[A neonate with a congenital hand defect]

A newborn presented with a birth defect of his left hand and unilateral hypoplasia of his left musculus pectoralis major and left nipple. He was diagnosed with Poland syndrome.

[Poland syndrome--clinical study]

Poland's Syndrome is a rare congenital abnormality involving functional and aesthetic impairments. Constitutive mark of the condition: partial or total absence of the pectoralis major and minor muscles, symmetric chest wall deformity, brachydactyly/syndactyly. This syndrome is occasionally associated with either unilateral or bilateral hypoplasia of breast.

AIM

We present a case of a patient with Poland's Syndrome. This association has not been previously reported in the medical literature. Difficulties by preoperative diagnosis. The purpose of this article--to propose a classification system for the treatment of this anomaly requiring defining the age of the patients for plastic surgery on the chest.

METHODS AND MATERIALS

A 16-year-old female with Poland's Syndrome complained of drastic mood changes consisting of depression and anxiety, regular menses, dysmenorrhea and hypomastia. Two reconstructive surgeries at the age of 12 years--surgical corrections of the sternal malformation.

RESULTS AND CONCLUSION

This work shall describe Poland's Syndrome from a clinical, diagnostic, genetic and therapeutic point of view. The Italian Association for Poland Syndrome founded in October 2003 and two nationwide scientific conferences dealt with the position of scientific research and future prospects with regards to Poland Syndrome. Patients are subject to multi-specialist (surgical, gynecological, genetic, psychological, orthopaedic and plastic surgical) checkups, aiming at an accurate genetic and clinical organisation of a therapeutic programme.

Athelia: case report and review of the literature

The absence of nipple-areola complex is a rare entity and is always associated with other anomalies. This paper described a case of bilateral athelia without other alterations. The atrophy of the dense mesenchyme due to absence of parathyroid hormone-related protein produced in epithelium may lead to nipple involution. Further cases should be studied to corroborate this theory.

Ipsilateral foot and controlateral hand anomalies in a patient with Poland–Moebius syndrome

This report describes a patient who had bilateral facial nerve paralysis, external ophthalmoplegia, absence of pectoralis major muscle at right side, ipsilateral hand and foot, and contralateral hand anomalies. To our knowledge, this is the first patient with Poland syndrome reported in combination with Moebius syndrome, presenting with contralateral hand and ipsilateral foot anomalies.

Report of a girl with Klippel-feil syndrome and Poland anomaly

Report of a girl with Klippel-feil syndrome and Poland anomaly: Klippel-Feil syndrome, consisting of the triad of a short neck, low posterior hairline, and limitation of neck movement, is a congenital anomaly characterized by the fusion of cervical vertebrae, Poland anomaly consists of unilateral aplasia of the chest wall muscles and ipsilateral anomalies of upper extremity. We report a 7-year-old girl with typical findings of Klippel-Feil syndrome and Poland anomaly. To the best of our knowledge a case of Klippel-Feil syndrome and Poland anomaly has not been described before, although a combination of Poland, Klippel-Feil and Moebius anomalies has been reported in the literature.

Poland anomaly--report of an unusual family

A family with classical Poland anomaly presenting in the son and a partially affected mother is reported. We hypothesize that Poland anomaly has a multifactorial basis involving vascular compromise in early development. Two possible predisposing factors are aberrant vascular formation and thrombophilia. The investigation of our family has not demonstrated an abnormality in coagulation, therefore, we surmise that an inherited structural variant of blood vessel formation is responsible.

Radiological aspects of the Poland syndrome and implications for treatment: a case study and review

Poland syndrome (PS) (OMIM 173800) is a rare congenital anomaly classically consisting of the combination of unilateral aplasia of the sternocostal head of the major pectoral muscle and an ipsilateral hypoplastic hand with simple syndactyly and short fingers. The aetiology is most probably a vascular disruption sequence of the subclavian arteries. In most cases, PS is sporadic. Familial occurrence suggests that genes exist which are involved in the pathogenesis as paradominant traits. The syndrome may include mammary hypoplasia and further muscle abnormalities which can be accurately defined by sonography and MRI. The evaluation of the vascular status can be performed using colour coded duplex sonography for peripheral arteries and contrast-enhanced MR-angiography for supra-aortic arteries.

CONCLUSION

We report a 7-year-old girl with unilateral right sided Poland syndrome with particular emphasis on the radiological investigations of vascular abnormalities. A review of the literature concerning the origin, outcome, and implications for treatment is given.

Poland-Möbius syndrome and disruption spectrum affecting the face and extremities: a review paper and presentation of five cases

The author summarizes hitherto assembled experience with the clinical and genetic characteristics of Poland's and Möbius syndrome. Five selected case-records with this disease and the sequence of the Poland-Möbius syndrome are presented. Another case-record is devoted to an allied syndrome, hypoglossia-hypodactyly, found in a spontaneously aborted fetus. For establishment of a more accurate symptomatology, an irreplaceable place is held by anthropometric examination; for objectifying the asymmetry of the chest the so-called cyrtogram, the chest circumference recorded by means of a wire, is valuable. From the aspect of genetic counseling, preconception care is always provided to mothers from families with reproductive intentions, as well as ultrasonographic examination of the fetus in areas of assumed acral symptomatology (signaling phenotype). In two families ultrasonography was used for prenatal diagnosis. Invasive prenatal diagnosis by amniocentesis was employed in a family with Möbius syndrome. In these families dermatoglyphs have certain common characteristics, such a tendency towards simple patterns. In the wider family of one of our patients we detected in a cousin Parkes-Weber-Klippel-Trenaunay's syndrome, which may indicate common vascular predisposing factors.

[Poland's syndrome]

Poland's syndrome consists of the variable clinical features, but always includes unilateral aplasia of the chest wall muscles and ipsilateral anomalies of upper extremity. The incidence of Poland's syndrome, reported by different authors ranges from 1:10,000 to 1:100,000 and is observed more frequently in males than in females with the right side of the body affected more often than the left. The etiology of this syndrome is still discussed. However most of described cases were sporadic, rare familial incidence of Poland's syndrome were also presented. Therefore different etiologic factors of the Poland's syndrome are taken into account: genetic, vascular compromise during early stages of embriogenesis but also teratogenic effect of environmental xenobiotics (e.g. cigarette smoking by pregnant women). The authors present also the case of 20-years old man with inherited bilateral syndactyly with the right side aplasia of major pectoralis muscle and face asymmetry. The familial history was negative in respect to the features, associated with Poland's syndrome.

Poland's syndrome and recessive X-linked ichthyosis in two brothers

Poland's syndrome consists of unilateral congenital absence of the pectoralis major muscle with a variable degree of ipsilateral upper limb deformity. The aetiology of Poland's syndrome is unknown, although an inherited tendency to develop a compromised embryonic vascular supply in the affected areas has been suggested. The majority of reported cases are sporadic, and in only a few instances is there a familial incidence. We describe the occurrence of Poland's syndrome in two brothers who also had recessive X-linked ichthyosis. To the best of our knowledge this is the first report of such an association.

Poland's syndrome in one identical twin

Female twins were evaluated at the Shriners Hospital in Lexington, Kentucky. One twin was normal, and the other twin had the classic findings of Poland's syndrome, manifested by absence of the pectoralis major and symbrachydactyly of the right upper extremity. Buccal smears from each child were submitted for DNA testing. The test confirmed monozygosity with 99.9% probability. Some previous reports have stated that Poland's syndrome is an autosomal dominant, genetically determined trait, whereas others have maintained that there is no genetic association. The original case described by Poland in 1841 was his cadaver, and no family history was reported. This twin study provides strong evidence that the condition is not determined by gene transmission.

Symbrachydactyly involving hands and feet

Two patients are described with a symbrachydactyly of the hand and foot. This is a rare combination which cannot be explained by the subclavian artery supply disruption sequence.

The occurrence of Poland and Poland-Moebius syndromes in the same family: further evidence of their genetic component

The combination of Moebius and Poland anomalies is rarely described in the literature. Some authors believe that this association is an independent syndrome, while others propose that Poland, Moebius and Poland-Moebius are a spectrum of the same condition. Here we report a family where a child has Poland-Moebius syndrome and an aunt is affected with Poland anomaly. This probably represents the second report of possible autosomal dominant transmission of Poland-Moebius syndrome. The presence of contralateral triphalangeal thumb in the proband and in other members of the family can be explained by chance alone or, alternatively, by a pleiotropic expression of this gene.

Bilateral Poland anomaly

Bilateral absence of the pectoralis major muscle with accompanying abnormalities of shoulder muscles has been reported in patients without Poland anomaly (PA). However, symmetric absence of pectoralis major muscles, hypoplasia of breasts and nipples with symmetric chest wall deformity and bilateral hand anomaly has not previously been reported. A 6-year-old girl with bilateral absence of pectoralis major muscles and hand involvement and symmetric chest wall deformity is, to our knowledge, the first known case of bilateral Poland anomaly.

Corroboration of the lower extremity counterpart of the Poland sequence

Gluteal and lower extremity hypoplasia with ipsilateral toe brachysyndactyly were noted in a 23-year-old woman similarly affected to the only previously reported case of the lower extremity counterpart of Poland sequence. Since no neurological deficit was found, and electromyographic and nerve conduction studies in the affected limb were normal, we propose a vascular origin which would involve the external iliac artery supply analogous to the subclavian artery supply disruption in the upper extremity Poland sequence.

Intrafamilial phenotypic heterogeneity of the Poland complex: a case report

Three cases of familial unilateral gluteal hypoplasia are reported. The index case in addition to having gluteal hypoplasia also has unilateral pectoral muscle hypoplasia. Another relative has unilateral symbrachydactyly of the distal phalanges of one foot. All four affected individuals in our pedigree were female. We propose that our cases are best classified as part of the Poland complex of anomalies. Our cases emphasize that intrafamilial phenotypic heterogeneity is possible within the Poland complex.

Peroneal muscular atrophy with Poland syndrome

A 22-year-old male college student had a syndactyly between the second and third fingers of his left hand, which was congenitally small in size. His left pectoralis muscles were absent. He first walked at the age of 12 months, but soon developed difficulties in walking due to weakness of the legs. Atrophy and weakness of the legs aggravated gradually. He was diagnosed as having peroneal muscular atrophy and Poland syndrome, an association of which has not been reported before. A small number of similar cases of peroneal muscular atrophy with various skeletal abnormalities in the literature suggest that the association is not incidental, but of clinical significance.

Ullrich-Turner syndrome with unilateral agenesis of breast, nipple, and pectoralis major

A 16-year-old girl with mosaic Ullrich-Turner syndrome [45,X/46,X,i(Xq)] had agenesis of the left breast, nipple, pectoralis major, and agenesis of hair follicles of the left axilla. This appears to be the first description of this anomaly in the Ullrich-Turner syndrome.

Poland-Moebius syndrome in a boy and Poland syndrome in his mother

A 4 4/12-year-old boy with the Poland-Moebius syndrome, whose mother had the POland syndrome, is presented. This is the first report of the occurrence of both syndromes in the same family, suggesting that they are expressions of the same autosomal dominant gene.

Possible common pathogenetic mechanisms for Poland sequence and Adams-Oliver syndrome

We report on 2 families having members affected with the Poland sequence and Adams-Oliver syndrome. In the first family, a 5-month-old boy presented with Adams-Oliver syndrome; his mother had Poland sequence. In the second family, a 12-year-old boy and his mother presented with findings suggestive of Adams-Oliver syndrome and Poland sequence. This suggests that the same genetic predisposition may result in either or both conditions.

Frontonasal dysplasia or craniofrontonasal dysplasia and the Poland anomaly?

We describe a 10-year-old girl with features of a frontonasal dysplasia and a right-sided Poland anomaly. As there has been one previous case report of pectoral muscle hypoplasia in association with craniofrontonasal dysplasia, the relationship between these two conditions is discussed.

[Concordant myaplasia of the thoracic wall in monozygotic twins (Poland anomaly)]

A set of monozygotic twins affected with unilateral shoulder girdle muscle aplasia is reported. One twin showed Poland-like aplasia of the pectoralis but without the ipsilateral dysmelia, the other aplasia of dorsal spinothoracic muscles. The controversy about exogenous or genetic causes of the Poland anomaly and the whole spectrum of shoulder myaplasia may be solved assuming a multifactorial origin. The striking sex distribution and the continuous range of symptoms observed are in keeping with this hypothesis.

Familial Poland's syndrome

Absence of the right pectoralis major muscle and hypoplasia of the ipsilateral breast was observed in 3 females and hypoplasia or agenesis of the right pectoralis major muscle in 2 males of the same family. One member of this family, a 17-year-old girl, underwent a right latissimus dorsi muscle flap, placement of silicone-gel breast implant, and a right infraclavicular natural Y prosthesis. Although none of our 5 patients from this family had congenital upper limb abnormalities, we believe that they still qualify as having Poland's syndrome. This would distinguish them as being the fourteenth known family reported in the world literature with this diagnosis. A brief review of the history as well as hypotheses of etiological mechanisms are presented.

Poland anomaly in mother and daughter

We report on Poland anomaly in a mother and her daughter. Further family history was negative for abnormalities of the hands or the pectoralis major muscle. A review of published cases of familial Poland anomaly is presented. Implications concerning the possible etiology of familial cases of Poland anomaly are given.

[Hereditary Poland syndrome with megacalycosis of the right kidney]

Poland's syndrome is characterized by congenital aplasia of the sternocostal head of the pectoralis major muscle associated with ipsilateral hand deformities (most often synbrachydactylia). 20% of patients have rib cage abnormalities, some with herniation of the lung. In some cases other associated ipsilateral anomalies (hypoplasia or absence of the nipple and/or the breast, defects of the vertebrae, dextrocardia, renal aplasia of hypoplasia, undescended testes, Möbius syndrome) have been described. We describe a patient with right-sided Poland's syndrome, the first published case associated with megacalycosis of the ipsilateral kidney. It is also the first publication of a familial case with this renal anomaly, since a brother has megacalycosis of the right kidney without Poland's syndrome. The majority of cases of Poland's syndrome are sporadic. The incidence has been estimated at between 1:30,000 and 1:80,000 of live births. The great uncle of our patient had a short forearm and only rudimentary fingers. The etiology of the syndrome is unknown. Toxic effects early in fetal life or effects on primary asymmetrical blood vessels, e.g. the subclavian artery, followed by uneven growth, are discussed as possible causes of Poland's syndrome.

Poland syndrome associated with 'morning glory' syndrome (coloboma of the optic disc)

A 12 year old girl with the Poland syndrome and the 'morning glory' syndrome is described. The patient presented with absence of the left pectoralis major muscle, hypoplasia of the left arm, symbrachydactyly, and ipsilateral coloboma of the optic disc. This is the first report of the association of these two congenital anomalies.