Our Dermatol Online. 2012; 3(1): 28
Date of submission: 12.12.2011 / acceptance: 15.12.2011
Conflicts of interest: None
FACIAL PLEXIFORM NEUROFIBROMATOSIS IN A PATIENT WITH NEUROFIBROMATOSIS TYPE1: A CASE REPORT
by
Iffat Hassan, Abid Keen, Parvaiz Ahmad Shah
COMMENT:
Dr. Daisuke Tsuruta PhD, Dr. Takashi Hashimoto – Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Japan
E-mail: hashimot@med.kurume-u.ac.jp
How to cite an article: Tsuruta D, Hashimoto T. Comment: Facial Plexiform neurofibromatosis in a patient with neurofibromatosis type1: a case report. Our Dermatol Online 2012; 3(1): 28.
The two major types of neurofibromatosis are neurofibromatosis type 1 (NF-1) and neurofibromatosis type 2 (NF-2) [1,2]. NF-1 is characterized clinically by multiple café-au-lait spots associated with discrete neurofibromas along peripheral nerves, while NF-2 is characterized clinically by acoustic neuromas associated with various tumors of the nervous systems, particularly meningiomas [1,2]. NF-1 is a synonym for von Recklinghausen’s disease, named after its first publication by von Recklinghausen in 1882 [3]. The diagnosis of NF-1 is made according to the list already mentioned in the text of Hassan et al [4]. Major findings found in NF-1 other than Café-au-lait spots and discrete neurofibromas are intertriginous freckling, optic pathway tumors, Lisch nodules, plexiform neurofibromas, oral lesions, osseous lesions, skeletal abnormalities, vasculopathy, endocrine disturbances, urinary symptoms, neurological manifestations, sarcomatous changes of neurofibromas and other malignant diseases [2,5]. Among these, Café-au-lait spots and freckling should be the earliest manifestations of NF-1 [2,5]. However, clinicians often have difficulty in diagnosing NF-1 when patients show minimum numbers of Café-au-lait spots or freckling in childhood cases. In such cases in the early diagnosis of NF-1, a knowledge of plexiform neurofibromas may be extremely helpful, as the association of plexiform neurofibromas in NF-1 is less common than that of discrete, classic neurofibromas and as it is noticeable by the age of 2 years [2,4,5]. Plexiform neurofibroma is histologically similar to discrete neurofibroma, and is a diffuse elongated fibromatous tumor involving the trigeminal or upper cervical nerves [5,6]. As plexiform neurofibromas occur at an early age with cosmetically disfiguring miserable features, it affects the patient both physically and mentally [4]. Therefore, elucidation of the pathogenesis and the development of a treatment for plexiform neurofibromas are highly essential. Surgical resection of plexiform neurofibroma should be the first choice, but offers no favorable results in patients with huge extensive lesions like Hassan’s case [4]. Currently, chemotherapeutic options for the management of plexiform neurofibromas are is under way, including retinoic acid, angiogenesis inhibitors such as pegylated interferon α-2b and thalidomide, farnesyl protein transferase inhibitors or cytokine modulators, as mentioned in Hassan’s report [4]. In addition, pirfenidone, an antifibrotic agent that decreases proliferation of fibroblasts and collagen matrix synthesis, and conventional chemotherapy including a combination of methotrexate and vinblastine were also applied to this horrible disease of NF-1 [5]. Hassan et al. had reported a typical, but extremely huge lesion of plexiform neurofibromas with best quality figures.
REFERENCES
1. Riccardi VM: Neurofibromatosis: clinical heterogeneity. Curr Probl Cancer 1982; 7: 1-3. 2. Irvine AD, Mellerio JE: Genetics and Genoermatoses. Burns T, Breathnach S, Cox N, Griffiths C (eds). In Rook’s Textbook of Dermatology. 8th edition. Chapter 15, pp. 15.15, 2010, Wiley-Blackwell, West Sussex, UK. 3. Von Recklinghausen FD: Ueber die multiplen Fibrome der Haut and ihre Beziehung zu den multiplen Neuromen. Berlin: Hirschwald; 1882. 4. Hassan I, Keen A, Shah PA: Facal plexiform neurofibromatosis in a patient with neurofibromatosis type 1: a case report. Our Dermatol Online 2012; 5: 1-4. 5. Listernick R, Charrow J: The neurofibromatosis. Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ (eds). In Fitzpatrick’s Dermatology in General Medicine. 7th edition. Chapter 142, pp. 1331-1338, 2008, McGraw Hill, New York. 6. Khachemoune A, Al Aboud K, Al Hawsawi K: Diffuse plexiform neurofibroma in a 13-year old girl. Dermatol Online J 2003; 9: 23.
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