摘要
RESUMO O objetivo deste estudo foi relatar a abordagem interdisciplinar no manejo da macroglossia em um caso de paciente com síndrome de Beckwith-Wiedemann, no período de dez anos. O acompanhamento iniciou pela equipe de Cirurgia Bucomaxilofacial, seguido da Fonoaudiologia, em função de dificuldades alimentares. Após avaliação clínica e instrumental, aos 8 meses de idade, iniciou-se a intervenção fonoaudiológica com foco na disfagia orofaríngea e na terapia miofuncional orofacial. Foi verificado, com 1 ano e 11 meses, ausência de sinais de alteração de deglutição em fase faríngea e melhora na postura de lábios e língua. Aos 3 anos, foram iniciados estímulos para retirada dos hábitos orais e o treino da função mastigatória. O tratamento ortodôntico para correção de mordida aberta anterior e mordida cruzada posterior unilateral iniciou-se aos 6 anos. Aos 7 anos e 5 meses de idade, constatou-se estabilidade do modo respiratório nasal e adequação da postura de repouso de lábios e língua. Aos 9 anos, em função de recidiva das alterações oclusais, optou-se pela redução cirúrgica da língua seguida de terapia miofuncional orofacial, retomada aos 9 anos e 3 meses. O resultado foi a correção da postura da língua na deglutição e a adequação da fala. A associação dos tratamentos, envolvendo Fonoaudiologia, Ortodontia e Cirurgia Bucomaxilofacial foi considerada efetiva no manejo da macroglossia, resultando na adequação e equilíbrio das funções orofaciais.
ABSTRACT This study aims to report the interdisciplinary management of macroglossia in a Beckwith-Wiedemann syndrome patient during ten years. Clinical follow-up started by the Oral and Maxillofacial Surgery team, followed by Speech Therapy due to feeding difficulties. After clinical and instrumental evaluation, at 8 months old, the speech therapy intervention was indicated, focusing on oropharyngeal dysphagia and orofacial myofunctional therapy. At 1 year and 11 months, no signs of swallowing alteration in the pharyngeal phase and improvement in the posture of the lips and tongue were found. At the age of 3, stimulation to remove oral habits and train masticatory function were initiated. Orthodontic treatment to correct anterior open bite and unilateral posterior crossbite started at age 6. At 7 years and 5 months, there was stability in the nasal breathing mode and adequacy of resting posture of lips and tongue. At the age of 9, due to relapse of the occlusal alterations, surgical reduction of the tongue was indicated, followed by orofacial myofunctional therapy, restarted at the age of 9 years and 3 months. The result was the correction of the posture of the tongue during swallowing and speech adequacy. The association of treatments involving Speech Therapy, Orthodontics and Oral and Maxillofacial Surgery was considered effective in the management of the macroglossia. It resulted in the adequacy and equilibrium of orofacial functions.
Subject(s)
Humans , Male , Child , Patient Care Team , Beckwith-Wiedemann Syndrome/diagnosis , Myofunctional Therapy/methods , Glossectomy , Macroglossia/therapy , Orthodontics , Speech, Language and Hearing Sciences摘要
OBJECTIVE@#To explore the genetic basis for a couple with recurrent conceptions of fetus with abnormal longbones, and another couple with a history of omphalocele.@*METHODS@#Genomic DNA was extracted from the peripheral blood samples from both couples. All exons and flanking regions were analyzed with next generation sequencing. Candidate variants were verified by Sanger sequencing.@*RESULTS@#Couple one was found to be heterozygous for, a c.997+1G>T splice-site variant and a missence c.871G>A(p.Glu291Lys) variant of the ALPL gene. Both variants were predicted to be pathogenic and may result in reduced function or loss of alkaline phosphatase. For couple two, the wife was found to harbor a novel c.637_652 delins CCC variant of the CDKN1C gene. This deletion-insertion variant resulted in frame-shift and loss of function (p.Ala213Profs*55) of the CDKN1C protein. Maternally inherited CDKN1C LOF variant has been found to underlie Beckwith-Wiedemann syndrome (BWS), which may manifest as omphalocele.@*CONCLUSION@#Dispite the lack the direct proof from the lost fetuses, the variants of ALPL and CDKN1C genes can explain the recurrence of fetal malformations for both couples.
Subject(s)
Humans , Beckwith-Wiedemann Syndrome , Fetus , MutationSubject(s)
Humans , Beckwith-Wiedemann Syndrome , Fragile X Syndrome , Glioma , Growth Disorders/genetics , Neurofibromatoses摘要
En pacientes con discapacidad, la ortodoncia tiene como objetivo mejorar la calidad de vida. Con una correcta oclusión dentaria, se favorece la higiene y se mejora la estética. El uso de placas alineadoras permite lograr los objetivos y evita las complicaciones existentes en la aparatología fija y las minuciosas técnicas de higiene que requiere.
Subject(s)
Humans , Female , Adult , Oral Hygiene , Orthodontic Appliances, Removable , Beckwith-Wiedemann Syndrome摘要
El síndrome de Beckwith-Wiedemann es caracterizado por presentar onfalocele, macroglosia, visceromegalias e hipoglucemia neonatal además de una gran diversidad de anomalías clínicas y de laboratorio. Esta enfermedad también se conoce como síndrome de onfalocele, macroglosia y gigantismo. Los problemas más significativos relacionados con la anestesia son hipoglicemia y macroglosia. Es imperativo realizar una evaluación preanestésica que incluya el sistema cardiovascular, sistema urinario, así como la vía aérea. Los niños con este síndrome pueden requerir diferentes procedimientos quirúrgicos. Se debe pronosticar un abordaje difícil de la vía respiratoria debido al crecimiento de la lengua que puede causar dificultad durante la ventilación y/o intubación endotraqueal. S debe monitorizar la glicemia perioperatoria para evitar secuelas neurológicas secundarias a hipoglicemia no diagnosticada. Se reporta el tratamiento perianestesiológico de un niño de cuatro años de edad con síndrome de Beckwith-Wiedemann que requirió tratamiento quirúrgico de un tumor de Wilms. Después de una evaluación minuciosa, se realizó intubación orotraqueal con un tubo 5.0 el cual se introdujo con facilidad bajo inducción con ketamina-vecuronio. La anestesia se mantuvo sin incidentes con isoflurano y fentanilo(AU)
Beckwith-Wiedemann syndrome is characterized by omphalocele, macroglossia, visceromegaly and neonatal hypoglycaemia, as well as a great diversity of clinical and laboratory abnormalities. This disease is also known as omphalocele, macroglossia and gigantism syndrome. The most significant problems related to anesthesia are hypoglycemia and macroglossia. It is imperative to perform a pre-anesthetic evaluation that includes the cardiovascular system, the urinary system, as well as the airway. Children with this syndrome may require different surgical procedures. A difficult approach to the airway should be predicted due to the growth of the tongue which can cause difficulty during ventilation and/or endotracheal intubation. Perioperative glycemia should be monitored in order to avoid neurological sequelae secondary to undiagnosed hypoglycemia. We report the perianesthesiological treatment of a four-year-old boy with Beckwith-Wiedemann syndrome who required surgical treatment for Wilms' tumor. After a thorough evaluation, orotracheal intubation was performed with a 5.0 tube, which was easily introduced with ketamine-vecuronium induction. Anesthesia was maintained without incident with isoflurane and fentanyl(AU)
Subject(s)
Humans , Male , Child, Preschool , Beckwith-Wiedemann Syndrome/diagnosis , Beckwith-Wiedemann Syndrome/epidemiology , Wilms Tumor/surgery , Intubation, Intratracheal/methods摘要
Patients with Beckwith-Wiedemann syndrome (BWS) are predisposed to developing embryonal tumors, with hepatoblastoma being the most common type. Our patient showed hemihypertrophy, macroglossia, and paternal uniparental disomy in chromosome 11 and was diagnosed with BWS. When the patient was 9 months old, a 2.5×1.5 cm oval hypoechoic exophytic mass was detected in the inferior tip of his right liver. Preoperative imaging identified it as hepatoblastoma; however, histologic, immunohistochemistry, and electron microscopic findings were compatible with adrenal cortical neoplasm with uncertain malignant potential. The origin of the adrenal tissue seemed to be heterotopic. Here, we describe for the first time an adrenal cortical neoplasm with uncertain malignant potential arising in the heterotopic adrenal cortex located in the liver of a patient with BWS.
Subject(s)
Humans , Adrenal Cortex , Adrenal Gland Neoplasms , Beckwith-Wiedemann Syndrome , Chromosomes, Human, Pair 11 , Hepatoblastoma , Immunohistochemistry , Liver , Macroglossia , Uniparental Disomy摘要
En personas con discapacidad se presentan las enfermedades prevalentes de la cavidad bucal con mayor frecuencia. Dentro de éstas, las alteraciones oclusales, como el apiñamiento dentario, son muy frecuentes y se considera responsable de exacerbar la patología gingival, periodontal y la estética, con impacto en la salud bucodental y la calidad de vida de estos pacientes. La técnica basada en el uso de placas alineadoras es sencilla, no invasiva y fundamentalmente preventiva de la enfermedad buco-dental (AU)
Subject(s)
Humans , Female , Adult , Orthodontics, Corrective , Quality of Life , Dental Care for Disabled , Malocclusion/therapy , Oral Hygiene , Arthrogryposis/therapy , Beckwith-Wiedemann Syndrome/therapy , Occlusal Splints , Williams Syndrome/therapy , Esthetics, Dental , Mouth Rehabilitation/methods摘要
El síndrome de Beckwith-Wiedemann es una enfermedad congénita, poco frecuente, caracterizada por presentar macroglosia, defectos de la pared abdominal, hemihipertrofia, onfalocele, hipoglucemia neonatal, hernia umbilical, hepatomegalia, anomalías cardíacas, entre otros. La macroglosia se presenta en el 90% de los casos y genera problemas en la masticación, deglución, fonación y respiración, que ocasionan un cierre de la vía aérea superior. La opción terapéutica de elección es la glosectomía parcial. Se presenta a un paciente pediátrico de dos meses de nacido, con síndrome de Beckwith-Wiedemann y obstrucción de la vía aérea por macroglosia grave. En los antecedentes médicos, se reportaron cardiopatías congénitas, comunicación interauricular, conducto arterioso persistente, epilepsia sintomática, falla renal, hipoglicemia, traqueotomía y gastrostomía por el colapso de la vía aérea y disfagia. Se realizó la técnica quirúrgica de glosectomía de reducción anterior, con resultados favorables.
Beckwith-Wiedemann syndrome is a rare congenital condition, characterized by presenting macroglossia, defects of the abdominal wall, hemihypertrophy, omphalocele, neonatal hypoglycemia, umbilical hernia, hepatomegaly, cardiac abnormalities, among others. Macroglossia occurs in 90% of cases, causing a problem in chewing, swallowing, phonation and breathing, resulting in a closure of the upper airway. The therapeutic option of choice is partial glossectomy. We present a 2-month-old pediatric patient with Beckwith-Wiedemann syndrome and area blockage due to severe macroglossia; in the medical history, congenital heart disease, interatrial communication, persistent ductus arteriosus, symptomatic epilepsy, renal failure, hypoglycemia, tracheotomy and gastrostomy, due to airway collapse and dysphagia. It was performed an anterior tongue reduction surgery as a surgical treatment with favorable results.
Subject(s)
Humans , Male , Infant , Beckwith-Wiedemann Syndrome/surgery , Glossectomy/methods , Macroglossia/congenital , Beckwith-Wiedemann Syndrome/diagnosis , Macroglossia/surgery , Macroglossia/diagnosis摘要
PURPOSE: Overgrowth syndromes are conditions that involve generalized or localized areas of excess growth. In this study, the clinical, molecular, and genetic characteristics of Korean patients with overgrowth syndrome were analyzed. MATERIALS AND METHODS: We recruited 13 patients who presented with overgrowth syndrome. All patients fulfilled inclusion criteria of overgrowth syndrome. Analysis of the clinical and molecular investigations of patients with overgrowth syndrome was performed retrospectively. RESULTS: Among the 13 patients with overgrowth syndrome, 9 patients (69.2%) were found to have molecular and genetic causes. Among the seven patients with Sotos syndrome (SS), two had a 5q35microdeletion that was confirmed by fluorescent in situ hybridization. In two patients with SS, intragenic mutations including a novel mutation, c.5993T>A (p.M1998L), were found by Sanger sequencing. One patient had one copy deletion of NDS1 gene which was confirmed by multiplex ligation-dependent probe amplification. Among five patients with Beckwith-Wiedemann syndrome, three had aberrant imprinting control regions; 2 hypermethylation of the differentially methylated region of H19, 1 hypomethylation of the differentially methylated region of Kv. In one patient displaying overlapping clinical features of SS, a de novo heterozygous deletion in the chromosomal region 7q22.1-22.3 was found by single nucleotide polymorphism-based microarray. CONCLUSION: Considering high detection rate of molecular and genetic abnormalities in this study, rigorous investigations of overgrowth syndrome may be an important tool for the early diagnosis and genetic counseling. A detailed molecular analysis of the rearranged regions may supply the clues for the identification of genes involved in growth regulation.
Subject(s)
Humans , Beckwith-Wiedemann Syndrome , Early Diagnosis , Genetic Counseling , In Situ Hybridization, Fluorescence , Multiplex Polymerase Chain Reaction , Retrospective Studies , Sotos Syndrome摘要
Os erros no padrão de imprinting são caracterizados como alterações epigenéticas por não afetarem a sequência nucleotídica do DNA mas modificarem a expressão gênica. Diversos aspectos do desenvolvimento embrionário, incluindo ocorrência de malformações congênitas e síndromes diversas, como a síndrome de Beckwith-Wiedemann (SBW; OMIM#130650) ocorrem em decorrência de eventos epigenéticos. A etiologia molecular de SBW é descrita com base em alterações epigenéticas na região cromossômica 11p15.5, que possui genes cuja expressão é regulada por dois centros de imprinting (IC) ou regiões diferencialmente metiladas (DMR). O IC1, que controla a expressão dos genes IGF2 e H19 apresenta metilação no alelo paterno e ausência de metilação no alelo materno; o IC2 encontra-se metilado normalmente no alelo materno, participando no controle da expressão dos genes CDKN1C, KCNQ1 e KNCQ1OT1. A etiologia de SBW também está associada a mutações pontuais em genes como CDKN1C, que codifica um inibidor de kinase dependente de ciclina da fase G1 do ciclo celular. O objetivo deste trabalho é investigar alterações genéticas e epigenéticas em amostras de DNA de 21 pacientes com SBW oriundos do Ambulatórido de Genética Médica do Instituto Nacional Fernandes Figueira IFF/FIOCRUZ. A abordagem metodológica consistiu na análise do perfil de metilação dos dois centros de imprinting de 11p15.5 com uso da ténica de MS-MLPA; análise de microssatélites dessa região, visando discriminar alterações epigenéticas em ambos os centros de imprinting de possíveis dissomias uniparentais (UPD); e a amplificação do gene CDKN1C, para sequenciamento de Sanger. Dos 21 pacientes analisados inicialmente por MS-MLPA, sete não apresentaram nenhuma alteração epigenética. Após reavaliação clínica foi confirmado o diagnóstico de SBW em três desses sete pacientes enquanto que os outros quatro pacientes apresentaram características clínicas isoladas associadas à SBW, sendo excluídos da amostra. Nos 14 pacientes restantes a análise de MS-MLPA identificou 10 casos de perda isolada de metilação no IC2, três casos de deleção em IC2 e um caso de ganho de metilação em IC1 com perda em IC2 (UPDp). Este trabalho confirmou estudos anteriores sobre a ocorrência de alterações epignéticas nesta síndrome; em consequência, permitindo uma orientação clínica e antecipação do monitoramento de pacientes quanto ao risco de tumores pediátricos.
Errors in imprinting pattern are characterized as epigenetic alterations, not affecting the nucleotide sequencing on DNA but affecting the gene expression. Several aspects of embrionary development, including occurrence of abnormalities and congenital disorders, as Beckwith-Wiedemann syndrome (BWS; OMIM#130650) occur due epignetics events. The molecular etiology of SBW is described based on epigenetic alterations in 11p15.5 chromossomic region, wich includes genes that have the expression regulated by two imprinting centers (IC) or differentialy methylated region (DMR). The IC1 regulates the gene expression of IGF2 and H19 genes. This IC shows a high methylation level only in the paternal allele. The IC2, normally methylated on the maternal allele, controls de gene expression of CDKN1C, KCNQ1 e KNCQ1OT1 genes. Besides this alterations, SBW's etiology is also associated with pontual mutations in CDKN1C gene, which encondes a cyclin dependent kinase inhibitor, acting on G1 celular cycle phase. The purpose of this study is to investigate genetics and epigenetics alterations in DNA samples of 21 patients with BWS from Instituto Nacional Fernandes Figueira IFF/FIOCRUZ. The methodological approach was based on the methylation profile's analysis of the two 11p15.5 imprinting centers using the MS-MLPA technique; microsatellite analysis of this region, aiming to distinguish epigenetic alterations on both imprinting centers from possible uniparental disomy (UPD); and CDKN1C gene Sanger sequencing. Seven of 21 patients analysed by MS-MLPA did not shown any epigenetic alteration. After a clinical revaluation the SBW diagnosys was confirmed to three of this sevens patients while the reamining four only shown isolated clinial features associated with BWS. On 14 patients MS-MLPA analysis identified 10 cases of isolated loss of methylation on IC2, three cases of IC2 deletions and one case with both gain of methylation on IC1 and loss of methylation on IC2 (UDPp). This study confirmed previous researches about the epigenetic alteration occurence ih BWS; in consequence, allowing a clinical monitoring to this patients due the risk of pediatric tumors.
Subject(s)
Humans , Beckwith-Wiedemann Syndrome/diagnosis , Beckwith-Wiedemann Syndrome/genetics , Gene Expression , Epigenesis, Genetic , Cyclin-Dependent Kinase Inhibitor p57 , Epigenomics , Brazil摘要
<p><b>OBJECTIVE</b>To explore the genetic cause for two children with omphalocele.</p><p><b>METHODS</b>The patients were examined, and the medical history of their families was collected. Methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) was performed to detect potential mutation in the patients.</p><p><b>RESULTS</b>Loss of methylation of imprinting center 2 (IC2) at the 11p15.5 region of the maternal chromosome was detected in both children.</p><p><b>CONCLUSION</b>The two patients were diagnosed with Beckwith-Wiedemann syndrome by MS-MLPA. The loss of methylation of IC2 probably underlies the disease in both patients.</p>
Subject(s)
Female , Humans , Infant , Infant, Newborn , Male , Beckwith-Wiedemann Syndrome , Genetics , Chromosomes, Human, Pair 11 , DNA Methylation , Genomic Imprinting , Multiplex Polymerase Chain Reaction摘要
Airway obstruction in pediatric patients always poses a challenge for anesthesiologists. Beckwith-Wiedemann syndrome causes various abnormalities such as macroglossia and omphalocele. Patients with these abnormalities often need corrective surgeries. Management of difficult airway caused by conditions such as macroglossia in patients with this syndrome could be challenging. We encountered a case of difficult airway in an infant with Beckwith-Wiedemann syndrome. It was predicted that macroglossia might cause difficult ventilation, intubation, and extubation. Preoperative assessment and preparations for difficult airway should be considered.
Subject(s)
Humans , Infant , Airway Management , Airway Obstruction , Anesthesia, General , Beckwith-Wiedemann Syndrome , Hernia, Umbilical , Intubation , Macroglossia , Ventilation摘要
A alta prevalência de tumores da glândula adrenal deve-se, em parte, ao avanço dos métodos de imagem. Os adenomas, carcinomas e hiperplasias oriundos do córtex adrenal são responsáveis por 80 a 90% dos processos tumorais. Alguns casos são herdados e podem estar associados a efeito compressivo de massa tumoral, hipersecreção de esteroides ou manifestações clínicas em outros órgãos. Considerando as hiperplasias e tumores adrenocorticais, o objetivo desse trabalho foi auxiliar os médicos na identificação de pacientes que apresentem risco para doença hereditária. As neoplasias e hiperplasias adrenocorticais podem ser encontradas em síndromes hereditárias, como a síndrome de Li-Fraumeni, síndrome de Beckwith-Wiedemann, neoplasia endócrina múltipla do tipo I, síndrome de Gardner e no complexo de Carney. A hereditariedade também está associada com doenças adrenocorticais na hiperplasia adrenal congênita, no aldosteronismo primário e/ou na síndrome de Cushing (doença clínica ou subclínica) na hiperplasia adrenal macronodular primária. Essa revisão descreve as características clínicas e os defeitos genéticos responsáveis pelas síndromes hereditárias. Relacionamos também a classificação histopatológica dos processos expansivos com os principais sinais clínicos e os genes relacionados. A identificação de defeitos genéticos em células germinativas nessas doenças familiais permite o conhecimento de alterações somáticas em alguns tipos de processos tumorais adrenocorticais de etiologia esporádica. Considerando a prevalência dos tumores do córtex adrenal, a identificação de predisposição hereditária é essencial para assegurar a conduta clínica correta do paciente e o aconselhamento genético de seus familiares.
The adrenal gland tumors are prevalent due in part by the widespread use of imaging studies. Adenomas, carcinomas and hyperplasias, originating from the adrenal cortex, account for 80-90% of adrenal tumoral processes. Some cases are inherited and may be associated with local mass effect, steroid hypersecretion and/or clinical manifestation in other organs. In the context of adrenocortical tumors and hyperplasias, the purpose of this article is to assist physicians in identifying patients who may be at risk of hereditary diseases. Adrenocortical hyperplasias and neoplasias can be found in familial tumor syndromes, such as Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome, multiple endocrine neoplasia type 1, Gardner syndrome and Carney complex. Heredity has been also associated with adrenocortical lesions in congenital adrenal hyperplasia, primary aldosteronism and/or Cushing syndrome (overt or subclinical disease) in primary macronodular adrenal hyperplasia (PMAH). This review describes the clinical recognition and genetic defects that have been found to be responsible for these hereditary diseases. Furthermore, we present the histopathologic classification of adrenocortical expansive processes in correlation to the main clinical features and related genes. The identification of germline genetic defects in such familial diseases lead to the identification of somatic alterations in a subgroup of sporadic adrenocortical lesions. Considering the prevalence of adrenocortical tumors, identification of a hereditary predisposition is essential to assure the adequate clinical management of the patient and to offer the genetic counselling to family members.
Subject(s)
Neoplastic Syndromes, Hereditary , Adrenal Cortex Neoplasms , Adrenocortical Adenoma , Adrenocorticotropic Hormone , Genetic Counseling , Beckwith-Wiedemann Syndrome , Gardner Syndrome , Li-Fraumeni Syndrome , Multiple Endocrine Neoplasia Type 1 , Genetic Diseases, Inborn/diagnosis摘要
Overgrowth syndromes comprise a diverse group of conditions with unique clinical, behavioral and molecular genetic features. While considerable overlap in presentation sometimes exists, advances in identification of the precise etiology of specific overgrowth disorders continue to improve clinicians' ability to make an accurate diagnosis. Among them, this paper introduces two classic genetic overgrowth syndromes: Sotos syndrome and Beckwith-Wiedemann syndrome. Historically, the diagnosis was based entirely on clinical findings. However, it is now understood that Sotos syndrome is caused by a variety of molecular genetic alterations resulting in haploinsufficiency of the NSD1 gene at chromosome 5q35 and that Beckwith-Wiedemann syndrome is caused by heterogeneous abnormalities in the imprinting of a number of growth regulatory genes within chromosome 11p15 in the majority of cases. Interestingly, the 11p15 imprinting region is also associated with Russell-Silver syndrome which is a typical growth retardation syndrome. Opposite epigenetic alterations in 11p15 result in opposite clinical features shown in Beckwith-Wiedemann syndrome and Russell-Silver syndrome. Although the exact functions of the causing genes have not yet been completely understood, these overgrowth syndromes can be good models to clarify the complex basis of human growth and help to develop better-directed therapies in the future.
Subject(s)
Humans , Beckwith-Wiedemann Syndrome , Epigenomics , Genes, Regulator , Genomic Imprinting , Haploinsufficiency , Molecular Biology , Silver-Russell Syndrome , Sotos Syndrome摘要
Beckwith-Wiedemann Syndrome (BWS) is a rare congenital overgrowth disorder due to alterations in specific genes in chromosome 11p15. It has a variable clinical picture. Infants may exhibit a combination of the following characteristics: macroglossia, macrosomia, abdominal wall defects, ear creases or posterior helical pits, hypoglycemia, polyhydramnios and prematurity. Presented is a case of a 24-year-old gravida 3 para 2 (2002) who manifested with preterm labor and polyhydramnios. She delivered a preterm live baby girl who was diagnosed to have Beckwith-Wiedemann syndrome. The rarity of this condition, as well as the significant maternal and perinatal complications associated with it, is discussed in this paper.
Subject(s)
Humans , Female , Adult , Pregnancy , Macroglossia , Beckwith-Wiedemann Syndrome , Polyhydramnios , Abdominal Wall , Fetal Macrosomia , Hypertrophy , Chromosomes , Hypoglycemia摘要
El síndrome de Beckwith-Wiedemann (SBW) es un desorden esporádico o heredado, infrecuente, que se caracteriza por peso elevado al nacimiento, macroglosia, defectos de la pared abdominal y menos frecuentemente hipoglucemia, hemihipertrofia y visceromegalia. Se presenta un paciente de sexo femenino de un mes de vida con antecedentes de nefromegalia evidenciada por ecografía prenatal con múltiples hemangiomas en tronco y labio superior. Al examen físico se evidenció notable macroglosia, hemihipertrofia con compromiso de genitales externos, onfalocele y percentilo de peso mayor a 90. El laboratorio demostró alfa fetoproteína de 608ng/ml. Se realizó diagnóstico de síndrome de Beckwith Wiedemann. El paciente evolucionó con aumento del número y tamaño de las lesiones hemangiomatosas, descenso de los niveles de alfa fetoproteína y su maduración psicomotriz fue adecuada a su edad. Presentamos un síndrome infrecuente en un paciente con hemangiomatosis neonatal benigna (HNB), asociación no descripta previamente en la literatura. Destacamos la importancia del examen físico en la consulta dermatológica como oportunidad diagnóstica.
Beckwith-Wiedemanns syndrome is a sporadic or hereditary rare disor-der characterized by macroglosia, omphalocele, visceromegalia, hypo-glycemia and hemihypertrophy.We report the case of a 1 month-old infant with a history of nephromegalia detected by prenatal ultrasound scan, who presented various generalized hemangiomas.On examination she had macroglosia, hemihypertrophy, omphalocele and high body weight. She also had alpha feto protein 608 ng/ml withno further abnormalities, leading us to diagnose Beckwith-Wiedemann ́s syndrome.The interest of this case is to report an infrecuent syndrome in a patient with diagnosis of neonatal hemangiomatosis. This association has not been previously reported in the literature. We wish to emphasize the importance of a thorough physical exam as part of the dermatologic consultation leading to the correct diagnosis.
Subject(s)
Humans , Female , Infant , Beckwith-Wiedemann Syndrome/diagnosis , Beckwith-Wiedemann Syndrome/genetics , Urogenital Abnormalities/genetics , Skin Diseases/pathology , Hyperplasia , Hemangioma/genetics , Macroglossia , Practice Guidelines as Topic , alpha-Fetoproteins/analysis摘要
PURPOSE: Beckwith-Wiedemann syndrome (BWS) is an overgrowth malformation syndrome caused by a methylation abnormality at chromosome 11p15, consisting of two imprinting centers, BWSIC1 (IGF2, H19) and BWSIC2 (LIT1, KvDMR). This study evaluated the applicability of a methylation-specific (MS) PCR RFLP method for the genetic diagnosis of BWS. MATERIALS AND METHODS: A total of 12 patients were recruited based on clinical findings. Karyotyping was performed using peripheral blood leukocytes, and genomic DNA was treated with bisulfate and amplified using methylation-specific primers. RFLP was conducted with restriction enzymes in differentially methylated regions of LIT1, H19, and IGF2. RESULTS: The 12 BWS patients had normal karyotypes. Abnormal methylation patterns in the BWSIC2 (LIT1) region were identified in seven patients (58.3%) using the MS-PCR RFLP method. CONCLUSIONS: The MS-PCR RFLP method is a simple, economical genetic test. It detected genetic abnormalities in 50-60% of BWS patients, suggesting that it can be used as a screening test. A more precise method is required, however, to enhance the detection rate of genetic abnormalities, especially in BWSIC1 region.
Subject(s)
Humans , Beckwith-Wiedemann Syndrome , DNA , Genetic Testing , Karyotype , Karyotyping , Leukocytes , Mass Screening , Methylation , Polymerase Chain Reaction , Polymorphism, Restriction Fragment Length摘要
Placental mesenchymal dysplasia (PMD) is a rare placental disorder that may coexist with a normal fetus but is frequently associated with fetal growth restriction, fetal demise, prematurity, and Beckwith-Wiedemann syndrome, as well as with various fetal anatomical and vascular anomalies. In this case, ultrasonography performed at 14 weeks of gestation revealed multiple, variable sized cysts in the placenta along with a morphologically normal fetus. Serial sonographic examinations found that the fetus became small for gestational age and had a dysplastic right kidney. After delivery at 33 weeks of gestation, histopathologic examination of the placenta showed enlarged, hydropic stem villi with cavity formation and absence of trophoblastic proliferation and pseudoinclusions, all of which were consistent with PMD. Neonatal abdominal ultrasonography showed multiple cysts in the right kidney consistent with a multicystic dysplastic condition. This appears to be the first case of PMD associated with fetal multicystic dysplastic kidney.
Subject(s)
Pregnancy , Beckwith-Wiedemann Syndrome , Fetal Development , Fetus , Gestational Age , Kidney , Multicystic Dysplastic Kidney , Placenta , Trophoblasts摘要
Children with overgrowth syndromes including isolated hemihyperplasia have an increased risk for developing embryonal tumors, particularly Wilms' tumor and hepatoblastoma. Screening with sonography has been suggested as a method of identifying these tumors while they are still at an early stage. We describe an infant diagnosed with Wilms tumor in whom isolated hemihyperplasia had been overlooked by several physicians prior to the tumor diagnosis. We recommend tumor surveillance for all patients with Beckwith-Wiedemann syndrome and isolated hemihyperplasia at least for the first six years of life since full molecular characterization of every patient is not readily available
Subject(s)
Humans , Female , Infant , Risk Assessment , Early Detection of Cancer , Beckwith-Wiedemann Syndrome , Hyperplasia , Syndrome摘要
Beckwith-Wiedemann syndrome consists of various abnormalities, including macroglossia, visceromegaly, omphalocele, and neonatal hypoglycemia. These abnormalities frequently require operative correction and careful anesthetic management. Principal problems associated with anesthetic management in this syndrome are congenital heart disease, hypoglycemia, and difficult airway combined with macroglossia. We report two cases of general anesthetic management in children with Beckwith-Wiedemann syndrome.