Mutational and Radiographic Analysis of Pulmonary Disease Consistent with Lymphangioleiomyomatosis and Micronodular Pneumocyte Hyperplasia in Women with Tuberous Sclerosis
| Autor: | Francis X. McCormack, David Neal Franz, Gail Chuck, Alan S. Brody, Jennifer Leonard, Gopalan Sethuraman, Sandra L. Dabora, Cristopher A. Meyer, David J. Kwiatkowski, Thomas V. Colby |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Adult
Pulmonary and Respiratory Medicine Pathology medicine.medical_specialty Lung Neoplasms Angiomyolipoma Adolescent Genotype DNA Mutational Analysis Critical Care and Intensive Care Medicine Pulmonary function testing Tuberous sclerosis Tuberous Sclerosis hemic and lymphatic diseases Prevalence medicine Humans Cyst Prospective Studies Solitary pulmonary nodule Hyperplasia business.industry Respiratory disease Solitary Pulmonary Nodule Middle Aged medicine.disease Pedigree Respiratory Function Tests Pulmonary Alveoli Spirometry Multifocal micronodular pneumocyte hyperplasia Lymphangioleiomyomatosis Female Kidney Diseases Tomography X-Ray Computed business Lymphangiomyoma |
| Zdroj: | Scopus-Elsevier |
| ISSN: | 1535-4970 1073-449X |
| DOI: | 10.1164/ajrccm.164.4.2011025 |
| Popis: | Lymphangioleiomyomatosis (LAM) and multifocal micronodular pneumocyte hyperplasia (MMPH) produce cystic and nodular disease, respectively, in the lungs of patients with tuberous sclerosis. The objective of this study was to prospectively characterize the prevalence, clinical presentation, and genetic basis of lung disease in TSC. We performed genotyping and computerized tomographic (CT) scanning of the chest on 23 asymptomatic women with tuberous sclerosis complex (TSC). Cystic pulmonary parenchymal changes consistent with LAM were found in nine patients (39%). These patients tended to be older than cyst-negative patients (31.9 +/- 7.6 yr versus 24.8 +/- 11.6 yr, p = 0.09). There was no correlation between presence of cysts and tobacco use, age at menarche, history of pregnancy, or estrogen-containing medications. Three of the cyst-positive patients had a prior history of pneumothorax. Pulmonary function studies revealed evidence of gas trapping but normal spirometric indices in the cyst-positive group. All nine cyst-positive patients had angiomyolipomas (AML), which were larger (p < 0.05) and more frequently required intervention (p = 0.08) than cyst-negative patients (8 of 14 with AMLs, p < 0.05). Ten patients (43%) had pulmonary parenchymal nodules. Pulmonary nodules were more common in women with cysts (78% versus 21%, p < 0.05), and 52% of all patients had either cystic or nodular changes. TSC2 mutations were identified in all cyst-positive patients who were tested (n = 8), whereas both TSC1 and TSC2 mutations were found in patients with nodular disease. Correlation of the mutational and radiographic data revealed one pair of sisters who were discordant for cystic disease, two mother- daughter pairs who were discordant for nodular disease, and no clear association between cyst development and a specific mutational type. This prospective analysis demonstrates that cystic and nodular pulmonary changes consistent with LAM and MMPH are common in women with TSC. |
| Databáze: | OpenAIRE |
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