Hidden association of Cowden syndrome, PTEN mutation and meningioma frequency

Eduard Yakubov1,2, Ali Ghoochani1, Rolf Buslei3, Michael Buchfelder1, Ilker Y. Eyüpoglu1, Nicolai Savaskan1,4

1Translational Neurooncology Laboratory, Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany

2Department of Neurosurgery, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany

3Department of Neuropathology, Universitätsklinikum Erlangen, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany

4BiMECON Ent., Berlin, Germany

Correspondence to:

Nicolai Savaskan, email: nic.savaskan@gmail.com; savaskan@gmx.net

Keywords: Cowden syndrome, PTEN gene, meningioma, multiple hamartoma syndrome, brain tumor

Received: February 29, 2016     Accepted: May 13, 2016     Published: May 27, 2016


Cowden syndrome (CS) is clinically presented by multiple hamartomas, often with mucocutaneous lesions, goiter, breast cancer and gastrointestinal polyps. CS is a genetic disorder of autosomal dominant inheritance and is one distinct syndrome of the phosphatase and tensin homolog on chromosome 10 (PTEN) hamartoma tumor spectrum. Noteworthy, PTEN germline mutations are related to a wide range of brain tumors. We performed a systematic analysis and review of the medical literature for Cowden syndrome and meningioma and additionally present the case of a 29-year-old CS patient diagnosed with multiple meningiomas. We found strong evidence for high incidence of brain tumors in CS patients. In particular meningiomas and gangliocytomas/Lhermitte-Duclos disease were often associated with 8% and 9% respectively in CS patients. Since aberrations in chromosome 10q are associated with meningiomas, it is likely that the underlying mutations in CS drive to a certain extent neoplastic meningioma growth. We propose to include meningiomas and brain tumors in the major criteria spectrum of CS-related disorders. This could warrant early diagnosis of brain lesions and close therapy, as well as better monitoring of patients with CS.

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