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Cowden syndrome and the PTEN hamartoma tumor syndrome: systematic review and revised diagnostic criteria.
[cowden syndrome]
PTEN
hamartoma
tumor
syndrome
(
PHTS
)
refers
to
a
spectrum
of
disorders
caused
by
mutations
in
the
phosphatase
and
tensin
homolog
(
PTEN
)
gene
.
Diagnostic
criteria
for
Cowden
syndrome
,
the
principal
PTEN
-related
disorder
,
were
first
established
in
1996
before
the
identification
of
the
PTEN
gene
and
the
ability
to
molecularly
confirm
a
clinical
diagnosis
.
These
consortium
criteria
were
based
on
clinical
experience
and
case
reports
in
the
existing
literature
,
with
their
inherent
selection
biases
.
Although
it
was
initially
reported
that
approximately
80
%
of
patients
with
Cowden
syndrome
had
an
identifiable
germline
PTEN
mutation
,
more
recent
work
has
shown
these
diagnostic
criteria
to
be
far
less
specific
.
In
addition
,
increasing
evidence
has
documented
the
association
of
a
broader
spectrum
of
clinical
features
with
PTEN
mutations
.
Our
goal
was
to
develop
revised
,
evidence-based
diagnostic
criteria
and
to
include
features
of
the
broader
spectrum
of
PTEN
-related
clinical
syndromes
.
We
performed
a
systematic
search
and
review
of
the
medical
literature
related
to
clinical
features
reported
in
individuals
with
a
PTEN
mutation
and
/
or
a
related
clinical
diagnosis
.
We
found
no
sufficient
evidence
to
support
inclusion
of
benign
breast
disease
,
uterine
fibroids
,
or
genitourinary
malformations
as
diagnostic
criteria
.
There
was
evidence
to
include
autism
spectrum
disorders
,
colon
cancer
,
esophageal
glycogenic
acanthosis
,
penile
macules
,
renal
cell
carcinoma
,
testicular
lipomatosis
,
and
vascular
anomalies
.
We
propose
revised
,
evidence-based
criteria
covering
the
spectrum
of
PTEN
-related
clinical
disorders
.
Additional
research
on
clinical
features
associated
with
PTEN
mutations
is
warranted
.
Diseases
Validation
Diseases presenting
"vascular anomalies"
symptom
coats disease
cowden syndrome
oculocutaneous albinism
primary hyperoxaluria type 1
proteus syndrome
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