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van der Wolk SL, Voogdt KGJA, van Tuyll van Serooskerken AM, van Haaften-de Jong AMLD. [Vulvar lymphangioma circumscriptum: diagnosis and treatment]. Ned Tijdschr Geneeskd 2022; 166:D6706. [PMID: 36300473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The vulvar form of lymphangioma circumscriptumis a rare condition. It is part of the acquired lymphangiectasia and arises secondary, for example, after surgery, radiotherapy for malignancies in the pelvic region, inflammation in which vulvar lymphedema occurs or Morbus Crohn. CASE DESCRIPTION A 44-year-old woman presented to the gynaecology outpatient department with a vulvar abnormality that was accompanied by pain and pruritus. Her medical history consisted of premalignant cervical abnormalities and a vulvar lichen simplex chronicus. A biopsy was taken and the diagnosis lymphangioma circumscriptum was made. Due to the growth and the complaints, the decision was made to remove the lesion in the operating room. CONCLUSION Lymphangioma circumscriptum is a rare condition that is often misdiagnosed. This case may describe the development of lymphangioma circumscriptum from a lichen simplex chronicus, which has not been described before. It also demonstrates that surgical treatment appears to be a good treatment with few complications in the postoperative course.
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Schneider-Yin X, van Tuyll van Serooskerken AM, Siegesmund M, Went P, Barman-Aksözen J, Bladergroen RS, Komminoth P, Cloots RHE, Winnepenninckx VJ, zur Hausen A, Weber M, Driessen A, Poblete-Gutiérrez P, Bauer P, Schroeder C, van Geel M, Minder EI, Frank J. Biallelic inactivation of protoporphyrinogen oxidase and hydroxymethylbilane synthase is associated with liver cancer in acute porphyrias. J Hepatol 2015; 62:734-8. [PMID: 25445397 DOI: 10.1016/j.jhep.2014.11.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/10/2014] [Accepted: 11/18/2014] [Indexed: 12/04/2022]
Abstract
Variegate porphyria (VP) and acute intermittent porphyria (AIP), the two most common types of acute porphyrias (AHPs), result from a partial deficiency of protoporphyrinogen oxidase (PPOX) and hydroxymethylbilane synthase (HMBS), respectively. A rare but serious complication in the AHPs is hepatocellular carcinoma (HCC). However, the underlying pathomechanisms are yet unknown. We performed DNA sequence analysis in cancerous and non-cancerous liver tissue of a VP and an AIP patient, both with HCC. In samples of both cancerous and non-cancerous liver tissues from the patients, we identified the underlying PPOX and HMBS germline mutations, c.1082dupC and p.G111R, respectively. Additionally, we detected a second somatic mutation, only in the cancer tissue i.e., p.L416X in the PPOX gene of the VP patient and p.L220X in the HMBS gene of the AIP patient, both located in trans to the respective germline mutations. Both somatic mutations were not detected in 10 non-porphyria-associated HCCs. Our data demonstrate that in the hepatic cancer tissue of AHP patients, somatic second-hit mutations result in nearly complete inactivation of the enzymes catalyzing major steps in the heme biosynthetic pathway. Both PPOX and HMBS, which might act as tumor suppressors, play a crucial role in the development of HCC in these individuals.
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Affiliation(s)
- Xiaoye Schneider-Yin
- Institute of Laboratory Medicine and Swiss Porphyrin Reference Laboratory, Stadtspital Triemli, Zürich, Switzerland
| | - Anne-Moon van Tuyll van Serooskerken
- Department of Dermatology, Maastricht University Medical Center (MUMC), The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands
| | - Marko Siegesmund
- Department of Dermatology and Skin Cancer Center and European Porphyria Specialist Center, Medical Faculty of the Heinrich Heine University, Düsseldorf, Germany
| | - Philip Went
- Institute of Pathology Enge, Zürich, Switzerland
| | - Jasmin Barman-Aksözen
- Institute of Laboratory Medicine and Swiss Porphyrin Reference Laboratory, Stadtspital Triemli, Zürich, Switzerland
| | - Reno S Bladergroen
- Department of Dermatology, Maastricht University Medical Center (MUMC), The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands
| | - Paul Komminoth
- Institute of Pathology, Stadtspital Triemli, Zürich, Switzerland
| | - Roy H E Cloots
- Department of Pathology, Maastricht University Medical Center (MUMC), The Netherlands
| | | | - Axel zur Hausen
- Department of Pathology, Maastricht University Medical Center (MUMC), The Netherlands
| | - Markus Weber
- Department of Surgery, Stadtspital Triemli, Zürich, Switzerland
| | - Ann Driessen
- Department of Pathology, Maastricht University Medical Center (MUMC), The Netherlands
| | - Pamela Poblete-Gutiérrez
- Department of Dermatology, Annadal Medical Center Maastricht, The Netherlands; Department of Dermatology, Ziekenhuis Oost-Limburg (ZOL) Genk, Belgium
| | - Peter Bauer
- Department of Medical Genetics, University of Tübingen, Tübingen, Germany
| | | | - Michel van Geel
- Department of Dermatology, Maastricht University Medical Center (MUMC), The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands
| | - Elisabeth I Minder
- Institute of Laboratory Medicine and Swiss Porphyrin Reference Laboratory, Stadtspital Triemli, Zürich, Switzerland
| | - Jorge Frank
- Department of Dermatology, Maastricht University Medical Center (MUMC), The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands; Department of Dermatology and Skin Cancer Center and European Porphyria Specialist Center, Medical Faculty of the Heinrich Heine University, Düsseldorf, Germany.
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Schneider-Yin X, van Tuyll van Serooskerken AM, Went P, Tyblewski W, Poblete-Gutiérrez P, Minder EI, Frank J. Hepatocellular carcinoma in variegate porphyria: a serious complication. Acta Derm Venereol 2010; 90:512-5. [PMID: 20814629 DOI: 10.2340/00015555-0870] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Variegate porphyria is an acute hepatic porphyria resulting from a partial deficiency of protoporphyrinogen oxidase, the penultimate enzyme in haem biosynthesis. Cutaneous symptoms and acute neurovisceral attacks are well-known clinical characteristics of the disease. Less studied, however, is the risk of developing hepatocellular carcinoma, an aggressive type of liver cancer. We describe here two Swiss patients with variegate porphyria and this serious complication. Common risk factors, including alcohol over-consumption or chronic hepatitis, were absent in both patients. Interestingly, one patient carried mutation 1082-1083insC in the PPOX gene, a prevalent sequence deviation in the Swiss variegate porphyria population, which was also found in a French patient with variegate porphyria and hepatocellular carcinoma. Recent studies indicate that individuals with acute hepatic porphyria have a 36- to 61-fold increased risk of manifesting hepatocellular carcinoma. The incidence rate ratio in the Swiss population was estimated to be 34, comparable with those found in the French and Finnish populations. Because this tumour is associated with a rising mortality, we suggest regular screening for hepatocellular carcinoma in all patients with variegate porphyria.
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Affiliation(s)
- Xiaoye Schneider-Yin
- Zentrallabor and Swiss Porphyrin Reference Laboratory, Stadtspital Triemli, Zürich, Switzerland
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van Tuyll van Serooskerken AM, Habets JMW, Badeloe S, Poblete-Gutiérrez P, Frank J. Porphyria cutanea tarda in pre-existent lupus erythematosus--is there an association? Int J Dermatol 2008; 46 Suppl 3:50-2. [PMID: 17973893 DOI: 10.1111/j.1365-4632.2007.03515.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In lupus erythematosus (LE), vesicles and bullae are only rarely seen. However, in some instances such efflorescences might suggest an association with distinct cutaneous diseases, including erythema multiforme, toxic epidermal necrolysis or autoimmune blistering disorders such as bullous pemphigoid, pemphigus vulgaris, and dermatitis herpetiformis Duhring. Another blistering disease that has been described in association with cutaneous and systemic LE is porphyria cutanea tarda (PCT). PCT is a metabolic disorder caused by a deficiency of the fifth enzyme in heme biosynthesis, uroporphyrinogen decarboxylase. Here, we report on a 57-year-old Caucasian woman of Dutch origin with a medical history of mild cutaneous LE who developed skin fragility, blistering skin lesions, milia, and facial hypertrichosis. Subsequent porphyrin analysis in urine and feces confirmed the suspected simultaneous manifestation of LE and PCT.
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Affiliation(s)
- Anne-Moon van Tuyll van Serooskerken
- Department of Dermatology and Euregional Porphyria Center Maastricht-Aachen (EPCMA), University Hospital Maastricht, Maastricht, The Netherlands.
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