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Seront E, Froidure A, Revencu N, Dekeuleneer V, Clapuyt P, Dumitriu D, Vikkula M, Boon LM. Targeted treatment in complex lymphatic anomaly: a case of synergistic efficacy of trametinib and sirolimus. Orphanet J Rare Dis 2024; 19:199. [PMID: 38750525 PMCID: PMC11097431 DOI: 10.1186/s13023-024-03211-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 05/05/2024] [Indexed: 05/18/2024] Open
Abstract
Repurposing anticancer drugs to vascular malformations has significantly improved patient outcomes. Complex Lymphatic Anomalies (CLA) are part of the spectrum of lymphatic malformations (LMs) that share similar oncogenic mutations to cancer. We report the case of a young patient with highly symptomatic CLA who was initially treated with sirolimus, due to the frequent involvement of the PI3K-AKT-mTOR pathway in CLA pathogenesis. Despite an initial reduction in symptoms, sirolimus progressively lost its effectiveness. After an unsuccessful attempt with trametinib alone, sirolimus was added to trametinib and resulted in a significant, rapid and sustained improvement in symptoms. This suggests that, contrary to current dogmas, combination therapy using sub-therapeutic doses targeting both the PI3K and RAS pathways retains efficacy without generating the toxicity known for combination therapies, and is beneficial in the management of CLAs and potentially other vascular anomalies.
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Affiliation(s)
- Emmanuel Seront
- Institut Roi Albert II, Department of Medical Oncology, Center for Vascular Anomalies, Saint-Luc University Hospital, VASCERN VASCA European Reference Centre, UCLouvain, Brussels, Belgium
| | - Antoine Froidure
- Department of Pneumology, Center for Vascular Anomalies, Saint-Luc University Hospital, VASCERN VASCA European Reference Centre, UCLouvain, Brussels, Belgium
| | - Nicole Revencu
- Center for Human Genetics, Center for Vascular Anomalies, Saint-Luc University Hospital, VASCERN VASCA European Reference Centre, UCLouvain, Brussels, Belgium
| | - Valerie Dekeuleneer
- Division of Plastic Surgery, Center for Vascular Anomalies, Saint-Luc University Hospital, VASCERN VASCA European Reference Centre, UCLouvain, Cliniques Universitaires St Luc, Avenue Hippocrate 10, Brussels, B-1200, Belgium
| | - Philippe Clapuyt
- Department of Pediatric Radiology, Center for Vascular Anomalies, Saint-Luc University Hospital, VASCERN VASCA European Reference Centre, UCLouvain, Brussels, Belgium
| | - Dana Dumitriu
- Department of Pediatric Radiology, Center for Vascular Anomalies, Saint-Luc University Hospital, VASCERN VASCA European Reference Centre, UCLouvain, Brussels, Belgium
| | - Miikka Vikkula
- Human Molecular Genetics, De Duve Institute, UCLouvain, Brussels, Belgium
- WELBIO Department, WEL Research Institute, Avenue Pasteur, 6, Wavre, 1300, Belgium
| | - Laurence M Boon
- Division of Plastic Surgery, Center for Vascular Anomalies, Saint-Luc University Hospital, VASCERN VASCA European Reference Centre, UCLouvain, Cliniques Universitaires St Luc, Avenue Hippocrate 10, Brussels, B-1200, Belgium.
- Human Molecular Genetics, De Duve Institute, UCLouvain, Brussels, Belgium.
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Seront E, Van Damme A, Legrand C, Bisdorff-Bresson A, Orcel P, Funck-Brentano T, Sevestre MA, Dompmartin A, Quere I, Brouillard P, Revencu N, De Bortoli M, Hammer F, Clapuyt P, Dumitriu D, Vikkula M, Boon LM. Preliminary results of the European multicentric phase III trial regarding sirolimus in slow-flow vascular malformations. JCI Insight 2023; 8:e173095. [PMID: 37937645 PMCID: PMC10721262 DOI: 10.1172/jci.insight.173095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/27/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUNDSlow-flow vascular malformations frequently harbor activating mutations in the PI3K/AKT/mTOR cascade. Phase II trials pinpointed sirolimus effectiveness as a drug therapy. Efficacy and safety of sirolimus thus need to be evaluated in large prospective phase III trials.METHODSThe Vascular Anomaly-Sirolimus-Europe (VASE) trial, initiated in 2016, is a large multicentric prospective phase III trial (EudraCT 2015-001703-32), which evaluates efficacy and safety of sirolimus for 2 years in pediatric and adult patients with symptomatic slow-flow vascular malformations. In this interim analysis, we studied all patients enrolled up to October 2021 who received sirolimus for 12 or more months or who prematurely stopped the treatment.RESULTSThirty-one pediatric and 101 adult patients were included in this analysis; 107 completed 12 or more months of sirolimus, including 61 who were treated for the whole 2-year period. Sirolimus resulted in a clinical improvement in 85% of patients. The efficacy appeared within the first month for the majority of them. Grade 3-4 adverse events were observed in 24 (18%) patients; all resolved after treatment interruption/arrest. Sirolimus increased feasibility of surgery or sclerotherapy in 20 (15%) patients initially deemed unsuitable for intervention. Among the 61 patients who completed the 2-year treatment, 33 (54%) reported a recurrence of symptoms after a median follow-up of 13 months after sirolimus arrest. While there was no difference in efficacy, clinical improvement was faster but subsided more rapidly in PIK3CA-mutated (n = 24) compared with TIE2-mutated (n = 19) patients.CONCLUSIONSirolimus has a high efficacy and good tolerance in treatment of slow-flow vascular malformations in children and adults.TRIAL REGISTRATIONClinicalTrials.gov NCT02638389 and EudraCT 2015-001703-32.FUNDINGThe Fonds de la Recherche Scientifique (FNRS grants T.0247.19, P.C005.22, T.0146.16, and P.C013.20), the Fund Generet managed by the King Baudouin Foundation (grant 2018-J1810250-211305), the Walloon Region through the FRFS-WELBIO strategic research programme (WELBIO-CR-2019C-06), the MSCA-ITN network V.A. Cure no. 814316, the Leducq Foundation Networks of Excellence Program grant "ReVAMP" (LFCR grant 21CVD03), the European Union's Horizon 2020 research and innovation programme under grant agreement no. 874708 (Theralymph), the Swiss National Science Foundation under the Sinergia project no. CRSII5_193694, and a Pierre M. fellowship.
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Affiliation(s)
- Emmanuel Seront
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Institut Roi Albert II, Department of Medical Oncology, and
| | - An Van Damme
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Institut Roi Albert II, Department of Pediatric Hematology & Oncology, Cliniques universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | | | - Annouk Bisdorff-Bresson
- Neuroradiology Department of Pr Houdart Lariboisière Hospital, Center of vascular anomalies clinic VASCERN VASCA European Reference Centre, Paris, France
| | - Philippe Orcel
- Department of Rheumatology – DMU Locomotion, AP-HP Nord – University of Paris and INSERM U1132 BIOSCAR, Paris, France, Paris, France
| | - Thomas Funck-Brentano
- Department of Rheumatology – DMU Locomotion, AP-HP Nord – University of Paris and INSERM U1132 BIOSCAR, Paris, France, Paris, France
| | | | - Anne Dompmartin
- Department of Dermatology, CHU Université Caen Normandie, Caen, France
| | - Isabelle Quere
- IDESP, Univeristy of Montpellier – INSERM, CHU Montpellier, CRMR FAVA-Multi, Montpellier, France
| | - Pascal Brouillard
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
| | - Nicole Revencu
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Centre for Human Genetics, Cliniques universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Martina De Bortoli
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
| | - Frank Hammer
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Division of Interventional Radiology, and
| | - Philippe Clapuyt
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Department of Pediatric Radiology, Cliniques universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Dana Dumitriu
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Department of Pediatric Radiology, Cliniques universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Miikka Vikkula
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
- WELBIO department, WEL Research Institute, Wavre, Belgium
| | - Laurence M. Boon
- Center for Vascular Anomalies, Cliniques universitaires Saint-Luc, University of Louvain, VASCERN VASCA European Reference Centre, Brussels, Belgium
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
- Division of Plastic Surgery, Cliniques universitaires Saint-Luc, University of Louvain, Brussels, Belgium
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Ramboux A, Poncelet A, Clapuyt P, Scheers I, Sokal E, Reding R, Stephenne X. Deoxyguanosine kinase deficiency and recurrent spontaneous pneumothorax: a case report. J Med Case Rep 2023; 17:413. [PMID: 37775787 PMCID: PMC10543300 DOI: 10.1186/s13256-023-04151-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 08/30/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Deoxyguanosine kinase deficiency is mainly manifested by hepatic and neurological damage, hence it belongs to the hepatocerebral form of mitochondrial deoxyribonucleic acid depletion syndrome. The association between deoxyguanosine kinase deficiency and recurrent spontaneous pneumothorax has not currently been reported. CASE PRESENTATION A 12-year-old Russian boy with deoxyguanosine kinase deficiency, a recipient of a liver transplant with amyotrophy secondary to his mitochondriopathy, presented with recurrent spontaneous bilateral pneumothorax refractory to drainage and surgery. CONCLUSION To our knowledge, this is the first documented case of deoxyguanosine kinase deficiency associated with recurrent spontaneous pneumothorax, which could be considered a late complication of deoxyguanosine kinase deficiency. At this point, this is only an association and further studies and research need to be performed to help confirm the pathogenesis of this association.
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Affiliation(s)
- Alice Ramboux
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
| | - Alain Poncelet
- Division of Cardiothoracic Surgery, Department of Surgery, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Philippe Clapuyt
- Division of Paediatric Radiology, Department of Radiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Isabelle Scheers
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Etienne Sokal
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Raymond Reding
- Division of Paediatric Surgery, Department of Surgery, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Xavier Stephenne
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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De Smedt F, Dessy F, Carestia L, Baldin P, Nana FA, Clapuyt P, Boon V, Amant F, Mhallem Gziri M. A pregnant patient with ALK-positive non-small cell lung cancer treated with alectinib: A case report and review of the literature. Oncol Lett 2022; 25:54. [PMID: 36644155 PMCID: PMC9827466 DOI: 10.3892/ol.2022.13640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/13/2022] [Accepted: 10/07/2022] [Indexed: 12/24/2022] Open
Abstract
Oncogenic rearrangements in the anaplastic lymphoma kinase (ALK) gene account for 5% of non-small cell lung cancer (NSCLC) cases. ALK inhibitors have markedly improved the outcome of metastatic ALK-positive NSCLC (ALK+ mNSCLC) by increasing long-term overall survival. Although a diagnosis of NSCLC during pregnancy or the peripartum period is rare, ALK+ NSCLC accounts for 38% of NSCLC cases in women of childbearing age (18-45 years old). The younger age and prolonged survival of patients with ALK+ mNSCLC bring new challenges for lung cancer and obstetrics research, and raises questions related to pregnancy and family planning. The present study described normal fetal development and no obstetric complications in a patient infected with HIV diagnosed with ALK+ mNSCLC, who became pregnant during treatment with alectinib, a third-generation ALK inhibitor.
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Affiliation(s)
- Fabian De Smedt
- Department of Obstetrics, Clinique Saint-Pierre, 1340 Ottignies, Belgium
| | - Frédérique Dessy
- Department of Obstetrics, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Luciano Carestia
- Department of Pneumology, Clinique Saint-Pierre, Avenue Reine Fabiola 9, 1340 Ottignies, Belgium
| | - Pamela Baldin
- Department of Pathology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Frank Aboubakar Nana
- Department of Pneumology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Philippe Clapuyt
- Department of Radiology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Véronique Boon
- Department of Obstetrics, Clinique Saint-Pierre, 1340 Ottignies, Belgium
| | - Frédéric Amant
- Department of Gynecologic Oncology, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium,Department of Surgery, Netherlands Cancer Institute, 1066 CX, Amsterdam, Netherlands
| | - Mina Mhallem Gziri
- Department of Obstetrics, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium,Correspondence to: Professor Mina Mhallem Gziri, Department of Obstetrics, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium, E-mail:
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Polle O, Delfosse A, Michoux N, Peeters F, Duchene G, Mouraux T, Clapuyt P, Louis J, Gies I, den Brinker M, Lebrethon MC, Seret N, Lysy P. RF16 | PSUN203 Deep Characterization of Pancreas Volume of New-Onset Type 1 Diabetes Patients Reveals Puberty-Specific Patterns and New Topographic Correlations with Pancreatic Functions. J Endocr Soc 2022. [PMCID: PMC9627796 DOI: 10.1210/jendso/bvac150.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
There is a current understanding of type 1 diabetes (T1D) as being the result of a heterogeneous disease of whole pancreas. So far, descriptions of pancreas alterations suggested a global involvement of inflammation throughout the organ, characterized by abnormal age-specific patterns (i.e. > or <7 yo). In our DIATAG study, we thoroughly characterized pancreatic structure modifications in new-onset T1D patients and investigated whether these correlated with pancreatic functions during the first postdiagnosis year. Pediatric patients with new-onset T1D (n=31; 11.2±2.9 years) underwent abdominal MRI scan at diagnosis (i.e. 40±37 days postdiagnosis). Exocrine function (i.e. serum trypsinogen) and residual endocrine secretion estimates (i.e. fasten = CPEPBASAL, stimulated model = CPEPEST (1)) were evaluated on fasten blood tests at diagnosis (Δ) and Δ+3, +12 months, respectively. Clinical parameters of glucose homeostasis (i.e. A1C, insulin daily dose, insulin-dose adjusted A1c [IDAA1C]) were collected at Δ+3, +6, +9 and +12 months. We compared pancreas volumes (i.e. PV, PVHEAD, PVBODY, PVTAIL) and ratios (pancreas volume ratio [PVR] = PVHEAD/PVBODY+TAIL; pancreas index [PI] = PV/body weight) to retrospectively identify age-, BMI- and sex-matched controls (n=29). Compared to control group, T1D patients demonstrated a homogeneous (PVR, 1.39±0.7 vs 1.46±0.4, p>0.05) decrease of PI (0.6±0.2 vs 1.1±0.3 mL/kg, p<0.0001) independently of pancreatic subregion. Interestingly, prepubertal children with T1D (n=15) exhibited greater pancreas atrophy of both the body-tail (10±5.6%, p<0.05) and head (7.2±3%, p<0.05) subregions compared to pubertal group (n=16; PI difference of mean, 0.64 vs 0.48 mL/kg). Next, we evaluated correlations between pancreatic volumes and functions during the natural evolution of T1D using multivariate and univariate linear regressions. PV and PI correlated moderately with exocrine function (trypsinogen; R=0.46, R=0.52, p<0.001) but not with residual endocrine function evaluated at Δ+3 months. Interestingly, we observed using topographical analysis that PVHEAD correlated with trypsinogen (R=0.5, p<0.001) but not with any endocrine estimates (p>0.05). PVTAIL positively correlated with CPEPEST and CPEPBASAL at Δ+3 months (R=0.55, p=0.002; R=0.47, p<0.01) and not with clinical parameters or trypsinogen (p>0.05). PVBODY did not correlate with any pancreatic function. Finally, we identified multivariate models that included PV and predicted pancreatic endocrine function at Δ+6 and +12 months (i.e. IDAA1C, HbA1C). MRI performed early after T1D onset helped us define specific pancreas alterations and demonstrate for the first time: (1) the increased pancreas atrophy in prepubertal children; (2) correlations between pancreatic subregion volumes and their respective residual functions early after diagnosis and (3) the improvement of endocrine function prediction models by adding PV estimates as predictors. (1) Wentworth et al. 2019;62(1): 33–40 Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Sunday, June 12, 2022 1:00 p.m. - 1:05 p.m.
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Hoornaert E, Clapuyt P, Dumitriu D, Niel O, Huybrechts S, Scheers I, Sokal E, Reding R, Stephenne X. Conservative management of congenital hepatic hemangioma complicated by ascites. Clin Case Rep 2022; 10:e05938. [PMID: 35846904 PMCID: PMC9281363 DOI: 10.1002/ccr3.5938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/28/2022] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
Involution of a rapidly involuting congenital hemangioma is an unknown cause of neonatal ascites. As involution phase is completed by 14 months after birth, conservative management with diuretics and drainage is possible and may avoid surgical resection.
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Affiliation(s)
- Emmy Hoornaert
- Division of Paediatric Gastroenterology and Hepatology Department of Paediatrics Cliniques Universitaires Saint Luc Université catholique de Louvain Brussels Belgium
| | - Philippe Clapuyt
- Division of Paediatric Radiology Department of Radiology Cliniques Universitaires Saint Luc Université catholique de Louvain Brussels Belgium
| | - Dana Dumitriu
- Division of Paediatric Radiology Department of Radiology Cliniques Universitaires Saint Luc Université catholique de Louvain Brussels Belgium
| | - Olivier Niel
- Department of Paediatrics Centre Hospitalier du Luxembourg Luxembourg Luxembourg
| | - Sophie Huybrechts
- Department of Paediatrics Centre Hospitalier du Luxembourg Luxembourg Luxembourg
| | - Isabelle Scheers
- Division of Paediatric Gastroenterology and Hepatology Department of Paediatrics Cliniques Universitaires Saint Luc Université catholique de Louvain Brussels Belgium
| | - Etienne Sokal
- Division of Paediatric Gastroenterology and Hepatology Department of Paediatrics Cliniques Universitaires Saint Luc Université catholique de Louvain Brussels Belgium
| | - Raymond Reding
- Division of Paediatric Surgery Department of Surgery Cliniques Universitaires Saint Luc Université catholique de Louvain Brussels Belgium
| | - Xavier Stephenne
- Division of Paediatric Gastroenterology and Hepatology Department of Paediatrics Cliniques Universitaires Saint Luc Université catholique de Louvain Brussels Belgium
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7
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Brouillard P, Schlögel MJ, Homayun Sepehr N, Helaers R, Queisser A, Fastré E, Boutry S, Schmitz S, Clapuyt P, Hammer F, Dompmartin A, Weitz-Tuoretmaa A, Laranne J, Pasquesoone L, Vilain C, Boon LM, Vikkula M. Non-hotspot PIK3CA mutations are more frequent in CLOVES than in common or combined lymphatic malformations. Orphanet J Rare Dis 2021; 16:267. [PMID: 34112235 PMCID: PMC8194016 DOI: 10.1186/s13023-021-01898-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 12/02/2020] [Accepted: 05/29/2021] [Indexed: 12/26/2022] Open
Abstract
Background Theragnostic management, treatment according to precise pathological molecular targets, requests to unravel patients’ genotypes. We used targeted next-generation sequencing (NGS) or digital droplet polymerase chain reaction (ddPCR) to screen for somatic PIK3CA mutations on DNA extracted from resected lesional tissue or lymphatic endothelial cells (LECs) isolated from lesions. Our cohort (n = 143) was composed of unrelated patients suffering from a common lymphatic malformation (LM), a combined lymphatic malformation [lymphatico-venous malformation (LVM), capillaro-lymphatic malformation (CLM), capillaro-lymphatico-venous malformation (CLVM)], or a syndrome [CLVM with hypertrophy (Klippel-Trenaunay-Weber syndrome, KTS), congenital lipomatous overgrowth-vascular malformations-epidermal nevi -syndrome (CLOVES), unclassified PIK3CA-related overgrowth syndrome (PROS) or unclassified vascular (lymphatic) anomaly syndrome (UVA)]. Results We identified a somatic PIK3CA mutation in resected lesions of 108 out of 143 patients (75.5%). The frequency of the variant allele ranged from 0.54 to 25.33% in tissues, and up to 47% in isolated endothelial cells. We detected a statistically significant difference in the distribution of mutations between patients with common and combined LM compared to the syndromes, but not with KTS. Moreover, the variant allele frequency was higher in the syndromes. Conclusions Most patients with an common or combined lymphatic malformation with or without overgrowth harbour a somatic PIK3CA mutation. However, in about a quarter of patients, no such mutation was detected, suggesting the existence of (an)other cause(s). We detected a hotspot mutation more frequently in common and combined LMs compared to syndromic cases (CLOVES and PROS). Diagnostic genotyping should thus not be limited to PIK3CA hotspot mutations. Moreover, the higher mutant allele frequency in syndromes suggests a wider distribution in patients’ tissues, facilitating detection. Clinical trials have demonstrated efficacy of Sirolimus and Alpelisib in treating patients with an LM or PROS. Genotyping might lead to an increase in efficacy, as treatments could be more targeted, and responses could vary depending on presence and type of PIK3CA-mutation. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01898-y.
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Affiliation(s)
- Pascal Brouillard
- Human Molecular Genetics, de Duve Institute, University of Louvain, Avenue Hippocrate 74 (+5), bte B1.74.06, 1200, Brussels, Belgium
| | - Matthieu J Schlögel
- Human Molecular Genetics, de Duve Institute, University of Louvain, Avenue Hippocrate 74 (+5), bte B1.74.06, 1200, Brussels, Belgium
| | - Nassim Homayun Sepehr
- Human Molecular Genetics, de Duve Institute, University of Louvain, Avenue Hippocrate 74 (+5), bte B1.74.06, 1200, Brussels, Belgium
| | - Raphaël Helaers
- Human Molecular Genetics, de Duve Institute, University of Louvain, Avenue Hippocrate 74 (+5), bte B1.74.06, 1200, Brussels, Belgium
| | - Angela Queisser
- Human Molecular Genetics, de Duve Institute, University of Louvain, Avenue Hippocrate 74 (+5), bte B1.74.06, 1200, Brussels, Belgium
| | - Elodie Fastré
- Human Molecular Genetics, de Duve Institute, University of Louvain, Avenue Hippocrate 74 (+5), bte B1.74.06, 1200, Brussels, Belgium
| | - Simon Boutry
- Human Molecular Genetics, de Duve Institute, University of Louvain, Avenue Hippocrate 74 (+5), bte B1.74.06, 1200, Brussels, Belgium
| | - Sandra Schmitz
- Otolaryngology Department, Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium.,Center for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium.,VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Philippe Clapuyt
- Otolaryngology Department, Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium.,Center for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium.,VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Frank Hammer
- Otolaryngology Department, Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium.,Center for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium.,VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Anne Dompmartin
- Department of Dermatology, Université de Caen Basse Normandie, CHU Caen, Caen, France
| | | | - Jussi Laranne
- Department of Otorhinolaryngology, Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
| | - Louise Pasquesoone
- Service de Chirurgie Plastique Reconstructive, Hôpital Salengro, CHU de Lille, Lille, France
| | - Catheline Vilain
- Department of Genetics, Hôpital Erasme, ULB Center of Human Genetics, Université Libre de Bruxelles, Brussels, Belgium
| | - Laurence M Boon
- Human Molecular Genetics, de Duve Institute, University of Louvain, Avenue Hippocrate 74 (+5), bte B1.74.06, 1200, Brussels, Belgium.,Center for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium.,VASCERN VASCA European Reference Centre, Brussels, Belgium
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, University of Louvain, Avenue Hippocrate 74 (+5), bte B1.74.06, 1200, Brussels, Belgium. .,Center for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium. .,VASCERN VASCA European Reference Centre, Brussels, Belgium. .,Walloon Excellence in Lifesciences and Biotechnology (WELBIO), University of Louvain, Brussels, Belgium.
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Biard JM, Payrat S, Clapuyt P, Barrea C, Benoit V, Baldin P, Bernard P, Van Grambezen B, Sznajer Y. Antenatal diagnosis of CHARGE syndrome: Prenatal ultrasound findings and crucial role of fetal dysmorphic signs. About a series of 10 cases and review of literature. Eur J Med Genet 2021; 64:104189. [PMID: 33662639 DOI: 10.1016/j.ejmg.2021.104189] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/14/2020] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 12/25/2022]
Abstract
Although the prognosis of CHARGE syndrome can be highly variable from mild until severe, final diagnosis is difficult to establish in utero. The aim of our study is to compare antenatal and postnatal findings in a retrospective cohort of 10 successive patients with a positive CHD7 gene variant in order to identify the specific prenatal features for CHARGE syndrome diagnosis. Fetal ultrasound, follow-up and supplementary investigations are collected and compared to postnatal findings. Congenital heart defect (7/10), choanal atresia (7/10) and tracheoesophageal atresia (4/10) are the most frequent fetal anomalies found. Inner and external ear anomalies appear as the keystone (constant features) for prenatal diagnosis of CHARGE syndrome in fetuses with multiple anomalies and normal microarray karyotype. External ear malformations are identified in all cases by 3D ultrasound when carefully evaluated. MRI and temporal bone CT-Scan are second line useful tools to assess the diagnosis when looking for semicircular canal agenesis, arhinencephaly and/or choanal atresia. Before availability of prenatal exome sequencing in clinical routine, present findings lead to the recommendation that fetuses, with congenital heart defect (mainly septal and conotruncal), cleft lip/palate or unexplained polyhydramnios should carefully be screened for clues suggesting CHARGE syndrome using 2D and 3D ultrasound, MRI and temporal bone CT-Scan. When CHARGE syndrome is suspected with normal molecular karyotype, CHD7 gene sequencing must be offered.
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Affiliation(s)
- Jean-Marc Biard
- Fetal Medicine Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Stéphanie Payrat
- Fetal Medicine Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Philippe Clapuyt
- Pediatric Radiology Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Catherine Barrea
- Cardiopediatric Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | | | - Pamela Baldin
- Department of Anatomopathology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Pierre Bernard
- Fetal Medicine Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Bénédicte Van Grambezen
- Neonatal Intensive Care Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Yves Sznajer
- Center for Human Genetics, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
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9
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Duquesne S, Nassogne MC, Clapuyt P, Stouffs K, Sznajer Y. Phenotype description in KIF5C gene hot-spot mutations responsible for malformations of cortical development (MCD). Eur J Med Genet 2020; 63:103991. [PMID: 32562872 DOI: 10.1016/j.ejmg.2020.103991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/20/2019] [Revised: 06/07/2020] [Accepted: 06/13/2020] [Indexed: 12/28/2022]
Abstract
Malformations of cortical development (MCD) represent a large group of brain cortical anomalies characterized by distinctive MRI findings. This 'radiologically-based' classification required re evaluation over time on identified underlying mechanisms (cytogenetic and/or molecular). The understanding of genotype findings (nature of cytogenetic/molecular mutation, cellular pathways consequences, timing, …) draw line of evidence on these distinctive group of conditions whereas sometimes precise and constant recurrent genotype/phenotype correlation may not be present. The clinical diagnosis of MCD is often difficult due to variability and rarity of individual types of malformations. Recent studies have established a relationship between lissencephaly and pathogenic variants in genes involved in the kinesin/tubulin pathways, as the KIF5C gene. Pathogenic variants in the KIF5C gene are a more recently discovered cause of severe developmental delay with epilepsy, characterized by specific malformation of cortical development such as pachygyria. Only seven children have been described to date. We report the natural history of a sixteen years old patient identified carrier of a KIF5C gene mutation who developed infantile epilepsy. We then gather phenotype description and molecular results of all reported patients so far in order to better define this entity.
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Affiliation(s)
- Sophie Duquesne
- Center for Human Genetics, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
| | - Marie-Cécile Nassogne
- Pediatric Neurology, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
| | - Philippe Clapuyt
- Pediatric Radiology, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
| | - Katrien Stouffs
- Centre for Medical Genetic, University Hospital of Brussels UZ Brussel, Brussels, Belgium
| | - Yves Sznajer
- Center for Human Genetics, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium.
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10
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Bonnet N, Paul J, Helleputte T, Veyckemans F, Pirotte T, Prégardien C, Eeckhoudt S, Hermans C, Detaille T, Clapuyt P, Menten R, Dumitriu D, Reding R, Scheers I, Varma S, Smets F, Sokal E, Stéphenne X. Novel insights into the assessment of risk of upper gastrointestinal bleeding in decompensated cirrhotic children. Pediatr Transplant 2019; 23:e13390. [PMID: 30888111 DOI: 10.1111/petr.13390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/04/2018] [Revised: 01/16/2019] [Accepted: 02/10/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Cirrhotic children wait-listed for liver transplant are prone to bleeding from gastrointestinal varices. Grade 2-3 esophageal varices, red signs, and gastric varices are well-known risk factors. However, the involvement of hemostatic factors remains controversial because of the rebalanced state of coagulation during cirrhosis. METHODS Children suffering from decompensated cirrhosis were prospectively included while being on waitlist. Portal hypertension was assessed by ultrasound and endoscopy. Coagulopathy was evaluated through conventional tests, thromboelastometry, and platelet function testing. The included children were followed up until liver transplantation, and all bleeding episodes were recorded. Children with or without bleeding were compared according to clinical, radiological, endoscopic, and biological parameters. In addition, validation of a predictive model for risk of variceal bleeding comprising of grade 2-3 esophageal varices, red spots, and fibrinogen level <150 mg/dL was applied on this cohort. RESULTS Of 20 enrolled children, 6 had upper gastrointestinal bleeding. Significant differences were observed in fibrinogen level, adenosine diphosphate, and thrombin-dependent platelet aggregation. The model used to compute the upper gastrointestinal bleeding risk had an estimated predictive performance of 81.0%. Platelet aggregation analysis addition improved the estimated predictive performance up to 89.0%. CONCLUSIONS We demonstrated an association between hemostatic factors and the upper gastrointestinal bleeding risk. A low fibrinogen level and platelet aggregation dysfunction may predict the risk of bleeding in children with decompensated cirrhosis. A predictive model is available to assess the upper gastrointestinal bleeding risk but needs further investigations. Clinicaltrials.gov number: NCT03244332.
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Affiliation(s)
- Nicolas Bonnet
- Service de gastroentérologie et hépatologie pédiatrique, Département de pédiatrie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | | | | | - Francis Veyckemans
- Service d'anesthésiologie pédiatrique, Département de médecine aigue, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Thierry Pirotte
- Service d'anesthésiologie, Département de médecine aigue, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Caroline Prégardien
- Service d'anesthésiologie, Département de médecine aigue, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Stéphane Eeckhoudt
- Service de biologie hématologique, Département de biologie clinique, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Cédric Hermans
- Service d'hématologie, Département de médecine interne, Cliniques Universitaires Saint-Luc, Unité d'hémostase, Bruxelles, Belgique
| | - Thierry Detaille
- Service des soins intensifs pédiatriques, Département de médecine aigue, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Philippe Clapuyt
- Service de radiologie pédiatrique, Département de radiologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Renaud Menten
- Service de radiologie pédiatrique, Département de radiologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Dana Dumitriu
- Service de radiologie pédiatrique, Département de radiologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Raymond Reding
- Service de chirurgie pédiatrique, Département de chirurgie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Isabelle Scheers
- Service de gastroentérologie et hépatologie pédiatrique, Département de pédiatrie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Sharat Varma
- Service de gastroentérologie et hépatologie pédiatrique, Département de pédiatrie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Françoise Smets
- Service de gastroentérologie et hépatologie pédiatrique, Département de pédiatrie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Etienne Sokal
- Service de gastroentérologie et hépatologie pédiatrique, Département de pédiatrie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Xavier Stéphenne
- Service de gastroentérologie et hépatologie pédiatrique, Département de pédiatrie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
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11
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Janssens P, Dekeuleneer V, Van Damme A, Brouillard P, Revencu N, Clapuyt P, Ferreira I, Ballieux F, Vikkula M, Marot L, Baeck M, Boon LM. Angiosarcoma arising from congenital primary lymphedema. Pediatr Dermatol 2018; 35:e382-e388. [PMID: 30216524 DOI: 10.1111/pde.13664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 01/10/2023]
Abstract
We herein report the case of a 3-year-old girl with atypical congenital right upper limb lymphedema who developed an angiosarcoma. Only a few cases have been reported following congenital form of lymphedema and only 4 in such a young child. We also summarize all cases of angiosarcoma associated with congenital lymphedema reported in the literature.
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Affiliation(s)
- Pauline Janssens
- Department of Dermatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Valérie Dekeuleneer
- Department of Dermatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - An Van Damme
- Department of Pediatric Hemato-Oncology, Center for Vascular Anomalies, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Pascal Brouillard
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
| | - Nicole Revencu
- Department of Clinical Genetics, Center for Vascular Anomalies, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Philippe Clapuyt
- Department of Pediatric Radiology, Center for Vascular Anomalies, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Ingrid Ferreira
- Department of Anatomopathology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Fanny Ballieux
- Division of Plastic Surgery, Center for Vascular Anomalies, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium.,Walloon Excellence in Lifesciences and Biotechnology (WELBIO), University of Louvain, Brussels, Belgium
| | - Liliane Marot
- Department of Anatomopathology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Marie Baeck
- Department of Dermatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laurence M Boon
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium.,Division of Plastic Surgery, Center for Vascular Anomalies, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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12
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Hammer J, Seront E, Duez S, Dupont S, Van Damme A, Schmitz S, Hoyoux C, Chopinet C, Clapuyt P, Hammer F, Vikkula M, Boon LM. Sirolimus is efficacious in treatment for extensive and/or complex slow-flow vascular malformations: a monocentric prospective phase II study. Orphanet J Rare Dis 2018; 13:191. [PMID: 30373605 PMCID: PMC6206885 DOI: 10.1186/s13023-018-0934-z] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [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: 06/19/2018] [Accepted: 10/11/2018] [Indexed: 01/19/2023] Open
Abstract
Background Extensive and complex vascular malformations often cause chronic pain and severe functional restraint. Conventional treatments, such as surgery and/or sclerotherapy, are rarely curative, underscoring the great need for new therapeutic modalities. Recent preclinical and clinical data demonstrated that sirolimus could offset the progression of vascular malformations and significantly improve quality of life of patients through inhibition of the Phosphatidylinositol-3-kinase (PI3K)/AKT/mammalian Target of Rapamycin (mTOR) pathway. The purpose of this prospective study was to assess the efficacy and safety of this treatment in patients with extensive or complex slow-flow vascular malformations. Methods Sirolimus was administered orally on a continuous dosing schedule with pharmacokinetic-guided target serum concentration level of 10 to 15 ng/ml. Patients were seen every month for the first three months and subsequently every three months. The primary endpoints were safety and efficacy, based on clinical, biological and radiological evaluations, as well as a quality of life questionnaire. Results Nineteen patients, from 3 to 64 years old, with lymphatic (LM), venous (VM) or complex slow-flow malformations, refractory to standard care, were enrolled and received sirolimus continuously. After 12 months of follow-up, 16 patients were available for assessment of efficacy and safety: all had a significant and rapid improvement of their symptoms and quality of life. In two patients, sirolimus treatment permitted sclerotherapy and surgery, initially evaluated unfeasible. Sirolimus was well tolerated, with mucositis as the most common (10% of patients) grade 3 adverse event. Conclusions Sirolimus was efficient in extensive LM, VM and/or complex malformations that were refractory to conventional treatments and was well tolerated.
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Affiliation(s)
| | - Emmanuel Seront
- Center for Vascular Anomalies, Institut Roi Albert II, Department of Medical Oncology, Cliniques universitaires Saint Luc, University of Louvain, Brussels, Belgium
| | - Steven Duez
- Center for Vascular Anomalies, Division of Plastic Surgery, Cliniques universitaires Saint Luc, University of Louvain, 10 avenue Hippocrate, B-1200, Brussels, Belgium
| | - Sophie Dupont
- Department of Pediatric Hemato-oncology, Cliniques universitaires Saint Luc, University of Louvain, Brussels, Belgium
| | - An Van Damme
- Center for Vascular Anomalies, Department of Pediatric Hemato-oncology, Cliniques universitaires Saint Luc, University of Louvain, Brussels, Belgium
| | - Sandra Schmitz
- Center for Vascular Anomalies, Department of Head and Neck Surgery, Cliniques universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Claire Hoyoux
- Department of Pediatric Hemato-oncology, CHR Citadelle, Liège, Belgium
| | | | - Philippe Clapuyt
- Division of Pediatric Radiology, Cliniques universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Frank Hammer
- Division of Interventional Radiology, Cliniques universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
| | - Laurence M Boon
- Center for Vascular Anomalies, Division of Plastic Surgery, Cliniques universitaires Saint Luc, University of Louvain, 10 avenue Hippocrate, B-1200, Brussels, Belgium. .,Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium.
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13
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Moortgat S, Lederer D, Deprez M, Buzatu M, Clapuyt P, Boulanger S, Benoit V, Mary S, Guichet A, Ziegler A, Colin E, Bonneau D, Maystadt I. Expanding the phenotypic spectrum associated with OPHN1 mutations: Report of 17 individuals with intellectual disability but no cerebellar hypoplasia. Eur J Med Genet 2018; 61:442-450. [PMID: 29510240 DOI: 10.1016/j.ejmg.2018.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/03/2017] [Revised: 03/02/2018] [Accepted: 03/02/2018] [Indexed: 01/20/2023]
Abstract
Mutations in the oligophrenin 1 gene (OPHN1) have been identified in patients with X-linked intellectual disability (XLID) associated with cerebellar hypoplasia and ventriculomegaly, suggesting it could be a recognizable syndromic intellectual disability (ID). Affected individuals share additional clinical features including speech delay, seizures, strabismus, behavioral difficulties, and slight facial dysmorphism. OPHN1 is located in Xq12 and encodes a Rho-GTPase-activating protein involved in the regulation of the G-protein cycle. Rho protein members play an important role in dendritic growth and in plasticity of excitatory synapses. Here we report on 17 individuals from four unrelated families affected by mild to severe intellectual disability due to OPHN1 mutations without cerebellar anomaly on brain MRI. We describe clinical, genetic and neuroimaging data of affected patients. Among the identified OPHN1 mutations, we report for the first time a missense mutation occurring in a mosaic state. We discuss the intrafamilial clinical variability of the disease and compare our patients with those previously reported. We emphasize the power of next generation techniques (X-exome sequencing, whole-exome sequencing and targeted multi-gene panel) to expand the phenotypic and mutational spectrum of OPHN1-related ID.
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Affiliation(s)
- Stéphanie Moortgat
- Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Charleroi, Gosselies, Belgium.
| | - Damien Lederer
- Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Charleroi, Gosselies, Belgium
| | - Marie Deprez
- Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Charleroi, Gosselies, Belgium; Département de Neuro-pédiatrie, Clinique Sainte-Elisabeth, Namur, Belgium
| | - Marga Buzatu
- Département de Neuro-pédiatrie, Hôpital Civil Marie Curie, Charleroi, Belgium
| | - Philippe Clapuyt
- Department of Radiology, Pediatric Imaging Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Sébastien Boulanger
- Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Charleroi, Gosselies, Belgium
| | - Valérie Benoit
- Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Charleroi, Gosselies, Belgium
| | - Sandrine Mary
- Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Charleroi, Gosselies, Belgium
| | - Agnès Guichet
- Department of Biochemistry and Genetics, Angers University Hospital, and UMR INSERM 1083, CNRS 6015, Angers, France
| | - Alban Ziegler
- Department of Biochemistry and Genetics, Angers University Hospital, and UMR INSERM 1083, CNRS 6015, Angers, France
| | - Estelle Colin
- Department of Biochemistry and Genetics, Angers University Hospital, and UMR INSERM 1083, CNRS 6015, Angers, France
| | - Dominique Bonneau
- Department of Biochemistry and Genetics, Angers University Hospital, and UMR INSERM 1083, CNRS 6015, Angers, France
| | - Isabelle Maystadt
- Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Charleroi, Gosselies, Belgium
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14
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de Magnée C, Veyckemans F, Pirotte T, Menten R, Dumitriu D, Clapuyt P, Carbonez K, Barrea C, Sluysmans T, Sempoux C, Leclercq I, Zech F, Stephenne X, Reding R. Liver and systemic hemodynamics in children with cirrhosis: Impact on the surgical management in pediatric living donor liver transplantation. Liver Transpl 2017; 23:1440-1450. [PMID: 28834223 DOI: 10.1002/lt.24850] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Received: 04/04/2017] [Revised: 07/12/2017] [Accepted: 08/03/2017] [Indexed: 02/07/2023]
Abstract
Cirrhosis in adults is associated with modifications of systemic and liver hemodynamics, whereas little is known about the pediatric population. The aim of this work was to investigate whether alterations of hepatic and systemic hemodynamics were correlated with cirrhosis severity in children. The impact of hemodynamic findings on surgical management in pediatric living donor liver transplantation (LT) was evaluated. Liver and systemic hemodynamics were studied prospectively in 52 children (median age, 1 year; 33 with biliary atresia [BA]). The hemodynamics of native liver were studied preoperatively by Doppler ultrasound and intraoperatively using invasive flowmetry. Portosystemic gradient was invasively measured. Systemic hemodynamics were studied preoperatively by Doppler transthoracic echocardiography and intraoperatively by using transpulmonary thermodilution. Hemodynamic parameters were correlated with Pediatric End-Stage Liver Disease (PELD) score and the histological degree of fibrosis (collagen proportionate area [CPA]). Cirrhosis was associated with a 60% reduction of pretransplant total liver flow (n = 46; median, 36 mL/minute/100 g of liver) compared with noncirrhotic livers (n = 6; median, 86 mL/minute/100 g; P = 0.002). Total blood flow into the native liver was negatively correlated with PELD (P < 0.001) and liver CPA (P = 0.005). Median portosystemic gradient was 14.5 mm Hg in children with cirrhosis and positively correlated with PELD (P < 0.001). Portal vein (PV) hypoplasia was observed mainly in children with BA (P = 0.02). Systemic hemodynamics were not altered in our children with cirrhosis. Twenty-one children met the intraoperative criteria for PV reconstruction using a portoplasty technique during the LT procedure and had a smaller PV diameter at pretransplant Doppler ultrasound (median = 3.4 mm; P < 0.001). Cirrhosis in children appears also as a hemodynamic disease of the liver, correlated with cirrhosis severity. Surgical technique for PV reconstruction during LT was adapted accordingly. Liver Transplantation 23 1440-1450 2017 AASLD.
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Affiliation(s)
| | | | | | | | | | | | - Karlien Carbonez
- Pediatric Cardiology, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Catherine Barrea
- Pediatric Cardiology, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Thierry Sluysmans
- Pediatric Cardiology, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Christine Sempoux
- Institute of Pathology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Francis Zech
- Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Xavier Stephenne
- Pediatric Gastroenterology and Hepatology, Cliniques Universitaires St. Luc, Brussels, Belgium
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15
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Van Lierde L, Clapuyt P, Nassogne MC, Oriot P. Cerebral germinoma revealed through a polydipsic polyuric syndrome in a 10-year-old girl: case report. Endocr Regul 2017; 51:216-219. [PMID: 29232188 DOI: 10.1515/enr-2017-0023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cerebral germinoma is rare. Although the imaging of the germinoma is very evocative, it's very polymorphic clinical expression is at the origin of misguided diagnosis, as illustrated in our case. We report the case of a 10-year-old girl with diabetes insipidus evolving for 12 months associated with a decrease in visual acuity. Brain MRI (Magnetic Resonance Imaging) revealed a tumor process in the suprasellar region. The stereotaxic biopsy of the tumor confirmed the diagnosis of the hypothalamic germinoma, which allowed the patient to be treated by radiotherapy and chemotherapy. The incidence of cerebral germinoma, its clinical (principally diabetes insipidus) and radiological features as well as therapeutic strategies are discussed hereby.
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Affiliation(s)
- L Van Lierde
- Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - P Clapuyt
- Department of Radiology, Universite Catholique de Louvain, Saint-Luc, Brussels, Belgium
| | - M C Nassogne
- Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Philippe Oriot
- Department of Endocrinology, Mouscron Hospital Centre, Mouscron, Belgium
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16
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Claes AS, Clapuyt P, Menten R, Michoux N, Dumitriu D. Performance of chest ultrasound in pediatric pneumonia. Eur J Radiol 2016; 88:82-87. [PMID: 28189214 DOI: 10.1016/j.ejrad.2016.12.032] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [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: 06/08/2016] [Revised: 12/18/2016] [Accepted: 12/27/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the performance of ultrasound in detecting lung consolidation in children suspected of pneumonia, in comparison to the current gold standard, chest X-rays. MATERIALS AND METHODS From September 2013 to June 2014, a monocentric prospective study was performed on all children between 0 and 16 years-old, referred for chest X-ray for suspected pneumonia. Each child was examined by chest ultrasound by an examiner blinded to the chest X-ray. The presence or absence of areas of consolidation, their number and location were noted for each technique. The size of the consolidations identified only on ultrasound was compared with that of consolidations visible on both techniques. RESULTS 143 children (mean age 3 years; limits between 8days and 14 years) were included. Ultrasound detected at least one area of consolidation in 44 out of 45 patients with positive X-rays. Of the 59 areas of consolidation on X-ray, ultrasound identified 54. In the 8 patients with negative X-ray, ultrasound revealed 17 areas of consolidation. The mean size of consolidations visible only on ultrasound was 9.4mm; for consolidations visible on both techniques the mean size was 26mm (p<0.0001). The sensitivity and specificity of ultrasound were calculated at 98% and 92%. PPV and NPV were 85% and 99%, respectively. CONCLUSION Chest ultrasound is a fast, non-ionizing and feasible technique. With its high negative predictive value, it can replace X-rays in order to exclude lung consolidation in children, thus reducing radiation exposure in this population.
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Affiliation(s)
- Anne-Sophie Claes
- Departement of Radiology, Pediatric and Thoracic Radiology Unit, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Philippe Clapuyt
- Departement of Radiology, Pediatric Radiology Unit, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Renaud Menten
- Departement of Radiology, Pediatric Radiology Unit, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Nicolas Michoux
- Departement of Radiology, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Dana Dumitriu
- Departement of Radiology, Pediatric Radiology Unit, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
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17
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Beleza-Meireles A, Steenhaut P, Hocq C, Clapuyt P, Bernard P, Debauche C, Sznajer Y. "Serpentine-like syndrome"-A very rare multiple malformation syndrome characterised by brachioesophagus and vertebral anomalies. Eur J Med Genet 2016; 60:100-104. [PMID: 27836748 DOI: 10.1016/j.ejmg.2016.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/31/2016] [Accepted: 11/06/2016] [Indexed: 11/25/2022]
Abstract
"Serpentine-like syndrome" is a severe and rare association of multiple congenital malformations, characterised by brachioesophagus, secondary intrathoracic stomach, and vertebral anomalies. Other associated anomalies have been described, such as malposition and herniation of abdominal organs. We report the natural history of a baby girl born at 29 weeks of gestation with intra uterine growth restriction, short neck, large rachischisis from cervical to thoracic spine, a very short oesophagus, thoracic stomach associated with a midline diaphragmatic hernia, malrotated gut and median cleft lip. Most of these anomalies were detected antenatally. Molecular karyotype was normal. She died at age 12 days. To our knowledge, the present patient represents the 8th report of a case of "Serpentine-like syndrome". Brachioesophagus and congenital vertebral anomalies, in particular rachischisis, are the cardinal features of this condition. All reported cases have been sporadic and the cause is still unknown. We believe that the specificity of the presentation as well as the similarities between available descriptions of patients suggests a common, yet to identify, molecular cause, possibly involving a developmental "toolkit"/homeobox gene or related pathways.
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Affiliation(s)
- Ana Beleza-Meireles
- Centre de Génétique Humaine, Cliniques Universitaires St. Luc, U.C.L., Brussels; Department of Clinical Genetics, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK.
| | | | - Catheline Hocq
- Neonatalogy Unit, Department of Paediatrics, Cliniques Universitaires St. Luc, U.C.L. Brussels
| | - Philippe Clapuyt
- Radiology Department, Cliniques Universitaires St. Luc, U.C.L. Brussels
| | - Pierre Bernard
- Obstetrics Department, Cliniques Universitaires St.Luc, U.C.L. Brussels
| | - Christian Debauche
- Neonatalogy Unit, Department of Paediatrics, Cliniques Universitaires St. Luc, U.C.L. Brussels
| | - Yves Sznajer
- Centre de Génétique Humaine, Cliniques Universitaires St. Luc, U.C.L., Brussels
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18
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Elajmi A, Clapuyt P, Hammer F, Bataille AC, Lengele B, Boon LM. [Management of vascular anomalies in children]. ANN CHIR PLAST ESTH 2016; 61:480-497. [PMID: 27641115 DOI: 10.1016/j.anplas.2016.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 01/19/2023]
Abstract
Vascular anomalies, which are broadly identified as "angiomas", are rare entities and often unknown by the medical sphere. They are divided in two different categories which carry different prognosis and management: "vascular tumors" and "vascular malformations". Their precise identification is crucial and involves a good knowledge of the biological classification published by Mulliken and Glowacki and that has recently been updated by the International Society for the Study of Vascular Anomalies (ISSVA). Vascular tumors are benign, common, inborn or not and most of the time disappear with growth. Vascular malformations are always congenital and growth with the child. They can involve type of vessels solely or combined with others. A rheologic differentiation between slow and fast flow malformations is essential in order to characterize the seriousness of the lesion. Frequently, their diagnosis is clinically established and the anamnesis is conducted to answer three questions that are the time of revelation of the lesion ("When?"), its aspect ("What?") and its evolution ("How?"). Further investigations are usually not required but a non-invasive imaging technique such as Doppler ultrasound could be useful if a doubt exists. Surgery is not mandatory and must always be well thought because its consequences might be disastrous. It must be left to cosmetic sequelae of these lesions or to lesions that are totally resectable without causing any unacceptable deformation.
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Affiliation(s)
- A Elajmi
- Service de chirurgie plastique, centre des anomalies vasculaires, cliniques universitaires Saint-Luc, 10, avenue Hippocrate, 1200 Bruxelles, Belgique
| | - P Clapuyt
- Service de radiologie pédiatrique, centre des anomalies vasculaires, cliniques universitaires Saint-Luc, Bruxelles, Belgique
| | - F Hammer
- Service de radiologie interventionelle, centre des anomalies vasculaires, cliniques universitaires Saint-Luc, Bruxelles, Belgique
| | - A-C Bataille
- Service de chirurgie plastique, centre des anomalies vasculaires, cliniques universitaires Saint-Luc, 10, avenue Hippocrate, 1200 Bruxelles, Belgique
| | - B Lengele
- Service de chirurgie plastique, centre des anomalies vasculaires, cliniques universitaires Saint-Luc, 10, avenue Hippocrate, 1200 Bruxelles, Belgique
| | - L M Boon
- Service de chirurgie plastique, centre des anomalies vasculaires, cliniques universitaires Saint-Luc, 10, avenue Hippocrate, 1200 Bruxelles, Belgique.
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19
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Delmelle F, Thöny B, Clapuyt P, Blau N, Nassogne MC. Neurological improvement following intravenous high-dose folinic acid for cerebral folate transporter deficiency caused by FOLR-1 mutation. Eur J Paediatr Neurol 2016; 20:709-13. [PMID: 27328863 DOI: 10.1016/j.ejpn.2016.05.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 10/31/2015] [Revised: 03/25/2016] [Accepted: 05/31/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Cerebral folate transporter deficiency caused by FOLR-1 mutations has been described in 2009. This condition is characterized by a 5MTHF level <5 nmol/l in the CSF, along with regression of acquisition in the second year of life, ataxia, and refractory myoclonic epilepsy. Oral or intravenous folinic acid (5-formyltetrahydrofolate) treatment has been shown to improve clinical status. CASE PRESENTATION We present the cases of two sisters with cerebral folate transport deficiency caused by mutation in the folate receptor 1 (FOLR1) gene (MIM *136430). Following recommendations, we administered oral folinic acid at 5 mg/kg/day, resulting in some initial clinical improvement, yet severe epilepsy persisted. During treatment, cerebrospinal fluid (CSF) analysis revealed normal 5-methyltetrahydrofolate (5MTHF) levels (60.1 nmol/l; normal range: 53-182 nmol/l). Epilepsy proved difficult to control and the younger patient exhibited neurological regression. We then administered high-dose folinic acid intravenously over 3 days (6 mg/kg/day for 24 h, then 12 mg/kg/day for 48 h), which significantly improved clinical status and epilepsy. CSF analysis revealed high 5MTHF levels following intravenous infusion (180 nmol/l). Treatment continued with monthly intravenous administrations of 20-25 mg/kg folinic acid. At 2 years post-treatment, clinical improvement was confirmed. CONCLUSIONS This report illustrates that cerebral folate transporter deficiency caused by FOLR-1 mutations is a treatable condition and can potentially be cured by folinic acid treatment. As already reported, early effective treatment is known to improve outcomes in affected children. In our study, intravenous high-dose folinic acid infusions appeared to optimize clinical response.
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Affiliation(s)
- Françoise Delmelle
- Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Beat Thöny
- Division of Metabolism, University Children's Hospital, Zürich, Switzerland
| | - Philippe Clapuyt
- Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Nenad Blau
- University Children's Hospital, Division of Inborn Metabolic Diseases, Department of General Pediatrics, Heidelberg, Germany
| | - Marie-Cécile Nassogne
- Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
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20
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Briggs TA, Rice GI, Adib N, Ades L, Barete S, Baskar K, Baudouin V, Cebeci AN, Clapuyt P, Coman D, De Somer L, Finezilber Y, Frydman M, Guven A, Heritier S, Karall D, Kulkarni ML, Lebon P, Levitt D, Le Merrer M, Linglart A, Livingston JH, Navarro V, Okenfuss E, Puel A, Revencu N, Scholl-Bürgi S, Vivarelli M, Wouters C, Bader-Meunier B, Crow YJ. Erratum to: Spondyloenchondrodysplasia Due to Mutations in ACP5: A Comprehensive Survey. J Clin Immunol 2016; 36:529-530. [PMID: 27125509 PMCID: PMC4969917 DOI: 10.1007/s10875-016-0287-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tracy A Briggs
- Manchester Centre for Genomic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK. .,St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Gillian I Rice
- Manchester Centre for Genomic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Navid Adib
- Department of Rheumatology, The Lady Cilento Children's Hospital, Brisbane, Australia
| | - Lesley Ades
- Department of Clinical Genetics, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paedatrics and Child Health, The University of Sydney, Sydney, Australia
| | - Stephane Barete
- Dermatology Department, Pitie-Salpetriere Hospital, Paris, France
| | - Kannan Baskar
- Creighton University, 2500 California Plaza, Omaha, NE, 68178, USA
| | - Veronique Baudouin
- Pediatric Nephrology Department, Robert Debré University Hospital- APHP, 48 boulevard Sérurier, 75019, Paris, France
| | - Ayse N Cebeci
- Goztepe Educational and Research Hospital Pediatric Endocrinology Clinic, Istanbul, Türkiye
| | - Philippe Clapuyt
- Pediatric Imaging Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - David Coman
- Neuroscience Department, The Lady Cilento Children's Hospital, Brisbane, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
| | - Lien De Somer
- Pediatric Rheumatology, Department of Pediatrics, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Yael Finezilber
- Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center, Tel Aviv, Israel
| | - Moshe Frydman
- Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayla Guven
- Goztepe Educational and Research Hospital Pediatric Endocrinology Clinic, Istanbul, Türkiye.,Amasya University Medical Faculty, Department of Pediatric Endocrinology, Istanbul, Türkiye
| | - Sébastien Heritier
- Department of Pediatric Hematology and Oncology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Daniela Karall
- Clinic for Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | | | - Pierre Lebon
- Service de Virologie, AP-HP Hôpital Cochin, Paris, France
| | - David Levitt
- Department of Paediatrics, The Lady Cilento Children's Hospital, Brisbane, Australia
| | - Martine Le Merrer
- Centre de Référence des Maladies Osseuses Constitutionnelles et Institut Imagine, Hopital Necker 149 rue de Sevres, 75015, Paris, France
| | - Agnes Linglart
- APHP, Bicêtre Paris Sud, Department of Pediatric Endocrinology and Diabetology for Children, 94270, Le Kremlin Bicêtre, France.,Reference Center for Rare Disorders of the Mineral Metabolism and Plateforme d'expertise Paris Sud Maladies Rares, APHP, 94270, Le Kremlin Bicêtre, France
| | - John H Livingston
- Department of Paediatric Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Ericka Okenfuss
- Kaiser Permanente - Genetics, 1650 Response Rd, Sacramento, CA, 95815, USA
| | - Anne Puel
- Génétique Humaine des Maladies Infectieuses, INSERM UMR 1163, Université Paris Descartes Sorbonne Paris Cité, Institut Imagine, Pièce 421-B1, 24 boulevard du Montparnasse, 75015, Paris, France
| | - Nicole Revencu
- Centre for Human Genetics, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Sabine Scholl-Bürgi
- Clinic for Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Marina Vivarelli
- Division of Nephrology, IRCCS Bambino Gesu' Pediatric Hospital, Rome, Italy
| | - Carine Wouters
- Department of Microbiology and Immunology, Pediatric Immunology, KU Leuven, University of Leuven, Leuven, Belgium
| | - Brigitte Bader-Meunier
- Pediatric Immunology and Rheumatology Unit, Hôpital Necker, APHP, Paris, France.,Institut Imagine, Paris, France
| | - Yanick J Crow
- Manchester Centre for Genomic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,Laboratory of Neurogenetics and Neuroinflammation, Institut Imagine, 24 boulevard du Montparnasse, 75015, Paris, France
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21
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Briggs TA, Rice GI, Adib N, Ades L, Barete S, Baskar K, Baudouin V, Cebeci AN, Clapuyt P, Coman D, De Somer L, Finezilber Y, Frydman M, Guven A, Heritier S, Karall D, Kulkarni ML, Lebon P, Levitt D, Le Merrer M, Linglart A, Livingston JH, Navarro V, Okenfuss E, Puel A, Revencu N, Scholl-Bürgi S, Vivarelli M, Wouters C, Bader-Meunier B, Crow YJ. Spondyloenchondrodysplasia Due to Mutations in ACP5: A Comprehensive Survey. J Clin Immunol 2016; 36:220-34. [PMID: 26951490 PMCID: PMC4792361 DOI: 10.1007/s10875-016-0252-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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: 12/15/2015] [Accepted: 02/22/2016] [Indexed: 02/06/2023]
Abstract
Purpose Spondyloenchondrodysplasia is a rare immuno-osseous dysplasia caused by biallelic mutations in ACP5. We aimed to provide a survey of the skeletal, neurological and immune manifestations of this disease in a cohort of molecularly confirmed cases. Methods We compiled clinical, genetic and serological data from a total of 26 patients from 18 pedigrees, all with biallelic ACP5 mutations. Results We observed a variability in skeletal, neurological and immune phenotypes, which was sometimes marked even between affected siblings. In total, 22 of 26 patients manifested autoimmune disease, most frequently autoimmune thrombocytopenia and systemic lupus erythematosus. Four patients were considered to demonstrate no clinical autoimmune disease, although two were positive for autoantibodies. In the majority of patients tested we detected upregulated expression of interferon-stimulated genes (ISGs), in keeping with the autoimmune phenotype and the likely immune-regulatory function of the deficient protein tartrate resistant acid phosphatase (TRAP). Two mutation positive patients did not demonstrate an upregulation of ISGs, including one patient with significant autoimmune disease controlled by immunosuppressive therapy. Conclusions Our data expand the known phenotype of SPENCD. We propose that the OMIM differentiation between spondyloenchondrodysplasia and spondyloenchondrodysplasia with immune dysregulation is no longer appropriate, since the molecular evidence that we provide suggests that these phenotypes represent a continuum of the same disorder. In addition, the absence of an interferon signature following immunomodulatory treatments in a patient with significant autoimmune disease may indicate a therapeutic response important for the immune manifestations of spondyloenchondrodysplasia.
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Affiliation(s)
- Tracy A Briggs
- Manchester Centre for Genomic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK. .,St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Gillian I Rice
- Manchester Centre for Genomic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Navid Adib
- Department of Rheumatology, The Lady Cilento Children's Hospital, Brisbane, Australia
| | - Lesley Ades
- Department of Clinical Genetics, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paedatrics and Child Health, The University of Sydney, Sydney, Australia
| | - Stephane Barete
- Dermatology Department, Pitie-Salpetriere Hospital, Paris, France
| | - Kannan Baskar
- Creighton University, 2500 California Plaza, NE 68178, Omaha, USA
| | - Veronique Baudouin
- Pediatric Nephrology Department, Robert Debré University Hospital - APHP, 48 boulevard Sérurier, 75019, Paris, France
| | - Ayse N Cebeci
- Goztepe Educational and Research Hospital Pediatric Endocrinology Clinic, Istanbul, Türkiye
| | - Philippe Clapuyt
- Pediatric Imaging Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - David Coman
- Neuroscience Department, The Lady Cilento Children's Hospital, Brisbane, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
| | - Lien De Somer
- Pediatric Rheumatology, Department of Pediatrics, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Yael Finezilber
- Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center, Tel Aviv, Israel
| | - Moshe Frydman
- Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayla Guven
- Goztepe Educational and Research Hospital Pediatric Endocrinology Clinic, Istanbul, Türkiye.,Amasya University Medical Faculty, Department of Pediatric Endocrinology, Istanbul, Türkiye
| | - Sébastien Heritier
- Department of Pediatric Hematology and Oncology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Daniela Karall
- Clinic for Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | | | - Pierre Lebon
- Service de Virologie, AP-HP Hôpital Cochin, Paris, France
| | - David Levitt
- Department of Paediatrics, The Lady Cilento Children's Hospital, Brisbane, Australia
| | - Martine Le Merrer
- Centre de Référence des Maladies Osseuses Constitutionnelles et Institut Imagine, Hopital Necker 149 rue de Sevres, 75015, Paris, France
| | - Agnes Linglart
- APHP, Bicêtre Paris Sud, Department of Pediatric Endocrinology and Diabetology for Children, 94270, Le Kremlin Bicêtre, France.,Reference Center for Rare Disorders of the Mineral Metabolism and Plateforme d'expertise Paris Sud Maladies Rares, APHP, 94270, Le Kremlin Bicêtre, France
| | - John H Livingston
- Department of Paediatric Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Ericka Okenfuss
- Kaiser Permanente - Genetics, 1650 Response Rd, Sacramento, CA, 95815, USA
| | - Anne Puel
- Génétique Humaine des Maladies Infectieuses, INSERM UMR 1163, Université Paris Descartes Sorbonne Paris Cité, Institut Imagine, Pièce 421-B1, 24 boulevard du Montparnasse, 75015, Paris, France
| | - Nicole Revencu
- Centre for Human Genetics, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Sabine Scholl-Bürgi
- Clinic for Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Marina Vivarelli
- Division of Nephrology, IRCCS Bambino Gesu' Pediatric Hospital, Rome, Italy
| | - Carine Wouters
- Department of Microbiology and Immunology, Pediatric Immunology, KU Leuven, University of Leuven, Leuven, Belgium
| | - Brigitte Bader-Meunier
- Pediatric Immunology and Rheumatology Unit, Hôpital Necker, APHP, Paris, France.,Institut Imagine, Paris, France
| | - Yanick J Crow
- Manchester Centre for Genomic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,Laboratory of Neurogenetics and Neuroinflammation, Institut Imagine, 24 boulevard du Montparnasse, 75015, Paris, France
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22
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Christiaens AB, Deprez PML, Amyere M, Mendola A, Bernard P, Gillerot Y, Clapuyt P, Godfraind C, Lengelé BG, Vikkula M, Nyssen-Behets C. Isolated bilateral transverse agenesis of the distal segments of the lower limbs at the level of the knee joint in a human fetus. Am J Med Genet A 2015; 170A:523-530. [PMID: 26544544 DOI: 10.1002/ajmg.a.37462] [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: 10/26/2013] [Accepted: 10/15/2015] [Indexed: 11/12/2022]
Abstract
Congenital limb anomalies occur in Europe with a prevalence of 3.81/1,000 births and can have a major impact on patients and their families. The present study concerned a female fetus aborted at 23 weeks of gestation because she was affected by non-syndromic bilateral absence of the zeugopod (leg) and autopod (foot). Autopsy of the aborted fetus, X-ray imaging, MRI, and histochemical analysis showed that the distal extremity of both femurs was continued by a cartilage-like mass, without joint cavitation. Karyotype was normal. Moreover, no damaging variant was detected by exome sequencing. The limb characteristics of the fetus, which to our knowledge have not yet been reported in humans, suggest a developmental arrest similar to anomalies described in chicks following surgical experiments on the apical ectodermal ridge of the lower limbs.
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Affiliation(s)
- Antoine B Christiaens
- Pôle de Morphologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Human Molecular Genetics, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre M L Deprez
- Ecole de Kinésiologie et Récréologie, Faculté des Sciences de la Santé et Services Communautaires, Université de Moncton, Moncton, New Brunswick, Canada.,Atlantic Cancer Research Institute, Moncton, New Brunswick, Canada
| | - Mustapha Amyere
- Human Molecular Genetics, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Antonella Mendola
- Human Molecular Genetics, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre Bernard
- Department of Obstetrics, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Yves Gillerot
- Centre for Human Genetics, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Philippe Clapuyt
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Catherine Godfraind
- Laboratory of Pathology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Benoît G Lengelé
- Pôle de Morphologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Catherine Nyssen-Behets
- Pôle de Morphologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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23
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Dumitriu D, Menten R, Smets F, Clapuyt P. Postendoscopic duodenal hematoma in children: ultrasound diagnosis and follow-up. J Clin Ultrasound 2014; 42:550-553. [PMID: 24615821 DOI: 10.1002/jcu.22145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 09/14/2013] [Accepted: 01/31/2014] [Indexed: 06/03/2023]
Abstract
Intramural duodenal hematomas have most frequently been reported in children in a traumatic setting. We present two cases of duodenal hematoma that occurred after upper gastrointestinal tract endoscopy with biopsy in children without significant prior medical history. The diagnosis was made by ultrasound, in correlation with the clinical presentation. Because the patients were hemodynamically stable, they were treated conservatively and the regression of the hematoma was followed up with ultrasound until its complete resolution. These cases demonstrate the risks of endoscopy, which are not to be neglected even in children without impaired coagulation, and the manner in which ultrasound can provide the correct diagnosis and follow-up.
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Affiliation(s)
- Dana Dumitriu
- Cliniques Universitaires Saint Luc, Department of Radiology, Pediatric Radiology Unit, Université Catholique de Louvain, Brussels, Belgium
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24
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Dumitriu DI, Menten R, Clapuyt P. Pitfalls in the diagnosis of common benign bone tumours in children. Insights Imaging 2014; 5:645-55. [PMID: 25256565 PMCID: PMC4263798 DOI: 10.1007/s13244-014-0356-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 11/30/2022] Open
Abstract
Benign bone tumours in children are frequent lesions, often with a typical and very identifiable radiological presentation. However, their natural evolution and complications may be the source of variations and errors in interpretation. It is therefore important to understand the possible sources of change in the radiological aspect and to be familiar with common pseudotumoral lesions. The main aim of this review is to review typical aspects of the most common benign bone tumours in children, as well as less frequent variants of these tumours. Teaching points • Benign bone tumours in children may have atypical radiological presentations. • Some normal variants are commonly misinterpreted as tumours. • X-ray is the main imaging tool for focal bone lesions. • Depending on the X-ray, complementary imaging examinations and biopsy may be necessary.
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Affiliation(s)
- Dana I Dumitriu
- Department of Radiology, Pediatric Radiology Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate no. 10, 1200, Brussels, Belgium,
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25
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Darius T, Rivera J, Fusaro F, Lai Q, de Magnée C, Bourdeaux C, Janssen M, Clapuyt P, Reding R. Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation. Liver Transpl 2014; 20:893-903. [PMID: 24809592 DOI: 10.1002/lt.23910] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [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] [Received: 12/10/2013] [Revised: 04/25/2014] [Accepted: 05/06/2014] [Indexed: 01/01/2023]
Abstract
Biliary complications (BCs) still remain the Achilles heel of liver transplantation (LT) with an overall incidence of 10% to 35% in pediatric series. We hypothesized that (1) the use of alternative techniques (reduced size, split, and living donor grafts) in pediatric LT may contribute to an increased incidence of BCs, and (2) surgery as a first treatment option for anastomotic BCs could allow a definitive cure for the majority of these patients. Four hundred twenty-nine primary pediatric LT procedures, including 88, 91, 47, and 203 whole, reduced size, split, and living donor grafts, respectively, that were performed between July 1993 and November 2010 were retrospectively reviewed. Demographic and surgical variables were analyzed, and their respective impact on BCs was studied with univariate and multivariate analyses. The modalities of BC management were also reviewed. The 1- and 5-year patient survival rates were 94% and 90%, 89% and 85%, 94% and 89%, and 98% and 94% for whole, reduced size, split, and living donor liver grafts, respectively. The overall incidence of BCs was 23% (n = 98). Sixty were anastomotic complications [47 strictures (78%) and 13 fistulas (22%)]. The graft type was not found to be an independent risk factor for the development of BCs. According to a multivariate analysis, only hepatic artery thrombosis and acute rejection increased the risk of anastomotic BCs (P < 0.001 and P = 0.003, respectively). Anastomotic BCs were managed primarily with surgical repair in 59 of 60 cases with a primary patency rate of 80% (n = 47). These results suggest that (1) most of the BCs were anastomotic complications not influenced by the type of graft, and (2) the surgical management of anastomotic BCs may constitute the first and best therapeutic option.
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Affiliation(s)
- Tom Darius
- Pediatric Surgery and Transplant Unit, Université Catholique de Louvain, Brussels, Belgium
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Revencu N, Boon LM, Mendola A, Cordisco MR, Dubois J, Clapuyt P, Hammer F, Amor DJ, Irvine AD, Baselga E, Dompmartin A, Syed S, Martin-Santiago A, Ades L, Collins F, Smith J, Sandaradura S, Barrio VR, Burrows PE, Blei F, Cozzolino M, Brunetti-Pierri N, Vicente A, Abramowicz M, Désir J, Vilain C, Chung WK, Wilson A, Gardiner CA, Dwight Y, Lord DJE, Fishman L, Cytrynbaum C, Chamlin S, Ghali F, Gilaberte Y, Joss S, Boente MDC, Léauté-Labrèze C, Delrue MA, Bayliss S, Martorell L, González-Enseñat MA, Mazereeuw-Hautier J, O'Donnell B, Bessis D, Pyeritz RE, Salhi A, Tan OT, Wargon O, Mulliken JB, Vikkula M. RASA1 mutations and associated phenotypes in 68 families with capillary malformation-arteriovenous malformation. Hum Mutat 2013; 34:1632-41. [PMID: 24038909 DOI: 10.1002/humu.22431] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [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: 03/17/2013] [Accepted: 08/20/2013] [Indexed: 01/13/2023]
Abstract
Capillary malformation-arteriovenous malformation (CM-AVM) is an autosomal-dominant disorder, caused by heterozygous RASA1 mutations, and manifesting multifocal CMs and high risk for fast-flow lesions. A limited number of patients have been reported, raising the question of the phenotypic borders. We identified new patients with a clinical diagnosis of CM-AVM, and patients with overlapping phenotypes. RASA1 was screened in 261 index patients with: CM-AVM (n = 100), common CM(s) (port-wine stain; n = 100), Sturge-Weber syndrome (n = 37), or isolated AVM(s) (n = 24). Fifty-eight distinct RASA1 mutations (43 novel) were identified in 68 index patients with CM-AVM and none in patients with other phenotypes. A novel clinical feature was identified: cutaneous zones of numerous small white pale halos with a central red spot. An additional question addressed in this study was the "second-hit" hypothesis as a pathophysiological mechanism for CM-AVM. One tissue from a patient with a germline RASA1 mutation was available. The analysis of the tissue showed loss of the wild-type RASA1 allele. In conclusion, mutations in RASA1 underscore the specific CM-AVM phenotype and the clinical diagnosis is based on identifying the characteristic CMs. The high incidence of fast-flow lesions warrants careful clinical and radiologic examination, and regular follow-up.
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Affiliation(s)
- Nicole Revencu
- Laboratory of Human Molecular Genetics, de Duve Institute, Université catholique de Louvain, Brussels, Belgium; Center for Human Genetics, Cliniques universitaires St Luc, Université catholique de Louvain, Brussels, Belgium
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Ballieux F, Modarressi A, Hammer F, Clapuyt P, Docquier PL, Godfraind C, Feyaerts A, Brouillard P, Vikkula M, Boon LM. Reconstructive surgery in the management of a patient with CLOVES syndrome. J Plast Reconstr Aesthet Surg 2013; 66:1813-5. [PMID: 23867238 DOI: 10.1016/j.bjps.2013.06.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 04/16/2013] [Accepted: 06/22/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Fanny Ballieux
- Center for Vascular Anomalies, Division of Plastic and Reconstructive Surgery, Cliniques universitaires St. Luc, Université catholique de Louvain, Belgium.
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Menten R, Dumitriu D, Clapuyt P, Yousefzadeh DK. Reply to Dr. B. Karmazyn regarding 'Duodenum between the aorta and the SMA does not exclude malrotation'. Pediatr Radiol 2013; 43:123. [PMID: 23143403 DOI: 10.1007/s00247-012-2550-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
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Rivera J, Fusaro F, de Magnée C, Clapuyt P, Reding R. Meso-Rex shunt for immediate portal revascularization in pediatric liver transplantation: first report. Pediatr Transplant 2012; 16:E235-7. [PMID: 21923884 DOI: 10.1111/j.1399-3046.2011.01576.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 11/27/2022]
Abstract
We describe the case of a 13-month-old girl transplanted for biliary atresia with PV hypoplasia. She received the left liver lobe of her mother and presented intraoperative portal thrombosis. Because of technical reasons, the opportunity to have conventional PV reconstruction using the donor left PV stump was lost. Immediate conversion to a meso-Rex shunt, using the recipient jugular vein as a bridge between the superior mesenteric vein and the graft Rex recessus, allowed excellent portal revascularization of the transplant. We suggest that synchronous meso-Rex shunt may constitute a valid alternative to truncal PV anastomosis during pediatric LT.
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Affiliation(s)
- Jairo Rivera
- Pediatric Surgery and Transplant Unit, Université Catholique de Louvain, Brussels, Belgium
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Menten R, Reding R, Godding V, Dumitriu D, Clapuyt P. Sonographic assessment of the retroperitoneal position of the third portion of the duodenum: an indicator of normal intestinal rotation. Pediatr Radiol 2012; 42:941-5. [PMID: 22684229 DOI: 10.1007/s00247-012-2403-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [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] [Received: 09/26/2011] [Revised: 01/25/2012] [Accepted: 01/29/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The diagnosis of intestinal malrotation is based on an upper gastrointestinal contrast series (UGI), which is considered the imaging reference standard. It may however be challenging even for experienced paediatric radiologists. OBJECTIVE The purpose of this study was to demonstrate the agreement between UGI and US in assessing the position of the third portion of the duodenum (D3) and to show that a retroperitoneal duodenum indicates normal forgut rotation. MATERIALS AND METHODS In a prospective study, US assessment of the duodenum and the superior mesenteric vessels was performed in consecutive children who were referred for clinically indicated UGI at a single institution. RESULTS Eighty-five children, 5 months to 14 years old, were studied. In 82/85 (96%), both US and UGI suggested normal forgut rotation. In three children, US demonstrated a normal position of the D3 whereas UGI showed an abnormal position of the duodeno-jejunal junction. CONCLUSION US is a non-invasive, easily performed technique for excluding malrotation. UGI may be reserved for situations where US does not demonstrate a normal position of the D3.
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Affiliation(s)
- Renaud Menten
- Paediatric Radiology Unit, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels 1200, Belgium.
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Detaille T, Joomye R, Barrea C, Clapuyt P, Boon LM, Clément de Cléty S. Acute life-threatening presentation of unknown lymphatic malformation. Am J Emerg Med 2010; 28:1062.e1-3. [PMID: 20825862 DOI: 10.1016/j.ajem.2010.01.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 01/23/2010] [Indexed: 10/19/2022] Open
Affiliation(s)
- Thierry Detaille
- Pediatric Intensive Care Unit, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels, Belgium.
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Brasseur B, Chantrain CF, Godefroid N, Sluysmans T, Anslot C, Menten R, Clapuyt P, Dupont S, Vermylen C, Brichard B. Development of renal and iliac aneurysms in a child with generalized infantile myofibromatosis. Pediatr Nephrol 2010; 25:983-6. [PMID: 19997940 DOI: 10.1007/s00467-009-1393-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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] [Received: 05/26/2009] [Revised: 10/17/2009] [Accepted: 10/20/2009] [Indexed: 10/20/2022]
Abstract
Infantile myofibromatosis is a rare disorder characterized by the formation of tumors in the skin, soft tissues, bone, and viscera. We report the case of a 3-week-old girl who presented with severe hypertension due to generalized infantile myofibromatosis including renal involvement. The infant was treated by chemotherapy and showed progressive regression of the tumors. However, her evolution was marked by the development of aneurismal dilations of the renal and iliac arteries as observed in fibromuscular dysplasia. We discuss the possibility of a link between these two mesenchymal disorders.
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Affiliation(s)
- Benoit Brasseur
- Department of Pediatric Hematology and Oncology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, Brussels, Belgium
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Dompmartin A, Ballieux F, Thibon P, Lequerrec A, Hermans C, Clapuyt P, Barrellier MT, Hammer F, Labbé D, Vikkula M, Boon LM. Elevated D-dimer level in the differential diagnosis of venous malformations. ACTA ACUST UNITED AC 2009; 145:1239-44. [PMID: 19917952 DOI: 10.1001/archdermatol.2009.296] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate if elevated D-dimer level is specific for venous malformations (VMs) and thus useful for differential diagnosis, which can be problematic even in specialized interdisciplinary centers. Localized intravascular coagulopathy, characterized by elevated D-dimer levels, has been observed in approximately 40% of patients with VMs. DESIGN Prospective convenience sample accrued from 2 interdisciplinary sites. SETTING Two interdisciplinary centers for vascular anomalies in Brussels, Belgium, and Caen, France PARTICIPANTS The study population comprised 280 patients with clinical data, Doppler ultrasonograms (for 251 patients), and coagulation parameter measurements. Main Outcome Measure Measurement of D-dimer levels. RESULTS A VM was diagnosed in 195 of 280 patients (69.6%), and 83 of them had elevated D-dimer levels; the sensitivity of D-dimer dosage was 42.6% (95% confidence interval, 35.6%-49.5%). Among the 85 patients without VM, D-dimer levels were elevated only in 3 patients; the specificity of the dosage was 96.5% (95% confidence interval, 92.5%-100%). CONCLUSIONS Elevated D-dimer level is highly specific for VMs (pure, combined, or syndromic), and therefore this easy and inexpensive biomarker test should become part of the clinical evaluation of vascular anomalies. It can detect hidden VMs and help differentiate glomuvenous malformation (normal D-dimer levels) from other multifocal venous lesions. Elevated D-dimer level also differentiates a VM from a lymphatic malformation. Moreover, slow-flow Klippel-Trenaunay syndrome (capillaro-lymphatico-venous malformation with limb hypertrophy) can be distinguished from fast-flow Parkes Weber syndrome (capillary malformation with underlying multiple microfistulas and limb hypertrophy). For these reasons, D-dimer level measurement is a useful complementary tool for diagnosing vascular anomalies in everyday practice.
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Affiliation(s)
- Anne Dompmartin
- Department of Dermatology, Université de Caen Basse, Normandie, Centre Hospitalier, Universitaire de Caen, Caen, France
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Revencu N, Boon LM, Mulliken JB, Enjolras O, Cordisco MR, Burrows PE, Clapuyt P, Hammer F, Dubois J, Baselga E, Brancati F, Carder R, Quintal JMC, Dallapiccola B, Fischer G, Frieden IJ, Garzon M, Harper J, Johnson-Patel J, Labrèze C, Martorell L, Paltiel HJ, Pohl A, Prendiville J, Quere I, Siegel DH, Valente EM, Van Hagen A, Van Hest L, Vaux KK, Vicente A, Weibel L, Chitayat D, Vikkula M. Parkes Weber syndrome, vein of Galen aneurysmal malformation, and other fast-flow vascular anomalies are caused by RASA1 mutations. Hum Mutat 2008; 29:959-65. [PMID: 18446851 DOI: 10.1002/humu.20746] [Citation(s) in RCA: 266] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Capillary malformation-arteriovenous malformation (CM-AVM) is a newly recognized autosomal dominant disorder, caused by mutations in the RASA1 gene in six families. Here we report 42 novel RASA1 mutations and the associated phenotype in 44 families. The penetrance and de novo occurrence were high. All affected individuals presented multifocal capillary malformations (CMs), which represent the hallmark of the disorder. Importantly, one-third had fast-flow vascular lesions. Among them, we observed severe intracranial AVMs, including vein of Galen aneurysmal malformation, which were symptomatic at birth or during infancy, extracranial AVM of the face and extremities, and Parkes Weber syndrome (PKWS), previously considered sporadic and nongenetic. These fast-flow lesions can be differed from the other two genetic AVMs seen in hereditary hemorrhagic telangiectasia (HHT) and in phosphatase and tensin homolog (PTEN) hamartomatous tumor syndrome. Finally, some CM-AVM patients had neural tumors reminiscent of neurofibromatosis type 1 or 2. This is the first extensive study on the phenotypes associated with RASA1 mutations, and unravels their wide heterogeneity.
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Affiliation(s)
- Nicole Revencu
- Laboratory of Human Molecular Genetics, de Duve Institute, Université catholique de Louvain, Brussels, Belgium
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Leonard A, Menten R, Clapuyt P, Lebecque P. Transient elastography (FibroScan) in patients with cystic fibrosis. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60315-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
CONTEXT Obesity in childhood is associated with an increased mortality due to cardiovascular (CV) diseases in adulthood, independent of adult weight. Recent studies in children indicate that the atherosclerosis process starts at an early age and is linked to obesity. OBJECTIVE The aim of the study was to investigate determinants of increased carotid intima-media thickness (IMT), an early marker of atherosclerosis, in obese children. DESIGN A total of 104 obese children [age, 12.7 +/- 0.2 yr; body mass index (BMI)-z-score, 2.8 +/- 0.7] underwent an oral glucose tolerance test. Fasting levels of glucose, insulin, C-reactive protein and adhesion molecules (sICAM, sVCAM, sE-selectin), lipid profile, adiponectin, and resistin were determined. IMT was measured by ultrasound. Insulin resistance was estimated by the homeostatic model assessment index. Baseline measurements of blood parameters were obtained from 93 nonobese children (age, 13.0 +/- 0.2 yr; BMI-z-score, -0.2 +/- 0.9), and IMT was measured in 23 other control children with similar characteristics. RESULTS Univariate analysis showed a significant positive correlation between IMT and relative BMI, the degree of systolic hypertension, fasting insulin levels, homeostatic model assessment-R index, and resistin concentrations, whereas an inverse correlation with adiponectin levels was found. No correlation was obtained between IMT and classical CV risk factors such as positive familial history of type 2 diabetes or precocious CV disease, visceral obesity, or the lipid profile. C-reactive protein and adhesion molecule levels were not associated with IMT in our obese population. When controlled for sex, Tanner stage, and relative BMI, only adiponectin levels remained an independent determinant of IMT. CONCLUSION Adiponectin more than conventional CV risk factors and inflammation status may be related to early atherosclerosis in obese children.
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Affiliation(s)
- Véronique Beauloye
- Unité d'Endocrinologie Pédiatrique, Université Catholique de Louvain, 1200 Brussels, Belgium.
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Brunati A, Feruzi Z, Sokal E, Smets F, Fervaille C, Gosseye S, Clapuyt P, de Ville de Goyet J, Reding R. Early occurrence of hepatocellular carcinoma in biliary atresia treated by liver transplantation. Pediatr Transplant 2007; 11:117-9. [PMID: 17239135 DOI: 10.1111/j.1399-3046.2006.00623.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A case of liver transplantation for HCC complicating BA in an eight-month old infant is reported. HCC in BA is extremely rare. Screening of AFP and ultrasonographic examination should be performed regularly in patients with secondary biliary cirrhosis for early detection of HCC.
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Affiliation(s)
- Andrea Brunati
- Pediatric Liver Transplant Program, Université Catholique de Louvain, St-Luc University Clinics, Brussels, Belgium
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38
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Roebuck DJ, Aronson D, Clapuyt P, Czauderna P, de Ville de Goyet J, Gauthier F, Mackinlay G, Maibach R, McHugh K, Olsen OE, Otte JB, Pariente D, Plaschkes J, Childs M, Perilongo G. 2005 PRETEXT: a revised staging system for primary malignant liver tumours of childhood developed by the SIOPEL group. Pediatr Radiol 2007; 37:123-32; quiz 249-50. [PMID: 17186233 PMCID: PMC1805044 DOI: 10.1007/s00247-006-0361-5] [Citation(s) in RCA: 233] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Accepted: 10/29/2006] [Indexed: 12/17/2022]
Abstract
Over the last 15 years, various oncology groups throughout the world have used the PRETEXT system for staging malignant primary liver tumours of childhood. This paper, written by members of the radiology and surgery committees of the International Childhood Liver Tumor Strategy Group (SIOPEL), presents various clarifications and revisions to the original PRETEXT system.
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Affiliation(s)
- Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, UK.
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Darwish AA, Debauche C, Clapuyt P, Feruzi Z, de Ville de Goyet J, Reding R. Pyloric obstruction, duodenal dilatation, and extrahepatic cholestasis: a neonatal triad suggesting multiple intestinal atresias. J Pediatr Surg 2006; 41:1771-3. [PMID: 17011287 DOI: 10.1016/j.jpedsurg.2006.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Whereas physiologic jaundice constitutes a common finding in neonates, a few cases present with cholestatic jaundice owing to various pathologic conditions, including extrahepatic biliary obstruction. We report the case of a 2-day-old female neonate presenting with neonatal cholestasis, nonbilious vomiting with pyloric obstruction, and multiple intestinal atresias. A pathognomonic clinicoradiologic triad is described, based on clinical data, plain abdominal x-ray, and ultrasound examination.
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Affiliation(s)
- Ahmed A Darwish
- Pediatric Surgery Unit, Saint-Luc University Clinics, Université catholique de Louvain, B-1200 Brussels, Belgium
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Abstract
The understanding of vascular anomalies (vascular tumours and vascular malformations) was obscured, for a long time, by confusion and uncertainties in nosology and terminology. The International Society for the Study of Vascular Anomalies (ISSVA) recently adopted a classification scheme, clearly separating vascular tumours (hemangiomas of different types) which result from active cell proliferation, from vascular malformations, which are inborn defects in vascular morphogenesis. These two types of lesions have different clinical behaviour and require different diagnostic and therapeutic strategies. The most frequent vascular tumour is infantile hemangioma. Its clinical aspects and evolution are well-known. New data have been recently obtained concerning the phenotype of tumour cells and its histogenesis. Of the numerous new vascular tumours, which have been recently described, only the congenital hemangiomas, the vascular tumours associated with the Maffucci syndrome and the tumours that may be complicated by a profound thrombocytopenia (Kasabach and Merritt phenomenon) will be considered. Vascular malformations can be classified according to the vessel(s) types they are composed of. A classification table is presented, separating the malformations of vascular trunks from tissular malformations which are more intimately embedded in the surrounding tissues. The different syndromes associated with vascular anomalies take also place in this table. The clinical, imaging and histological aspects of the most frequent malformations (capillary, venous, lymphatic and arteriovenous) are presented. This classification intend to clarify the nosology and terminology of the complex field of vascular tumours and malformation and to offer a common language to the different physicians and specialists contributing, preferably with a interdisciplinary approach, to the diagnosis and treatment of these difficult lesions.
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Affiliation(s)
- M Wassef
- Assistance publique-Hôpitaux de Paris, hôpital Lariboisière, laboratoire Jean-Roujeau, 2, université Paris-VII-René-Descartes, faculté de médecine, France.
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41
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Hermoye L, Saint-Martin C, Cosnard G, Lee SK, Kim J, Nassogne MC, Menten R, Clapuyt P, Donohue PK, Hua K, Wakana S, Jiang H, van Zijl PCM, Mori S. Pediatric diffusion tensor imaging: normal database and observation of the white matter maturation in early childhood. Neuroimage 2005; 29:493-504. [PMID: 16194615 DOI: 10.1016/j.neuroimage.2005.08.017] [Citation(s) in RCA: 324] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Revised: 07/22/2005] [Accepted: 08/01/2005] [Indexed: 11/19/2022] Open
Abstract
Recent advances in diffusion tensor imaging (DTI) have made it possible to reveal white matter anatomy and to detect neurological abnormalities in children. However, the clinical use of this technique is hampered by the lack of a normal standard of reference. The goal of this study was to initiate the establishment of a database of DTI images in children, which can be used as a normal standard of reference for diagnosis of pediatric neurological abnormalities. Seven pediatric volunteers and 23 pediatric patients (age range: 0-54 months) referred for clinical MR examinations, but whose brains were shown to be normal, underwent anatomical and DTI acquisitions on a 1.5 T MR scanner. The white matter maturation, as observed on DTI color maps, was described and illustrated. Changes in diffusion fractional anisotropy (FA), average apparent diffusion constant (ADC(ave)), and T2-weighted (T2W) signal intensity were quantified in 12 locations to characterize the anatomical variability of the maturation process. Almost all prominent white matter tracts could be identified from birth, although their anisotropy was often low. The evolution of FA, shape, and size of the white matter tracts comprised generally three phases: rapid changes during the first 12 months; slow modifications during the second year; and relative stability after 24 months. The time courses of FA, ADC(ave), and T2W signal intensity confirmed our visual observations that maturation of the white matter and the normality of its architecture can be assessed with DTI in young children. The database is available online and is expected to foster the use of this promising technique in the diagnosis of pediatric pathologies.
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Affiliation(s)
- Laurent Hermoye
- Diagnostic Radiology Unit, Saint-Luc University Hospital, Universite Catholique de Louvain, Brussels, Belgium
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42
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Menten R, Lebecque P, Saint-Martin C, Clapuyt P. Outer diameter of the vermiform appendix: not a valid sonographic criterion for acute appendicitis in patients with cystic fibrosis. AJR Am J Roentgenol 2005; 184:1901-3. [PMID: 15908550 DOI: 10.2214/ajr.184.6.01841901] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to investigate whether the outer diameter of the vermiform appendix on cross-sectional sonography is as reliable a criterion with which to confirm acute appendicitis in patients with cystic fibrosis as in those without cystic fibrosis. CONCLUSION The outer appendiceal diameter of 6 mm or more cannot be considered a reliable criterion for the diagnosis of acute appendicitis in patients with cystic fibrosis.
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Affiliation(s)
- Renaud Menten
- Department of Pediatric Radiology, Cliniques Universitaires Saint Luc, 10, avenue Hippocrate, Brussels B1200, Belgium
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Menten R, Mousny M, Saint-Martin C, Clapuyt P. Planispheric multiplanar reformatted CT: a new method for evaluation of paediatric congenital spine abnormalities. Pediatr Radiol 2005; 35:627-9. [PMID: 15735969 DOI: 10.1007/s00247-005-1412-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Accepted: 12/28/2004] [Indexed: 10/25/2022]
Abstract
We describe an original reconstruction method for spine CT performed in four patients with single or multiple congenital spine abnormalities. Conventional radiographic imaging is at the forefront of diagnosis and follow-up of congenital scoliosis, but is frequently difficult to interpret. Three-dimensional CT reconstruction facilitates visualization of complex anatomic structures, but does not give a reliable assessment of failures of segmentation. Mental three-dimensional reconstruction of the information displayed by classical multiplanar reformatted CT remains difficult. Planispheric reformatted imaging allows the visualization of all deformities in a single plane.
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Affiliation(s)
- Renaud Menten
- Department of Paediatric Radiology, Saint Luc University Hospital, Avenue Hippocrate 10, Brussels 1200, Belgium.
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Viejo-Fuertes D, Clapuyt P, Staelens JP, Delronge G, Lecouvet F, Rombouts JJ. [Subacute osteomyelitis of the acetabulum]. Rev Chir Orthop Reparatrice Appar Mot 2004; 90:569-72. [PMID: 15672925 DOI: 10.1016/s0035-1040(04)70432-8] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
A 15-months-old girl presented an excentration of the hip associated with a defect image of the acetabulum. Arthrography revealed a communication between the hip joint and the acetabular defect. Bacteriological specimens of the articular fluid were negative. The radiographic images were compatible with subacute osteomyelitis. Relative immobilization using an Atlanta abduction devise was undertaken. No medical treatment was prescribed for this adolescent who had received antibiotics for polymicrobial urinary tract infections and for pharyngitis prior to detection of the orthopedic disorder. Outcome was satisfactory with progressive filling of the acetabular defect but also with development of a subluxating coxa valga which required varus osteotomy of the femur. This case appears to illustrate a particular form of subacute osteomyelitis which is not described in earlier classifications.
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Affiliation(s)
- D Viejo-Fuertes
- Service de Chirurgie Orthopédique et de Traumatologie de l'Appareil Locomoteur, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Bruxelles, Belgique
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Reding R, Bourdeaux C, Gras J, Evrard V, Buts JP, Carlier M, Ciccarelli O, Clapuyt P, de Clety SC, De Kock M, Hermans D, Janssen M, Moulin D, Rahier J, Saint-Martin C, Sempoux C, Van Obbergh L, Veyckemans F, Lerut J, de Ville de Goyet J, Sokal E, Otte JB. The paediatric liver transplantation program at the Université catholique de Louvain. Acta Gastroenterol Belg 2004; 67:176-8. [PMID: 15285574] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The Paediatric Liver Transplant Program at Saint-Luc University Clinics constitutes a substantial single centre experience, including 667 transplantations performed between March 1984 and April 2003, and the history of this program reflects the tremendous progress in this field since twenty years. Liver transplantation in children constitutes a considerable undertaking and its results depend on multiple, intermingled risk factors. An analysis of the respective impact of several surgical and immunological parameters on patient/graft outcome and allograft rejection after paediatric liver transplantation showed a significant learning curve effect as well as the respective impact of pre-transplant diagnosis on survival and of primary immunosuppression on the rejection incidence. The introduction of living related liver transplantation in 1993 not only permitted to provide access to liver replacement in as many as 74% more candidate recipients, but also resulted in better graft survival and reduced retransplantation rate. The results of a recent pilot study suggest that steroid avoidance is not harmful, and could even be beneficial for paediatric liver recipients, particularly regarding growth, and that combining tacrolimus with basiliximab (anti-CD25 chimeric monoclonal antibody) for steroid substitution appears to constitute a safe alternative in this context. The long-term issues represent the main future challenges in the field, including the possibility of a full rehabilitation through immunosuppression withdrawal and tolerance induction, the development of adolescence transplant medicine, and the risk of early atherogenesis in the adulthood.
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Affiliation(s)
- R Reding
- Paediatric Liver Transplantation Program, Université catholique de Louvain, Saint Luc university Clinics, Brussels, Belgium.
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Wallot MA, Klepper J, Clapuyt P, Dirsch O, Malagó M, Reding R, Otte JB, Sokal EM. Repeated detection of gas in the portal vein after liver transplantation: A sign of EBV-associated post-transplant lymphoproliferation? Pediatr Transplant 2002; 6:332-6. [PMID: 12234275 DOI: 10.1034/j.1399-3046.2002.02001.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 1-yr-old child presented with intractable right sided pleural effusion and progressive clinical deterioration 3 weeks after liver transplantation for Alagille Syndrome. He had been treated successfully for severe acute rejection before. Ultrasound and Doppler mode studies repeatedly demonstrated air in the portal vein. Intra-abdominal and intra-thoracic lymphoproliferation was detected, and EBV virus load and serology were suggestive of primary EBV infection. Liver biopsy revealed blast-like infiltrates of B-cells, considered diagnostic for post-transplant lymphoproliferative disease. The disease resolved upon reduction of immunosuppression. We suggest that the detection of portal vein gas in pediatric liver transplant recipients beyond the early post-operative period may be a sign of intra-abdominal post-transplant lymphoproliferative disease.
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Affiliation(s)
- Michael A Wallot
- Department of Pediatrics, Universitätsklinikum Essen, Hufelandstr.55, 45122 Essen, Germany.
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Rombaux P, Hamoir M, Gilain V, Verellen G, Debauche C, Clapuyt P, Eloy P, Bertrand B. [Choanal atresia: a retrospective study of 39 cases]. Rev Laryngol Otol Rhinol (Bord) 2002; 122:147-54. [PMID: 11799853] [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: 02/23/2023]
Abstract
The purpose of this study was to investigate the clinical characteristics and the surgical management in patients with choanal atresia. We performed a retrospective study at the Saint-Luc University hospital, Brussels, between January 1988 and June 2000. Surgical corrections were performed using different approach (transnasal endoscopic, transpalatal) and different instrumentations (urethral sounds, laser nd-YAG, laser CO2, microdebrider). Portex endotracheal tubes were inserted as nasal stents in the vast majority of the patients with bilateral choanal atresia. Thirty-nine children with choanal atresia (22 unilateral and 17 bilateral) (9: M, 30: F) were studied. 38 of them were surgically managed. Based on clinical inspection and On CT-Scan, choanal atresia was defined as membranous for 4 patients, osseous for 6 and mixte for 29. Associated congenital anomalies were found in 22.7% of unilateral and in 70.5% of bilateral choanal atresia (Total: 43.5%). Of those children with bilateral choanal atresia, 75% were asymptomatic after four surgical procedures. In children with unilateral choanal atresia, 45% were asymptomatic after one surgical correction and 100% after three surgical corrections. Four patients were managed using an endoscopic endonasal approach with the microdebrider and showed no evidence of recurrence. Outcome analyses of factors that may influence the results of surgery are difficult to establish since many different surgical options were taken during this period. However, it seems that bilateral choanal atresia is associated with more surgical corrections before achieving a normal nasal breathing than unilateral choanal atresia. After this review, our current strategy regarding the choanal atresia will be to begin with the endoscopic endonasal approach using the microdebrider (stents if bilateral) and to propose the transpalatal approach in case of recurrence.
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Affiliation(s)
- P Rombaux
- Cliniques Universitaires Saint-Luc, Service d'Oto-Rhino-Laryngologie, avenue Hippocrate 10, 1200 Bruxelles, Belgique.
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Chardot C, Saint Martin C, Gilles A, Brichard B, Janssen M, Sokal E, Clapuyt P, Lerut J, Reding R, Otte JB. Living-related liver transplantation and vena cava reconstruction after total hepatectomy including the vena cava for hepatoblastoma. Transplantation 2002; 73:90-2. [PMID: 11792985 DOI: 10.1097/00007890-200201150-00017] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND In most cases of total hepatectomy (TH) required for hepatoblastoma (HB), the retrohepatic inferior vena cava (IVC) has to be removed with the native liver for complete tumor excision. Because the liver graft procured by living donation has no IVC, a reconstruction of the recipient IVC is needed. We report our experience with living-related liver transplantation (LRLT) and IVC replacement in such cases. METHODS Between May 1998 and December 1999, four children underwent TH, including IVC and LRLT with IVC replacement for otherwise irresectable HB after chemotherapy (SIOPEL 2 and 3 protocols). IVC reconstruction used an allogenic iliac vein procured from a cadaveric donor (bank graft) in two cases and an internal jugular vein procured from the donor parent in two cases. Median age and weight at surgery were 17 months (range 10-60) and 9.6 kg (range 8.3-17.9). RESULTS In the living donors, there were two complications of the procurement: one intra-abdominal biliary collection and one subcutaneous abscess. In all four children, complete excision of the tumor could be achieved without any intra-operative complication. One patient died 5 months after LRLT due to lung metastases. Three patients were alive and well with no evidence of tumor recurrence 13-24 months after surgery. Reconstructed IVC was patent in two patients, and asymptomatic thrombosis occurred 2 years after operation in one patient. CONCLUSION Total hepatectomy including the retrohepatic IVC is not a technical obstacle to LRLT. Therefore, scheduled surgery, at the best time after chemotherapy, can be considered in all patients with otherwise irresectable HBs.
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Affiliation(s)
- Christophe Chardot
- Centre Hospitalier Universitaire de Bicêtre, 78 rue du Général Leclerc, F-94275 Le Kremlin Bicetre, France.
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Nchimi A, Khamis J, Langhendries JP, Clapuyt P, Saint Martin C, Sokal E, Reding R. [Diagnosis and follow-up of a large intrahepatic portocaval fistula in a newborn]. J Radiol 2001; 82:1642-4. [PMID: 11894551] [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: 02/24/2023]
Abstract
Portocaval fistulas are rare and only exceptionally discovered in newborns. We report the case of a large portocaval fistula associated with portal hypoperfusion detected at Doppler US imaging in an otherwise asymptomatic 5 week old infant. The patient remained asymptomatic over the following two years. At that time, preoperative angiogram showed a normal portal venous system and the fistula was surgically closed. Postoperative US showed a normal and patent portal system, without evidence of portal hypertension.
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Affiliation(s)
- A Nchimi
- Service d'imagerie médicale, Les cliniques Saint-Joseph, clinique de l'Espérance, rue Saint Nicolas, 447B-4420 Liège, Bruxelles.
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Brichard B, Smets F, Sokal E, Clapuyt P, Vermylen C, Cornu G, Rahier J, Otte JB. Unusual evolution of an Epstein-Barr virus-associated leiomyosarcoma occurring after liver transplantation. Pediatr Transplant 2001; 5:365-9. [PMID: 11560757 DOI: 10.1034/j.1399-3046.2001.00022.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We report the case of a child who developed, 2 yr after orthotopic liver transplantation (OLTx) for biliary atresia, a multi-focal hepatic tumor with lymphonodular metastases, identified as an Epstein-Barr virus (EBV)-associated leiomyosarcoma. Chemotherapy was given without tumor response. Subsequently, slow growth of the tumor was observed. Immunosuppression was tapered and stopped 9 yr after transplantation. At the present time, 12 yr after the discovery of the first hepatic lesions, the patient is alive and completely symptom-free, the abdominal masses are stable, and liver function tests are completely normal. Smooth muscle tumors are increasingly recognized in children with various immunodeficiencies occurring after organ transplantation. This unusual evolution of a clinically aggressive tumor into a stable disease after restoration of immunity confirms that the immune status of the patient is a crucial factor.
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Affiliation(s)
- B Brichard
- Department of Pediatric Hematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium.
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