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Published in: BMC Medical Genetics 1/2011

Open Access 01-12-2011 | Case report

Systemic epidermal nevus with involvement of the oral mucosa due to FGFR3mutation

Authors: Anette Bygum, Christina R Fagerberg, Ole J Clemmensen, Britta Fiebig, Christian Hafner

Published in: BMC Medical Genetics | Issue 1/2011

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Abstract

Background

Epidermal nevi (EN) represent benign congenital skin lesions following the lines of Blaschko. They result from genetic mosaicism, and activating FGFR3 and PIK3CA mutations have been implicated.

Case presentation

We report a female patient with a systemic keratinocytic nevus also involving the oral mucosa. Molecular genetic analysis revealed a mosaicism of the FGFR3 hotspot mutation R248C in the EN lesions of the skin and of the oral mucosa. The detection of the R248C mutation in a proportion of blood leukocytes and a slight scoliosis suggest an EN syndrome.

Conclusions

Our results show that activating FGFR3 mutations can also affect the oral mucosa and that extracutaneous manifestations of EN syndrome can be subtle. We highlight the theoretical risk of the patient having an offspring with thanatophoric dysplasia as gonadal mosaicism for the R248C mutation cannot be excluded.
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Literature
1.
go back to reference Happle R: The group of epidermal nevus syndromes Part I. Well defined phenotypes. J Am Acad Dermatol. 2010, 63: 1-22. 10.1016/j.jaad.2010.01.017.CrossRefPubMed Happle R: The group of epidermal nevus syndromes Part I. Well defined phenotypes. J Am Acad Dermatol. 2010, 63: 1-22. 10.1016/j.jaad.2010.01.017.CrossRefPubMed
2.
go back to reference Sugarman JL: Epidermal nevus syndromes. Semin Cutan Med Surg. 2007, 26: 221-230. 10.1016/j.sder.2008.03.006.CrossRefPubMed Sugarman JL: Epidermal nevus syndromes. Semin Cutan Med Surg. 2007, 26: 221-230. 10.1016/j.sder.2008.03.006.CrossRefPubMed
3.
go back to reference Happle R: Mosaicism in human skin. Understanding the patterns and mechanisms. Arch Dermatol. 1993, 129: 1460-1470. 10.1001/archderm.129.11.1460.CrossRefPubMed Happle R: Mosaicism in human skin. Understanding the patterns and mechanisms. Arch Dermatol. 1993, 129: 1460-1470. 10.1001/archderm.129.11.1460.CrossRefPubMed
4.
go back to reference Happle R, Rogers M: Epidermal nevi. Adv Dermatol. 2002, 18: 175-201.PubMed Happle R, Rogers M: Epidermal nevi. Adv Dermatol. 2002, 18: 175-201.PubMed
5.
go back to reference Hafner C, López-Knowles E, Luis NM, Toll A, Baselga E, Fernández-Casado A, Hernández S, Ribé A, Mentzel T, Stoehr R, et al: Oncogenic PIK3CA mutations occur in epidermal nevi and seborrheic keratoses with a characteristic mutation pattern. Proc Natl Acad Sci USA. 2007, 104: 13450-13454. 10.1073/pnas.0705218104.CrossRefPubMedPubMedCentral Hafner C, López-Knowles E, Luis NM, Toll A, Baselga E, Fernández-Casado A, Hernández S, Ribé A, Mentzel T, Stoehr R, et al: Oncogenic PIK3CA mutations occur in epidermal nevi and seborrheic keratoses with a characteristic mutation pattern. Proc Natl Acad Sci USA. 2007, 104: 13450-13454. 10.1073/pnas.0705218104.CrossRefPubMedPubMedCentral
6.
go back to reference Hafner C, van Oers JM, Vogt T, Landthaler M, Stoehr R, Blaszyk H, Hofstaedter F, Zwarthoff EC, Hartmann A: Mosaicism of activating FGFR3 mutations in human skin causes epidermal nevi. J Clin Invest. 2006, 116: 2201-2207. 10.1172/JCI28163.CrossRefPubMedPubMedCentral Hafner C, van Oers JM, Vogt T, Landthaler M, Stoehr R, Blaszyk H, Hofstaedter F, Zwarthoff EC, Hartmann A: Mosaicism of activating FGFR3 mutations in human skin causes epidermal nevi. J Clin Invest. 2006, 116: 2201-2207. 10.1172/JCI28163.CrossRefPubMedPubMedCentral
7.
go back to reference Hurst CD, Zuiverloon TC, Hafner C, Zwarthoff EC, Knowles MA: A SNaPshot assay for the rapid and simple detection of four common hotspot codon mutations in the PIK3CA gene. BMC Res Notes. 2009, 2: 66-10.1186/1756-0500-2-66.CrossRefPubMedPubMedCentral Hurst CD, Zuiverloon TC, Hafner C, Zwarthoff EC, Knowles MA: A SNaPshot assay for the rapid and simple detection of four common hotspot codon mutations in the PIK3CA gene. BMC Res Notes. 2009, 2: 66-10.1186/1756-0500-2-66.CrossRefPubMedPubMedCentral
8.
go back to reference Rogers M, McCrossin I, Commens C: Epidermal nevi and the epidermal nevus syndrome. A review of 131 cases. J Am Acad Dermatol. 1989, 20: 476-488. 10.1016/S0190-9622(89)70061-X.CrossRefPubMed Rogers M, McCrossin I, Commens C: Epidermal nevi and the epidermal nevus syndrome. A review of 131 cases. J Am Acad Dermatol. 1989, 20: 476-488. 10.1016/S0190-9622(89)70061-X.CrossRefPubMed
9.
go back to reference Cappellen D, De Oliveira C, Ricol D, de Medina S, Bourdin J, Sastre-Garau X, Chopin D, Thiery JP, Radvanyi F: Frequent activating mutations of FGFR3 in human bladder and cervix carcinomas. Nat Genet. 1999, 23: 18-20.PubMed Cappellen D, De Oliveira C, Ricol D, de Medina S, Bourdin J, Sastre-Garau X, Chopin D, Thiery JP, Radvanyi F: Frequent activating mutations of FGFR3 in human bladder and cervix carcinomas. Nat Genet. 1999, 23: 18-20.PubMed
10.
go back to reference Gymnopoulos M, Elsliger MA, Vogt PK: Rare cancer-specific mutations in PIK3CA show gain of function. Proc Natl Acad Sci USA. 2007, 104: 5569-5574. 10.1073/pnas.0701005104.CrossRefPubMedPubMedCentral Gymnopoulos M, Elsliger MA, Vogt PK: Rare cancer-specific mutations in PIK3CA show gain of function. Proc Natl Acad Sci USA. 2007, 104: 5569-5574. 10.1073/pnas.0701005104.CrossRefPubMedPubMedCentral
11.
go back to reference Tavormina PL, Shiang R, Thompson LM, Zhu YZ, Wilkin DJ, Lachman RS, Wilcox WR, Rimoin DL, Cohn DH, Wasmuth JJ: Thanatophoric dysplasia (types I and II) caused by distinct mutations in fibroblast growth factor receptor 3. Nat Genet. 1995, 9: 321-328. 10.1038/ng0395-321.CrossRefPubMed Tavormina PL, Shiang R, Thompson LM, Zhu YZ, Wilkin DJ, Lachman RS, Wilcox WR, Rimoin DL, Cohn DH, Wasmuth JJ: Thanatophoric dysplasia (types I and II) caused by distinct mutations in fibroblast growth factor receptor 3. Nat Genet. 1995, 9: 321-328. 10.1038/ng0395-321.CrossRefPubMed
12.
go back to reference Happle R: Lethal genes surviving by mosaicism: a possible explanation for sporadic birth defects involving the skin. J Am Acad Dermatol. 1987, 16: 899-906. 10.1016/S0190-9622(87)80249-9.CrossRefPubMed Happle R: Lethal genes surviving by mosaicism: a possible explanation for sporadic birth defects involving the skin. J Am Acad Dermatol. 1987, 16: 899-906. 10.1016/S0190-9622(87)80249-9.CrossRefPubMed
13.
go back to reference Hafner C, van Oers JM, Hartmann A, Landthaler M, Stoehr R, Blaszyk H, Hofstaedter F, Zwarthoff EC, Vogt T: High Frequency of FGFR3 Mutations in Adenoid Seborrheic Keratoses. J Invest Dermatol. 2006, 126: 2404-2407. 10.1038/sj.jid.5700422.CrossRefPubMed Hafner C, van Oers JM, Hartmann A, Landthaler M, Stoehr R, Blaszyk H, Hofstaedter F, Zwarthoff EC, Vogt T: High Frequency of FGFR3 Mutations in Adenoid Seborrheic Keratoses. J Invest Dermatol. 2006, 126: 2404-2407. 10.1038/sj.jid.5700422.CrossRefPubMed
14.
go back to reference Logié A, Dunois-Lardé C, Rosty C, Levrel O, Blanche M, Ribeiro A, Gasc JM, Jorcano J, Werner S, Sastre-Garau X, et al: Activating mutations of the tyrosine kinase receptor FGFR3 are associated with benign skin tumors in mice and humans. Hum Mol Genet. 2005, 14: 1153-1160. 10.1093/hmg/ddi127.CrossRefPubMed Logié A, Dunois-Lardé C, Rosty C, Levrel O, Blanche M, Ribeiro A, Gasc JM, Jorcano J, Werner S, Sastre-Garau X, et al: Activating mutations of the tyrosine kinase receptor FGFR3 are associated with benign skin tumors in mice and humans. Hum Mol Genet. 2005, 14: 1153-1160. 10.1093/hmg/ddi127.CrossRefPubMed
15.
go back to reference Hafner C, Vogt T: Seborrheic keratosis. J Dtsch Dermatol Ges. 2008, 6: 664-677. 10.1111/j.1610-0387.2008.06788.x.CrossRefPubMed Hafner C, Vogt T: Seborrheic keratosis. J Dtsch Dermatol Ges. 2008, 6: 664-677. 10.1111/j.1610-0387.2008.06788.x.CrossRefPubMed
16.
go back to reference Bernard-Pierrot I, Brams A, Dunois-Lardé C, Caillault A, Diez de Medina SG, Cappellen D, Graff G, Thiery JP, Chopin D, Ricol D, et al: Oncogenic properties of the mutated forms of fibroblast growth factor receptor 3b. Carcinogenesis. 2006, 27: 740-747.CrossRefPubMed Bernard-Pierrot I, Brams A, Dunois-Lardé C, Caillault A, Diez de Medina SG, Cappellen D, Graff G, Thiery JP, Chopin D, Ricol D, et al: Oncogenic properties of the mutated forms of fibroblast growth factor receptor 3b. Carcinogenesis. 2006, 27: 740-747.CrossRefPubMed
17.
go back to reference Bader AG, Kang S, Vogt PK: Cancer-specific mutations in PIK3CA are oncogenic in vivo. Proc Natl Acad Sci USA. 2006, 103: 1475-1479. 10.1073/pnas.0510857103.CrossRefPubMedPubMedCentral Bader AG, Kang S, Vogt PK: Cancer-specific mutations in PIK3CA are oncogenic in vivo. Proc Natl Acad Sci USA. 2006, 103: 1475-1479. 10.1073/pnas.0510857103.CrossRefPubMedPubMedCentral
18.
go back to reference Hafner C, Di Martino E, Pitt E, Stempfl T, Tomlinson D, Hartmann A, Landthaler M, Knowles M, Vogt T: FGFR3 mutation affects cell growth, apoptosis and attachment in keratinocytes. Exp Cell Res. 2010, 316: 2008-2016. 10.1016/j.yexcr.2010.04.021.CrossRefPubMed Hafner C, Di Martino E, Pitt E, Stempfl T, Tomlinson D, Hartmann A, Landthaler M, Knowles M, Vogt T: FGFR3 mutation affects cell growth, apoptosis and attachment in keratinocytes. Exp Cell Res. 2010, 316: 2008-2016. 10.1016/j.yexcr.2010.04.021.CrossRefPubMed
19.
go back to reference Hafner C, Toll A, Fernández-Casado A, Earl J, Marqués M, Acquadro F, Méndez-Pertuz M, Urioste M, Malats N, Burns JE, et al: Multiple oncogenic mutations and clonal relationship in spatially distinct benign human epidermal tumors. Proc Natl Acad Sci USA. 2010, 107: 20780-20785. 10.1073/pnas.1008365107.CrossRefPubMedPubMedCentral Hafner C, Toll A, Fernández-Casado A, Earl J, Marqués M, Acquadro F, Méndez-Pertuz M, Urioste M, Malats N, Burns JE, et al: Multiple oncogenic mutations and clonal relationship in spatially distinct benign human epidermal tumors. Proc Natl Acad Sci USA. 2010, 107: 20780-20785. 10.1073/pnas.1008365107.CrossRefPubMedPubMedCentral
20.
go back to reference Haberland-Carrodeguas C, Allen CM, Lovas JG, Hicks J, Flaitz CM, Carlos R, Stal S: Review of linear epidermal nevus with oral mucosal involvement--series of five new cases. Oral Dis. 2008, 14: 131-137. 10.1111/j.1601-0825.2006.01355.x.CrossRefPubMed Haberland-Carrodeguas C, Allen CM, Lovas JG, Hicks J, Flaitz CM, Carlos R, Stal S: Review of linear epidermal nevus with oral mucosal involvement--series of five new cases. Oral Dis. 2008, 14: 131-137. 10.1111/j.1601-0825.2006.01355.x.CrossRefPubMed
21.
go back to reference Collin B, Taylor IB, Wilkie AO, Moss C: Fibroblast growth factor receptor 3 (FGFR3) mutation in a verrucous epidermal naevus associated with mild facial dysmorphism. Br J Dermatol. 2007, 156: 1353-1356. 10.1111/j.1365-2133.2007.07869.x.CrossRefPubMed Collin B, Taylor IB, Wilkie AO, Moss C: Fibroblast growth factor receptor 3 (FGFR3) mutation in a verrucous epidermal naevus associated with mild facial dysmorphism. Br J Dermatol. 2007, 156: 1353-1356. 10.1111/j.1365-2133.2007.07869.x.CrossRefPubMed
22.
go back to reference García-Vargas A, Hafner C, Pérez-Rodríguez AG, Rodriguez-Rojas LX, González-Esqueda P, Stoehr R, Hernández-Torres M, Happle R: An epidermal nevus syndrome with cerebral involvement caused by a mosaic FGFR3 mutation. Am J Med Genet A. 2008, 2275-2279. 146A García-Vargas A, Hafner C, Pérez-Rodríguez AG, Rodriguez-Rojas LX, González-Esqueda P, Stoehr R, Hernández-Torres M, Happle R: An epidermal nevus syndrome with cerebral involvement caused by a mosaic FGFR3 mutation. Am J Med Genet A. 2008, 2275-2279. 146A
23.
go back to reference Rongioletti F, Rebora A: Epidermal nevus with transitional cell carcinomas of the urinary tract. J Am Acad Dermatol. 1991, 25 (5 Pt 1): 856-858.CrossRefPubMed Rongioletti F, Rebora A: Epidermal nevus with transitional cell carcinomas of the urinary tract. J Am Acad Dermatol. 1991, 25 (5 Pt 1): 856-858.CrossRefPubMed
24.
go back to reference Rosenthal D, Fretzin DF: Epidermal nevus syndrome: report of association with transitional cell carcinoma of the bladder. Pediatr Dermatol. 1986, 3: 455-458. 10.1111/j.1525-1470.1986.tb00650.x.CrossRefPubMed Rosenthal D, Fretzin DF: Epidermal nevus syndrome: report of association with transitional cell carcinoma of the bladder. Pediatr Dermatol. 1986, 3: 455-458. 10.1111/j.1525-1470.1986.tb00650.x.CrossRefPubMed
25.
go back to reference García de Jalón A, Azúa-Romeo J, Trivez MA, Pascual D, Blas M, Rioja LA: Epidermal naevus syndrome (Solomon's syndrome) associated with bladder cancer in a 20-year-old female. Scand J Urol Nephrol. 2004, 38: 85-87. 10.1080/00365590310017316.CrossRefPubMed García de Jalón A, Azúa-Romeo J, Trivez MA, Pascual D, Blas M, Rioja LA: Epidermal naevus syndrome (Solomon's syndrome) associated with bladder cancer in a 20-year-old female. Scand J Urol Nephrol. 2004, 38: 85-87. 10.1080/00365590310017316.CrossRefPubMed
26.
go back to reference Hernández S, Toll A, Baselga E, Ribé A, Azua-Romeo J, Pujol RM, Real FX: Fibroblast growth factor receptor 3 mutations in epidermal nevi and associated low grade bladder tumors. J Invest Dermatol. 2007, 127: 1664-1666.CrossRefPubMed Hernández S, Toll A, Baselga E, Ribé A, Azua-Romeo J, Pujol RM, Real FX: Fibroblast growth factor receptor 3 mutations in epidermal nevi and associated low grade bladder tumors. J Invest Dermatol. 2007, 127: 1664-1666.CrossRefPubMed
27.
go back to reference Chesi M, Nardini E, Brents LA, Schröck E, Ried T, Kuehl WM, Bergsagel PL: Frequent translocation t(4;14)(p16.3;q32.3) in multiple myeloma is associated with increased expression and activating mutations of fibroblast growth factor receptor 3. Nat Genet. 1997, 16: 260-264. 10.1038/ng0797-260.CrossRefPubMedPubMedCentral Chesi M, Nardini E, Brents LA, Schröck E, Ried T, Kuehl WM, Bergsagel PL: Frequent translocation t(4;14)(p16.3;q32.3) in multiple myeloma is associated with increased expression and activating mutations of fibroblast growth factor receptor 3. Nat Genet. 1997, 16: 260-264. 10.1038/ng0797-260.CrossRefPubMedPubMedCentral
28.
go back to reference Ichikawa T, Saiki M, Kaneko M, Saida T: Squamous cell carcinoma arising in a verrucous epidermal nevus. Dermatology. 1996, 193: 135-138. 10.1159/000246229.CrossRefPubMed Ichikawa T, Saiki M, Kaneko M, Saida T: Squamous cell carcinoma arising in a verrucous epidermal nevus. Dermatology. 1996, 193: 135-138. 10.1159/000246229.CrossRefPubMed
29.
go back to reference Hafner C, Klein A, Landthaler M, Vogt T: Clonality of basal cell carcinoma arising in an epidermal nevus. New insights provided by molecular analysis. Dermatology. 2009, 218: 278-281. 10.1159/000189209.CrossRefPubMed Hafner C, Klein A, Landthaler M, Vogt T: Clonality of basal cell carcinoma arising in an epidermal nevus. New insights provided by molecular analysis. Dermatology. 2009, 218: 278-281. 10.1159/000189209.CrossRefPubMed
30.
go back to reference Sugarman JL: Epidermal nevus syndromes. Semin Cutan Med Surg. 2004, 23: 145-157. 10.1016/j.sder.2004.01.008.CrossRefPubMed Sugarman JL: Epidermal nevus syndromes. Semin Cutan Med Surg. 2004, 23: 145-157. 10.1016/j.sder.2004.01.008.CrossRefPubMed
31.
go back to reference Hyland VJ, Robertson SP, Flanagan S, Savarirayan R, Roscioli T, Masel J, Hayes M, Glass IA: Somatic and germline mosaicism for a R248C missense mutation in FGFR3, resulting in a skeletal dysplasia distinct from thanatophoric dysplasia. Am J Med Genet A. 2003, 120: 157-168.CrossRef Hyland VJ, Robertson SP, Flanagan S, Savarirayan R, Roscioli T, Masel J, Hayes M, Glass IA: Somatic and germline mosaicism for a R248C missense mutation in FGFR3, resulting in a skeletal dysplasia distinct from thanatophoric dysplasia. Am J Med Genet A. 2003, 120: 157-168.CrossRef
Metadata
Title
Systemic epidermal nevus with involvement of the oral mucosa due to FGFR3mutation
Authors
Anette Bygum
Christina R Fagerberg
Ole J Clemmensen
Britta Fiebig
Christian Hafner
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Medical Genetics / Issue 1/2011
Electronic ISSN: 1471-2350
DOI
https://doi.org/10.1186/1471-2350-12-79

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