Neurofibromatosis最新文献

Four patients with Proteus syndrome are reported; 3 of the 4 died of unusual causes. Current findings of the syndrome are reviewed, and the present state of its delineation is assessed with emphasis on what is known about natural history. Differential diagnosis includes neurofibromatosis, Klippel-Trénaunay-Weber syndrome, Maffucci syndrome, epidermal nevus syndrome, and the combination of Bannayan-Zonana syndrome, Riley-Smith syndrome, and Ruvalcaba-Myhre syndrome, now thought to constitute a single disorder. Conditions that may possibly overlap with Proteus syndrome--encephalocraniocutaneous lipomatosis and Thanos syndrome--receive special attention. Various suggested diagnoses for the elephant man's disorder are evaluated, and it is concluded that he suffered from Proteus syndrome, not neurofibromatosis. Finally, the psychosocial significance of elephant fever (EF) is discussed, and a plea is made for taking the EF out of NF.

The Neurofibromatosis Clinic of the Children's Hospital of Philadelphia is a multidisciplinary clinic that provides a setting in which the diagnosis of neurofibromatosis can be made and follow-up of children with neurofibromatosis coordinated. It also offers genetic counseling to affected individuals and families. The Clinic acts as a referral center to the subspecialty disciplines when such specialty services are required. This report outlines the organization and operation of the Children's Hospital of Philadelphia Neurofibromatosis Clinic. It discusses the protocol used to evaluate the pediatric patient with neurofibromatosis and the importance of continuity of care for the patients and families.

A schematic diagram depicting the full spectrum of clinical features of von Recklinghausen neurofibromatosis (NF-1) is presented.

The notion that vascular alterations represent a major feature of the pathogenesis of neurofibromatosis (NF) has been supported by an increasing number of observations. We present data about skin Morgan angiomas in the general US white population and a cohort of patients with NF-1 and their unaffected relatives. Among patients with NF-1, angiomas were significantly more common, but not so among unaffected relatives. The striking nature of skin angiomas in some patients is illustrated by a mother-daughter pair with innumerable lesions of early onset. The mother also had a large venous angioma and a constriction of the siphon of an internal carotid artery.

Mast cells are in close contact with other cells in neurofibromatosis, e.g. neural cells and fibroblasts. Secretory products of mast cells may be important in the regulation of collagen synthesis by fibroblasts and Schwann cells. Newer methods of detecting mast cells by avidin staining of granules and localization of membrane Fc receptors for IgE have been exploited in at least one experimental model of fibrosis (murine chronic graft-versus-host disease). Such approaches should help in understanding parameters involved in modulation of cell growth in neurofibromas. Future directions for the study of cellular dynamics in neurofibromas should include detection of activated (degranulated) mast cells, Schwann cells and effects of mast cell products on collagen gene expression.

One neurofibrosarcoma from each of three patients with von Recklinghausen neurofibromatosis (VRNF) was studied for the expression of selected growth factor genes and oncogenes. Comparative analyses were also performed on four neurofibromas and skin, nerve and muscle specimens from one of the patients with neurofibrosarcoma, an autopsy kidney specimen from a fifth VRNF patient, and normal liver and term placenta specimens from healthy control subjects. Northern blot hybridization techniques were used to analyze the amounts and sizes of mRNA resulting from the expression of eight genes. Insulin-like growth factor I showed a moderate level of expression in normal nerve and lower expression in two neurofibrosarcomas. Insulin-like growth factor II was moderately to heavily expressed in all specimens, and differential splicing patterns were seen. Platelet-derived growth factor showed low levels of expression in all three neurofibrosarcomas, skin, nerve, muscle and normal liver, low to moderate levels of expression in the neurofibromas, and high expression in normal control placenta. Beta-nerve growth factor was expressed at low levels in two neurofibrosarcomas and skin, but was not seen in other specimens. N-myc showed a low level of expression in one neurofibrosarcoma and a neurofibroma, and a higher level of expression in a second neurofibrosarcoma (and in this same subject's skin and nerve). Tissue-type plasminogen activator showed moderate levels of expression in two neurofibrosarcomas and one neurofibroma, but it was not seen in skin, nerve, kidney and normal term placenta specimens.

Two cases of von Recklinghausen neurofibromatosis with a hitherto unreported association of ventriculomegaly and a Chiari type I malformation are described. Both cases had skeletal abnormalities at the cervicomedullary junction, contributing to neurological symptoms in 1. The literature on nontumor-related ventriculomegaly in neurofibromatosis is reviewed. The Chiari type I malformation should be considered as a cause of nontumoral ventricular enlargement in patients with von Recklinghausen neurofibromatosis.