Cowden disease with Lhermitte-Duclos disease: case report.
BACKGROUND
We report a case and review the recent literature describing 36 patients with both Lhermitte-Duclos disease (LDD) and Cowden disease (CD). Lhermitte-Duclos disease, or dysplastic gangliocytoma, is a benign hamartomatous condition involving the cerebellum. The presenting symptoms are usually headaches, gait ataxia, and symptoms of lower cranial nerve involvement. Cowden disease is a rare autosomal dominant disease that usually presents with multiple mucocutaneous lesions. Patients with CD are prone to multiple systemic malignancies, the most common of which is breast cancer. Recent studies have demonstrated an association between LDD and CD.


METHODS
A 44-year-old woman with a previous history of breast cancer, multiple benign skin lesions, Hashimoto's thyroiditis, and chronic headaches presented with exacerbation of her headaches during the previous year. Magnetic resonance imaging of the brain revealed a right cerebellar nonenhancing mass and an acquired tonsillar herniation.


RESULTS
The patient underwent resection of the right cerebellar mass, posterior fossa decompression, C1 and C2 laminectomies, and a duraplasty. Pathologic examination confirmed LDD. The patient recovered well after surgery, with immediate improvement of her headaches.


CONCLUSIONS
The association between LDD and CD has been under-recognized and under-reported. Recognition of this association has direct clinical relevance, because diligent monitoring of individuals with LDD and CD may lead to the early detection of systemic malignancies.
Prabhu
Sujit S
SS
Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, The Brain Tumor Center, Houston, Texas, USA.
Aldape
Kenneth D
KD
Bruner
Janet M
JM
Weinberg
Jeffrey S
JS
D000328:Adult; D002528:Cerebellar Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D002531:Cerebellum / Q000473:pathology / Q000601:surgery; D005260:Female; D005729:Ganglioneuroma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006223:Hamartoma Syndrome, Multiple / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D020752:Neurocutaneous Syndromes / Q000175:diagnosis / Q000601:surgery; D016896:Treatment Outcome