Skip to main content
Top
Published in: BMC Medical Genetics 1/2018

Open Access 01-12-2018 | Case report

Upper limb muscle overgrowth with hypoplasia of the index finger: a new over-growth syndrome caused by the somatic PIK3CA mutation c.3140A>G

Authors: Mohammad M. Al-Qattan, Ali Hadadi, Abdullah M. Al-Thunayan, Ahmed A. Eldali, Mohammed A. AlBalwi

Published in: BMC Medical Genetics | Issue 1/2018

Login to get access

Abstract

Background

Scientists have previously described an overgrowth syndrome in Saudi patients and named it ‘Upper limb muscle overgrowth with hypoplasia of the index finger’ syndrome.

Case presentation

We describe a new case and document that the syndrome is caused by the somatic PIK3CA mutation c.3140A>G, p.His1047Arg. We also recruited one of the previously reported cases and found the same somatic mutation in the affected muscles. A wider classification of ‘PIK3CA-related pathology spectrum’ is presented which includes cancer, benign skin lesions/tumors, Cowden syndrome, isolated vascular malformations and various overgrowth syndromes. The latter entity is sub-divided into 3 sub-groups: overgrowth with brain involvement, overgrowth with multiple lipomatosis, and overgrowth without brain involvement/multiple lipomatosis.

Conclusion

Our literature review indicated that “upper limb muscle overgrowth with hypoplasia of the index finger” is not as rare as previously thought to be. This overgrowth syndrome is unique and is caused by the somatic PIK3CA mutation c.3140A>G.
Literature
1.
go back to reference Keppler-Noreuil KM, Rios JJ, Parker VE, Semple RK, Lindhurst MJ, Sapp JC, Alomari A, Ezaki M, Dobyns W, Biesecker LG. PIK3CA-related overgrowth spectrum (PROS): diagnostic and testing eligibility criteria, differential diagnosis, and evaluation. Am J Med Genet A. 2015;167A(2):287–95.CrossRefPubMed Keppler-Noreuil KM, Rios JJ, Parker VE, Semple RK, Lindhurst MJ, Sapp JC, Alomari A, Ezaki M, Dobyns W, Biesecker LG. PIK3CA-related overgrowth spectrum (PROS): diagnostic and testing eligibility criteria, differential diagnosis, and evaluation. Am J Med Genet A. 2015;167A(2):287–95.CrossRefPubMed
2.
go back to reference Al-Qattan MM. Muscle overgrowth of the upper limb in a proximo-distal gradient and concurrent hypoplasia of the index finger. J Pediatr Orthop. 2014;34(7):715–9.CrossRefPubMed Al-Qattan MM. Muscle overgrowth of the upper limb in a proximo-distal gradient and concurrent hypoplasia of the index finger. J Pediatr Orthop. 2014;34(7):715–9.CrossRefPubMed
3.
go back to reference Bachman KE, Argani P, Samuels Y, Silliman N, Ptak J, Szabo S, Konishi H, Karakas B, Blair BG, Lin C, et al. The PIK3CA gene is mutated with high frequency in human breast cancers. Cancer Biol Ther. 2004;3(8):772–5.CrossRefPubMed Bachman KE, Argani P, Samuels Y, Silliman N, Ptak J, Szabo S, Konishi H, Karakas B, Blair BG, Lin C, et al. The PIK3CA gene is mutated with high frequency in human breast cancers. Cancer Biol Ther. 2004;3(8):772–5.CrossRefPubMed
4.
go back to reference So YC. An unusual association of the windblown hand with upper limb hypertrophy. J Hand Surg Br. 1992;17(1):113–7.CrossRefPubMed So YC. An unusual association of the windblown hand with upper limb hypertrophy. J Hand Surg Br. 1992;17(1):113–7.CrossRefPubMed
5.
go back to reference Seto Y, Nishijima N, Mototsu M. Congenital anomaly of the hand due to aberrant muscles. Central Japan J Orthop Surg Traumatol. 1992;34:985–7. Seto Y, Nishijima N, Mototsu M. Congenital anomaly of the hand due to aberrant muscles. Central Japan J Orthop Surg Traumatol. 1992;34:985–7.
6.
go back to reference Lanz U, Hahn P, Varela C. Congenital unilateral muscle hyperplasia of the hand with ulnar deviation of the fingers. J Hand Surg Br. 1994;19:683–8.CrossRefPubMed Lanz U, Hahn P, Varela C. Congenital unilateral muscle hyperplasia of the hand with ulnar deviation of the fingers. J Hand Surg Br. 1994;19:683–8.CrossRefPubMed
7.
go back to reference Tanabe K, Tada K, Doi T. Unilateral hypertrophy of the upper extremity due to aberrant muscles. J Hand Surg Br. 1997;22(2):253–7.CrossRefPubMed Tanabe K, Tada K, Doi T. Unilateral hypertrophy of the upper extremity due to aberrant muscles. J Hand Surg Br. 1997;22(2):253–7.CrossRefPubMed
8.
go back to reference Teoh LC, Yong FC, Guo CM. Congenital isolated upper limb hypertrophy with hand abnormality--a report of 2 cases. J Hand Surg Br. 2001;26(5):492–5.CrossRefPubMed Teoh LC, Yong FC, Guo CM. Congenital isolated upper limb hypertrophy with hand abnormality--a report of 2 cases. J Hand Surg Br. 2001;26(5):492–5.CrossRefPubMed
9.
go back to reference Takka S, Doi K, Hattori Y, Kitajima I, Sano K. Proposal of new category for congenital unilateral upper limb muscular hypertrophy. Ann Plast Surg. 2005;54(1):97–102.CrossRefPubMed Takka S, Doi K, Hattori Y, Kitajima I, Sano K. Proposal of new category for congenital unilateral upper limb muscular hypertrophy. Ann Plast Surg. 2005;54(1):97–102.CrossRefPubMed
10.
go back to reference Castiglioni C, Bertini E, Orellana P, Villarroel C, Las Heras F, Hinzpeter D, Paolinelli P, Bevilacqua JA, Alvarez K. Activating PIK3CA somatic mutation in congenital unilateral isolated muscle overgrowth of the upper extremity. Am J Med Genet A. 2014;164A(9):2365–9.CrossRefPubMed Castiglioni C, Bertini E, Orellana P, Villarroel C, Las Heras F, Hinzpeter D, Paolinelli P, Bevilacqua JA, Alvarez K. Activating PIK3CA somatic mutation in congenital unilateral isolated muscle overgrowth of the upper extremity. Am J Med Genet A. 2014;164A(9):2365–9.CrossRefPubMed
11.
go back to reference Rasmussen M, Sunde L, Weigert KP, Bogaard PW, Lildballe DL. Segmental overgrowth syndrome due to an activating PIK3CA mutation identified in affected muscle tissue by exome sequencing. Am J Med Genet A. 2014;164A(5):1318–21.CrossRefPubMed Rasmussen M, Sunde L, Weigert KP, Bogaard PW, Lildballe DL. Segmental overgrowth syndrome due to an activating PIK3CA mutation identified in affected muscle tissue by exome sequencing. Am J Med Genet A. 2014;164A(5):1318–21.CrossRefPubMed
12.
go back to reference Yeung KS, Ip JJ, Chow CP, Kuong EY, Tam PK, Chan GC, Chung BH. Somatic PIK3CA mutations in seven patients with PIK3CA-related overgrowth spectrum. Am J Med Genet A. 2017;173(4):978–84.CrossRefPubMed Yeung KS, Ip JJ, Chow CP, Kuong EY, Tam PK, Chan GC, Chung BH. Somatic PIK3CA mutations in seven patients with PIK3CA-related overgrowth spectrum. Am J Med Genet A. 2017;173(4):978–84.CrossRefPubMed
13.
go back to reference Filipenko ML, Os’kina NA, Oskorbin IA, Mishukova OV, Ovchinnikova LK, Gershtein ES, Kushlinskii NE. Association between the prevalence of somatic mutations in PIK3CA gene in tumors and clinical and morphological characteristics of breast cancer patients. Bull Exp Biol Med. 2017;163(2):250–4.CrossRefPubMed Filipenko ML, Os’kina NA, Oskorbin IA, Mishukova OV, Ovchinnikova LK, Gershtein ES, Kushlinskii NE. Association between the prevalence of somatic mutations in PIK3CA gene in tumors and clinical and morphological characteristics of breast cancer patients. Bull Exp Biol Med. 2017;163(2):250–4.CrossRefPubMed
14.
go back to reference Goto K, Maeda D, Kudo-Asabe Y, Hibiya T, Hayashi A, Fukayama M, Ohashi K, Goto A. PIK3CA and AKT1 mutations in hidradenoma papilliferum. J Clin Pathol. 2017;70(5):424–7.CrossRefPubMed Goto K, Maeda D, Kudo-Asabe Y, Hibiya T, Hayashi A, Fukayama M, Ohashi K, Goto A. PIK3CA and AKT1 mutations in hidradenoma papilliferum. J Clin Pathol. 2017;70(5):424–7.CrossRefPubMed
15.
go back to reference Hafner C, López-Knowles E, Luis NM, Toll A, Baselga E, Fernández-Casado A, Hernandez 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 U S A. 2007;104(33):13450–4.CrossRefPubMedPubMedCentral Hafner C, López-Knowles E, Luis NM, Toll A, Baselga E, Fernández-Casado A, Hernandez 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 U S A. 2007;104(33):13450–4.CrossRefPubMedPubMedCentral
16.
go back to reference Orloff MS, He X, Peterson C, Chen F, Chen JL, Mester JL, Eng C. Germline PIK3CA and AKT1 mutations in Cowden and Cowden-like syndromes. Am J Hum Genet. 2013;92(1):76–80.CrossRefPubMedPubMedCentral Orloff MS, He X, Peterson C, Chen F, Chen JL, Mester JL, Eng C. Germline PIK3CA and AKT1 mutations in Cowden and Cowden-like syndromes. Am J Hum Genet. 2013;92(1):76–80.CrossRefPubMedPubMedCentral
17.
go back to reference Limaye N, Kangas J, Mendola A, Godfraind C, Schlögel MJ, Helaers R, Eklund L, Boon LM, Vikkula M. Somatic activating PIK3CA mutations cause venous malformation. Am J Hum Genet. 2015;97(6):914–21.CrossRefPubMedPubMedCentral Limaye N, Kangas J, Mendola A, Godfraind C, Schlögel MJ, Helaers R, Eklund L, Boon LM, Vikkula M. Somatic activating PIK3CA mutations cause venous malformation. Am J Hum Genet. 2015;97(6):914–21.CrossRefPubMedPubMedCentral
18.
go back to reference Keppler-Noreuil KM, Sapp JC, Lindhurst MJ, Parker VE, Blumhorst C, Darling T, Tosi LL, Huson SM, Whitehouse RW, Jakkula E, et al. Clinical delineation and natural history of the PIK3CA-related overgrowth spectrum. Am J Med Genet A. 2014;164A(7):1713–33.CrossRefPubMed Keppler-Noreuil KM, Sapp JC, Lindhurst MJ, Parker VE, Blumhorst C, Darling T, Tosi LL, Huson SM, Whitehouse RW, Jakkula E, et al. Clinical delineation and natural history of the PIK3CA-related overgrowth spectrum. Am J Med Genet A. 2014;164A(7):1713–33.CrossRefPubMed
19.
go back to reference Jansen LA, Mirzaa GM, Ishak GE, O'Roak BJ, Hiatt JB, Roden WH, Gunter SA, Christian SL, Collins S, Adams C, et al. PI3K/AKT pathway mutations cause a spectrum of brain malformations from megalencephaly to focal cortical dysplasia. Brain. 2015;138:1613–28.CrossRefPubMedPubMedCentral Jansen LA, Mirzaa GM, Ishak GE, O'Roak BJ, Hiatt JB, Roden WH, Gunter SA, Christian SL, Collins S, Adams C, et al. PI3K/AKT pathway mutations cause a spectrum of brain malformations from megalencephaly to focal cortical dysplasia. Brain. 2015;138:1613–28.CrossRefPubMedPubMedCentral
20.
go back to reference Couto JA, Konczyk DJ, Vivero MP, Kozakewich HPW, Upton J, Fu X, Padwa Bl MJB, Warman ML, Greene AK. Somatic PIK3CA mutations are present in multiple tissues of facial infiltrating lipomatosis. Pediatr Res. 2017;82(5):850–4.CrossRefPubMedPubMedCentral Couto JA, Konczyk DJ, Vivero MP, Kozakewich HPW, Upton J, Fu X, Padwa Bl MJB, Warman ML, Greene AK. Somatic PIK3CA mutations are present in multiple tissues of facial infiltrating lipomatosis. Pediatr Res. 2017;82(5):850–4.CrossRefPubMedPubMedCentral
21.
go back to reference Cohen AS, Townsend KN, Xiang QS, Attariwala R, Borchers C, Senger C, Picker W, Levi J, Yewchuk L, Tan J, et al. Somatic mosaicism for the p.His1047Arg mutation in PIK3CA in a girl with mesenteric lipomatosis. Am J Med Genet A. 2014;164A(9):2360–4.CrossRefPubMed Cohen AS, Townsend KN, Xiang QS, Attariwala R, Borchers C, Senger C, Picker W, Levi J, Yewchuk L, Tan J, et al. Somatic mosaicism for the p.His1047Arg mutation in PIK3CA in a girl with mesenteric lipomatosis. Am J Med Genet A. 2014;164A(9):2360–4.CrossRefPubMed
22.
go back to reference Martinez-Lopez A, Blasco-Morente G, Perez-Lopez I, Herrera-Garcia JD, Luque-Valenzuela M, Sanchez-Cano D, Lopez-Gutierrez JC, Ruiz-Villaverde R. Tercedor-Sanchez J. CLOVES syndrome: review of a PIK3CA-related overgrowth spectrum (PROS). Clin Genet. 2017;91(1):14–21.CrossRefPubMed Martinez-Lopez A, Blasco-Morente G, Perez-Lopez I, Herrera-Garcia JD, Luque-Valenzuela M, Sanchez-Cano D, Lopez-Gutierrez JC, Ruiz-Villaverde R. Tercedor-Sanchez J. CLOVES syndrome: review of a PIK3CA-related overgrowth spectrum (PROS). Clin Genet. 2017;91(1):14–21.CrossRefPubMed
23.
go back to reference Lindhurst MJ, Parker VE, Payne F, Sapp JC, Rudge S, Harris J, Witkowski AM, Zhang Q, Groeneveld MP, Scott CE, et al. Mosaic overgrowth with fibroadipose hyperplasia is caused by somatic activating mutations in PIK3CA. Nat Genet. 2012;44(8):928–33.CrossRefPubMedPubMedCentral Lindhurst MJ, Parker VE, Payne F, Sapp JC, Rudge S, Harris J, Witkowski AM, Zhang Q, Groeneveld MP, Scott CE, et al. Mosaic overgrowth with fibroadipose hyperplasia is caused by somatic activating mutations in PIK3CA. Nat Genet. 2012;44(8):928–33.CrossRefPubMedPubMedCentral
24.
go back to reference Rios JJ, Paria N, Burns DK, Israel BA, Cornelia R, Wise CA, Ezaki M. Somatic gain-of-function mutations in PIK3CA in patients with macrodactyly. Hum Mol Genet. 2013;22(3):444–51.CrossRefPubMed Rios JJ, Paria N, Burns DK, Israel BA, Cornelia R, Wise CA, Ezaki M. Somatic gain-of-function mutations in PIK3CA in patients with macrodactyly. Hum Mol Genet. 2013;22(3):444–51.CrossRefPubMed
25.
go back to reference Al-Qattan MM. Lipofibromatous hamartoma of the median nerve and its associated conditions. J Hand Surg Br. 2001;26(4):368–72.CrossRefPubMed Al-Qattan MM. Lipofibromatous hamartoma of the median nerve and its associated conditions. J Hand Surg Br. 2001;26(4):368–72.CrossRefPubMed
26.
go back to reference Mirzaa G, Timms AE, Conti V, Boyle EA, Girisha KM, Martin B, Kircher M, Olds C, Juusola J, Collins S, et al. PIK3CA-associated developmental disorders exhibit distinct classes of mutations with variable expression and tissue distribution. JCI Insight. 2016;1(9):e87623. https://doi.org/10.1172/jci.insight.87623 Mirzaa G, Timms AE, Conti V, Boyle EA, Girisha KM, Martin B, Kircher M, Olds C, Juusola J, Collins S, et al. PIK3CA-associated developmental disorders exhibit distinct classes of mutations with variable expression and tissue distribution. JCI Insight. 2016;1(9):e87623. https://​doi.​org/​10.​1172/​jci.​insight.​87623
28.
go back to reference Lindhurst MJ, Sapp JC, Teer JK, Johnston JJ, Finn EM, Peters K, Turner J, Cannons JL, Bick D, Blakemore L, et al. A mosaic activating mutation in AKT1 associated with the Proteus syndrome. N Engl J Med. 2011;365(7):611–9.CrossRefPubMedPubMedCentral Lindhurst MJ, Sapp JC, Teer JK, Johnston JJ, Finn EM, Peters K, Turner J, Cannons JL, Bick D, Blakemore L, et al. A mosaic activating mutation in AKT1 associated with the Proteus syndrome. N Engl J Med. 2011;365(7):611–9.CrossRefPubMedPubMedCentral
29.
go back to reference Smith JM, Kirk EP, Theodosopoulos G, Marshall GM, Walker J, Rogers M, Field M, Brereton JJ, Marsh DJ. Germline mutation of the tumor suppressor PTEN in Proteus syndrome. J Med Genet. 2002;39(12):937–40.CrossRefPubMedPubMedCentral Smith JM, Kirk EP, Theodosopoulos G, Marshall GM, Walker J, Rogers M, Field M, Brereton JJ, Marsh DJ. Germline mutation of the tumor suppressor PTEN in Proteus syndrome. J Med Genet. 2002;39(12):937–40.CrossRefPubMedPubMedCentral
30.
go back to reference Smith LD, Saunders CJ, Dinwiddie DL, Atherton AM, Miller NA, Soden SE, Farrow EG, Abdelmoity ATG, Kingsmore SF. Exome sequencing reveals De novo germline mutation of the mammalian target of rapamycin (mTOR) in a patient with megalencephaly and intractable seizures. J Genomes Exomes. 2013;2:63–72.CrossRef Smith LD, Saunders CJ, Dinwiddie DL, Atherton AM, Miller NA, Soden SE, Farrow EG, Abdelmoity ATG, Kingsmore SF. Exome sequencing reveals De novo germline mutation of the mammalian target of rapamycin (mTOR) in a patient with megalencephaly and intractable seizures. J Genomes Exomes. 2013;2:63–72.CrossRef
Metadata
Title
Upper limb muscle overgrowth with hypoplasia of the index finger: a new over-growth syndrome caused by the somatic PIK3CA mutation c.3140A>G
Authors
Mohammad M. Al-Qattan
Ali Hadadi
Abdullah M. Al-Thunayan
Ahmed A. Eldali
Mohammed A. AlBalwi
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Medical Genetics / Issue 1/2018
Electronic ISSN: 1471-2350
DOI
https://doi.org/10.1186/s12881-018-0672-z

Other articles of this Issue 1/2018

BMC Medical Genetics 1/2018 Go to the issue