title: Assessment of PTEN-associated vascular malformations in a patient with Bannayan-Riley-Ruvalcaba syndrome.
abstract: Misdiagnosis of phosphatase and tensin homologue hamartoma syndromes is common. Correct diagnosis has a relevant impact on patients, as the risk of malignancies is high and treatment options are limited. We report the case of a 24-year-old man who presented with symptomatic vascular intramuscular lesions of the left forearm and right calf, macrocephaly, post Hashimoto thyroiditis, a multicystic intracranial paratrigonal lesion, lentiginous hyperpigmented maculae on the foreskin and multiple skin lesions. MRI showed extended fibrofatty changes and malformed vessels in the forearm and calf lesions, also, arteriovenous shunting was present in these lesions. The patient had been treated by embolisation and surgically in the past, with limited results. A multidisciplinary assessment and genetic counselling were undertaken and a surveillance programme was initiated. Treatment options of the symptomatic vascular lesions include excision or possibly cryoablation. Physiotherapy to prevent progression of the contractures should be initiated meanwhile.
authors.affiliation: Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Sandra
authors.initials: S
authors.lastname: Anusic
authors.affiliation: Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Robert Karl Josef
authors.initials: RK
authors.lastname: Clemens
authors.affiliation: Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Thomas Oleg
authors.initials: TO
authors.lastname: Meier
authors.affiliation: Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Beatrice Ruth
authors.initials: BR
authors.lastname: Amann-Vesti
mesh_terms: D000015:Abnormalities, Multiple / Q000235:genetics; D003937:Diagnosis, Differential; D005542:Forearm / Q000098:blood supply; D006223:Hamartoma Syndrome, Multiple / Q000175:diagnosis / Q000235:genetics*; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D018810:Magnetic Resonance Angiography; D008297:Male; D058627:Megalencephaly / Q000235:genetics; D018482:Muscle, Skeletal / Q000098:blood supply; D059352:Musculoskeletal Pain / Q000209:etiology; D051059:PTEN Phosphohydrolase / Q000235:genetics*; D018615:Ultrasonography, Doppler, Color; D054079:Vascular Malformations / Q000235:genetics*; D055815:Young Adult
chemical_list: D051059:PTEN Phosphohydrolase; C494929:PTEN protein, human