1
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The association of genitourinary cancer among Saudi patients with gastrointestinal stromal tumors and a systematic literature review. Sci Rep 2023; 13:4325. [PMID: 36922517 PMCID: PMC10017771 DOI: 10.1038/s41598-023-28060-x] [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: 05/14/2022] [Accepted: 01/12/2023] [Indexed: 03/17/2023] Open
Abstract
The gastrointestinal tract's most commonly occurring primary mesenchymal tumor is the gastrointestinal stromal tumor (GIST). However, few cases worldwide were reported associated with renal cell carcinoma (RCC). Therefore, we aimed to identify the association of genitourinary tumors in patients with GIST in our tertiary care hospital in Saudi Arabia and compare it to the literature. We identified all patients in the pathology department database with the diagnosis of GIST. We excluded duplicate and recurrent cases. We examined patients' files for the presence of RCC, adrenal tumors, or other genitourinary cancer. A systematic review of the association was conducted. From 2003 to 2020, 170 patients had a histopathologic diagnosis of primary GIST, 100 men and 70 women, median age of 57 (range 9-91) years at the time of diagnosis. The site of primary GIST was gastric 103, small bowel 43, mesenteric 5, omentum/peritoneum 7, abdomen 4, isolated adrenal 1, and other 7. Six patients had associated primary genitourinary cancer. Three patients had RCC (two clear cell RCC and one radiologic diagnosis only), and three had adrenal tumors (one adrenal carcinoma, one an isolated adrenal GIST, and one pheochromocytoma). In addition, two patients had a tumor invading the urinary bladder. Although the cohort included 63 men aged 60 or above (median 71 ± 8.7 years, range 60-94), none demonstrated clinical prostatic carcinoma. Data was compared to 69 systematic review articles. We report the rare association between GIST tumors and primary genitourinary cancer, mainly RCC and adrenal tumors. Also, we identified a secondary invasion of the urinary bladder. Unlike the reported series, none of the older male patients had clinical prostate cancer.
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2
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Gunawardene A, Fischer J. Obscure gastrointestinal bleeding in a patient with neurofibromatosis type 1. ANZ J Surg 2022; 92:3105-3106. [PMID: 35212097 PMCID: PMC9790566 DOI: 10.1111/ans.17573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Ashok Gunawardene
- Department of General SurgeryWaikato District Health BoardHamiltonNew Zealand,Department of SurgeryUniversity of AucklandAucklandNew Zealand
| | - Jesse Fischer
- Department of General SurgeryWaikato District Health BoardHamiltonNew Zealand,Department of SurgeryUniversity of AucklandAucklandNew Zealand
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3
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Giant composite pheochromocytoma and gastrointestinal stromal tumor in a patient with neurofibromatosis: A case report. North Clin Istanb 2022; 8:629-633. [PMID: 35284800 PMCID: PMC8848499 DOI: 10.14744/nci.2020.37431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 12/14/2022] Open
Abstract
A 54-year-old male was admitted to our department with neurofibromatosis and hypertension. During his examination, a mass was detected in the abdomen, and he was transferred to a surgical clinic. At the first examination of the patient, extensive café-au-lait spots and granulomas were detected on the body and the mass occupying right abdomen quadrant was palpable. The patient’s medical history indicated that he had hypertension for almost a decade. The patient also stated that nodules on the body existed from his earliest recollection and he had relatives with neurofibromatosis. The patient was taken to a surgical operation. A mass with 30×23 cm in size was removed. The area of the nodular structure, with 0.5 cm in diameter, in the stomach serosa was also removed. The tumor was composed of phaeochromocytoma in the larger spaces and ganglioneuromas in the relatively narrow spaces. The nodular area removed in gastric serosa was reported as a very low-risk gastrointestinal stromal tumor. Apart from this rare combination, adrenal mass removed from the patient was considerably larger than the masses in the literature until now. Therefore, we aimed to present this rare case with a literature background.
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Sur ML, Armat I, Sur G, Pop DC, Samasca G, Lupan I, Timis TL, Florian IA, Sur D. Neurofibromatosis in Children: Actually and Perspectives. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9010040. [PMID: 35053664 PMCID: PMC8774615 DOI: 10.3390/children9010040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/18/2021] [Accepted: 12/27/2021] [Indexed: 12/16/2022]
Abstract
The three types of neurofibromatosis, namely type 1, type 2, and schwannomatosis, are generally associated with various benign tumors affecting the skin and the nervous system. On rare occasions, especially in patients with neurofibromatosis type 1 (NF1), malignant neoplasms may also be present, several of them possessing a more aggressive course than in individuals without this syndrome. As such, a clear delineation between the three variants of neurofibromatosis is crucial to establish the correct diagnosis and management, as well as predict the neoplasm-related outcomes. Neurofibromin, the principal product of the NF1 gene, is a potent inhibitor of cellular proliferation, having been linked to several key signaling pathways involved in tumor growth. Therefore, it may provide a useful therapeutic target for tumor management in these patients. In this article, we want to present the association between deficiency of neurofibromin and the consequences of the lack of this protein leading to different kinds of malignant tumors. The therapy is still uncertain and most therapeutic options are in development or clinical trials.
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Affiliation(s)
- Maria Lucia Sur
- Department of Pediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (M.L.S.); (D.-C.P.); (D.S.)
- Children Emergency Clinical Hospital, 400006 Cluj-Napoca, Romania;
| | - Ionel Armat
- Cardiovascular and Transplant Emergency Institute of Târgu Mureș, 540136 Targu Mures, Romania;
| | - Genel Sur
- Children Emergency Clinical Hospital, 400006 Cluj-Napoca, Romania;
| | - Diana-Cristina Pop
- Department of Pediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (M.L.S.); (D.-C.P.); (D.S.)
| | - Gabriel Samasca
- Department of Pediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (M.L.S.); (D.-C.P.); (D.S.)
- Children Emergency Clinical Hospital, 400006 Cluj-Napoca, Romania;
- Correspondence: ; Tel.: +40-264532216
| | - Iulia Lupan
- Department of Molecular Biology, Babes-Bolyai University, 400084 Cluj-Napoca, Romania;
| | - Teodora-Larisa Timis
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Ioan-Alexandru Florian
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Daniel Sur
- Department of Pediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (M.L.S.); (D.-C.P.); (D.S.)
- Institute of Oncology “Ion Chiricuta”, 400015 Cluj-Napoca, Romania
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5
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Mishra A, Gyawali S, Kharel S, Mishra A, Pathak N, Subedi N, Gaire P. Multiple jejunal gastrointestinal stromal tumors and Neurofibromatosis type 1: A rare association. Int J Surg Case Rep 2021; 85:106178. [PMID: 34274754 PMCID: PMC8319367 DOI: 10.1016/j.ijscr.2021.106178] [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: 05/31/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE The association between gastrointestinal stromal tumor (GIST), mesenchymal tumor arising from the interstitial cells of cajal and Neurofibromatosis type 1 (NF1), an autosomal dominant disease has been reported in the literature. GIST in NF1 patients are multiple and located in the small intestine. Tumorigenesis in NF1 associated GIST is different to that of sporadic GIST and hence the treatment. Here we report a rare case of an NF1 patient with multiple jejunal GISTs. CASE PRESENTATION We here present a rare case of a 57-year-old male diagnosed with NF1 30 years back, presented in our emergency department with complaints of black, tarry stools later diagnosed to have multiple GIST in jejunum. Contrast enhanced computed tomography (CECT) of the abdomen showed a large 10.1 × 7.33 × 6.2 cm heterogeneous, exophytic, solid mass with cystic areas originating from the jejunum. The microscopic examination of the specimen showed spindle shaped tumor cells while immunohistochemistry showed CD117 (c-KIT) and DOG-1 positivity. The primary treatment was complete surgical excision of the tumor. CLINICAL DISCUSSION The incidence of GISTs in NF1 patient is around 6-7%; however, concomitant presence of multiple GISTs is rare. CECT of abdomen along with histopathological and immunohistochemistry studies are diagnostic. The management of GIST includes surgical and adjuvant therapy methods based on the tumorigenesis and recurrent risk stratification. CONCLUSION Early clinical suspicion and imaging aids in early detection of the tumor in patients with NF1 presenting with gastrointestinal symptoms. Postoperatively, screening for recurrence with radiology is of utmost importance.
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Affiliation(s)
- Aakash Mishra
- Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
| | - Sandesh Gyawali
- Department of General Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Sanjeev Kharel
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
| | - Aman Mishra
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
| | - Nibesh Pathak
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
| | - Nirajan Subedi
- Department of GI and General Surgery, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Prabin Gaire
- Department of Pathology, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
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6
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Vongsumran N, Kongkarnka S, Watanawittawas P, Manosroi W. Pheochromocytoma and gastrointestinal stromal tumours in an adult neurofibromatosis type 1 patient: a rare co-occurrence. BMJ Case Rep 2020; 13:13/6/e235129. [PMID: 32595117 DOI: 10.1136/bcr-2020-235129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The risk of tumours including pheochromocytoma and gastrointestinal stromal tumour (GIST) has been reported to be higher in neurofibromatosis type 1 (NF1) patients. The concomitant occurrence of these two tumours was rare in NF1 patient and most were symptomatic. In this case report, we describe the case of a 47-year-old man with NF1 who presented with microscopic haematuria. Neither hypertension nor any gastrointestinal symptoms were reported by the patient. While investigating for haematuria, left adrenal mass and arterial enhancing lesions in the small bowel were incidentally documented during computerised urography. The patient subsequently underwent a left adrenalectomy and small bowel resection. The pheochromocytoma and multiple GIST tumours were diagnosed based on pathology. Here, we discuss the rare association of pheochromocytoma and GIST and the asymptomatic presentation of those tumours in an NF1 patient. We further suggest that in NF1 patients a heightened level of vigilance can help identify this infrequent combination.
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Affiliation(s)
- Nuttawut Vongsumran
- Endocrine and Metabolism Unit, Internal Medicine Department, Faculty of Medicine, Chiang Mai University, Muang Chiang Mai, Chiang Mai, Thailand
| | - Sarawut Kongkarnka
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Muang Chiang Mai, Chiang Mai, Thailand
| | - Pittaporn Watanawittawas
- Endocrine and Metabolism Unit, Internal Medicine Department, Faculty of Medicine, Chiang Mai University, Muang Chiang Mai, Chiang Mai, Thailand.,Endocrine and Metabolism Unit, Sriphat Medical Center, Faculty of Medicine, Chiang Mai University, Muang Chiang Mai, Chiang Mai, Thailand
| | - Worapaka Manosroi
- Endocrine and Metabolism Unit, Internal Medicine Department, Faculty of Medicine, Chiang Mai University, Muang Chiang Mai, Chiang Mai, Thailand
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7
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Peces R, Mena R, Martín Y, Hernández C, Peces C, Tellería D, Cuesta E, Selgas R, Lapunzina P, Nevado J. Co-occurrence of neurofibromatosis type 1 and optic nerve gliomas with autosomal dominant polycystic kidney disease type 2. Mol Genet Genomic Med 2020; 8:e1321. [PMID: 32533764 PMCID: PMC7434601 DOI: 10.1002/mgg3.1321] [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: 01/10/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) and neurofibromatosis type 1 (NF1) are both autosomal dominant disorders with a high rate of novel mutations. However, the two disorders have distinct and well-delineated genetic, biochemical, and clinical findings. Only a few cases of coexistence of ADPKD and NF1 in a single individual have been reported, but the possible implications of this association are unknown. METHODS We report an ADPKD male belonging to a family of several affected members in three generations associated with NF1 and optic pathway gliomas. The clinical diagnosis of ADPKD and NF1 was performed by several image techniques. RESULTS Linkage analysis of ADPKD family was consistent to the PKD2 locus by a nonsense mutation, yielding a truncated polycystin-2 by means of next-generation sequencing. The diagnosis of NF1 was confirmed by mutational analysis of this gene showing a 4-bp deletion, resulting in a truncated neurofibromin, as well. The impact of this association was investigated by analyzing putative genetic interactions and by comparing the evolution of renal size and function in the proband with his older brother with ADPKD without NF1 and with ADPKD cohorts. CONCLUSION Despite the presence of both conditions there was not additive effect of NF1 and PKD2 in terms of the severity of tumor development and/or ADPKD progression.
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Affiliation(s)
- Ramón Peces
- Servicio de Nefrología, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma, Madrid, Spain
| | - Rocío Mena
- Instituto de Genética Médica y Molecular (INGEMM)-IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma, Madrid, Spain.,CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - Yolanda Martín
- Servicio de Genética, Hospital Universitario Ramón y Cajal, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Concepción Hernández
- Servicio de Genética, Hospital Universitario Ramón y Cajal, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Carlos Peces
- Area de Tecnologías de la Información, SESCAM, Toledo, Spain
| | - Dolores Tellería
- Servicio de Genética, Hospital Universitario Ramón y Cajal, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Emilio Cuesta
- Servicio de Radiología, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma, Madrid, Spain
| | - Rafael Selgas
- Servicio de Nefrología, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma, Madrid, Spain
| | - Pablo Lapunzina
- Instituto de Genética Médica y Molecular (INGEMM)-IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma, Madrid, Spain.,CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - Julián Nevado
- Instituto de Genética Médica y Molecular (INGEMM)-IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma, Madrid, Spain.,CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
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8
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Abstract
Phakomatoses present with characteristic findings on the skin, central or peripheral nervous system, and tumors. Neurofibromatosis type 1 is the most common syndrome and is characterized by Café-au-lait macules, intertriginous freckling, Lisch nodules, and tumors including neurofibromas, malignant peripheral nerve sheath tumors, and gliomas. Tuberous Sclerosis Complex is characterized by benign hamartomas presenting with hypomelanotic macules, shagreen patches, angiofibromas, confetti lesions and tumors including cortical tubers, subependymal nodules, subependymal giant cell astrocytomas and tumors of the kidney, lung, and heart. Managing these disorders requires disease specific supportive care, tumor monitoring, surveillance for selected cancers, and treatment of comorbid conditions.
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Affiliation(s)
- Benjamin Becker
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
| | - Roy E Strowd
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA; Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest Baptist Health, Winston Salem, NC 27157, USA; Translational Science Institute, Wake Forest Baptist Health, Winston Salem, NC 27157, USA
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9
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van Lierop ZY, Jentjens S, Anten MH, Wierts R, Stumpel CT, Havekes B, van Kroonenburgh MJ. Thyroid Gland 18F-FDG Uptake in Neurofibromatosis Type 1. Eur Thyroid J 2018; 7:155-161. [PMID: 30023349 PMCID: PMC6047496 DOI: 10.1159/000488706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/19/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate thyroid gland characteristics on 18F-FDG positron emission tomography/computed tomography (PET/CT) imaging in patients with neurofibromatosis type 1 (NF1). SUBJECTS AND METHODS Thyroid gland characteristics of patients with a clinical diagnosis of NF1 who underwent 18F-FDG PET/CT imaging for the first time to distinguish benign neurofibroma from malignant peripheral nerve sheath tumor (MPNST) at our institution (n = 69) were compared to PET/CT imaging of sarcoidosis (n = 25) and early stage lung cancer (T1N0M0 tumors, n = 15) patients. RESULTS Two NF1 patients (3%) showed a diffuse 18F-FDG uptake in the thyroid gland, 2 patients (3%) had an irregular uptake, and 7 patients (10%) had a focal uptake. Among the sarcoidosis patients, 1 showed a diffuse uptake (4%) and 1 had an irregular uptake (4%). In the early stage lung cancer group, 1 patient showed a diffuse uptake (7%) and 1 had a focal uptake (7%). NF1 patients had larger mean thyroid volume and mean SUVmax compared to sarcoidosis patients but not compared to early stage lung cancer patients. Four NF1 patients were diagnosed with multinodular goiter, 2 patients were diagnosed with benign chronic lymphocytic thyroiditis, 1 patient had metastasis to the thyroid, and 1 patient had medullary thyroid cancer. CONCLUSION Even though NF1 patients did not show an increased risk of thyroid incidentaloma on PET/CT compared to previous studies on non-thyroid cancer patients, the incidence shows that awareness of possible thyroid disease is important.
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Affiliation(s)
- Zoë Y.G.J. van Lierop
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
- **Zoë Y.G.J. van Lierop, MD, Department of Neurology, Maastricht University Medical Centre, PO Box 5800, NL-6202 AZ Maastricht (The Netherlands), E-Mail
| | - Sander Jentjens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Monique H.M.E. Anten
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Neurofibromatosis Expert Team, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Roel Wierts
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Connie T. Stumpel
- Neurofibromatosis Expert Team, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bas Havekes
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marinus J.P.G. van Kroonenburgh
- Neurofibromatosis Expert Team, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- *Marinus J.P.G. van Kroonenburgh, MD, PhD, Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, NL-6202 AZ Maastricht (The Netherlands), E-Mail
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10
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Efared B, Atsame-Ebang G, Tahirou S, Mazaz K, Hammas N, El Fatemi H, Chbani L. Bilateral pheochromocytoma with ganglioneuroma component associated with multiple neuroendocrine neoplasia type 2A: a case report. J Med Case Rep 2017; 11:208. [PMID: 28760150 PMCID: PMC5537993 DOI: 10.1186/s13256-017-1364-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/23/2017] [Indexed: 12/01/2022] Open
Abstract
Background Composite pheochromocytoma/paragangliomas are very rare tumors composed of ordinary pheochromocytoma paragangliomas associated with neurogenic tumors. Several hereditary susceptibility disorders are known to be associated with pheochromocytoma/paragangliomas such as multiple endocrine neoplasia type 2 (2A or B). To the best of our knowledge, only four cases of composite pheochromocytoma/paragangliomas associated with multiple endocrine neoplasia type 2 have been reported. Case presentation A 40-year-old Arabic woman presented with headache, palpitations, paroxysmal hypertension, and weight loss, which she had had for the last 3 years. She had a familial history of diabetes and multiple endocrine neoplasia type 2. A radiological examination revealed thyroid lesions and bilateral adrenal medulla tumors. Our patient had undergone bilateral adrenalectomy, total thyroidectomy with cervical lymphadenectomy, and parathyroidectomy. A pathological examination confirmed the multiple endocrine neoplasia type 2A consisting of left medullary pheochromocytoma, right medullary composite pheochromocytoma-ganglioneuroma, medullary carcinoma of the thyroid with lymph node metastasis and parathyroid hyperplasia. A genetic analysis also revealed that our patient had a RET germline mutation. Conclusion Composite pheochromocytoma/paraganglioma associated with multiple endocrine neoplasia type 2 is a very rare occurrence, as the current literature provides only a few cases. Further reported cases are needed in order to understand the behavior and the pathogenesis of this uncommon entity.
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Affiliation(s)
- Boubacar Efared
- Department of Pathology, Hassan II University Hospital, Fès, Morocco.
| | | | - Soufiane Tahirou
- Department of Radiology, Hassan II University Hospital, Fès, Morocco
| | - Khalid Mazaz
- Department of General and Visceral Surgery, Hassan II University Hospital, Fès, Morocco.,Faculty of Medicine and Pharmacology, Sidi Mohamed Ben Abdellah University, Fès, Morocco
| | - Nawal Hammas
- Department of Pathology, Hassan II University Hospital, Fès, Morocco.,Faculty of Medicine and Pharmacology, Sidi Mohamed Ben Abdellah University, Fès, Morocco
| | - Hinde El Fatemi
- Department of Pathology, Hassan II University Hospital, Fès, Morocco.,Faculty of Medicine and Pharmacology, Sidi Mohamed Ben Abdellah University, Fès, Morocco
| | - Laila Chbani
- Department of Pathology, Hassan II University Hospital, Fès, Morocco.,Faculty of Medicine and Pharmacology, Sidi Mohamed Ben Abdellah University, Fès, Morocco
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Abstract
INTRODUCTION Neurofibromatosis type 1 (NF1) is the most commonly inherited autosomal dominant disorder in humans. NF1 patients have increased risk for gastrointestinal stromal tumors (GISTs). A Meckel's diverticulum (MD) represents a persistent embryonic omphalomesenteric duct characterized as a true diverticulum located near the ileocecal valve. We report a unique clinical case whereby a patient with NF1 developed a GIST within a MD. CASE An adolescent male with NF1 presented with persistent lower abdominal pain. Clinical evaluation demonstrated a large pelvic mass. In the operating room, the mass was noted to emerge from a MD. Final pathology demonstrated a GIST with negative margins and CD117 positivity. DISCUSSION Patients with NF1 are at increased risk for mesenchymal tumors including malignant peripheral nerve sheath tumors. GISTs are the most important and frequent non-neurological malignancy in NF1 and develop in ∼7% of NF1 patients. GISTs tend to be multifocal in NF1; however, they rarely occur within a Meckel's diverticula. CONCLUSIONS Our case represents a rare case of a patient with NF1 who developed a symptomatic GIST within a MD. We recommend utilizing laparoscopy to determine resectability and clarify the diagnosis in this unique patient population who are at risk for multiple neoplasms.
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12
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Adrenal Collision Tumor: Coexistence of Pigmented Adrenal Cortical Oncocytoma and Ganglioneuroma. Case Rep Surg 2017; 2016:5790645. [PMID: 28053800 PMCID: PMC5178330 DOI: 10.1155/2016/5790645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/13/2016] [Accepted: 11/08/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Adrenal collision tumors (ACTs), in which distinct tumors coexist without intermingling in the same adrenal gland, are rare and their actual prevalence is unknown. ACTs commonly consist of adrenal cortical adenoma, pheochromocytoma, or metastatic malignant tumor. Case Report. A 32-year-old woman who had been experiencing gastric discomfort for one month was referred to our hospital with abnormal imaging findings. The physical examination and the laboratory data including endocrine studies were unremarkable. Abdomen computed tomography (CT) and magnetic resonance imaging (MRI) showed two adjacent masses in the left suprarenal fossa, and a laparoscopic left adrenalectomy was done. Histological and immunohistochemical (IHC) examinations revealed two distinct tumors: a pigmented adrenal cortical oncocytoma (ACO) and a ganglioneuroma, respectively. Conclusion. Both tumors are rare in the adrenal gland and exist as ACTs only exceptionally rarely. This is the first reported case of coexisting oncocytoma and ganglioneuroma in the same adrenal gland to our knowledge.
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13
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Multiple Gastric Gastrointestinal Stromal Tumors in a Patient with Neurofibromatosis Type 1. Case Rep Surg 2016; 2016:1515202. [PMID: 27375917 PMCID: PMC4914732 DOI: 10.1155/2016/1515202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/16/2016] [Indexed: 01/21/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are relatively common in neurofibromatosis type 1 (NF 1) patients. Approximately 90% of GISTs associated with NF 1 are located in the small intestine, while sporadic GISTs are most commonly located in the stomach. Here we report an extremely rare case of an NF 1 patient with multiple gastric GITs (90 or more) but without multiple small intestinal tumors. A 63-year-old female patient who had a history of NF 1 underwent surgery for a gastric neuroendocrine tumor and gastric submucosal tumor (SMT). During the operation, multiple small nodules were identified on the serosal surface of the upper stomach. SMT and multiple nodules on the serosal surface were diagnosed as GISTs consisting of spindle cells positive for KIT, CD34, and DOG-1. Both GIST and the normal gastric mucosa showed no mutations not only in the c-kit gene (exons 8, 9, 11, 13, and 17) but also in the PDGFRA gene (exons 12, 14, and 18). This patient is being followed up without the administration of a tyrosine kinase inhibitor.
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Jayalakshmy PS, Mohan AA, Kumar RK, Beevi PJ. A rare combination of pheochromocytoma and gastrointestinal stromal tumour in a patient with neurofibromatosis 1 syndrome-a case report. Surg Case Rep 2015; 1:102. [PMID: 26943426 PMCID: PMC4605922 DOI: 10.1186/s40792-015-0107-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/06/2015] [Indexed: 11/10/2022] Open
Abstract
Neurofibromatosis 1 is a rare inherited autosomal dominant syndrome. It comprises 90 % of neurofibromatosis cases. These patients may develop various types of tumours in early age, especially multiple neurofibromas with a high risk of developing malignant peripheral nerve sheath tumours. Other tumours can also develop like pheochromocytoma, optic nerve and brain stem gliomas, carcinoids and rarely gastrointestinal stromal tumours. A combination of pheochromocytoma and gastrointestinal stromal tumour is very rare. Only a few cases have been reported. Here, we are reporting a case of NF1 syndrome with a combination of pheochromocytoma and gastrointestinal stromal tumour with additional findings of multiple clear cell nodules and brown fat in the periadrenal connective tissue.
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Affiliation(s)
- P S Jayalakshmy
- Government Medical College, Thrissur, Kerala, India. .,, Parijatham, Royal Avenue, Near Attore Road Bus Stop, Kuttur. P.O., Thrissur, PIN-680013, Kerala, India.
| | - A Anish Mohan
- Government Medical College, Thrissur, Kerala, India.
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