Association of multiple vertebral hemangiomas and severe paraparesis in a patient with a PTEN hamartoma tumor syndrome. Case report.
The PTEN hamartoma tumor syndrome, manifestations of which include Cowden disease and Bannayan-Riley-Ruvalcaba syndrome, is caused by various mutations of the PTEN gene located at 10q23. Its major criteria are macrocephaly and a propensity to develop breast and thyroid cancers as well as endometrial carcinoma. Minor diagnostic criteria include hamartomatous intestinal polyps, lipomas, fibrocystic disease of the breasts, and fibromas. Mutations of PTEN can also be found in patients with Lhermitte-Duclos disease (dysplastic gangliocytoma of the cerebellum). The authors report the case of a 17-year-old girl who had a severe cyanotic cardiac malformation for which surgery was not advised and a heterozygous missense mutation (c.406T>C) in exon 5 of PTEN resulting in the substitution of cysteine for arginine (p.Cysl36Arg) in the protein, which was also found in her mother and sister. The patient presented in the pediatric emergency department with severe spastic paraparesis. A magnetic resonance imaging study of the spine showed vertebral hemangiomas at multiple levels, but stenosis and compression were maximal at level T5-6. An emergency T5-6 laminectomy was performed. The decompression was extremely hemorrhagic because the rapid onset of paraparesis necessitated prompt treatment, and there was no time to perform preoperative embolization. The patient's postoperative course was uneventful with gradual recovery. This represents the first report of an association of a PTEN mutation and multiple vertebral angiomas. The authors did not treat the remaining angiomas because surgical treatment was contraindicated without previous embolization, which in itself would present considerable risk in this patient with congenital cyanotic heart disease.
Jenny
Benoit
B
Department of Neurosurgery, University Hospitals of Geneva, Switzerland.
Radovanovic
Ivan
I
Haenggeli
Charles-Antoine
CA
Delavelle
Jacqueline
J
Rüfenacht
Daniel
D
Kaelin
André
A
Blouin
Jean-Louis
JL
Bottani
Armand
A
Rilliet
Bénédict
B
D000293:Adolescent; D000792:Angiography; D001120:Arginine; D003490:Cyanosis / Q000151:congenital / Q000209:etiology; D003545:Cysteine; D019299:Decompression, Surgical; D005260:Female; D006223:Hamartoma Syndrome, Multiple / Q000175:diagnosis / Q000235:genetics*; D006330:Heart Defects, Congenital / Q000150:complications; D006391:Hemangioma / Q000150:complications / Q000175:diagnosis / Q000235:genetics* / Q000601:surgery; D006579:Heterozygote; D006801:Humans; D008279:Magnetic Resonance Imaging; D020125:Mutation, Missense; D051059:PTEN Phosphohydrolase / Q000235:genetics*; D020335:Paraparesis / Q000209:etiology*; D012720:Severity of Illness Index; D013117:Spinal Cord Compression / Q000150:complications / Q000209:etiology / Q000503:physiopathology; D013125:Spinal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000235:genetics* / Q000601:surgery; D013904:Thoracic Vertebrae; D014057:Tomography, X-Ray Computed
D001120:Arginine; D051059:PTEN Phosphohydrolase; C494929:PTEN protein, human; D003545:Cysteine