affiliation(s)
- Kristina Bevanda
- Health Center Mostar, Hrvatskih Branitelja b.b., 88000 Mostar, Bosnia and Herzegovina
| | - Irma Memidžan
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Ana Boban-Raguž
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
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27
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Kim RB, Robbins R, Rollins MD, Brockmeyer DL. Currarino syndrome presenting as a cerebrospinal fluid leak from the dermal sinus tract: case report. J Neurosurg Pediatr 2020; 25:648-652. [PMID: 32114544 DOI: 10.3171/2020.1.peds19692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/07/2020] [Indexed: 11/06/2022]
Abstract
Currarino syndrome is an autosomal dominant condition with variable expressivity and penetrance that is associated with several classic features: sacral dysgenesis, presacral mass, and/or anorectal anomalies. The authors present a unique case in which the patient's initial presentation was a CSF leak from a sinus tract. The sinus tract was identified and disconnected from the thecal sac, obliterating the anterior sacral meningocele. This case represents a unique scenario in which Currarino syndrome manifested as a CSF leak from a dermal sinus tract.
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Affiliation(s)
| | - Riann Robbins
- 2Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Michael D Rollins
- 2Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
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AbouZeid AA, Mohammad SA, Seada M, Khiamy K, Gamal R. Currarino Triad: Importance of Preoperative Magnetic Resonance Imaging. European J Pediatr Surg Rep 2019; 7:e86-e89. [PMID: 31763131 PMCID: PMC6874504 DOI: 10.1055/s-0039-3399533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/17/2019] [Indexed: 11/29/2022] Open
Abstract
Currarino triad is a rare syndrome that may be occasionally encountered during managing cases of anorectal anomalies. The triad consists of anorectal anomaly, sacral bony defect, and a presacral mass. It may be familial or sporadic, with a reported female predominance. Identification of the characteristic notched sacrum (sacral scimitar) in plain X-ray (anteroposterior view) is considered the key for the diagnosis; however, not infrequently, this radiological sign is overlooked, especially with a small sacral defect. Excision of the presacral cyst is usually performed concomitantly during anorectoplasty. The prone position is the standard approach for posterior sagittal anorectoplasty (PSARP) in males; however, in females, the supine position can be used as an alternative (anterior sagittal anorectoplasty). In this case report, excision of the presacral cyst took place in two steps: the first excision during the PSARP procedure in the prone position, and a second operation in the supine lithotomy position to remove a residual component of the lesion that was missed during the primary operation. It was clear that the supine lithotomy position provided better access to explore the presacral space than the prone position, especially with a deeply located cyst as in our case. The role of magnetic resonance imaging (MRI) in the identification of the exact nature and extent of the lesion before surgery is crucial and should be performed in all cases.
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Affiliation(s)
| | | | - Mohammad Seada
- Department of Pediatric Surgery, Benha Specialized Children Hospital, Benha, Egypt
| | - Khaled Khiamy
- Department of Pediatric Surgery, Benha Specialized Children Hospital, Benha, Egypt
| | - Radwa Gamal
- Genetics Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
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29
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Chatani S, Onaya H, Kato S, Inaba Y. Adenocarcinoma and neuroendocrine tumor arising within presacral teratoma associated with Currarino syndrome: A case report. Indian J Radiol Imaging 2019; 29:327-331. [PMID: 31741605 PMCID: PMC6857249 DOI: 10.4103/ijri.ijri_148_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/03/2019] [Accepted: 09/11/2019] [Indexed: 11/17/2022] Open
Abstract
We present a case of a 59-year-old woman with a malignant tumor arising within presacral teratoma associated with Currarino syndrome (CS). A characteristic crescent-shaped sacrum was detected on preoperative image examination and the presacral mass was pathologically diagnosed as a malignant tumor associated with CS. To our knowledge, this is the first case report of presacral teratoma associated with CS coexisting with both adenocarcinoma and a neuroendocrine tumor.
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Affiliation(s)
- Shohei Chatani
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku Nagoya 464-8681, Japan
| | - Hiroaki Onaya
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku Nagoya 464-8681, Japan
| | - Seiichi Kato
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku Nagoya 464-8681, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku Nagoya 464-8681, Japan
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Hage P, Kseib C, Adem C, Chouairy CJ, Matta R. Atypical presentation of currarino syndrome: A case report. Int J Surg Case Rep 2019; 57:102-105. [PMID: 30933899 PMCID: PMC6441767 DOI: 10.1016/j.ijscr.2019.02.047] [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: 11/22/2018] [Revised: 02/10/2019] [Accepted: 02/26/2019] [Indexed: 11/13/2022] Open
Abstract
Currarino syndrome is a rare congenital disorder characterized by a triad. MRI is the best imaging modality in early diagnosis and follow up for recurrences. The presacral mass can be a malignancy in Currarino syndrome. Both neurosurgery and pediatric surgery are needed in tackling Currarino syndrome.
Introduction Currarino syndrome is a rare congenital disorder characterized by a triad of anorectal malformation, a sacral bone defect, and a presacral mass. It results of an abnormal separation of the ectoderm from the endoderm caused by HLXB9 mutation in chromosome 7q36 in 50% of cases. The disorder is mostly hereditary as it can also be sporadic with a variable expression spectrum. Presentation of Case The case of a previously healthy 3-month-old girl with abdominal distension, post-prandial vomiting, obstipation, and anuria of 5 days’ history is presented in this article. Abdomino-pelvic magnetic resonance imaging (MRI) showed a large cystic multilobulated mass in the sacrococcygeal region with a dural communication evident of an anterior sacral meningocele. 1 year later, the child came back with constipation and was found to a have a malignant mixed germ cell tumor in the presacral area, a very rare presentation in Currarino syndrome. Discussion In a child presenting with at least one of the features of Currarino syndrome’s triad, a diagnosis should be suspected. After reviewing the literature, the syndrome is usually missed and hence is under diagnosed. MRI is the best imaging modality for diagnostics and follow-up for any mass, benign or malignant, can bring life saving measures. Most masses are benign but can undergo malignant transformation even after resection. De novo malignancy is very rare and is described in our case. Conclusion Physicians treating patients with spinal dysraphism should suspect a diagnosis of Currarino syndrome by follow up imaging for any new benign or malignant growth.
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Affiliation(s)
- Paul Hage
- Department of Neurosurgery, Saint George Hospital University Medical Center, Balamand University, Beirut, Lebanon
| | - Cedric Kseib
- Department of Neurosurgery, Saint George Hospital University Medical Center, Balamand University, Beirut, Lebanon.
| | - Carmen Adem
- Department of Radiology, Saint George Hospital University Medical Center, Balamand University, Beirut, Lebanon
| | - Camil J Chouairy
- Department of Pathology, Saint George Hospital University Medical Center, Balamand University, Beirut, Lebanon
| | - Reva Matta
- Department of Pediatric Surgery, Saint George Hospital University Medical Center, Balamand University, Beirut, Lebanon
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Currarino syndrome in an adult woman. Obstet Gynecol Sci 2019; 62:367-370. [PMID: 31538082 PMCID: PMC6737057 DOI: 10.5468/ogs.2019.62.5.367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/03/2019] [Accepted: 01/17/2019] [Indexed: 11/25/2022] Open
Abstract
Currarino syndrome is a hereditary disease characterized by the triad of sacral agenesis, anorectal malformation, and presacral mass. Most patients are diagnosed in childhood, and this condition rarely manifests in adulthood. In women, gynecological malformations associated with Currarino syndrome have been reported, such as bicornuate uterus, rectovaginal fistula, and septate uterus. We present a rare case of a 29-year-old woman with a suspected pelvic mass who was diagnosed with Currarino syndrome.
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Kremer MEB, Althof JF, Derikx JPM, van Baren R, Heij HA, Wijnen MHWA, Wijnen RMH, van der Zee DC, van Heurn LWE. The incidence of associated abnormalities in patients with sacrococcygeal teratoma. J Pediatr Surg 2018; 53:1918-1922. [PMID: 29453131 DOI: 10.1016/j.jpedsurg.2018.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Gross genetic causes for SCT are unknown; however, it might be associated with other abnormalities. We assessed the incidence of associated abnormalities in a large national cohort of neonates with SCT and aimed to identify predictive risk factors. PROCEDURE The medical records were reviewed of 235 consecutive neonates with SCT treated at the six pediatric surgical centers in the Netherlands from 1970 to 2010. Potential risk factors for associated abnormalities analyzed included sex, gestational age, tumor-volume/histology and Altman-classification. RESULTS In 76 patients (32.3%) at least one associated abnormality was diagnosed, with hydronephrosis as the most common (16.2%) and hip dysplasia in 4.3%. Multiple abnormalities were documented for 21 (9.0%). Prematurity and Altman type IV SCT were associated with an increased risk of any associated abnormality. No association between increased tumor-volume and hydronephrosis or hip dysplasia was found. Patients with type IV Altman SCT had a fourfold risk of suffering from hydronephrosis compared to Altman type I SCT. CONCLUSIONS SCT was associated with other abnormalities in one-third of children. Some were tumor-related while others were related to prematurity or occurred sporadically. In contrast to clinically obvious anomalies, hip dysplasia or hydronephrosis might be latently present with more subtle clinical presentation. We therefore suggest renal- and hip-ultrasound in all patients, certainly those with Altman type IV SCT. LEVEL OF EVIDENCE RATING Level II (retrospective study).
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Affiliation(s)
- Marijke E B Kremer
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands
| | - Jessica F Althof
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands
| | - Joep P M Derikx
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands
| | - Robertine van Baren
- Department of Paediatric Surgery-University Medical Centre, Groningen, The Netherlands
| | - Hugo A Heij
- Pediatric Surgical Centre of Amsterdam (Emma Children's Hospital University Medical Centre and VU Medical Centre), The Netherlands
| | - Marc H W A Wijnen
- Department of Paediatric Surgery-University Medical Centre, Nijmegen, The Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery, Sophia Children's Hospital-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - David C van der Zee
- Department of Paediatric Surgery, Wilhelmina Children's Hospital-University Medical Centre, Utrecht, The Netherlands
| | - L W Ernest van Heurn
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands.
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Zhang H, Guo H, He S, Hui H, Hao D. Sacral agenesis combined with spinopelvic dissociation: A case report and literature review. Medicine (Baltimore) 2018; 97:e12162. [PMID: 30212942 PMCID: PMC6155972 DOI: 10.1097/md.0000000000012162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Sacral agenesis is a rare congenital disease with radiologic manifestation of sacrum deformity. Its clinical manifestations include spinopelvic instability due to sacroiliac joint deformity, spinal rotation, scoliosis, difficulties in walking, and claudication. Surgical intervention aims to prevent further deformity progression and to improve the patients' walking function. It is challenging to achieve solid arthrodesis for this congenital disease, and fusion failure could aggravate deformity. CASE PRESENTATION We retrospectively studied one case of a 12-year-old girl with sacral agenesis combined with spinopelvic dissociation and spinal scoliosis. She was presented with intermittent lumbosacral pain and worsening walking instability. We reconstructed the posterior pelvic ring through 1 iliac screw implanted in the bilateral posterior superior iliac spine, and the preflexed connecting rod was tightly locked with bilateral screws through the opening at the right spinal process of S2. With this method, bilateral ilia and sacrum were integrated and hemipelvic floating could be corrected. Bone fusion was achieved between the bilateral ilia and the sacrum. CONCLUSION Ilium-sacrum-ilium internal fixation and fusion for treating sacral agenesis combined with spinopelvic dissociation could achieve sacroiliac joint fusion. It is easy to perform and could cause little trauma while preserving the lumbar motion segment, which will provide new insight for treating sacral agenesis.
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Little TA, Compson KE, Hall K, Murdoch MJ, Neas KR, Kenwright D, Stringer MD. Currarino syndrome with two synchronous presacral teratomas. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Szumera E, Jasiewicz B, Potaczek T. Atypical caudal regression syndrome with agenesis of lumbar spine and presence of sacrum - case report and literature review. J Spinal Cord Med 2018; 41:496-500. [PMID: 28875772 PMCID: PMC6055966 DOI: 10.1080/10790268.2017.1369211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CONTEXT Caudal regression syndrome is a rare disorder, not well described in the literature. FINDINGS Authors treated two patients with congenital absence of thoracolumbar vertebrae and lower limbs paraplegia. Patients had hypoplasia of the lower trunk and extremities with motion between upper and lower torso. Imaging showed caudal spine agenesis, but cleft sacrum was present. Due to severe kyphotic deformity and spinal instability, deformity correction and posterior fusion was performed at the age 6 and 8. Finally, fusion was achieved in one case and stable but non-fusion kyphotic posture was observed in second. CONCLUSION surgery in caudal regression syndrome is challenging and bears high risk of complications.
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Affiliation(s)
| | - Barbara Jasiewicz
- Correspondence to: Barbara Jasiewicz, Department of Orthopedics and Rehabilitation, Jagiellonian University Medical College, Krakow, Poland.
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Costanzo S, Spaccini L, Pio L, Mattioli G, Virgone C, Dall'Igna P, Iacobelli B, Inserra A, Brisighelli G, Fagnani AM, Leva E, Giannotti G, Cheli M, Frumento P, Riccipetitoni G. Currarino syndrome: does the presence of a genetic anomaly correlate with a more severe phenotype? A multicentre study. J Pediatr Surg 2017; 52:1591-1596. [PMID: 28689883 DOI: 10.1016/j.jpedsurg.2017.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/11/2017] [Accepted: 06/13/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE Currarino syndrome (CS) phenotype, initially described as the triad of hemisacrum, anorectal malformation (ARM) and presacral mass, can be extremely variable. The triad is often incomplete and 3 main CS phenotypical subtypes have been described: Complete, Mild and Minimal. Various associated malformations are often present. Mutations in the MNX1 gene are the main genetic background of CS, although they are not present in almost half of the cases. Aim of our study is to analyze the distribution of the 3 CS subtypes and the incidence of associated malformations in a large sample of patients and to add information about the role of the genetic testing in guiding the diagnostic and prognostic evaluation of CS patients. METHODS A multicentre retrospective data collection was performed. CS patients' phenotype was accurately analyzed according to a diagnostic-therapeutic standardized data collection sheet. The distribution of the three CS types and the frequency of each associated malformation were calculated. The phenotype of the patients with a known genetic anomaly was compared to the phenotype of the population with no genetic diagnosis, in order to determine whether the presence of a known genetic defect could correlate with a more severe CS phenotype. RESULTS Data from 45 patients were analyzed. Twenty patients (44.5%) presented a Complete CS type, 19 (42.2%) a Mild CS and 6 (13.3%) a Minimal CS. In addition to the classical triad elements, 38 (84.5%) patients showed associated anomalies. The group of patients who resulted positive for a MNX1 mutation comprised a higher number (56.5%) of Complete CS cases than the group of patients that did not carry any MNX1 mutation (13%) (p = 0.0085). We could not find any relationship between CS subtype and the number of associated anomalies (p = 0.5102). CONCLUSIONS The presence of a MNX1 mutation seems to correlate with a more severe CS phenotype. MNX1 seems the main responsible for the expression and the severity of the CS triad, while the associated anomalies appear to be prevalently determined by genes sited on different loci. A thorough multidisciplinary diagnostic overview of CS patients should always include genetic counseling and analysis, both in postnatal and prenatal settings. TYPE OF STUDY Retrospective Study. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Sara Costanzo
- Pediatric Surgery Unit, V. Buzzi Children's Hospital, Milan, Italy.
| | | | - Luca Pio
- Pediatric Surgery Department, DINOGMI - University of Genoa, Genoa, Italy
| | - Girolamo Mattioli
- Pediatric Surgery Department, DINOGMI - University of Genoa, Genoa, Italy; Pediatric Surgery Unit, G. Gaslini Children's Hospital, Genoa, Italy
| | - Calogero Virgone
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Patrizia Dall'Igna
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | | | | | - Giulia Brisighelli
- Pediatric Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Maria Fagnani
- Pediatric Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ernesto Leva
- Pediatric Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Giannotti
- Pediatric Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maurizio Cheli
- Pediatric Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Frumento
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Yamamichi K, Manabe T, Uekihara T. Caudal Regression Syndrome with Pressure Ulcers of the Foot: A Case Report. J Clin Diagn Res 2017; 11:PD19-PD20. [PMID: 28892975 DOI: 10.7860/jcdr/2017/25980.10291] [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: 12/29/2016] [Accepted: 05/11/2017] [Indexed: 11/24/2022]
Abstract
Caudal Regression Syndrome (CRS) is a rare disorder which consists of abnormalities in the lumbosacral spine, rectum, urinary system and lower limbs. These abnormalities also include orthopaedic deformities, such as hip dislocation, knee-flexion contracture with popliteal webbing and talipes equinovarus. Because of the rarity of this condition, few medical personnel are aware of it. Here, we present a case of CRS in a 15-year-old girl with pressure ulcers on the lateral malleolus and plantar surface of the foot, which had come into contact with the wheelchair footrest. Although the foot ulcers healed after off-loading, the ulcer on the lateral malleolus did not heal with conservative treatment and was covered by a lateral supramalleolar flap after debridement. Stable coverage and good contours were present at 18 months postoperatively. CRS patients may have a risk factor for developing pressure ulcers of the foot due to the characteristic lower limb deformities and a loss of sensation. Preventive foot care measures such as off-loading devices combined with modern dressings should be applied as routine when the medical personnel is to attend such patients.
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Affiliation(s)
- Kosaku Yamamichi
- Director, Department of Plastic and Reconstructive Surgery, Fukuoka Sanno Hospital, 3-6-45 Momochihama, Sawara-ku, Fukuoka, Japan
| | - Tsuyoshi Manabe
- Director, Department of Plastic and Reconstructive Surgery, Hakujyuji Hospital, 3-2-1 Ishimaru, Nishi-ku, Fukuoka, Japan
| | - Tatsuya Uekihara
- Senior Resident, Department of Plastic and Reconstructive Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa, Japan
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AbouZeid AA, Mohammad SA, Abolfotoh M, Radwan AB, Ismail MME, Hassan TA. The Currarino triad: What pediatric surgeons need to know. J Pediatr Surg 2017; 52:1260-1268. [PMID: 28065719 DOI: 10.1016/j.jpedsurg.2016.12.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/14/2016] [Accepted: 12/20/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE We report our experience in managing a group of patients with Currarino syndrome, highlighting diagnostic challenges, surgical techniques, in addition to a review of current neurosurgical options. PATIENTS AND METHODS The study included patients with Currarino syndrome who presented to our pediatric surgery department during the period 2010 through 2016. The 'sacral scimitar' in plain X-ray provided the clue for the diagnosis; while MRI examination was essential to define the nature of the presacral mass and associated spinal anomalies. RESULTS The study included 17 patients (13 girls and 4 boys). Their age at presentation ranged from 7months to 10years. We used posterior sagittal approach to correct anorectal anomalies, and excise presacral cysts that were subjected to histopathological examination. Two cases presented with a pelvic abscess (infected presacral dermoid cyst), which were initially drained followed by excision. The presacral mass consisted of either lipomyelocele (6), lipomyelomeningocele (3), or a developmental (dermoid) cyst (8). Tethering of the spinal cord was a common association (70%) CONCLUSION: Apart from diagnostic challenges, the management of Currarino syndrome is similar to the usual management of ARM regarding the surgical approach and probably the prognosis that mainly depends on degree of associated sacral dysplasia. LEVEL OF EVIDENCE This is a case series with no comparison group (level IV).
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40
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Colombo F, Janous P, Buxton N. Carcinoid transformation of presacral dermoid cyst in patient with currarino syndrome: a case report. Br J Neurosurg 2017; 33:285-286. [DOI: 10.1080/02688697.2017.1339226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Francesca Colombo
- Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Petr Janous
- Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Neil Buxton
- Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
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Chakhalian D, Gunasekaran A, Gandhi G, Bradley L, Mizell J, Kazemi N. Multidisciplinary surgical treatment of presacral meningocele and teratoma in an adult with Currarino triad. Surg Neurol Int 2017; 8:77. [PMID: 28584680 PMCID: PMC5445655 DOI: 10.4103/sni.sni_439_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/13/2017] [Indexed: 12/03/2022] Open
Abstract
Background: Currarino syndrome (CS) is a rare genetic condition that presents with the defining triad of anorectal malformations, sacral bone deformations, and presacral masses, which may include teratoma. Neurosurgeons are involved in the surgical treatment of anterior meningoceles, which are often associated with this condition. The accepted surgical treatment is a staged anterior-posterior resection of the presacral mass and obliteration of the anterior meningocele. Case Description: This case involved a 36-year-old female who presented with late onset of symptoms attributed to CS (e.g., presacral mass, anterior sacral meningocele, and sacral agenesis). She successfully underwent multidisciplinary single-stage approach for treatment of the anterior sacral meningocele and resection of the presacral mass. This required obliteration of the meningocele and closure of the dural defect. One year later, her meningocele had fully resolved. Conclusion: While late presentations with CS are rare, early detection and multidisciplinary treatment including single-state anterior may be successful for managing these patients.
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Affiliation(s)
- Daniel Chakhalian
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Arunprasad Gunasekaran
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Gautam Gandhi
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lucas Bradley
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jason Mizell
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Noojan Kazemi
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Holm I, Spildrejorde M, Stadheim B, Eiklid KL, Samarakoon PS. Whole exome sequencing of sporadic patients with Currarino Syndrome: A report of three trios. Gene 2017; 624:50-55. [PMID: 28456592 DOI: 10.1016/j.gene.2017.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/06/2017] [Accepted: 04/19/2017] [Indexed: 12/14/2022]
Abstract
Currarino Syndrome is a rare congenital malformation syndrome described as a triad of anorectal, sacral and presacral anomalies. Currarino Syndrome is reported to be both familial and sporadic. Familial CS is today known as an autosomal dominant disorder caused by mutations in the transcription factor MNX1. The aim of this study was to look for genetic causes of Currarino Syndrome in sporadic patients after ruling out other causes, like chromosome aberrations, disease-causing variants in possible MNX1 cooperating transcription factors and aberrant methylation in the promoter of the MNX1 gene. The hypothesis was that MNX1 was affected through interactions with other transcription factors or through other regulatory elements and thereby possibly leading to abnormal function of the gene. We performed whole exome sequencing with an additional 6Mb custom made region on chromosome 7 (GRCh37/hg19, chr7:153.138.664-159.138.663) to detect regulatory elements in non-coding regions around the MNX1 gene. We did not find any variants in genes of interest shared between the patients. However, after analyzing the whole exome sequencing data with Filtus, the in-house SNV filtration program, we did find some interesting variants in possibly relevant genes that could be explaining these patients` phenotypes. The most promising genes were ETV3L, ARID5A and NCAPD3. To our knowledge this is the first report of whole exome sequencing in sporadic CS patients.
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Affiliation(s)
- Ingunn Holm
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway.
| | - Mari Spildrejorde
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Barbro Stadheim
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Kristin L Eiklid
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
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Rydzewska M, Krawczuk-Rybak M, Zajkowska A, Jurczuk N, Polnik D, Szalecki M, Moszczyńska E, Savage MO, Bossowski A. Cushing's syndrome in infancy due to ectopic ACTH secretion by a sacro-coccygeal teratoma. J Pediatr Endocrinol Metab 2017; 30:475-478. [PMID: 28328532 DOI: 10.1515/jpem-2016-0339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 02/06/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adenocorticotropic hormone (ACTH)-dependent Cushing's syndrome in infancy is extremely rare. We describe the case of a sacro-coccygeal ectopic ACTH-secreting immature teratoma in an infant who also presented the triad of defects characteristic of Currarino syndrome. CASE PRESENTATION A girl was born with a large immature teratoma in the sacro-coccygeal region associated with anal atresia. At the age of 7 days, the concentration of α-fetoprotein (AFP) was above the age-specific normal range. Two non-radical surgical excisions of the tumour were performed. At the age of 7 months, she developed polyphagia, acne, hirsutism, hypertension and hypokalemia with elevated ACTH and absence of serum cortisol circadian rhythm. Immunostaining of tumour tissue showed ACTH-immunoreactive cells. Due to unsuccessful therapy with ketoconazole and resistance to antihypertensive medications [blood pressure (BP) 210/160 mmHg], metyrapone was administered, which controlled her ACTH and cortisol levels in the normal range. Following further removal of tumour bulk after three operations during the first year of life, there was a decrease of BP to normal values. CONCLUSIONS A rare case of ectopic ACTH syndrome causing Cushing's syndrome in infancy in the context of Currarino syndrome is reported. Radical surgery has resulted in excision of the tumour and current control of Cushing's syndrome.
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Affiliation(s)
- Marta Rydzewska
- Department of Pediatrics, Endocrinology and Diabetes with a Cardiology Unit, Medical University in Bialystok, Bialystok
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Bialystok
| | - Adrianna Zajkowska
- Department of Pediatrics, Endocrinology and Diabetes with a Cardiology Unit, Medical University in Bialystok, Bialystok
| | - Natalia Jurczuk
- Department of Pediatrics, Endocrinology and Diabetes with a Cardiology Unit, Medical University in Bialystok, Bialystok
| | - Dariusz Polnik
- Department of Children's Surgery and Transplantology, Children's Memorial Health Institute, Warsaw
| | - Mieczysław Szalecki
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw
| | - Elżbieta Moszczyńska
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw
| | - Martin O Savage
- Barts and the London School of Medicine and Dentistry, London
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology and Diabetes with a Cardiology Unit, Medical University in Bialystok, ul. Waszyngtona 17, 15-274 Białystok
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Aggarwal V, Aggarwal N, Bhoil R, Kumar V, Kumar N, Singh SP, Verma M. Currarino syndrome masquerading as recurrent pre-sacral abscess. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2016.12.012] [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] Open
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Currarino Syndrome in a Fetus, Infant, Child, and Adolescent: Spectrum of Clinical Presentations and Imaging Findings. Can Assoc Radiol J 2017; 68:90-95. [DOI: 10.1016/j.carj.2016.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/01/2016] [Accepted: 05/04/2016] [Indexed: 11/21/2022] Open
Abstract
In 1981, Currarino et al described a triad of findings that consist of partial sacral dysgenesis, presacral mass (anterior meningocele, enteric cyst, or presacral teratoma) and anorectal malformation. Currarino syndrome exhibits variable expressivity and the clinical presentation tends to vary with the age of the subject such as spinal anomaly detected in the fetus, imperforate anus in the newborn, and intractable constipation or neurologic symptoms in the infant and older child. At any age, meningitis can be the presenting symptom and imaging is required for proper investigation. Meningitis, sepsis, urinary tract infections, and, rarely, malignant transformation of a teratoma are serious potential complications. This pictorial review describes the imaging findings, clinical history, surgical interventions, and genetic background in 5 children with this syndrome who presented in our hospital in the interval of 1 year.
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Farajli Abbasi M, Shojaei B, Azari O. Congenital lumbar vertebrae agenesis in a lamb. VETERINARY RESEARCH FORUM : AN INTERNATIONAL QUARTERLY JOURNAL 2017; 8:361-363. [PMID: 29326797 PMCID: PMC5756258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 10/04/2017] [Indexed: 11/08/2022]
Abstract
Congenital agenesis of lumbar vertebrae was diagnosed in a day-old female lamb based on radiology and clinical examinations. There was no neurological deficit in hindlimb and forelimb associated with standing disability. Radiography of the abdominal region revealed absence of lumbar vertebrae. Necropsy confirmed clinical and radiographic results. No other anomaly or agenesis was seen macroscopically in the abdominal and thoracic regions as well as vertebral column. Partial absence of vertebral column has been reported in human and different animal species, as an independent occurrence or associated with other organs anomalies. The latter has been designated as caudal regression syndrome. Vertebral agenesis may arise from irregularity in the differentiation of somites to the sclerotome or sclerotome to the vertebral primordium. Most of the previously reported cases of agenesis were related to the lumbosacral region, lonely or along with other visceral absences. This case was the first report of congenital agenesis of lumbar vertebrae in a lamb.
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Affiliation(s)
- Mohammad Farajli Abbasi
- Post Graduate Student of Veterinary Surgery, Shahid Bahonar University of Kerman, Kerman, Iran;
| | - Bahador Shojaei
- Department of Basic Sciences, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran; ,Correspondence: Bahador Shojaei. DVM, PhD, Department of Basic Sciences, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran, E-mail:
| | - Omid Azari
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran.
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Fatal Meningitis in a 14-Month-Old with Currarino Triad. Case Rep Radiol 2016; 2016:1346895. [PMID: 27597920 PMCID: PMC4997085 DOI: 10.1155/2016/1346895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/10/2016] [Accepted: 07/25/2016] [Indexed: 12/02/2022] Open
Abstract
We report a case of a 14-month-old girl with undiagnosed Currarino triad presenting acutely with meningitis caused by enteric commensals. Head CT demonstrated a large pneumocephalus. A fistulous neurenteric tract through a presacral mass was present on spine MRI and abdominal CT. The patient had a history of constipation for the last three months. However, an underlying diagnosis of Currarino triad had not been suspected. In retrospect, a sickle-shaped sacral anomaly was present on a previous abdominal radiograph. The patient succumbed to complications of meningitis. The purpose of the case report is to highlight the potentially fatal complication of Currarino triad and sensitize radiologists to look actively for sacral anomalies on abdominal radiographs, especially of children with chronic constipation.
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Scimone C, Donato L, Rinaldi C, Sidoti A, D'Angelo R. First case of Currarino syndrome and trimethylaminuria: two rare diseases for a complex clinical presentation. J Dig Dis 2016; 17:628-632. [PMID: 27335202 DOI: 10.1111/1751-2980.12373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/06/2016] [Accepted: 06/20/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Concetta Scimone
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Molecular Genetics and Preventive Medicine, University of Messina, Messina, Italy.,Department of Cutting-Edge Medicine and Therapies, Biomolecular Strategies and Neuroscience, Section of Molecular Genetics applied to Neuroscience and Predictive Medicine, I.E.ME.S.T., Palermo, Italy
| | - Luigi Donato
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Molecular Genetics and Preventive Medicine, University of Messina, Messina, Italy.,Department of Cutting-Edge Medicine and Therapies, Biomolecular Strategies and Neuroscience, Section of Molecular Genetics applied to Neuroscience and Predictive Medicine, I.E.ME.S.T., Palermo, Italy
| | - Carmela Rinaldi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Molecular Genetics and Preventive Medicine, University of Messina, Messina, Italy
| | - Antonina Sidoti
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Molecular Genetics and Preventive Medicine, University of Messina, Messina, Italy.,Department of Cutting-Edge Medicine and Therapies, Biomolecular Strategies and Neuroscience, Section of Molecular Genetics applied to Neuroscience and Predictive Medicine, I.E.ME.S.T., Palermo, Italy
| | - Rosalia D'Angelo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Molecular Genetics and Preventive Medicine, University of Messina, Messina, Italy
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Jacquinet A, Millar D, Lehman A. Etiologies of uterine malformations. Am J Med Genet A 2016; 170:2141-72. [PMID: 27273803 DOI: 10.1002/ajmg.a.37775] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 03/10/2016] [Indexed: 12/11/2022]
Abstract
Ranging from aplastic uterus (including Mayer-Rokitansky-Kuster-Hauser syndrome) to incomplete septate uterus, uterine malformations as a group are relatively frequent in the general population. Specific causes remain largely unknown. Although most occurrences ostensibly seem sporadic, familial recurrences have been observed, which strongly implicate genetic factors. Through the study of animal models, human syndromes, and structural chromosomal variation, several candidate genes have been proposed and subsequently tested with targeted methods in series of individuals with isolated, non-isolated, or syndromic uterine malformations. To date, a few genes have garnered strong evidence of causality, mainly in syndromic presentations (HNF1B, WNT4, WNT7A, HOXA13). Sequencing of candidate genes in series of individuals with isolated uterine abnormalities has been able to suggest an association for several genes, but confirmation of a strong causative effect is still lacking for the majority of them. We review the current state of knowledge about the developmental origins of uterine malformations, with a focus on the genetic variants that have been implicated or associated with these conditions in humans, and we discuss potential reasons for the high rate of negative results. The evidence for various environmental and epigenetic factors is also reviewed. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Adeline Jacquinet
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada.,Center for Human Genetics, Centre Hospitalier Universitaire and University of Liège, Liège, Belgium
| | - Debra Millar
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Anna Lehman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada.,Child and Family Research Institute, Vancouver, Canada
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Cho PS, Bauer SB, Pennison M, Rosoklija I, Bellows AL, Logvinenko T, Khoshbin S, Borer JG. Sacral agenesis and neurogenic bladder: Long-term outcomes of bladder and kidney function. J Pediatr Urol 2016; 12:158.e1-7. [PMID: 26897325 PMCID: PMC4927372 DOI: 10.1016/j.jpurol.2015.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/17/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sacral agenesis (SA) is a rare congenital condition that refers to the absence of part or all of two or more lower sacral vertebral bodies. It can be associated with neurogenic bladder dysfunction that does not necessarily correlate with the level of spinal or skeletal defect. Patients with SA should undergo urodynamic studies (UDS) to guide lower urinary tract (LUT) management. OBJECTIVE This review aimed to update the present institutional experience since 1981 of this rare patient population with detailed, long-term follow-up of bladder and kidney function. STUDY DESIGN A single institution, retrospective, IRB-approved review was performed on patients born after January 1, 1981 with an isolated diagnosis of sacral agenesis without spina bifida, and followed with urologic involvement at Boston Children's Hospital. Records were reviewed for demographics, radiologic imaging, UDS including cystometrogram (CMG) and electromyography (EMG), surgery, and blood chemistries. Comparisons were made between groups of patients based on age at diagnosis, with specific focus on renal function and stability of neurogenic bladder lesion. RESULTS Forty-three patients were identified: 23 female and 20 male. Thirty-seven children (86%) had a known age of diagnosis. Nineteen were diagnosed before 2 months old, including five who were diagnosed prenatally, 11 were diagnosed between 2 and 18 months, and seven were diagnosed after 18 months. All 43 had UDS, with 24 (55.8%) studied at the time of diagnosis (Summary Table). Twenty had serial full UDS, with 30% demonstrating neurourologic instability. None developed end-stage renal disease (ESRD) or required spinal cord detethering. DISCUSSION Many children with SA appeared to be diagnosed prenatally or early in life; SA was mostly identified during evaluation of associated anomalies. Though UDS aid in urologic management, testing was not routinely utilized at the time of diagnosis. CONCLUSIONS This review of long-term follow-up in SA patients showed stable LUT and renal function, with minimal risk of progression to ESRD.
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Affiliation(s)
- P S Cho
- Department of Urology, Boston Children's Hospital, Boston, USA.
| | - S B Bauer
- Department of Urology, Boston Children's Hospital, Boston, USA
| | - M Pennison
- Department of Urology, Boston Children's Hospital, Boston, USA
| | - I Rosoklija
- Department of Urology, Boston Children's Hospital, Boston, USA
| | - A L Bellows
- Department of Urology, Boston Children's Hospital, Boston, USA
| | - T Logvinenko
- Department of Urology, Boston Children's Hospital, Boston, USA
| | - S Khoshbin
- Department of Urology, Boston Children's Hospital, Boston, USA
| | - J G Borer
- Department of Urology, Boston Children's Hospital, Boston, USA
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