Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Case Report

Birt-hogg-Dubé Syndrome Incidentally Identified in a Potential Liver Donor

Author(s): Elif Gündoğdu*, Emre Emekli, Ersoy Acer and İlter Özer

Volume 17, Issue 6, 2021

Published on: 17 December, 2020

Page: [807 - 810] Pages: 4

DOI: 10.2174/1573405616666201217111929

Price: $65

Abstract

Background: Birt-Hogg-Dubé Syndrome (BHDS), an autosomal dominant hereditary condition, occurs due to mutations in the gene encoding folliculin (FLCN) in the short arm of the 17th chromosome characterized by lung cysts with specific skin findings and renal cell carcinoma. Patients have usually complaints related to dyspnea and chest pain due to pneumothorax but they may be asymptomatic due to wide phenotypic heterogeneity. Herein, we report the imaging findings of a case 32-year-old male with BHDS without any symptom who was diagnosed incidentally by computed tomography (CT) due to organ donation.

Case Report: In a 32-year-old male patient evaluated as a potential liver donor, CT was performed for preoperative preparation. The patient's medical history was unremarkable. In the CT examination, multiple air cysts of different sizes in both lungs were observed and also, a 7-cm solid renal mass of the right kidney was observed in the dynamic examination. Due to a large number of lung cysts and the presence of solid renal tumors at a young age, BHDS was considered. The patient underwent partial nephrectomy, and the pathology result was hybrid oncocytic-chromophobe renal cell carcinoma. In the genetic examination, a heterozygous germline mutation was detected in the 11th exon of the FLCN gene.

Conclusion: While potential organ donors are generally healthy and asymptomatic individuals, incidental lesions can be detected in the donor organ or other organs in the examination area during radiological imaging. Although most incidental lesions are benign, important clinical conditions can rarely be observed, as in our case. Familial and syndromic conditions should also be considered for the presence of solid renal masses incidentally detected at a young age. To the best of our knowledge, this is the first reported case of BHDS in English literature who was diagnosed incidentally on computed tomography for being a living liver donor.

Keywords: Birt-Hogg-Dubé syndrome, FLCN gene, lung cysts, renal cell cancer, computed tomography, living liver donor.

Graphical Abstract
[1]
Birt AR, Hogg GR, Dubé WJ. Hereditary multiple fibrofolliculomas with trichodiscomas and acrochordons. Arch Dermatol 1977; 113(12): 1674-7.
[http://dx.doi.org/10.1001/archderm.1977.01640120042005] [PMID: 596896]
[2]
Hasumi H, Baba M, Hasumi Y, Furuya M, Yao M. Birt-Hogg- Dubé syndrome: Clinical and molecular aspects of recently identified kidney cancer syndrome. Int J Urol 2016; 23(3): 204-10.
[http://dx.doi.org/10.1111/iju.13015] [PMID: 26608100]
[3]
Toro JR, Glenn G, Duray P, et al. Birt-Hogg-Dubé syndrome: a novel marker of kidney neoplasia. Arch Dermatol 1999; 135(10): 1195-202.
[http://dx.doi.org/10.1001/archderm.135.10.1195] [PMID: 10522666]
[4]
Pagger RT, Akbari K, Fellner FA, Firmötz A. Secondary pneumothorax associated with Birt-Hogg-Dubé syndrome: a case report. Radiol Case Rep 2020; 15(9): 1464-7.
[http://dx.doi.org/10.1016/j.radcr.2020.05.049] [PMID: 32642019]
[5]
Balsamo F, Cardoso PAS, do Amaral Junior SA, et al. Birt-Hogg- Dubé syndrome with simultaneous hyperplastic polyposis of the gastrointestinal tract: case report and review of the literature. BMC Med Genet 2020; 21(1): 52.
[http://dx.doi.org/10.1186/s12881-020-0991-8] [PMID: 32171268]
[6]
Spring P, Fellmann F, Giraud S, Clayton H, Hohl D. Syndrome of Birt-Hogg-Dubé, a histopathological pitfall with similarities to tuberous sclerosis: a report of three cases. Am J Dermatopathol 2013; 35(2): 241-5.
[http://dx.doi.org/10.1097/DAD.0b013e318259b593] [PMID: 23542717]
[7]
O’Neill DC, Davis NF, Murray TÉ, Lee MJ, Little D, Morrin MM. Prevalence of Incidental Findings on Multidetector Computed Tomography in Potential Nephrectomy Donors: A Prospective Observational Study. Exp Clin Transplant 2019; 17(2): 177-82.
[http://dx.doi.org/10.6002/ect.2017.0340] [PMID: 30119619]
[8]
Ringe KI, Ringe BP, von Falck C, et al. Evaluation of living liver donors using contrast enhanced multidetector CT - The radiologists impact on donor selection. BMC Med Imaging 2012; 12: 21.
[http://dx.doi.org/10.1186/1471-2342-12-21] [PMID: 22828359]
[9]
Tan N, Charoensak A, Ajwichai K, et al. Prevalence of incidental findings on abdominal computed tomography angiograms on prospective renal donors. Transplantation 2015; 99(6): 1203-7.
[http://dx.doi.org/10.1097/TP.0000000000000486] [PMID: 25651306]
[10]
Berland LL, Silverman SG, Gore RM, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 2010; 7(10): 754-73.
[http://dx.doi.org/10.1016/j.jacr.2010.06.013] [PMID: 20889105]
[11]
Daccord C, Good JM, Morren MA, Bonny O, Hohl D, Lazor R. Birt-Hogg-Dubé syndrome. Eur Respir Rev 2020; 29(157): 200042.
[http://dx.doi.org/10.1183/16000617.0042-2020] [PMID: 32943413]
[12]
Menko FH, Johannesma PC, van Moorselaar RJ, et al. A de novo FLCN mutation in a patient with spontaneous pneumothorax and renal cancer; a clinical and molecular evaluation. Fam Cancer 2013; 12(3): 373-9.
[http://dx.doi.org/10.1007/s10689-012-9593-8] [PMID: 23264078]
[13]
Burkett A, Coffey N, Tomiak E, Voduc N. Recurrent spontaneous pneumothoraces and bullous emphysema. A novel mutation causing Birt-Hogg-Dube syndrome. Respir Med Case Rep 2016; 19: 106-8.
[http://dx.doi.org/10.1016/j.rmcr.2016.08.006] [PMID: 27642565]
[14]
Karaman E, Ufuk F, Demirci M, Yavaş HG. A Rrare cuse of recurrent spontaneous pneumothorax: Birt-hogg-dube syndrome. Turk Thorac J 2018; 19(3): 150-2.
[http://dx.doi.org/10.5152/TurkThoracJ.2018.17045] [PMID: 30083407]
[15]
Skolarus TA, Serrano MF, Berger DA, et al. The distribution of histological subtypes of renal tumors by decade of life using the 2004 WHO classification. J Urol 2008; 179(2): 439-43.
[http://dx.doi.org/10.1016/j.juro.2007.09.076] [PMID: 18076932]
[16]
Pavlovich CP, Grubb RL III, Hurley K, et al. Evaluation and management of renal tumors in the Birt-Hogg-Dubé syndrome. J Urol 2005; 173(5): 1482-6.
[http://dx.doi.org/10.1097/01.ju.0000154629.45832.30] [PMID: 15821464]
[17]
Pavlovich CP, Walther MM, Eyler RA, et al. Renal tumors in the Birt-Hogg-Dubé syndrome. Am J Surg Pathol 2002; 26(12): 1542-52.
[http://dx.doi.org/10.1097/00000478-200212000-00002] [PMID: 12459621]
[18]
Ardolino L, Silverstone E, Varjavandi V, Yates D. Birt-Hogg- Dubé syndrome presenting with macroscopic pulmonary cyst formation in a 15-year-old. Respirol Case Rep 2020; 8(6): e00610.
[http://dx.doi.org/10.1002/rcr2.610] [PMID: 32595975]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy