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Plamper M, Gohlke B, Woelfle J. PTEN hamartoma tumor syndrome in childhood and adolescence-a comprehensive review and presentation of the German pediatric guideline. Mol Cell Pediatr 2022; 9:3. [PMID: 35187600 PMCID: PMC8859017 DOI: 10.1186/s40348-022-00135-1] [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: 09/24/2021] [Accepted: 01/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background The PTEN hamartoma tumor syndrome (PHTS) encompasses several different syndromes, which are linked to an autosomal-dominant mutation of the tumor suppressor PTEN gene on chromosome 10. Loss of PTEN activity leads to an increased phosphorylation of different cell proteins, which may have an influence on growth, migration, and apoptosis. Excessive activity of the PI3K/AKT/mTOR pathway due to PTEN deficiency may lead to the development of benign and malignant tumors and overgrowth. Diagnosis of PHTS in childhood can be even more challenging than in adulthood because of a lack of well-defined diagnostic criteria. So far, there are no official recommendations for cancer surveillance in affected children and adolescents. Main body All individuals with PHTS are at high risk for tumor development and thus might benefit from cancer surveillance strategies. In childhood, macrocephaly may be the only evident symptom, but developmental delay, behavioral problems, dermatological features (e.g., penile freckling), vascular anomalies, lipoma, or enlarged perivascular spaces in cerebral magnetic resonance imaging (cMRI) may help to establish the diagnosis. Regular psychomotor assessment and assistance in subjects with neurological impairment play an important role in the management of affected children. Already in early childhood, affected patients bear a high risk to develop thyroid pathologies. For that reason, monitoring of thyroid morphology and function should be established right after diagnosis. We present a detailed description of affected organ systems, tools for initiation of molecular diagnostic and screening recommendations for patients < 18 years of age. Conclusion Affected families frequently experience a long way until the correct diagnosis for their child’s peculiarity is made. Even after diagnosis, it is not easy to find a physician who is familiar with this rare group of diseases. Because of a still-limited database, it is not easy to establish evidence-based (cancer) surveillance recommendations. The presented screening recommendation should thus be revised regularly according to the current state of knowledge.
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Affiliation(s)
- Michaela Plamper
- Pediatric Endocrinology and Diabetology Division, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Bettina Gohlke
- Pediatric Endocrinology and Diabetology Division, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Joachim Woelfle
- Children's and Adolescents Hospital, University of Erlangen, Erlangen, Germany
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McLean A, Alalade AF, Golash A, Gurusinghe N. De Novo Cavernoma Formation in a Patient With Cowden Syndrome and Lhermitte-Duclos Disease. World Neurosurg 2020; 143:308-314. [PMID: 32777405 DOI: 10.1016/j.wneu.2020.07.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cowden syndrome (CS) is an autosomal dominant genodermatosis with a predisposition for the development of multiple cancers, benign hamartomas, and extracranial vascular malformations. Rarely, intracranial lesions like meningiomas and vascular malformations can also be present with CS. These vascular malformations include developmental venous anomalies, arteriovenous fistulae and cavernomas. Most cases of cavernomas are thought to be congenital, although in recent literature they have been shown to occur de novo with other conditions (e.g., other vascular malformations, trauma, postcranial surgery, viral infection, and genetic disorders). CASE DESCRIPTION We present a 29-year-old woman who was diagnosed with Lhermitte-Duclos disease after episodes of persistent generalized headaches. She underwent a foramen magnum decompression and was subsequently diagnosed with CS. Ten years, later she was also diagnosed with 2 cerebral cavernomas that were not present on her prior monitoring scans. CONCLUSIONS We present a case of a patient with CS and LDD who had de novo cavernoma development several years after the initial diagnosis, as well as a review of the literature. We highlight the need of surveillance neuroimaging for patients with CS, as there is the risk of new development of vascular abnormalities (particularly cavernomas).
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Affiliation(s)
- Ailsa McLean
- Department of Neurosurgery, Royal Preston Hospital, United Kingdom
| | - Andrew F Alalade
- Department of Neurosurgery, Royal Preston Hospital, United Kingdom.
| | - Aprajay Golash
- Department of Neurosurgery, Royal Preston Hospital, United Kingdom
| | - Nihal Gurusinghe
- Department of Neurosurgery, Royal Preston Hospital, United Kingdom
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Hedjoudje A, Peng X, Gautam A, Pardo CA, Sciubba D, Gailloud P. Case of Cowden Syndrome with 15 Spinal Arteriovenous Fistulas. World Neurosurg 2020; 139:567-576. [PMID: 32344142 DOI: 10.1016/j.wneu.2020.04.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Spinal vascular malformations are rarely multiple: fewer than 50 observations have been documented so far, with a maximum of 4 coexisting lesions per patient, always restricted to a single vertebral region (e.g., cervical or thoracic). CASE DESCRIPTION We describe the case of a 61-year-old woman with Cowden syndrome with 15 spinal arteriovenous fistulas (AVFs) at the cervical, thoracic, and lumbar levels and an adrenal AVF. She was initially referred for reevaluation of an upper cervical spinal epidural spinal arteriovenous fistula diagnosed 6 years earlier. Her history included breast carcinoma, a malignant salivary gland tumor, and removal of multiple ovarian, thyroid, and gastric hamartomas. Computed tomography and magnetic resonance imaging confirmed the presence of a prominent cervical vascular lesion. Spinal digital subtraction angiography revealed the presence of 15 additional vascular anomalies. CONCLUSIONS This multiplicity of AVFs appears to result from a combination of various factors including local regional hemodynamic changes, growth factor-mediated alterations involving notably vascular endothelial growth factor pathways, and the prothrombotic state associated with abnormalities in blood vessel structure.
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Affiliation(s)
- Abderrahmane Hedjoudje
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
| | - Xiao Peng
- Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ayushi Gautam
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Carlos A Pardo
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Daniel Sciubba
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Philippe Gailloud
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Pilarski R. PTEN Hamartoma Tumor Syndrome: A Clinical Overview. Cancers (Basel) 2019; 11:cancers11060844. [PMID: 31216739 PMCID: PMC6627214 DOI: 10.3390/cancers11060844] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/12/2022] Open
Abstract
The phosphatase and tensin homolog (PTEN) hamartoma tumor syndrome (PHTS) is a grouping of related genetic disorders that has been linked to germline mutations in the PTEN gene. These disorders include Cowden syndrome (CS), Bannayan–Riley–Ruvalcaba syndrome, adult Lhermitte–Duclos disease, and autism spectrum disorders associated with macrocephaly. The majority of the clinical information available on PHTS, however, is related to individuals diagnosed with CS. There is still much to be learned about this disorder, since diagnostic criteria for CS were only established in 1996, before the identification of the PTEN gene, and were based primarily on features seen in cases reported in the existing literature. More recently, however, data from several large series of patients have shown that a number of the clinical features associated with PTEN mutations are either more or less common than previously reported. In addition, we now know that only about 30–35% of patients meeting clinical diagnostic criteria for Cowden syndrome actually have a detectable PTEN mutation. Thus, our understanding of PTEN-related diseases and their management has evolved significantly over time. The United States National Comprehensive Cancer Network (NCCN) has produced and regularly updates practice guidelines which include clinical diagnostic criteria as well as guidelines for PTEN testing and management of patients with mutations. This review will summarize the overall literature on PHTS as well as recent findings which are broadening our understanding of this set of disorders.
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Affiliation(s)
- Robert Pilarski
- Division of Human Genetics, Department of Internal Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43221, USA.
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Pimpalwar S, Yoo R, Chau A, Ashton D, Margolin J, Iacobas I. Temporal Evolution and Management of Fast Flow Vascular Anomalies in PTEN Hamartoma Tumor Syndrome. Int J Angiol 2018; 27:158-164. [PMID: 30154635 DOI: 10.1055/s-0038-1661377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Phosphatase and tensin homolog (PTEN) hamartoma tumor syndrome (PHTS) is characterized by formation of recurrent benign tumors described as PTEN hamartoma of soft tissue that may contain fast flow vascular anomalies (FFVA). The purpose of this study is to review the temporal evolution and management of FFVA in PHTS. A retrospective review of 22 patients (9 males), age 1 to 18 (median 9) years diagnosed with PHTS at a tertiary care pediatric hospital between October 2002 and August 2017 revealed 4 patients with FFVA. Imaging, management, and treatment complications were reviewed. During median follow-up of 8 (range: 4-13) years, ultrasound and magnetic resonance imaging performed for recurrent pain, showed progressive increase in the size of hamartomas and development of new FFVA in three-fourth patients. Medical management included pain medications, oral sirolimus, and physical and psychiatric therapy. Surgical excision of hamartoma ( n = 1) resulted in recurrence within 3 months. Between 4 and 24 (average 1.5/year) embolizations were performed per patient. Pain related to FFVA responded well to embolization. Pain secondary to PTEN hamartoma responded poorly to percutaneous sclerosant injection, but demonstrated improvement with sirolimus. There was no correlation between serum sirolimus levels and frequency/timing of recurrence of FFVA/hamartoma. Complications included sclerosant migration into digital arteries ( n = 1), subclavian vein stenosis due to glue migration ( n = 1), oral mucositis ( n = 4), and elevated triglycerides ( n = 4). Patients with PHTS present with recurrent pain requiring life-long management with a multi-disciplinary team. Pain due to FFVA responds to embolization, and pain due to hamartoma responds to sirolimus. This improves quality of life, but does not prevent disease progression.
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Affiliation(s)
- Sheena Pimpalwar
- Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, Houston Texas
| | - Raphael Yoo
- Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, Houston Texas
| | - Alex Chau
- Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, Houston Texas
| | - Daniel Ashton
- Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, Houston Texas
| | - Judith Margolin
- Cancer and Hematology Centers, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Ionela Iacobas
- Cancer and Hematology Centers, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Inukai K, Takashima N, Fujihata S, Miyai H, Yamamoto M, Kobayashi K, Tanaka M, Hayakawa T. Arteriovenous malformation in the sigmoid colon of a patient with Cowden disease treated with laparoscopy: a case report. BMC Surg 2018; 18:21. [PMID: 29636101 PMCID: PMC5894182 DOI: 10.1186/s12893-018-0355-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cowden disease is a genetic disorder associated with a mutation of the PTEN gene and is known to be easily complicated by generalized vascular malformations and malignant tumors. However, only a few reports have investigated the relationship between Cowden disease and vascular malformations. We present a case of Cowden disease along with a review of the literature. CASE PRESENTATION The patient was a 48-year-old man who visited our hospital complaining of fresh blood in his stools and shortness of breath. Hematological tests showed the patient had severe anemia. On physical examination, white papules-several millimeters in size-were observed between the patient's eyebrows. White papules were also observed on the left corner of his mouth and buccal mucosa. An upper gastrointestinal endoscopy showed densely-packed, white, flat protrusions in the esophagus. While lower gastrointestinal endoscopy revealed a mass accompanied by arterial pulsation in the sigmoid colon. A diagnosis of Cowden disease was confirmed and a laparoscopic sigmoidectomy was performed to address the arteriovenous malformations in the sigmoid colon. Post-surgery, the patient had an unremarkable recovery and was discharged 7 days later. CONCLUSIONS We present a very rare case of Cowden disease with arteriovenous malformations occurring in the colon. Surgical resection is believed to be the first choice for treating congenital arteriovenous malformations of the intestines. However, the arteriovenous malformations in the colon in our patient were treated under laparoscopic guidance, making ours the first report describing laparoscopic treatment of colonic arteriovenous malformations occurring in the inferior mesenteric artery. Thus we demonstrate that laparoscopic treatment of arteriovenous malformations in the intestines is a minimally invasive and can be successfully applied in such cases.
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Affiliation(s)
- Koichi Inukai
- Department of Surgery, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, Aichi, 448-8505, Japan.
| | - Nobuhiro Takashima
- Department of Surgery, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, Aichi, 448-8505, Japan
| | - Shiro Fujihata
- Department of Surgery, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, Aichi, 448-8505, Japan
| | - Hirotaka Miyai
- Department of Surgery, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, Aichi, 448-8505, Japan
| | - Minoru Yamamoto
- Department of Surgery, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, Aichi, 448-8505, Japan
| | - Kenji Kobayashi
- Department of Surgery, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, Aichi, 448-8505, Japan
| | - Moritsugu Tanaka
- Department of Surgery, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, Aichi, 448-8505, Japan
| | - Tetsushi Hayakawa
- Department of laparoscopic hernia center, Kariya Toyota General Hospital, 5-15 Sumiyoshi-cho, Kariya, Aichi, 448-8505, Japan
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Torres AC, Upadhyaya P, Agrawal R. Dural AVM (dAVM) in Cowden disease. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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8
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Reply. J Vasc Surg Venous Lymphat Disord 2016; 4:539-40. [PMID: 27639016 DOI: 10.1016/j.jvsv.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/01/2016] [Indexed: 11/23/2022]
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Matsuhisa A, Kishino M, Nakadate M, Kudo T, Inoue Y, Tateishi U. Embolosclerotherapy by the Transvenous Approach for Lower Extremity Arteriovenous Malformation in Cowden Syndrome: A Case Report. Ann Vasc Dis 2016; 9:66-9. [PMID: 27087878 DOI: 10.3400/avd.cr.15-00058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 12/23/2015] [Indexed: 11/13/2022] Open
Abstract
A 69-year-old female with Cowden syndrome presented with pain at rest in the right leg. Arteriovenous malformations (AVMs) of the right lower extremity were detected by computed tomography and magnetic resonance imaging. Angiography indicated arteriolovenous fistulae, which were initially treated using a transarterial approach with minimal therapeutic effect. In contrast, excellent outcomes were achieved with a transvenous approach using coil embolization and liquid sclerotherapy for the venous component of the nidus. At 15 months after embolosclerotherapy, no angiographic evidence of AVM recurrence was noted. Embolosclerotherapy by the transvenous approach for AVM in Cowden syndrome was a useful therapeutic strategy for arteriolovenous fistulae.
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Affiliation(s)
- Akiyuki Matsuhisa
- Department of Radiology, Saitama Cancer Center, Kitaadachi-gun, Saitama, Japan
| | - Mitsuhiro Kishino
- Department of Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masashi Nakadate
- Department of Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Kudo
- Department of Surgery, Division of Vascular and Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshinori Inoue
- Department of Surgery, Division of Vascular and Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Radiology, Tokyo Medical and Dental University, Tokyo, Japan
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Abstract
Vascular malformations (VMs) comprise a wide spectrum of lesions that are classified by content and flow characteristics. These lesions, occurring in both focal and diffuse forms, can involve any organ and tissue plane and can cause significant morbidity in both children and adults. Since treatment strategy depends on the type of malformation, correct diagnosis and classification of a vascular lesion are crucial. Slow-flow VMs (venous and lymphatic malformations) are often treated by sclerotherapy, whereas fast-flow lesions (arteriovenous malformations) are generally managed with embolization. In addition, some cases of VMs are best treated surgically. This review will present an overview of VMs in the female pelvis as well as a discussion of endovascular therapeutic techniques.
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Affiliation(s)
- Brian M Christenson
- Division of Interventional Radiology, Department of Radiology, University of Colorado School of Medicine, Denver Anschutz Medical Campus, Aurora, Colorado
| | - Matthew G Gipson
- Division of Interventional Radiology, Department of Radiology, University of Colorado School of Medicine, Denver Anschutz Medical Campus, Aurora, Colorado
| | - Mitchell T Smith
- Division of Interventional Radiology, Department of Radiology, University of Colorado School of Medicine, Denver Anschutz Medical Campus, Aurora, Colorado
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Pilarski R, Burt R, Kohlman W, Pho L, Shannon KM, Swisher E. Cowden Syndrome and the PTEN Hamartoma Tumor Syndrome: Systematic Review and Revised Diagnostic Criteria. J Natl Cancer Inst 2013; 105:1607-16. [DOI: 10.1093/jnci/djt277] [Citation(s) in RCA: 372] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Kędzierski B, Nowak G, Kuśmierska M, Jaźwiec P, Szuba A. Giant congenital malformation of the perirectal plexus in computed tomography imaging - case report. Pol J Radiol 2013; 78:50-3. [PMID: 23807885 PMCID: PMC3693837 DOI: 10.12659/pjr.883945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 02/18/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Congenital arteriovenous malformation (AVM) in the pelvic area is uncommon in males. CASE REPORT The described case is of a giant lesion of this type that caused recurrent hemorrhaging in the lower part of the gastrointestinal tract. Preliminary diagnosis of vascular pathology was made on the basis of an endoscopic examination that revealed numerous pulsating protuberances of the rectal wall, in which blood flow was identified by means of transrectal ultrasonography. Complementing the diagnostics with a CT revealed a considerable extent of malformation, as well as its morphology and anatomical relations with the surrounding tissues. RESULTS Following a two-year follow-up period, the malformation did not progress or demonstrate any intensification of clinical symptoms, therefore the patient continues to undergo conservative treatment.
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Affiliation(s)
- Bartłomiej Kędzierski
- Department of Clinical Radiology and Imaging Diagnostics, 4 Military Hospital in Wrocław, Wrocław, Poland
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13
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Nakayama Y, Segawa J, Sujita K, Minagawa N, Torigoe T, Hisaoka M, Yamaguchi K. Intestinal bleeding from arteriovenous malformations of the small bowel in a patient with Cowden syndrome: report of a case. Surg Today 2012; 43:542-6. [PMID: 23247890 DOI: 10.1007/s00595-012-0460-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 01/12/2012] [Indexed: 10/27/2022]
Abstract
This report presents the case of a patient with Cowden syndrome who had arteriovenous malformations (AVMs) at the jejunum and the ileum and experienced intestinal bleeding. A 54-year-old Japanese male presented with general fatigue and melena. Endoscopic examinations showed gastrointestinal polyposis from the esophagus to the rectum. However, the site of bleeding was not identified. There were some papules on his face and neck. He also had macrocephaly and had multiple papillomas along the gum-line. These findings indicated a clinical diagnosis of Cowden syndrome. Enhanced computed tomography (CT) and angiography analyses indicated the presence of AVMs at the jejunum and the ileum. He was treated with partial resection of the jejunum and ileum including these two AVMs. This was a rare case of two AVMs involving the small bowel in a patient with Cowden syndrome. Enhanced CT was very useful and convenient for the detection of gastrointestinal AVMs in this case.
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Affiliation(s)
- Yoshifumi Nakayama
- Department of Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kita-kyushu 807-8555, Japan.
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Abstract
Vascular malformations (VM) are classified by flow characteristics and channel content. They can involve any organ and tissue plane, and occur in focal and diffuse forms. Slow-flow vascular malformations (venous and lymphatic malformations) are typically treated by sclerotherapy, whereas fast-flow lesions (arteriovenous malformations) are managed with embolizations. Some VMs, such as VMs of the rectum or uterus, are best dealt with surgically. This review will present a summary of the conditions, their imaging features, and some useful endovascular therapeutic techniques.
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Rademaker J, Kim YJ, Leibecke T, Raman SS, Voit C. Cowden disease: CT findings in three patients. ACTA ACUST UNITED AC 2005; 30:204-7. [PMID: 15812679 DOI: 10.1007/s00261-004-0250-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2004] [Accepted: 03/10/2004] [Indexed: 11/28/2022]
Abstract
Cowden disease, also known as multiple hamartoma syndromes, is an autosomal dominant disease characterized by numerous benign mucocutaneous tumors, hamartomas of multiple organs, and malignancies of the breast and thyroid. In this report, we present the computed tomographic findings in three patients with Cowden disease. In addition to the classic findings, the patients were diagnosed with spinal neurinoma (n=1), meningioma (n=1), and hepatic hemangioma (n=3). We also review current clinical and genetic concepts that unify Cowden disease.
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Affiliation(s)
- J Rademaker
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Larroche C, Aymard A, Martinod E, Mihaileanu S, Caux F. Une langue révélatrice. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80651-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Neuroradiologists have extended their treatment modalities in the field of vascular neurosurgery. The rapidly emerging and re-engineered neuroradiological techniques confront the anaesthetist with an increasing number of patients with severe neurological disease. More of these patients will need general anaesthesia in order to facilitate the endovascular procedure, including catheter placement, deposition of embolic material, and improved imaging. Anaesthetists are challenged by additional anaesthesiological aspects previously not encountered in neuroanaesthesia. A safe anaesthetic management is based on a broad understanding of pathophysiological and technical issues that arise with the endovascular treatment of cerebral vasculopathy.
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Affiliation(s)
- S Krayer
- Department of Anaesthesiology, University Hospital, Zürich, Switzerland.
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