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Sato Y, Watanabe Y, Morisaki T, Hayashi S, Otsubo Y, Ochiai Y, Mizoguchi K, Takao Y, Yamada M, Mizuuchi Y, Nakamura M, Kubo M. Beckwith-Wiedemann syndrome with juvenile fibrous nodules and lobular breast tumors: a case report and review of the literature. Surg Case Rep 2024; 10:69. [PMID: 38514513 PMCID: PMC10957838 DOI: 10.1186/s40792-024-01865-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Beckwith-Wiedemann syndrome (BWS) is a genomic imprinting disorder caused by diverse genetic and/or epigenetic disorders of chromosome 11p15.5. BWS presents with a variety of clinical features, including overgrowth and an increased risk of embryonal tumors. Notably however, reports of patients with BWS and breast tumors are rare, and the association between these conditions is still unclear. Insulin-like growth factor-2 (IGF2) expression is known to be associated with the development of various cancers, including breast cancer, and patients with BWS with specific subtypes of molecular defects are known to show characteristic clinical features and IGF2 overexpression. CASE PRESENTATION A 17-year-old girl who had been diagnosed with BWS based on an umbilical hernia, hyperinsulinemia, and left hemihypertrophy at birth, visited our department with a gradually swelling left breast. Her left breast was markedly larger than her right breast on visual examination. Imaging examinations showed two tumors measuring about 10 cm each in the left breast, and she was diagnosed with juvenile fibroadenoma following core needle biopsy. The two breast tumors were removed surgically and the patient remained alive with no recurrence. The final diagnosis was juvenile fibroadenoma without malignant findings. Immunohistochemical staining using IGF2 antibody revealed overexpression of IGF2 in the cytoplasm of ductal epithelial cells. Because of her clinical features and IGF2 overexpression, molecular defects of 11p15.5 including a possible genetic background of paternal uniparental disomy of chromosome 11 or hypermethylation of imprinting center 1 was suspected. CONCLUSIONS In this case, overexpression of IGF2 suggested a possible relationship between BWS and breast tumors. Moreover, the characteristic clinical features and IGF2 staining predicted the subtype of 11p15.5 molecular defects in this patient.
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Affiliation(s)
- Yo Sato
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yusuke Watanabe
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Takafumi Morisaki
- Department of Breast Surgical Oncology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Saori Hayashi
- Department of Breast Surgical Oncology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Yoshiki Otsubo
- Department of Breast Surgical Oncology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yurina Ochiai
- Department of Breast Surgical Oncology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kimihisa Mizoguchi
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yuka Takao
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Mai Yamada
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yusuke Mizuuchi
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Masafumi Nakamura
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Makoto Kubo
- Departments of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
- Department of Breast Surgical Oncology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
- Department of Clinical Genetics and Medicine, Kyushu University Hospital, Fukuoka, Japan.
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Hailu SS, Zewdneh D, Hailu D, Hailemariam T. Beckwith-Wiedemann syndrome in a child with multifocal Wilms tumor and lateralized overgrowth: A case report. Radiol Case Rep 2023; 18:2966-2970. [PMID: 37520386 PMCID: PMC10375379 DOI: 10.1016/j.radcr.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 08/01/2023] Open
Abstract
Beckwith-Wiedemann syndrome (BWS) is a rare imprinting disorder and overgrowth syndrome with a prevalence of 1 in 10,000 live births. It is characterized by predilection for embryonal tumor growth, especially Wilms tumor (WT), and manifestations like lateralized overgrowth/hemihypertrophy, macroglossia, macrosomia, anterior abdominal wall defects, and hyperinsulinism. Our case is a 1 year of female child who presented with abdominal swelling and limb length discrepancies. A clinical diagnosis of BWS was made based on multifocal WT and hepatomegaly and nephromegaly detected on contrast-enhanced abdominal computed tomography and physical examination findings of lateralized overgrowth and umbilical hernia. A molecular genetic test was not available. The patient was started on preoperative chemotherapy with good tolerance. Clinical criteria can be used to diagnose WBS in a setting where confirmatory molecular testing is unavailable. This will considerably change approaches to management of presenting complications such as WT .
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Affiliation(s)
- Samuel Sisay Hailu
- Department of Radiology, Addis Ababa University, School of Medicine, Addis Ababa, 9080 Ethiopia
| | - Daniel Zewdneh
- Department of Radiology, Addis Ababa University, School of Medicine, Addis Ababa, 9080 Ethiopia
| | - Daniel Hailu
- Department of Pediatrics and Child Health, Addis Ababa University, School of Medicine, Addis Ababa, Ethiopia
| | - Tesfahunegn Hailemariam
- Department of Radiology, Addis Ababa University, School of Medicine, Addis Ababa, 9080 Ethiopia
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Duffy KA, Hathaway ER, Klein SD, Ganguly A, Kalish JM. Epigenetic mosaicism and cell burden in Beckwith-Wiedemann Syndrome due to loss of methylation at imprinting control region 2. Cold Spring Harb Mol Case Stud 2021; 7:mcs.a006115. [PMID: 34697083 PMCID: PMC8751414 DOI: 10.1101/mcs.a006115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022] Open
Abstract
Beckwith–Wiedemann syndrome (BWS) is a rare overgrowth disorder caused by epigenetic alterations on Chromosome 11p15.5. Most molecular changes are sporadic and are thought to occur in a mosaic pattern. Thereby, the distribution of affected cells differs between tissues for each individual, which can complicate genotype–phenotype correlations. In two of the BWS molecular subtypes, tissue mosaicism has been demonstrated; however, mosaicism has not been specifically studied in the most common cause of BWS, loss of methylation (LOM) at KCNQ1OT1:TSS differentially methylated region (DMR) imprinting center 2 (IC2) LOM. The increased prevalence of twinning associated with the IC2 LOM subtype and the discordant phenotypes between the twins previously led to the proposal of diffused epigenetic mosaicism, leading to asymmetric distribution of affected cells during embryonic development. In this study, we evaluated the level of methylation detected in 64 samples collected from 30 individuals with IC2 LOM. We demonstrate that the IC2 LOM defect can occur in mosaic and nonmosaic patterns, and tissues from the same individual can show variable patterns, which suggests that this asymmetric distribution occurs during development. We further suggest that the clinical phenotype in individuals with BWS IC2 LOM is correlated with the epigenetic burden of affected cells in each tissue type. This series is the first report to demonstrate tissue mosaicism within the IC2 LOM epigenotype, and consideration of this mosaicism is necessary to understanding the pathogenesis of BWS.
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Snee IA, Mazzola CA, Sikorskyj T. Chiari I malformation with Klippel-Trenaunay syndrome: case report and review of the literature. Childs Nerv Syst 2021; 37:2369-2373. [PMID: 33492467 PMCID: PMC8263457 DOI: 10.1007/s00381-020-04992-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/30/2020] [Indexed: 01/19/2023]
Abstract
We present a rare case of an 8-year-old male with Klippel-Trenaunay syndrome (KTS) and a Chiari I malformation (CIM). Magnetic resonance imaging (MRI) to investigate facial asymmetry and speech delay at age two revealed CIM with cerebellar tonsils 1.3 cm below the foramen magnum without syringomyelia. The patient underwent a craniectomy and posterior fossa decompression with C1 laminectomy. While gene sequencing determined the patient was negative for the PIK3CA gene mutation, the patient's clinical history strongly suggests KTS. He has hemihypertrophy, leg length discrepancy, hemangiomas and pigmentary mosaicism along the upper and lower extremities, heart murmur, chronic low heart rate, recurrent hip pain, and mild scoliosis. Neurodevelopmental concerns include difficulty reading, attention deficit hyperactivity disorder (ADHD), anxiety, and difficulty running and going downstairs. His most recent MRI shows good decompression at the cervicomedullary junction, global cerebrospinal fluid (CSF) flow, and less peg-like cerebellar tonsils. Also noted were two intravertebral hemangiomas at T5 and T6. While the patient's speech has improved, there is still difficulty with the expressive language. He still has mild delays, runs slowly, and does not alternate feet when climbing stairs. The patient is being followed by multiple specialists including neurology, hematology-oncology, genetics, orthopedic surgery, and developmental pediatrics.
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Affiliation(s)
- Isabel A. Snee
- The University of Notre Dame, Notre Dame, IN USA ,The New Jersey Pediatric Neuroscience Institute, Morristown, NJ USA
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Deka JB, Deka NK, Shah MV, Bhatnagar N, Nanni AL, Jimenez F. Intraneural hemangioma in Klippel-Trenaunay syndrome: role of musculo-skeletal ultrasound in diagnosis-case report and review of the literature. J Ultrasound 2020; 23:435-42. [PMID: 32078146 DOI: 10.1007/s40477-020-00434-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 01/19/2023] Open
Abstract
Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder with an incidence of 1 in 100,000. It is characterized by a triad of capillary malformations (hemangiomas) or port-wine stains, venous varicosities, and bony- or soft-tissue hypertrophy. The capillary malformation is usually confined to a single extremity, usually a lower limb. The disease can lead to various morbidities, such as bleeding, deep vein thrombosis, venous ulcers, and embolic complications. We report a case of an 11-year-old girl who presented with the three classical symptoms of KTS, with port-wine stains in the left leg, an enlarged and elongated left leg, and soft-tissue hypertrophy and multiple venous varicosities in the left tibia. A subcutaneous hemangioma along with intramuscular hemangiomas in the leg muscles was noted with increased adipose tissue. The rare finding of an intraneural hemangioma of the distal posterior tibial nerve was also diagnosed. Ultrasound of the lower limb was the main tool in making the diagnosis of KTS. X-Ray and MRI were ancillary imaging modalities. This article describes the case study of the child and the findings of a detailed ultrasound examination.
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Vaiman M, Shilco P, Roitblat Y, Padilla-Raygoza N, Leit A, Kavin A, Schonberger E, Nehuliaieva L, Buchris N, Shterenshis M. Screening Procedure for Hemihypertrophy: Preliminary Results of International Multicenter Prospective Study. Cent Asian J Glob Health 2019; 8:336. [PMID: 31321153 PMCID: PMC6564096 DOI: 10.5195/cajgh.2019.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Isolated or congenital hemihypertrophy is a rare disorder characterized by asymmetric overgrowth of one side of the body. This article describes the protocol and preliminary results of a lateral body asymmetry (hemihypertrophy) screening procedure performed in healthy adolescents in a multicenter study. The reported incidence of hemihypertrophy varies between different publications and standardized protocols are needed to improve research in this area. Methods Our screening program is taking place in Australia, Israel, Mexico, Ukraine and USA. Procedure includes two steps: (1) “three measurements – three questions” screening, or assessment of face, palms, and shins; (2) in-depth assessment of selected cases in order to exclude localized, lesional, and syndrome-related cases as well as body asymmetry within normative range and to select suspected cases of isolated hemihypertrophy. This step includes measurements of various anatomical regions and a detailed questionnaire. Results At this stage, the screening procedure is completed and the selected participants are advised to refer to medical institutions for further clinical and genetic follow up to exclude possible tumors and other accompanying disorders. Conclusion We present an easy-to-use selection tool to identify children with suspected IH, which results in the selection of the risk group that may benefit from referral to a pediatrician and a clinical geneticist.
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Affiliation(s)
- Michael Vaiman
- Department of Otolaryngology, Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Phillip Shilco
- "Briut HaShen" Dental Health Clinic, Jerusalem, Israel.,Science Research Department, Alexander Muss High School in Israel (AMHSI) affiliated with Alexander Muss Institute for Israel Education (AMIIE), Hod HaSharon, Israel
| | - Yulia Roitblat
- Department of Sciences, Belkind School for Special Education, Rishon-LeZion, Israel
| | - Nicolas Padilla-Raygoza
- Department of Nursing and Obstetrics, Division of Health Sciences and Engineering, Campus Celaya-Salvatierra, University of Guanajuato, Mexico
| | - Aidan Leit
- Department of Sciences, The Harley School, Rochester, NY, USA
| | - Aaron Kavin
- Department of Anatomy, Mount Moriah College, Sydney, Australia
| | | | - Liliia Nehuliaieva
- Department of Pediatrics, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Noa Buchris
- Dept. of Sciences, El Camino Real Charter High School, Woodland Hills, CA, USA.,Science Research Department, Alexander Muss High School in Israel (AMHSI) affiliated with Alexander Muss Institute for Israel Education (AMIIE), Hod HaSharon, Israel
| | - Michael Shterenshis
- Science Research Department, Alexander Muss High School in Israel (AMHSI) affiliated with Alexander Muss Institute for Israel Education (AMIIE), Hod HaSharon, Israel
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