title: A patient with TSC1 germline mutation whose clinical phenotype was limited to lymphangioleiomyomatosis.
abstract: BACKGROUND
  Lymphangioleiomyomatosis (LAM) can occur as in isolated form (sporadic LAM) or as a pulmonary manifestation of tuberous sclerosis complex (TSC) (TSC-associated LAM). Recent studies, however, revealed that both forms of LAM are genetically related but that sporadic LAM is a distinct clinical entity caused by somatic mutations of TSC2 (not TSC1) rather than a forme fruste of TSC carrying either of the TSC1 or TSC2 germline mutations.
  
  
  METHODS
  Case presentation and in-depth molecular and histopathological examinations. A 34-year-old Japanese woman was diagnosed as having pulmonary lymphangioleiomyomatosis (LAM) when bilateral pneumothoraces were surgically treated in 1992. Although slowly progressive renal disfunction was observed due to bilateral multiple renal cysts during the past 4 years, she had no other clinical features of TSC and was diagnosed as having sporadic LAM with multiple renal cysts of undetermined aetiology. Her subsequent clinical course was complicated by an endobrochial carcinoid tumour, which eventually resulted in her death in June 1999 due to massive haemoptysis.
  
  
  RESULTS
  Postmortem examination revealed the presence of LAM lesions in the lungs, mediastinal lymph nodes, kidneys and uterus. Diffuse renal LAM lesions are presumed to generate multiple renal cysts by constricting the nephron rather than epithelial hyperplasia obstructing lumina, which is analysis of the TSC genes demonstrated that she did not have TSC2/PKD1 contiguous gene syndrome but had a TSC1 germline mutation (Sato T et al. J Hum Genet 2002; 47: 20-8) that had occured de novo.
  
  
  CONCLUSIONS
  This patient therefore illustrates that clinical manifestations of TSC are sufficiently diverse as to allow a forme fruste of TSC that mimics sporadic LAM and that TSC1 mutation can cause multiple renal cysts resulting in renal failure.
authors.affiliation: Department of Respiratory Medicine, Juntendo University School of Medicine, Hongo Bunkyo-Ku, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Sato
authors.forename: K
authors.initials: K
authors.lastname: Seyama
authors.forename: T
authors.initials: T
authors.lastname: Kumasaka
authors.forename: H
authors.initials: H
authors.lastname: Fujii
authors.forename: Y
authors.initials: Y
authors.lastname: Setoguchi
authors.forename: T
authors.initials: T
authors.lastname: Shirai
authors.forename: Y
authors.initials: Y
authors.lastname: Tomino
authors.forename: O
authors.initials: O
authors.lastname: Hino
authors.forename: Y
authors.initials: Y
authors.lastname: Fukuchi
mesh_terms: D000328:Adult; D002276:Carcinoid Tumor / Q000150:complications / Q000235:genetics; D017809:Fatal Outcome; D005260:Female; D018095:Germ-Line Mutation; D006469:Hemoptysis / Q000209:etiology / Q000235:genetics; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000150:complications / Q000235:genetics; D008175:Lung Neoplasms / Q000150:complications / Q000235:genetics*; D018192:Lymphangioleiomyomatosis / Q000150:complications / Q000235:genetics*; D011506:Proteins / Q000235:genetics*; D000077004:Tuberous Sclerosis Complex 1 Protein; D025521:Tumor Suppressor Proteins
chemical_list: D011506:Proteins; C000624650:TSC1 protein, human; D000077004:Tuberous Sclerosis Complex 1 Protein; D025521:Tumor Suppressor Proteins