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Differential expression of PTEN gene correlates with phenotypic heterogeneity in three cases of patients showing clinical manifestations of PTEN hamartoma tumour syndrome.
[proteus syndrome]
Cowden
syndrome
(
CS
)
,
Bannayan-
Riley
-
Ruvalcaba
syndrome
(
BRRS
)
and
proteus
syndrome
are
disorders
known
as
PTEN
hamartoma
tumour
syndrome
(
PHTS
)
,
that
can
show
remarkable
clinical
overlap
and
are
all
caused
by
germline
PTEN
mutations
.
We
here
present
two
families
,
one
affected
by
CS
and
the
other
affected
by
BRRS
,
both
carriers
of
specific
pathogenetic
missense
mutation
in
exon
5
of
PTEN
gene
,
within
the
catalitic
domain
.
Both
PHTS
families
exhibited
extremely
variable
phenotypes
,
showing
inter-
and
intra-
familial
variability
.
One
of
the
two
characterised
mutations
,
the
c
.
320
A-
 
>
 
T
;
p
.
107
Asp-
 
>
 
Val
,
identified
in
the
CS
family
,
was
not
previously
described
in
the
literature
.
Furthermore
,
the
BRRS
family
,
carrier
of
the
c
.
406
Â
T
-
 
>
 
C
;
p
.
136
Cys-
 
>
 
Arg
mutation
,
shows
a
substantial
alteration
of
PTEN
protein
expression
that
well
correlates
with
intra-familial
phenotypic
variability
.
Finally
,
we
describe
an
apparently
sporadic
case
of
an
80
-
year
-old
man
,
with
a
very
low
level
of
PTEN
mRNA
and
protein
expression
,
both
in
healthy
and
tumour
colon
mucosa
,
associated
with
a
very
atypical
phenotype
.
He
developed
a
metastatic
colorectal
carcinoma
,
macrocephaly
and
pheochromocytoma
.
According
to
literature
data
,
our
observations
confirm
that
PTEN
mutations
of
catalytic
domain
can
cause
different
syndromes
.
We
suggest
that
PTEN
expression
could
represent
one
of
the
mechanisms
involved
in
the
remarkable
heterogeneity
of
the
clinical
PHTS
manifestations
within
affected
families
.
Furthermore
,
constitutive
strong
decrease
of
PTEN
expression
in
colon
normal
mucosa
could
be
associated
with
late
onset
of
colorectal
cancer
.
Diseases
Validation
Diseases presenting
"hamartoma"
symptom
coats disease
cowden syndrome
focal myositis
liposarcoma
monosomy 21
pendred syndrome
proteus syndrome
werner syndrome
This symptom has already been validated