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Miao J, Gao Q, Wang Z, Hou G. Familial pulmonary cysts: A clue to diagnose Birt-Hogg-Dubé syndrome: A case report and literature review. Respirol Case Rep 2024; 12:e01319. [PMID: 38455502 PMCID: PMC10918712 DOI: 10.1002/rcr2.1319] [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: 01/27/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
Birt-Hogg-Dubé syndrome (BHD) is an inherited autosomal dominant condition caused by germline mutations in the FLCN gene, mapped to chromosome 17p11.2. Typical manifestations include pulmonary cysts, spontaneous pneumothorax, fibrofolliculomas, and kidney neoplasms. This report details the case of a 56-year-old female non-smoker diagnosed with multiple pulmonary cysts, presenting with a history of recurrent spontaneous pneumothorax. A computed tomography (CT) scan of her daughter revealed similar pulmonary cysts, raising suspicion of BHD. Further abdominal enhanced CT revealed a left renal tumour and cutaneous fibrofolliculomas on her daughter's neck. Consequently, whole-exome sequencing confirmed an FLCN germline mutation in the patient and three relatives, establishing a diagnosis of BHD. This case highlights the importance of familial pulmonary cysts as a clue for diagnosing BHD, providing crucial insights into comparable clinical presentations.
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Affiliation(s)
- Jinrui Miao
- Department of Pulmonary and Critical Care MedicineThe Second Affiliated Hospital of Harbin Medical University, Harbin Medical UniversityHarbinChina
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory MedicineChina‐Japan Friendship HospitalBeijingChina
| | - Qian Gao
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory MedicineChina‐Japan Friendship HospitalBeijingChina
| | - Zilin Wang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory MedicineChina‐Japan Friendship HospitalBeijingChina
| | - Gang Hou
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory MedicineChina‐Japan Friendship HospitalBeijingChina
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2
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Leivaditis V, Papatriantafyllou A, Koletsis E, Mulita F, Dedopoulou P, Panagiotopoulos I, Verras GI, Anzoulas A, Dahm M. A Rare Case of Spontaneous Pneumothorax Recurrence 30 Years After Surgery in a Patient with Birt-Hogg-Dube Syndrome: Case Presentation and Short Review of the Literature. Acta Inform Med 2023; 31:146-150. [PMID: 37711493 PMCID: PMC10498363 DOI: 10.5455/aim.2023.31.146-150] [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: 05/05/2023] [Accepted: 06/25/2023] [Indexed: 09/16/2023] Open
Abstract
Background Birt-Hogg-Dube syndrome (BHDS), also known as Hornstein-Knickenberg syndrome is a rare, autosomal dominant genetic disorder characterized by a triad of clinical manifestations: skin fibrofolliculomas, renal tumors, and multiple pulmonary cysts. The exact incidence of BHDS syndrome is unknown. This hereditary syndrome is caused by mutations in the folliculin (FLCN) gene, located on chromosome 17p11.2, which encodes the folliculin protein. Objective This case report aims to highlight the importance of increased vigilance and long-term follow-up in BHDS patients, even decades after surgical intervention, to detect and manage potential pulmonary complications effectively. Case presentation: We present a unique case of spontaneous pneumothorax recurrence in a 63-year-old patient with a history of Birt-Hogg-Dube syndrome. The patient had undergone surgical treatment for pneumothorax 30 years ago and remained asymptomatic until presenting to our clinic with acute dyspnea and a dry cough. A recurrent pneumothorax was diagnosed and treated with a chest tube. Further chest imaging revealed extensive ground-glass opacities and cysts in both lungs. The patient was diagnosed with active pneumonia. A conservative approach was adopted due to the pneumonia diagnosis, and the patient showed a successful recovery without pneumothorax recurrence. Conclusion This case highlights the importance of long-term follow-up in patients with Birt-Hogg-Dube syndrome and previous pneumothorax episodes.
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Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany
| | | | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, University Hospital of Patras, Patras, Greece
| | - Francesk Mulita
- Department of General Surgery, University Hospital of Patras, Patras, Greece
| | | | - Ioannis Panagiotopoulos
- Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany
| | | | - Andreas Anzoulas
- Department of General Surgery, University Hospital of Patras, Patras, Greece
| | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany
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3
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Dhaliwal A, Le N, Razick DI, Akhtar M, Chima BS. Hydropneumothorax as a Presentation of Birt-Hogg-Dubé Syndrome. Cureus 2023; 15:e38465. [PMID: 37273290 PMCID: PMC10235213 DOI: 10.7759/cureus.38465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Birt-Hogg-Dubé syndrome (BHDS) is a rare genetic disorder characterized by cutaneous, pulmonary, and renal manifestations. We present a unique case in which a combination of multiple chronic illnesses, genetic testing, and significant family history led to a diagnosis of BHDS. A 72-year-old male patient presented to their primary care physician with a persistent cough of four months and was admitted to the emergency department after the discovery of a left hydropneumothorax. The patient's medical history was significant for recurrent spontaneous bilateral pneumothoraces diagnosed over 20 years ago, chronic obstructive pulmonary disease (COPD), and many other systemic illnesses. A combination of the patient's significant past medical and family history led to a diagnosis of BHDS. Genetic testing was also done to confirm the diagnosis. Despite benign skin lesions being the most common finding, they are not always present, as seen in our case, which can result in missed diagnosis. Due to the autosomal dominant nature of BHDS, it is vital to make an accurate diagnosis to allow for proper genetic counseling, as the development of renal cancer is the leading cause of mortality.
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Affiliation(s)
- Anand Dhaliwal
- Surgery, California Northstate University College of Medicine, Elk Grove, USA
| | - Nancy Le
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Daniel I Razick
- Surgery, California Northstate University College of Medicine, Elk Grove, USA
| | - Muzammil Akhtar
- Surgery, California Northstate University College of Medicine, Elk Grove, USA
| | - Biljinder S Chima
- Family Medicine, Sports Medicine, Rocklin Family Practice and Sports Medicine, Rocklin, USA
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4
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Muacevic A, Adler JR. Birt-Hogg-Dubé Syndrome: Two Patients With Different Initial Presentations. Cureus 2022; 14:e30578. [PMID: 36348850 PMCID: PMC9629874 DOI: 10.7759/cureus.30578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2022] [Indexed: 01/24/2023] Open
Abstract
Birt-Hogg-Dubé syndrome (BHD) is a rare genetic disorder caused by germline mutations in the tumor suppressor folliculin gene (FLCN). This condition is characterized by benign skin hamartomas, pulmonary cysts, spontaneous pneumothorax, and an increased risk for developing kidney tumors which range from benign oncocytomas to malignant renal cell carcinomas including chromophobe, clear cell, or papillary subtypes. We describe two cases of BHD with different initial presentations. Patients underwent genetic testing and an FLCN mutation was identified, confirming the diagnosis. Through this case series, we aim to highlight the importance of recognizing key manifestations of BHD whether alone or in combination, followed by genetic testing and counseling and the need for regular follow-ups with surveillance imaging tests to detect renal cancer early on.
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5
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Park HJ, Kim YJ, Kim MJ, Kim HC. Epidemiology and clinical features of Birt-Hogg-Dubé syndrome: A nationwide population-based study in South Korea. PLoS One 2022; 17:e0269358. [PMID: 35666727 PMCID: PMC9170097 DOI: 10.1371/journal.pone.0269358] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/19/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Birt-Hogg-Dubé (BHD) syndrome is an ultrarare lung disease with unclear prevalence and incidence. Our study aimed to identify the epidemiological and clinical features of BHD syndrome by using nationwide claims data from the Korean Health Insurance Review and Assessment service. METHODS Patients with BHD syndrome who had the following criteria were included: 1) tested for folliculin gene mutation, and 2) had at least one of the conditions: other specified malformation syndromes, fibrofolliculoma, acrochordon, lung cyst, cancer, and pneumothorax based on International Classification of Disease-10 code. RESULTS We found 26 patients with BHD syndrome from 2017 to 2019. The prevalence of BHD syndrome was 5.67 per 107 population, with no peak age. Among incidence cases, the median age of diagnosis was 51 years, with slightly more females than males (n = 15, 57.7%). Over half of the patients (n = 14, 53.8%) experienced pneumothorax, and 10 (38.5%) developed malignant neoplasm within the clinical course. CONCLUSIONS The prevalence of BHD syndrome in Korea is extremely low. However, affected patients manifest several comorbidities, including malignant neoplasm and repetitive pneumothorax.
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Affiliation(s)
- Hyung Jun Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Cheol Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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6
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Liu S, Xia K, Liu X, Duan Y, Hu M, Xia H, Lv J, Zhang L, Liu Y, Xia X, Li G, Cui X. Bibliometric Analysis of Birt-Hogg-Dubé Syndrome From 2001 to 2021. Front Med (Lausanne) 2022; 9:857127. [PMID: 35479937 PMCID: PMC9035795 DOI: 10.3389/fmed.2022.857127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/11/2022] [Indexed: 01/27/2023] Open
Abstract
Background Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominant inherited disorder caused by germline mutations in folliculin (FLCN). Despite our significantly evolved understanding of BHD over the past decades, no bibliometric analyses have been conducted in this field. This study aimed to analyze and visualize the characteristics of publication outputs, the research hotspots, and scientific frontiers about BHD using bibliometric analysis. Methods All relevant literature on BHD was culled from the Web of Science Core Collection (WoSCC) database. Valid data were extracted from the articles and visually analyzed using CiteSpace and VOSviewer. Results A total of 751 qualifying papers were included. Publication outputs concerning BHD increased over time. The dominant position of the United States and Japan in BHD research field was evident. National Cancer Institute (the USA) and Yokohama City University (Japan) were the two most productive organizations. W. Marston Linehan exerted a considerable publication impact and had made the most remarkable contributions in the field of BHD. Plos One was the journal with the highest publication outputs, and half of the top 10 journals and co-cited journals belonged to Q1 or Q2. Keyword citation bursts revealed that management, tumor suppressor, flcn gene, spectrum, diagnosis, risk, computed tomography were the emerging research hotspots. Conclusion Research on BHD is prosperous. International cooperation between countries and organizations is also expected to deepen and strengthen in the future. Our results indicated that FLCN-associated pathways involved in the pathogenesis of BHD, specific options for early diagnosis, and molecular-targeting therapies will remain research hotspots in the future.
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Affiliation(s)
- Shixu Liu
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Kun Xia
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaohong Liu
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanyuan Duan
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mu Hu
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Hongsheng Xia
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiayu Lv
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Lili Zhang
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanyi Liu
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Xiao Xia
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Guangxi Li
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Guangxi Li
| | - Xiangning Cui
- Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Xiangning Cui
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7
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Degheili JA, Tanios B, Nasser M. Renal and Lung Cysts in Birt-Hogg-Dubé Syndrome: A Continuum of the Same Disorder. Cureus 2021; 13:e18878. [PMID: 34804727 PMCID: PMC8599113 DOI: 10.7759/cureus.18878] [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] [Accepted: 10/18/2021] [Indexed: 11/06/2022] Open
Abstract
Birt-Hogg-Dubé (BHD) syndrome is a rare autosomal-dominant disorder, affecting multiple organs, mostly the skin, lungs, and kidneys. The prevalence of BHD syndrome is difficult to define given the rarity of the disease. Patients present most often with primary spontaneous pneumothorax. Renal tumors are a characteristic finding in BHD, and are often bilateral and multifocal and of the chromophobe and oncocytoma variant. Very scarce reports have highlighted the presence of simple renal cysts, as the only phenotypical renal manifestation, in BHD patients. Herein, we highlight two novel cases of bilateral multiple renal and pelvic cysts, in two females with genetically proven BHD syndrome, doubting a potential association with BHD syndrome.
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Affiliation(s)
- Jad A Degheili
- Division of Pediatric Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, CAN.,Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, LBN
| | - Bassem Tanios
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, LBN
| | - Mouhamad Nasser
- Department of Respiratory Medicine, National Coordinating Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, University Hospital of Lyon, Lyon, FRA
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8
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Birt-Hogg-Dubé syndrome: Clinical and genetic characterization. Med Clin (Barc) 2021; 158:397-398. [PMID: 34657746 DOI: 10.1016/j.medcli.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022]
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9
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A systematic review assessing the existence of pneumothorax-only variants of FLCN. Implications for lifelong surveillance of renal tumours. Eur J Hum Genet 2021; 29:1595-1600. [PMID: 34267338 PMCID: PMC8560836 DOI: 10.1038/s41431-021-00921-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/14/2021] [Accepted: 06/04/2021] [Indexed: 11/09/2022] Open
Abstract
Individuals with Birt-Hogg-Dubé syndrome (BHDS) may develop fibrofolliculomas, pneumothorax and/or renal cell carcinoma (RCC). Currently, all patients with pathogenic FLCN variants are recommended to have renal surveillance. It has however been suggested that some FLCN variants only cause pneumothorax, which would make surveillance unnecessary in certain cases. This review assesses this possibility. We provide an up-to-date analysis of clinical and genetic features of BHDS. The PUBMED database was systematically searched to find all articles describing patients with pathogenic FLCN variants. The relevant clinical and genetic features of these patients were recorded and analysed. The prevalence of pneumothorax, pulmonary cysts, RCC and characteristic skin lesions in BHDS were 50.9% (n = 1038), 91.9% (n = 720), 22.5% (n = 929) and 47.9% (n = 989), respectively. There was a higher prevalence of pneumothoraces (p < 0.0001) but lower prevalence of dermatological findings (p < 0.0001) in patients from East Asia compared to North America or Europe. Of the 194 pathogenic FLCN variants, 76 could be defined as 'pneumothorax-only'. Pneumothorax only pathogenic variants (POPVs) were distributed throughout the gene, and there were no statistical differences in variant type. The majority of POPVs (65/76) affected no more than three individuals. Individuals with 'POPVs' also tended to be younger (45 vs. 47 years, p < 0.05). Many apparent POPVs in the literature could result from variable expressivity, age-related penetrance and other confounding factors. We therefore recommend that all individuals found to carry a pathogenic FLCN variant be enroled in lifelong surveillance for RCC.
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10
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Muller ME, Daccord C, Taffé P, Lazor R. Prevalence of Birt-Hogg-Dubé Syndrome Determined Through Epidemiological Data on Spontaneous Pneumothorax and Bayes Theorem. Front Med (Lausanne) 2021; 8:631168. [PMID: 33987191 PMCID: PMC8111214 DOI: 10.3389/fmed.2021.631168] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Birt-Hogg-Dubé syndrome (BHD) is a rare inherited disorder characterized by cutaneous fibrofolliculomas, multiple pulmonary cysts, recurrent spontaneous pneumothorax (SP), and renal tumors. More than 40 years after its description, the prevalence of BHD in the general population remains unknown. This study aimed at determining the prevalence of BHD by applying the Bayes theorem of conditional probability to epidemiological data on SP. Methods: We performed a meta-analysis of published data on: (1) the probability of having BHD among patients with apparent primary SP (4 studies), (2) the incidence rate of primary SP in the general population (9 studies), and (3) the probability of experiencing a SP in BHD (16 studies). Results were corrected for SP relapses, stratified by gender and year of study publication (before and after 2000), and computed with the Bayes equation. Results: The probability of having BHD among patients with apparent primary SP was 0.09 (95% confidence interval: 0.07, 0.11) or 9%. It was 0.20 (0.14, 0.27) in women and 0.05 (0.04, 0.07) in men. The incidence rate of primary SP in the general population was 8.69 (6.58, 11.46) per 100,000 person-years (p-y). It was 3.44 (2.36, 4.99) per 100,000 p-y in women and 13.96 (10.72, 18.18) per 100,000 p-y in men, and was about 2 times higher in studies published after 2000 than in those published before 2000. The probability of experiencing at least one SP among patients with BHD was 0.43 (0.31, 0.54) or 43%, without gender difference. By combining these data in the Bayes equation, we found a prevalence of BHD in the general population of 1.86 (1.16, 3.00) per million, with values of 1.86 (1.02, 3.39) per million in men, and 1.88 (0.97, 3.63) per million in women. Conclusion: The prevalence of BHD in the general population is about 2 cases per million, without difference between genders.
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Affiliation(s)
- Marie-Eve Muller
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Cécile Daccord
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Patrick Taffé
- University Center for Primary Care and Public Health (Unisanté), DFRI/Division of Biostatistics, University of Lausanne, Lausanne, Switzerland
| | - Romain Lazor
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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11
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Guo T, Shen Q, Ouyang R, Song M, Zong D, Shi Z, Long Y, Chen P, Peng H. The clinical characteristics of East Asian patients with Birt-Hogg-Dubé syndrome. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1436. [PMID: 33313181 PMCID: PMC7723594 DOI: 10.21037/atm-20-1129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Birt-Hogg-Dube (BHD) syndrome is an autosomal dominant disease that has been characterized by skin lesions, multiple pulmonary cysts, spontaneous pneumothorax, and renal tumors, but the patients in Asian countries may show fewer symptoms. We aimed to explore and summarize the clinical features of BHD patients in East Asia to facilitate early diagnosis and timely interventions. Methods We collected and analyzed the clinical data of patients diagnosed with BHD in our hospital by reviewing medical records. We performed a systematic literature search regarding the presenting clinical features in BHD patients from China, Japan, and Korea and then reviewed the publications that were identified. Results In our hospital, 10 patients were diagnosed with BHD from April 2015 to September 2019. After reviewing the literature, we recruited 38 articles, including 12, 20, and 6 reports from China, Japan, and Korea, respectively. A total of 166 patients were included in this study, and 100 of them (60.2%) were females. Multiple pulmonary cysts were present in 145 patients (87.3%), and 124 patients (74.7%) had a history of pneumothorax on at least one occasion. Skin biopsy confirmed fibrofolliculomas (FFs) alone in 22 patients (13.3%), trichodiscomas (TDs) alone in 3 patients (1.8%), and both FFs and TDs in 7 patients (4.2%). Renal carcinoma only occurred in 12 (7.2%) patients. The most frequent genetic mutations in East Asian patients were c.1285delC on exon 11 (18.4%), c.1285dupC on exon 11 (18.4%), and c.1347_1353dupCCACCCT on exon 12 (8.2%). Conclusions Our findings suggested that pulmonary cysts are the most frequent radiological findings, and pneumothorax is the most common symptom in East Asian patients with BHD, and that skin lesions and kidney involvement are less frequent. To make an early diagnosis and minimize the severity of complications, careful observation, and timely genetic examination of the FLCN gene is essential.
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Affiliation(s)
- Ting Guo
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, China.,Research Unit of Respiratory Disease, Central-South University, Changsha, China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, China
| | - Qinxue Shen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, China.,Research Unit of Respiratory Disease, Central-South University, Changsha, China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, China
| | - Ruoyun Ouyang
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, China.,Research Unit of Respiratory Disease, Central-South University, Changsha, China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, China
| | - Min Song
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, China.,Research Unit of Respiratory Disease, Central-South University, Changsha, China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, China
| | - Dandan Zong
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, China.,Research Unit of Respiratory Disease, Central-South University, Changsha, China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, China
| | - Zhihui Shi
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, China.,Research Unit of Respiratory Disease, Central-South University, Changsha, China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, China
| | - Yingjiao Long
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, China.,Research Unit of Respiratory Disease, Central-South University, Changsha, China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, China
| | - Ping Chen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, China.,Research Unit of Respiratory Disease, Central-South University, Changsha, China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, China
| | - Hong Peng
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central-South University, Changsha, China.,Research Unit of Respiratory Disease, Central-South University, Changsha, China.,The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, China
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12
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Daccord C, Good JM, Morren MA, Bonny O, Hohl D, Lazor R. Birt-Hogg-Dubé syndrome. Eur Respir Rev 2020; 29:29/157/200042. [PMID: 32943413 PMCID: PMC9489184 DOI: 10.1183/16000617.0042-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/22/2020] [Indexed: 12/22/2022] Open
Abstract
Birt–Hogg–Dubé syndrome (BHD) is a rare inherited autosomal dominant disorder caused by germline mutations in the tumour suppressor gene FLCN, encoding the protein folliculin. Its clinical expression typically includes multiple pulmonary cysts, recurrent spontaneous pneumothoraces, cutaneous fibrofolliculomas and renal tumours of various histological types. BHD has no sex predilection and tends to manifest in the third or fourth decade of life. Multiple bilateral pulmonary cysts are found on chest computed tomography in >80% of patients and more than half experience one or more episodes of pneumothorax. A family history of pneumothorax is an important clue, which suggests the diagnosis of BHD. Unlike other cystic lung diseases such as lymphangioleiomyomatosis and pulmonary Langerhans cell histiocytosis, BHD does not lead to progressive loss of lung function and chronic respiratory insufficiency. Renal tumours affect about 30% of patients during their lifetime, and can be multiple and recurrent. The diagnosis of BHD is based on a combination of genetic, clinical and/or skin histopathological criteria. Management mainly consists of early pleurodesis in the case of pneumothorax, periodic renal imaging for tumour detection, and diagnostic work-up in search of BHD in relatives of the index patient. Birt–Hogg–Dubé syndrome is a rare genetic disorder characterised by multiple lung cysts, recurrent pneumothoraces, skin lesions and kidney tumours. As the presenting symptoms may be respiratory, chest physicians should be able to identify this disease.https://bit.ly/2xsOTuk
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Affiliation(s)
- Cécile Daccord
- Respiratory Medicine Dept, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Marc Good
- Division of Genetic Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie-Anne Morren
- Pediatric Dermatology Unit, Dept of Pediatrics and Dermatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Bonny
- Service of Nephrology, Dept of Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Dept of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Daniel Hohl
- Dermatology Dept, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Romain Lazor
- Respiratory Medicine Dept, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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13
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Yang T, Heydarian M, Kozjak-Pavlovic V, Urban M, Harbottle RP, Rudel T. Folliculin Controls the Intracellular Survival and Trans-Epithelial Passage of Neisseria gonorrhoeae. Front Cell Infect Microbiol 2020; 10:422. [PMID: 33014885 PMCID: PMC7499807 DOI: 10.3389/fcimb.2020.00422] [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: 05/04/2020] [Accepted: 07/08/2020] [Indexed: 12/18/2022] Open
Abstract
Neisseria gonorrhoeae, a Gram-negative obligate human pathogenic bacterium, infects human epithelial cells and causes sexually transmitted diseases. Emerging multi-antibiotic resistant gonococci and increasing numbers of infections complicate the treatment of infected patients. Here, we used an shRNA library screen and next-generation sequencing to identify factors involved in epithelial cell infection. Folliculin (FLCN), a 64 kDa protein with a tumor repressor function was identified as a novel host factor important for N. gonorrhoeae survival after uptake. We further determined that FLCN did not affect N. gonorrhoeae adherence and invasion but was essential for its survival in the cells by modulating autophagy. In addition, FLCN was also required to maintain cell to cell contacts in the epithelial layer. In an infection model with polarized cells, FLCN inhibited the polarized localization of E-cadherin and the transcytosis of gonococci across polarized epithelial cells. In conclusion, we demonstrate here the connection between FLCN and bacterial infection and in particular the role of FLCN in the intracellular survival and transcytosis of gonococci across polarized epithelial cell layers.
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Affiliation(s)
- Tao Yang
- Biocenter, Chair of Microbiology, University of Würzburg, Würzburg, Germany
| | | | | | - Manuela Urban
- DNA Vector Lab, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | | | - Thomas Rudel
- Biocenter, Chair of Microbiology, University of Würzburg, Würzburg, Germany
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14
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Alexander A, Hunter K, Passerini S, Bhat R, Bhat AP. Appendiceal diverticulosis in a patient with family history of Birt-Hogg-Dubé syndrome--a case report. Radiol Case Rep 2020; 15:1317-1322. [PMID: 32612732 PMCID: PMC7322125 DOI: 10.1016/j.radcr.2020.05.071] [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: 05/04/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022] Open
Abstract
Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominant disorder that predisposes patients to cutaneous tumors, pulmonary cysts with recurrent spontaneous pneumothoraces, and a variety of renal neoplasms including hybrid oncocytic and chromophobe renal cell carcinomas. There has been much debate regarding the genetic link with the occurrence of colorectal cancer and other colonic anomalies. Associations between BHD and intestinal adenomatous polyposis and sigmoid diverticulosis have been described in the literature, but there have been no prior reports of appendiceal diverticulosis in patients with BHD. Here, we present a 40-year-old female patient with a known family history of BHD, who was found to have diverticulosis of the appendix and pulmonary blebs on computed tomography upon routine screening for renal and pulmonary abnormalities, suggesting additional focus be given to the gastrointestinal tract (including the appendix) at the time of CT assessment.
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Affiliation(s)
- Alan Alexander
- Renaissance Imaging Medical Associates, Northridge, CA, USA
| | - Kyle Hunter
- Department of Radiology, Cleveland Clinic, OH, USA
| | | | - Roopa Bhat
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri- Columbia, One Hospital Drive, Columbia, MO, 65212, USA
| | - Ambarish P Bhat
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri- Columbia, One Hospital Drive, Columbia, MO, 65212, USA
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15
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Daccord C, Cottin V, Prévot G, Uzunhan Y, Mornex JF, Bonniaud P, Borie R, Briault A, Collonge-Rame MA, Crestani B, Devouassoux G, Freynet O, Gondouin A, Hauss PA, Khouatra C, Leroy S, Marchand-Adam S, Marquette C, Montani D, Naccache JM, Nadeau G, Poulalhon N, Reynaud-Gaubert M, Salaun M, Wallaert B, Cordier JF, Faouzi M, Lazor R. Lung function in Birt-Hogg-Dubé syndrome: a retrospective analysis of 96 patients. Orphanet J Rare Dis 2020; 15:120. [PMID: 32448321 PMCID: PMC7245949 DOI: 10.1186/s13023-020-01402-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/06/2020] [Indexed: 12/21/2022] Open
Abstract
Background Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominant disorder caused by mutations in the FLCN gene coding for folliculin. Its clinical expression includes cutaneous fibrofolliculomas, renal tumors, multiple pulmonary cysts, and recurrent spontaneous pneumothoraces. Data on lung function in BHD are scarce and it is not known whether lung function declines over time. We retrospectively assessed lung function at baseline and during follow-up in 96 patients with BHD. Results Ninety-five percent of BHD patients had multiple pulmonary cysts on computed tomography and 59% had experienced at least one pneumothorax. Mean values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and total lung capacity were normal at baseline. Mean (standard deviation) residual volume (RV) was moderately increased to 116 (36) %pred at baseline, and RV was elevated > 120%pred in 41% of cases. Mean (standard deviation) carbon monoxide transfer factor (DLco) was moderately decreased to 85 (18) %pred at baseline, and DLco was decreased < 80%pred in 33% of cases. When adjusted for age, gender, smoking and history of pleurodesis, lung function parameters did not significantly decline over a follow-up period of 6 years. Conclusions Cystic lung disease in BHD does not affect respiratory function at baseline except for slightly increased RV and reduced DLco. No significant deterioration of lung function occurs in BHD over a follow-up period of 6 years.
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Affiliation(s)
- C Daccord
- Service de pneumologie, Centre hospitalier universitaire vaudois, Université de Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - V Cottin
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, hôpital Louis Pradel, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, UMR754 INRA, IVPC, Lyon, France
| | - G Prévot
- Service de pneumologie, Centre hospitalier universitaire de Toulouse, Toulouse, France
| | - Y Uzunhan
- Service de pneumologie, Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, INSERM UMR 1272, Université Paris 13, Bobigny, France
| | - J F Mornex
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, hôpital Louis Pradel, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, UMR754 INRA, IVPC, Lyon, France
| | - P Bonniaud
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre hospitalier universitaire Dijon/Bourgogne, Université Bourgogne-Franche Comté, INSERM U123-1, Dijon, France
| | - R Borie
- Service de pneumologie, Assistance Publique Hôpitaux de Paris, Hôpital Bichat - Claude Bernard, Paris, France
| | - A Briault
- Service de pneumologie, Centre hospitalier universitaire de Grenoble, Grenoble, France
| | - M A Collonge-Rame
- Service de génétique biologique - histologie, UF cytogénétique, UF consultations d'oncogénétique, Centre hospitalier universitaire de Besançon, Besançon, France
| | - B Crestani
- Service de pneumologie, Assistance Publique Hôpitaux de Paris, Hôpital Bichat - Claude Bernard, Paris, France
| | - G Devouassoux
- Service de pneumologie, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France
| | - O Freynet
- Service de pneumologie, Assistance Publique Hôpitaux de Paris, Hôpital Avicenne, INSERM UMR 1272, Université Paris 13, Bobigny, France
| | - A Gondouin
- Service de pneumologie, Centre hospitalier universitaire de Besançon, Besançon, France
| | - P A Hauss
- Centre hospitalier intercommunal Elbeuf - Louviers - Val de Reuil, Elbeuf, France
| | - C Khouatra
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, hôpital Louis Pradel, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, UMR754 INRA, IVPC, Lyon, France
| | - S Leroy
- Service de pneumologie, Université Côte d'Azur, Centre hospitalier universitaire de Nice, CNRS, INSERM, FHU OncoAge, Nice, France
| | - S Marchand-Adam
- Service de pneumologie, Centre hospitalier universitaire de Tours, Tours, France
| | - C Marquette
- Service de pneumologie, Université Côte d'Azur, Centre hospitalier universitaire de Nice, CNRS, INSERM, FHU OncoAge, Nice, France
| | - D Montani
- Service de Pneumologie, Université Paris-Sud, Assistance Publique Hôpitaux de Paris, INSERM UMR S999, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - J M Naccache
- Service de Pneumologie, Site constitutif du Centre de référence des maladies pulmonaires rares OrphaLung, Assistance Publique Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - G Nadeau
- Centre hospitalier Métropole Savoie, UF de Génétique chromosomique, Chambéry, France
| | - N Poulalhon
- Service de dermatologie, Hospices Civils de Lyon, Centre hospitalier Lyon-Sud, Lyon, France
| | - M Reynaud-Gaubert
- Service de pneumologie, Centre de compétences des maladies pulmonaires rares, Assistance Publique Hôpitaux de Marseille, Centre hospitalier universitaire de Marseille, Aix Marseille Université, Marseille, France
| | - M Salaun
- Service de pneumologie, Centre hospitalier universitaire de Rouen, Rouen, France
| | - B Wallaert
- Service de pneumologie, Centre hospitalier universitaire de Lille, Lille, France
| | - J F Cordier
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, hôpital Louis Pradel, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, UMR754 INRA, IVPC, Lyon, France
| | - M Faouzi
- Division de biostatistique, Centre universitaire de médecine générale et santé publique (Unisanté), Université de Lausanne, Lausanne, Switzerland
| | - R Lazor
- Service de pneumologie, Centre hospitalier universitaire vaudois, Université de Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
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16
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Recurrent primary spontaneous pneumothorax in a large Chinese family: a clinical and genetic investigation. Chin Med J (Engl) 2020; 132:2402-2407. [PMID: 31567476 PMCID: PMC6831060 DOI: 10.1097/cm9.0000000000000442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) is a common manifestation of Birt-Hogg-Dubé (BHD) syndrome, which is an autosomal dominant disorder caused by mutation of the folliculin (FLCN) gene. This study was established to investigate the mutation of the FLCN gene and the phenotype in a family with PSP. METHODS We investigated the clinical and genetic characteristics of a large Chinese family with recurrent spontaneous pneumothorax. Genetic testing was performed by Sanger sequencing of the coding exons (4-14 exons) of the FLCN gene. RESULTS Among ten affected members in a multi-generational PSP kindred, with a total of 18 episodes of spontaneous pneumothorax, the median age for the initial onset of pneumothorax was 42.5 years (interquartile range: 28.8-57.2 years). Chest computed tomography scan of the proband showed pulmonary cysts and pneumothorax. A novel nonsense mutation (c.1273C>T) in exon 11 of FLCN gene that leads to a pre-mature stop codon (p.Gln425*) was identified in the family. The genetic analysis confirmed the diagnosis of BHD syndrome in this family in the absence of skin lesions or renal tumors. CONCLUSIONS A novel nonsense mutation of FLCN gene was found in a large family with PSP in China. Our results expand the mutational spectrum of FLCN gene in patients with BHD syndrome.
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17
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Vogl M, Scheed A, Seebacher G, Stubenberger E, Ghanim B. A novel mutation of the folliculin gene causing Birt-Hogg-Dubé syndrome as rare cause for secondary pneumothorax. Oxf Med Case Reports 2020; 2020:omaa016. [PMID: 32257251 PMCID: PMC7104189 DOI: 10.1093/omcr/omaa016] [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: 11/14/2019] [Revised: 01/28/2020] [Accepted: 02/19/2020] [Indexed: 12/02/2022] Open
Abstract
The Birt–Hogg–Dubé syndrome is an orphan genetic disease characterized by the development of renal neoplasms, fibrofolliculomas, pulmonary cysts and spontaneous pneumothoraces. Here, we report on the case of a 21-year-old man presenting with a primary event of a persistent spontaneous pneumothorax. Computed tomography images and a positive family history for pneumothoraces led to the suspicion of Birt–Hogg–Dubé syndrome. Genetic testing then confirmed the suspected clinical diagnosis, however with a mutation that has not yet been reported.
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Affiliation(s)
- Melanie Vogl
- Division of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Axel Scheed
- Division of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria.,Institute of Clinical Surgery, Karl Landsteiner Society, Krems an der Donau, Austria
| | - Gernot Seebacher
- Division of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria.,Institute of Clinical Surgery, Karl Landsteiner Society, Krems an der Donau, Austria
| | - Elisabeth Stubenberger
- Division of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Bahil Ghanim
- Division of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria.,Institute of Clinical Surgery, Karl Landsteiner Society, Krems an der Donau, Austria
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18
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Boone PM, Scott RM, Marciniak SJ, Henske EP, Raby BA. The Genetics of Pneumothorax. Am J Respir Crit Care Med 2019; 199:1344-1357. [PMID: 30681372 PMCID: PMC6543724 DOI: 10.1164/rccm.201807-1212ci] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/23/2019] [Indexed: 12/21/2022] Open
Abstract
A genetic influence on spontaneous pneumothoraces-those occurring without a traumatic or iatrogenic cause-is supported by several lines of evidence: 1) pneumothorax can cluster in families (i.e., familial spontaneous pneumothorax), 2) mutations in the FLCN gene have been found in both familial and sporadic cases, and 3) pneumothorax is a known complication of several genetic syndromes. Herein, we review known genetic contributions to both sporadic and familial pneumothorax. We summarize the pneumothorax-associated genetic syndromes, including Birt-Hogg-Dubé syndrome, Marfan syndrome, vascular (type IV) Ehlers-Danlos syndrome, alpha-1 antitrypsin deficiency, tuberous sclerosis complex/lymphangioleiomyomatosis, Loeys-Dietz syndrome, cystic fibrosis, homocystinuria, and cutis laxa, among others. At times, pneumothorax is their herald manifestation. These syndromes have serious potential extrapulmonary complications (e.g., malignant renal tumors in Birt-Hogg-Dubé syndrome), and surveillance and/or treatment is available for most disorders; thus, establishing a diagnosis is critical. To facilitate this, we provide an algorithm to guide the clinician in discerning which cases of spontaneous pneumothorax may have a genetic or familial contribution, which cases warrant genetic testing, and which cases should prompt an evaluation by a geneticist.
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Affiliation(s)
- Philip M. Boone
- Harvard Genetics Training Program, Boston, Massachusetts
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Rachel M. Scott
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - Stefan J. Marciniak
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
- Division of Respiratory Medicine, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Elizabeth P. Henske
- Pulmonary Genetics Center, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Benjamin A. Raby
- Pulmonary Genetics Center, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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19
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Escalon JG, Richards JC, Koelsch T, Downey GP, Lynch DA. Isolated Cystic Lung Disease: An Algorithmic Approach to Distinguishing Birt-Hogg-Dubé Syndrome, Lymphangioleiomyomatosis, and Lymphocytic Interstitial Pneumonia. AJR Am J Roentgenol 2019; 212:1260-1264. [PMID: 30888864 DOI: 10.2214/ajr.18.20920] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Birt-Hogg-Dubé (BHD) syndrome, lymphangioleiomyomatosis (LAM), and lymphocytic interstitial pneumonia (LIP) frequently present as isolated cystic lung disease and can be challenging to distinguish. If imaging findings are otherwise unremarkable, the radiologist is unaided by ancillary CT findings in narrowing the diagnosis. We hypothesized that the distribution and morphologic features of lung cysts could be used to differentiate BHD syndrome, LAM, and LIP. Therefore, the purpose of this study was to characterize the CT appearances of these conditions and create a practical CT-based algorithm to differentiate among them. MATERIALS AND METHODS. The study was a retrospective review of the CT images of 16 patients with BHD syndrome, 17 patients with LAM, and 14 patients with LIP. On the basis of the data collected, a CT-based algorithm was created, and the CT images were reviewed again. RESULTS. Lower lung-predominant cysts were significantly more likely to be found in patients with BHD syndrome (100% of patients) or LIP (71-93% of patients) than in patients with LAM (6-12% of patients), who were more likely to have diffuse cysts. Compared with patients with LIP or LAM, patients with BHD syndrome were significantly more likely to have elliptical (floppy) paramediastinal cysts (88-94% of patients with BHD syndrome, 36-43% of patients with LIP, and 6-12% of patients with LAM) or a disproportionate number of paramediastinal cysts (69-88% of patients with BHD syndrome, 0-14% of patients with LIP, and 0-6% of patients with LAM). Our algorithm enabled differentiation of BHD syndrome, LAM, and LIP with a high level of accuracy and high interreader agreement (κ = 0.809). CONCLUSION. Radiologists can use the proposed CT-based algorithm to prospectively and confidently suggest one of these disorders as the favored diagnosis. Of importance, this will allow diagnosing the disorder early and accurately, screening for comorbidities, and prevention of potential complications.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, National Jewish Health, Denver, CO
- Present address: NewYork-Presbyterian/Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | | | - Tilman Koelsch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Gregory P Downey
- Department of Medicine, National Jewish Health, Denver, CO
- Department of Pediatrics, National Jewish Health, Denver, CO
- Department of Biomedical Research, National Jewish Health, Denver, CO
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Aurora, CO
- Department of Immunology and Microbiology, University of Colorado, Aurora, CO
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
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20
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Birt-Hogg-Dubé Syndrome: A Review of Dermatological Manifestations and Other Symptoms. Am J Clin Dermatol 2018; 19:87-101. [PMID: 28695430 DOI: 10.1007/s40257-017-0307-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Birt-Hogg-Dubé syndrome (BHD) is an autosomal dominant genodermatosis with malignant potential characterized by cutaneous and extracutaneous stigmata. Aberrations in the folliculin (FLCN) gene, which is located on chromosome 17, have been discovered in individuals with this condition. Over 150 unique mutations have been identified in BHD. The skin lesions associated with this condition include fibrofolliculomas, trichodiscomas, perifollicular fibromas, and acrochordons. Extracutaneous features of the syndrome typically include the lung (spontaneous pneumothorax and cysts) and the kidney (neoplasms). The only malignancies associated with BHD are renal cancers; however, other tumors have been observed in individuals with BHD. In this article, the skin lesions associated with this condition are reviewed, lung and renal manifestations associated with this syndrome are presented, and malignancies occurring in these patients are summarized.
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21
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Daccord C, Nicod L, Lazor R. Cystic Lung Disease in Genetic Syndromes with Deficient Tumor Suppressor Gene Function. Respiration 2017; 94:467-485. [DOI: 10.1159/000485106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 12/28/2022] Open
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22
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Xing H, Liu Y, Jiang G, Li X, Hou Y, Yang F, Wang J. Clinical and genetic study of a large Chinese family presented with familial spontaneous pneumothorax. J Thorac Dis 2017; 9:1967-1972. [PMID: 28839995 DOI: 10.21037/jtd.2017.06.69] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Familial spontaneous pneumothorax (FSP) is an inherited disease, and Birt-Hogg-Dubé (BHD) syndrome is its leading cause. BHD syndrome is an autosomal dominant disorder characterized by pulmonary cysts, spontaneous pneumothorax, renal cancer, and skin fibrofolliculomas. It is caused by germline mutations in the FLCN gene. Thus far a variety of mutations have been reported; however, the unique characteristics of BHD syndrome-related FSP are still unclear. METHOD We reviewed the family history of a large Chinese family that presented with FSP. Genetic testing of the FLCN gene was performed and the special clinical characteristics of BHD syndrome-related FSP were discussed. RESULTS This family comprised 5 generations and 76 members. Six of these had experienced pneumothorax episodes and 35 members had undergone genetic analysis of the FLCN gene, except for one member who had pneumothorax. Among the 35 members, 17 had the mutation in the FLCN gene. All five members with pneumothorax had the mutation. Frequency of pneumothorax in the mutation members was 29.4% (5/17). Clinical characteristics of the BHD syndrome-related pneumothorax differed from those of primary spontaneous pneumothorax, which typically affects tall, thin young men, and the recurrence rate of BHD syndrome-related pneumothorax after observation, needle aspiration or tube drainage was higher than that of primary spontaneous pneumothorax, and higher than that observed after VATS bullectomy and mechanical pleurodesis. CONCLUSIONS We reported the largest single family that presented with FSP from China. The clinical and genetic characteristics of the BHD syndrome-related pneumothorax differ from those of primary spontaneous pneumothorax.
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Affiliation(s)
- Huajie Xing
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Yanguo Liu
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Guanchao Jiang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Xiao Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Yanyan Hou
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
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23
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Rato M, Monteiro AF, Parente J, Aranha J, Tavares E. Birt-Hogg-Dubé Syndrome - report of two cases with two new mutations. J Dermatol Case Rep 2017; 11:12-15. [PMID: 28539984 DOI: 10.3315/jdcr.2017.1242] [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: 10/05/2016] [Accepted: 11/13/2016] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Birt-Hogg-Dubé syndrome (BHDS) is a rare autosomal dominant genodermatosis characterized by cutaneous fibrofolliculomas and/or trichodiscomas, lung cysts, spontaneous pneumothorax and renal tumors. However, its clinical expression is highly variable. This syndrome is caused by germline mutations in the folliculin gene (FLCN) on chromosome 17p11.2. MAIN OBSERVATIONS Two men, 60 and 39-year-old, presented with a several year history of asymptomatic whitish papules scattered over the face and neck. Skin biopsies revealed fibrofolliculomas. The clinical diagnosis of BHDS was corroborated by identification of new heterozygotic mutations in FLCN gene, in exon 6 (C.573_574delinsT) and in exon 9 (c.1015C>T), respectively. Computed tomography scan of the thorax and abdomen showed pulmonary cysts with no suspicious kidneys lesions, and, in the case of the second patient, a mass in left adrenal gland. Laparoscopic left adrenalectomy was performed and histopathological examination was compatible with a malignant perivascular epithelioid cell tumor. CONCLUSIONS The presence of multiple fibrofolliculomas should raise the suspicion of BHDS. Patients with this syndrome, regardless of the detected mutation, should be carefully monitored to ensure that potentially serious disease-related conditions can be detected early.
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Affiliation(s)
- Margarida Rato
- Dermatology Department of Hospital de Santarém EPE, Santarém, Portugal
| | | | - Joana Parente
- Dermatology Department of Hospital de Santarém EPE, Santarém, Portugal
| | - João Aranha
- Dermatology Department of Hospital de Santarém EPE, Santarém, Portugal
| | - Ermelindo Tavares
- Dermatology Department of Hospital de Santarém EPE, Santarém, Portugal
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24
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Jensen DK, Villumsen A, Skytte AB, Madsen MG, Sommerlund M, Bendstrup E. Birt-Hogg-Dubé syndrome: a case report and a review of the literature. Eur Clin Respir J 2017; 4:1292378. [PMID: 28326182 PMCID: PMC5345590 DOI: 10.1080/20018525.2017.1292378] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/31/2017] [Indexed: 01/12/2023] Open
Abstract
Background: Birt-Hogg-Dubé syndrome (BHDS) is a rare autosomal dominant inherited syndrome caused by mutations in the folliculin coding gene (FLCN). The clinical manifestations of the syndrome involve the skin, lungs, and kidneys. Because of the rarity of the syndrome, guidelines for diagnosis and management of the patients with BHDS are lacking. Objective: To present a case story and a review of the literature on BHDS in order to give an update on genetics, clinical manifestations, diagnosis, treatment, prognosis and follow-up strategies. Design: Literature review and case story. Results: A PubMed and Embase search identified 330 papers. BHDS is characterized by small benign tumors in the skin, spontaneous pneumothoraces caused by cysts in the lungs and a seven-fold increased risk of renal cancer. A case story of a young female patient presenting with pneumothorax and a family history of recurrent pneumothoraces in many relatives illustrates how the history and the diagnostic work up resulted in a diagnosis of BHDS. Conclusion: BHDS is a rare inherited disorder. In patients with spontaneous pneumothorax or cystic lung disease without any obvious explanation, BHDS should be considered. Concomitant skin manifestations, a family history of familiar pneumothorax, renal cancers and skin manifestations supports the suspicion of BHDS. Early diagnosis is important in order to subject patients to systematic screening for renal cancers. A radiological surveillance strategy for renal cancer is proposed.
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Affiliation(s)
- Dea Kejlberg Jensen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital , Aarhus , Denmark
| | - Anders Villumsen
- Institute of Clinical Medicine, Aarhus University , Aarhus , Denmark
| | - Anne-Bine Skytte
- Department of Clinical Genetics, Aarhus University Hospital , Aarhus , Denmark
| | | | - Mette Sommerlund
- Department of Dermatology, Aarhus University Hospital , Aarhus , Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital , Aarhus , Denmark
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Park HJ, Park CH, Lee SE, Lee GD, Byun MK, Lee S, Lee KA, Kim TH, Kim SH, Yang SY, Kim HJ, Ahn CM. Birt-Hogg-Dube syndrome prospectively detected by review of chest computed tomography scans. PLoS One 2017; 12:e0170713. [PMID: 28151982 PMCID: PMC5289479 DOI: 10.1371/journal.pone.0170713] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/09/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Birt-Hogg-Dube syndrome (BHD) is a rare disorder caused by mutations in the gene that encodes folliculin (FLCN) and is inherited in an autosomal dominant manner. BHD is commonly accompanied by fibrofolliculomas, renal tumors, multiple pulmonary cysts, and spontaneous pneumothorax. The aim of this study was to detect BHD prospectively in patients undergoing chest computed tomography (CT) scans and to evaluate further the characteristics of BHD in Korea. METHODS We prospectively checked and reviewed the chest CT scans obtained for 10,883 patients at Gangnam Severance Hospital, Seoul, Korea, from June 1, 2015 to May 31, 2016. Seventeen patients met the study inclusion criteria and underwent screening for FLCN mutation to confirm BHD. We analyzed the characteristics of the patients confirmed to have BHD and those for a further 6 patients who had previously been described in Korea. RESULTS Six (0.06%) of the 10,883 patients reviewed were diagnosed with BHD. There was no difference in demographic or clinical features between the patients with BHD (n = 6) and those without BHD (n = 11). Pneumothorax was present in 50% of the patients with BHD but typical skin and renal lesions were absent. The maximum size of the cysts in the BHD group (median 39.4 mm; interquartile range [IQR] 11.4 mm) was significantly larger than that in the non-BHD group (median 15.8 mm; IQR 7.8 mm; P = 0.001). Variable morphology was seen in 100.0% of the cysts in the BHD group but in only 18.2% of the cysts in the non-BHD group (P = 0.002). Nine (95%) of the total of 12 Korean patients with BHD had experienced pneumothorax. Typical skin and renal lesions were present in 20.0% of patients with BHD. CONCLUSIONS Our findings suggest that BHD can be detected if chest CT scans are read in detail.
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Affiliation(s)
- Hye Jung Park
- Pulmonary Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Hwan Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Eun Lee
- Department of Dermatology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kwang Byun
- Pulmonary Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-A Lee
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Han Kim
- Pulmonary Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seo Yeon Yang
- Pulmonary Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Jung Kim
- Pulmonary Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Min Ahn
- Pulmonary Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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