Frequent association between MEN 2A and cutaneous lichen amyloidosis

Uberta Verga, Laura Fugazzola, Stefano Cambiaghi, Chiara Pritelli, Elvio Alessi, Donatella Cortelazzi, Emanuela Gangi, Paolo Beck-Peccoz

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Abstract

OBJECTIVE: Multiple endocrine neoplasia type 2A (MEN 2A) and familial medullary thyroid carcinoma (FMTC) are genetic diseases due to activating mutations of the RET proto-oncogene. Affected patients develop medullary thyroid carcinoma (100%), in an isolated form (FMTC) or in association with phaeochromocytoma (30-50%), and primary hyperparathyroidism (10-20%) (MEN 2A). The presence of cutaneous lichen amyloidosis (CLA) has been anecdotally described in few families harbouring RET proto-oncogene mutation in codon 634. The aim of the study was to evaluate the incidence of CLA in MEN 2A/FMTC families. PATIENTS AND DESIGN: Ten MEN 2A/FMTC families were studied and RET gene mutations identified in all. Complete dermatological assessment was carried out in each family member. Skin biopsy for histological studies was performed in patients with CLA. RESULTS: Among 10 MEN 2A/FMTC families, the presence of CLA was found only in patients belonging to the three families with MEN 2A and RET mutation in codon 634. Nine of 25 patients (36%) with codon 634 mutation presented CLA, though two of them did not show CLA skin lesions but the typical neurological pruritus in the upper back. In all patients, neurological pruritus was present since infancy as a precocious marker of the disorder. The dermatological study of patients with CLA skin lesions added further evidence that pruritus has a pivotal role in the development of CLA, the amyloid deposition being the consequence of repeated scratching. Light microscopy revealed orthokeratotic hyperkeratosis, with elongation of the rete ridges, rare intramalpighian apoptic keratinocytes and deposits of amorphous material in the superficial dermis. Examination under ultraviolet light showed thioflavin T-positive staining, confirming the presence of amyloid in the papillary dermis. The use of Capsaicin at the dilution of 0-025% had a mild efficacy on the cutaneous symptoms. CONCLUSIONS: Among the members of the three families with MEN 2A and RET 634 mutation, the incidence of CLA was 36%, a figure similar to that reported in the literature for phaeochromocytoma (30-50%) and even higher than that for hyperparathyroidism (10-20%). The present data confirm that CLA is linked to codon 634 RET mutations and is a precocious marker of the disorder.

Original languageEnglish
Pages (from-to)156-161
Number of pages6
JournalClinical Endocrinology
Volume59
Issue number2
DOIs
Publication statusPublished - Aug 1 2003

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Multiple Endocrine Neoplasia Type 2a
Lichens
Amyloidosis
Skin
Mutation
Codon
Pruritus
Proto-Oncogenes
Pheochromocytoma
Dermis
Amyloid
Inborn Genetic Diseases
Primary Hyperparathyroidism
Hyperparathyroidism
Capsaicin
Incidence
Ultraviolet Rays
Keratinocytes

ASJC Scopus subject areas

  • Endocrinology

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Frequent association between MEN 2A and cutaneous lichen amyloidosis. / Verga, Uberta; Fugazzola, Laura; Cambiaghi, Stefano; Pritelli, Chiara; Alessi, Elvio; Cortelazzi, Donatella; Gangi, Emanuela; Beck-Peccoz, Paolo.

In: Clinical Endocrinology, Vol. 59, No. 2, 01.08.2003, p. 156-161.

Research output: Contribution to journalArticle

Verga, U, Fugazzola, L, Cambiaghi, S, Pritelli, C, Alessi, E, Cortelazzi, D, Gangi, E & Beck-Peccoz, P 2003, 'Frequent association between MEN 2A and cutaneous lichen amyloidosis', Clinical Endocrinology, vol. 59, no. 2, pp. 156-161. https://doi.org/10.1046/j.1365-2265.2003.01782.x
Verga, Uberta ; Fugazzola, Laura ; Cambiaghi, Stefano ; Pritelli, Chiara ; Alessi, Elvio ; Cortelazzi, Donatella ; Gangi, Emanuela ; Beck-Peccoz, Paolo. / Frequent association between MEN 2A and cutaneous lichen amyloidosis. In: Clinical Endocrinology. 2003 ; Vol. 59, No. 2. pp. 156-161.
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abstract = "OBJECTIVE: Multiple endocrine neoplasia type 2A (MEN 2A) and familial medullary thyroid carcinoma (FMTC) are genetic diseases due to activating mutations of the RET proto-oncogene. Affected patients develop medullary thyroid carcinoma (100{\%}), in an isolated form (FMTC) or in association with phaeochromocytoma (30-50{\%}), and primary hyperparathyroidism (10-20{\%}) (MEN 2A). The presence of cutaneous lichen amyloidosis (CLA) has been anecdotally described in few families harbouring RET proto-oncogene mutation in codon 634. The aim of the study was to evaluate the incidence of CLA in MEN 2A/FMTC families. PATIENTS AND DESIGN: Ten MEN 2A/FMTC families were studied and RET gene mutations identified in all. Complete dermatological assessment was carried out in each family member. Skin biopsy for histological studies was performed in patients with CLA. RESULTS: Among 10 MEN 2A/FMTC families, the presence of CLA was found only in patients belonging to the three families with MEN 2A and RET mutation in codon 634. Nine of 25 patients (36{\%}) with codon 634 mutation presented CLA, though two of them did not show CLA skin lesions but the typical neurological pruritus in the upper back. In all patients, neurological pruritus was present since infancy as a precocious marker of the disorder. The dermatological study of patients with CLA skin lesions added further evidence that pruritus has a pivotal role in the development of CLA, the amyloid deposition being the consequence of repeated scratching. Light microscopy revealed orthokeratotic hyperkeratosis, with elongation of the rete ridges, rare intramalpighian apoptic keratinocytes and deposits of amorphous material in the superficial dermis. Examination under ultraviolet light showed thioflavin T-positive staining, confirming the presence of amyloid in the papillary dermis. The use of Capsaicin at the dilution of 0-025{\%} had a mild efficacy on the cutaneous symptoms. CONCLUSIONS: Among the members of the three families with MEN 2A and RET 634 mutation, the incidence of CLA was 36{\%}, a figure similar to that reported in the literature for phaeochromocytoma (30-50{\%}) and even higher than that for hyperparathyroidism (10-20{\%}). The present data confirm that CLA is linked to codon 634 RET mutations and is a precocious marker of the disorder.",
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AU - Verga, Uberta

AU - Fugazzola, Laura

AU - Cambiaghi, Stefano

AU - Pritelli, Chiara

AU - Alessi, Elvio

AU - Cortelazzi, Donatella

AU - Gangi, Emanuela

AU - Beck-Peccoz, Paolo

PY - 2003/8/1

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N2 - OBJECTIVE: Multiple endocrine neoplasia type 2A (MEN 2A) and familial medullary thyroid carcinoma (FMTC) are genetic diseases due to activating mutations of the RET proto-oncogene. Affected patients develop medullary thyroid carcinoma (100%), in an isolated form (FMTC) or in association with phaeochromocytoma (30-50%), and primary hyperparathyroidism (10-20%) (MEN 2A). The presence of cutaneous lichen amyloidosis (CLA) has been anecdotally described in few families harbouring RET proto-oncogene mutation in codon 634. The aim of the study was to evaluate the incidence of CLA in MEN 2A/FMTC families. PATIENTS AND DESIGN: Ten MEN 2A/FMTC families were studied and RET gene mutations identified in all. Complete dermatological assessment was carried out in each family member. Skin biopsy for histological studies was performed in patients with CLA. RESULTS: Among 10 MEN 2A/FMTC families, the presence of CLA was found only in patients belonging to the three families with MEN 2A and RET mutation in codon 634. Nine of 25 patients (36%) with codon 634 mutation presented CLA, though two of them did not show CLA skin lesions but the typical neurological pruritus in the upper back. In all patients, neurological pruritus was present since infancy as a precocious marker of the disorder. The dermatological study of patients with CLA skin lesions added further evidence that pruritus has a pivotal role in the development of CLA, the amyloid deposition being the consequence of repeated scratching. Light microscopy revealed orthokeratotic hyperkeratosis, with elongation of the rete ridges, rare intramalpighian apoptic keratinocytes and deposits of amorphous material in the superficial dermis. Examination under ultraviolet light showed thioflavin T-positive staining, confirming the presence of amyloid in the papillary dermis. The use of Capsaicin at the dilution of 0-025% had a mild efficacy on the cutaneous symptoms. CONCLUSIONS: Among the members of the three families with MEN 2A and RET 634 mutation, the incidence of CLA was 36%, a figure similar to that reported in the literature for phaeochromocytoma (30-50%) and even higher than that for hyperparathyroidism (10-20%). The present data confirm that CLA is linked to codon 634 RET mutations and is a precocious marker of the disorder.

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