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Query: UMLS:C0033377 (
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Germline mutations in the gene
CBL
(Casitas B-lineage lymphoma), involved in the RAS-MAPK signaling pathway, have been found as a rare cause of the neuro-cardio-facial-cutaneous syndromes. Somatically acquired homozygous
CBL
mutations were initially identified in association with myeloproliferative disorders, particularly juvenile myelomonocytic leukemia (JMML). We describe a girl with a Noonan-like phenotype of bilateral
ptosis
, lymphedema of the lower limbs and moderate intellectual disability, due to a de novo heterozygous mutation in
CBL
. She developed an ovarian mixed germ cell/teratoma with later occurrence of mature liver, omental, and ovarian teratomas. Copy neutral loss of heterozygosity for the
CBL
mutation due to acquired segmental uniparental disomy of 11q23 was observed in three teratomas, suggesting a specific association of
CBL
mutations in germ cell tumor predisposition.
...
PMID:Germline CBL mutation associated with a noonan-like syndrome with primary lymphedema and teratoma associated with acquired uniparental isodisomy of chromosome 11q23. 2445 50
Cardiofaciocutaneous (CFC) syndrome is one of the developmental disorders caused by a dysregulation of the Ras/mitogen-activated protein kinase (MAPK) pathway. RASopathies share overlapping clinical features, making the diagnosis challenging, especially in the newborn period. The majority of CFC syndrome cases arise by a mutation in the
BRAF, MAP2K1, MAP2K2
, or (rarely)
KRAS
genes. Germline
KRAS
mutations are identified in a minority of CFC and Noonan syndrome cases. Here, we describe a patient with a
KRAS
mutation presenting with a CFC syndrome phenotype. The female patient was referred for genetic testing because of congenital exophthalmos. Her facial appearance is distinctive with a coarse face, exophthalmos,
ptosis
, downslanting palpebral fissures, hypertelorism, deep philtrum, downturned corners of the mouth, and a short neck. She suffered from feeding difficulties, poor weight gain, and developmental delay. The sequencing of the genes involved in the MAPK pathway (
PTPN11, SOS1, RAF1, KRAS, NRAS, MAP2K1, SHOC2,
CBL
, and SPRED1
) identified a heterozygous de novo NM_004985.4:c.173C>T (p.Thr58Ile) in the
KRAS
gene. Germline
KRAS
mutations have been identified in approximately 2% of the reported NS cases and less than 5% of the reported CFC syndrome cases. Because CFC and Noonan syndrome share clinical overlapping features, the phenotype caused by
KRAS
mutations is often difficult to assign to one of the 2 entities. The mutation that we detected in our patient was previously reported in a patient with an Noonan syndrome phenotype. However, our patient predominantly exhibits CFC clinical features. In our case, coarse facial appearance and severe developmental delay help discriminate CFC from Noonan syndrome. Thus, patient follow-up, especially for delayed motor milestones suspected from RASopathies, is important for the discrimination of overlapping conditions as in the abovementioned syndromes.
...
PMID:Cardiofaciocutaneous Syndrome Phenotype in a Case with de novo
KRAS
Pathogenic Variant. 3202 10