[Unusual diffuse bone disease].
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Two homologous genes, EXT1 and EXT2, responsible for the development of benign multiple cartilagenous bone tumors (exostoses) on the long bones, have been identified in the past 2 years. Several arguments have been provided to support the hypothesis that these genes have tumor suppressor activity and that loss of function of these genes may contribute to the development of bone tumors. The recent identification of two EXT-like genes, EXTL1 and EXTL2, homologous to the EXT genes and to each other, revealed the existence of a larger family of genes. We now report the identification of a homologous EST (EST01365), not derived from the known EXT and EXTL genes, indicating the existence of one additional member of this gene family. We characterized this third EXT-like gene, EXTL3, and compared it with the other four members of the EXT-EXTL family. In view of its putative tumor suppressor function, the EXTL3 gene can be considered a candidate gene for the breast cancer locus on chromosome 8p12-p22.
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The authors describe a case of microcephalic dwarfism observed in a newborn until 10 months of age and discuss the diagnostic challenge. They show that the Taybi-Linder syndrome and the primordial dwarfism type I and type III of Majewski are an identical recessive autosomal entity. The radiological evolution explains the initial separation of type I and type III. Because of the skeletal lesions, lacking in the Seckel syndrome, the name of sublethal microcephalic chondrodysplasia is proposed for this disease.
Multiple hereditary osteochondromata is a disorder consisting of multiple projections of bone (exostoses) capped by cartilage. The lesions are most numerous in the metaphyses of long bones but may appear on diaphyses of long bones and on flat bones and vertebrae. The transmission is autosomal dominant. Sarcomatous transformation is uncommon and probably occurs in fewer than 1% of patients. The more common indications for surgical excision of lesions are pain, growth disturbance, compromised joint motion, cosmesis, and secondary impingement of tendon, nerve, or vessel. Excision of the lesions is effective in relieving pain, improving cosmesis and joint motion, and removing secondary impingement of tendon, nerve, or vessel, and may retard or prevent progressive disturbance of osseous growth. Wrist and ankle deformities are often associated with relative shortening and bowing of the ulna and fibula, respectively; tilt and tapering of the distal radial and tibial epiphyses; and distal radioulnar and tibio-fibular diastasis. These deformities can be effectively treated by ulnar and fibular lengthening combined with hemiphyseal stapling of the distal radius and tibia. Progressive genu valgum is well corrected by placement of staples over the medial side of the physis of the distal femur or proximal tibia or both.
The tricho-rhino-phalangeal syndrome (TRPS) is a rare congenital disorder, characterized by (1) a peculiar and somewhat pear-shaped nose, (2) sparse and brittle scalp hair, and (3) radiographic evidence of cone-shaped epiphyses of the hands. On the basis of clinical, radiographic and genetic criteria, two subtypes (type I and II) are discerned. We describe an intermediate "hybrid" variant of the TRPS in a patient with clinical and radiographic features of TRPS type I, but with a clearly abnormal karyotype, consistent with TRPS type II. The radiographic findings of the syndrome are reviewed, with particular emphasis on the cone-shaped epiphyses in the hands, the changes in the coxo-femoral joints and the atypical appearance of the pubic symphysis.
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We report a male infant with a lethal short limb Skeletal Dysplasia, born in a District Hospital in the South of Portugal. Local paediatricians investigated clinical and radiographical data. At the Perinatal Pathology Unit of the Egas Moniz hospital the diagnosis of Atelosteogenesis type II was proposed by the Clinical Geneticist and was supported by histopathological findings. Only a collaborative approach turned possible the diagnosis of this unusual entity. Atelosteogenesis type II and Diastrophic Dysplasia are closely related diseases, with similarities in phenotypic and histopathological presentation. Recently, these similarities were extended to molecular levels. The DNA analysis, in progress, will be able to establish a final diagnosis for this affected family.
Multiple cartilaginous exostoses (MCE) is an autosomal dominant disorder that can lead to malignant transformation from exostoses to a secondary chondrosarcoma. We present a case report of a 52-year-old man with MCE who had a palpable mass at the left shoulder. At the site of the left proximal humerus, a cartilaginous exostosis was localized, suggesting that the tumor developed by a malignant transformation of an exostosis into a secondary chondrosarcoma. Interestingly, a biopsy showed a diffuse large B-cell lymphoma with Burkitt-like features. To our knowledge, the association of high-grade lymphoma and hereditary exostoses has not been described previously. This case demonstrates that a malignant tumor at the location of a cartilaginous exostosis is not necessarily a chondrosarcoma and that a biopsy is an essential part of the diagnostic work-up.
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