Cranial irradiation in childhood mimicking neurofibromatosis type II

Am J Med Genet A. 2017 Jun;173(6):1635-1639. doi: 10.1002/ajmg.a.38211. Epub 2017 Apr 19.

Abstract

Neurofibromatosis type II (NF2) is a genetic disease characterized by bilateral vestibular schwannomas (VS) and other nerve system tumors. However, such tumors may be associated with environmental, rather than a genetic, etiology. Individuals fulfilling the clinical criteria of NF2 who had been treated by head ionized irradiation at a young age were compared for disease characteristics and molecular analysis with non-irradiated sporadic NF2 cases. In the study cohort, three of 33 sporadic adult cases fulfilling NF2 diagnostic criteria had a history of early age cranial irradiation exposure. None of the irradiated patients had bilateral VS compared with 73.3% of the non-irradiated individuals. One of the irradiated patients had no VS, while none of the non-irradiated NF2 cases had absence of VS. All of the irradiated individuals had brain meningiomas and thyroid tumors compared with 47% and 0%, respectively, of the non-irradiated individuals. Molecular analyses for NF2 mutations in blood of the irradiated individuals failed to detect disease-causing mutations. This study suggest that environmental factors may mimic NF2. Identifying such non-genetic cases fulfilling clinical criteria of the genetic disease may be crucial for the purposes of genetic counseling and patient management.

Keywords: NF2; neurofibromatosis type II; radiation; tinea capitis; vestibular schwannoma.

MeSH terms

  • Adult
  • Cranial Irradiation / adverse effects*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurofibromatosis 2 / etiology
  • Neurofibromatosis 2 / genetics*
  • Neurofibromatosis 2 / physiopathology
  • Neurofibromin 2 / genetics*
  • Radiation, Ionizing
  • Vestibular Nucleus, Lateral / physiopathology

Substances

  • Neurofibromin 2