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Noonan Syndrome-Like Disorder with Juvenile Myelomonocytic Leukemia

CBL Syndrome


Presentation

  • CLINICAL REPORT: A 7-year-old boy presented with unexplained splenomegaly, attention deficit hyperactivity disorder, mild learning difficulties, easy bruising, mild thrombocytopenia, and subtle dysmorphic features.[eunetworkadultadhd.com]
  • Acronym NSLL Any medical or genetic information present in this entry is provided for research, educational and informational purposes only.[uniprot.org]
  • We present a patient with JMML who developed moyamoya disease and neovascular glaucoma. Our patient exhibited a Noonan syndrome-like phenotype. Genetic analysis revealed acquired isodisomy and a germline heterozygous mutation in CBL.[pubfacts.com]
  • Hypertrophic cardiomyopathy (obstructive or nonobstructive type) is present in up to 30% of patients and can present at birth or in infancy or childhood.[misc.medscape.com]
  • Both twins presented with somatic aberrations of chromosome 7 and mutations in PTPN11.[clinmedjournals.org]
Regurgitation
  • […] fissures ; Epicanthus ; Fine hair ; Frontal bossing ; Generalized hypotonia ; Global developmental delay ; Hypertelorism ; Joint hypermobility ; Joint laxity ; Juvenile myelomonocytic leukemia ; Long philtrum ; Low-set ears ; Lymphedema ; Macrotia ; Mitral regurgitation[mousephenotype.org]
Piebaldism
  • […] mastocytosis Chronic myelomonocytic leukemia Classic mast cell leukemia Cutaneous mastocytoma Isolated bone marrow mastocytosis Lymphoadenopathic mastocytosis with eosinophilia Myeloid neoplasm associated with PDGFRB rearrangement Nodular urticaria pigmentosa Piebaldism[csbg.cnb.csic.es]
Pachyonychia
  • Juvenile myelomonocytic leukemia Precursor B-cell acute lymphoblastic leukemia Epidermolytic palmoplantar keratoderma Pachyonychia congenita Precursor T-cell acute lymphoblastic leukemia Familial idiopathic steroid-resistant nephrotic syndrome with focal[csbg.cnb.csic.es]
Macrotia
  • […] palpebral fissures ; Epicanthus ; Fine hair ; Frontal bossing ; Generalized hypotonia ; Global developmental delay ; Hypertelorism ; Joint hypermobility ; Joint laxity ; Juvenile myelomonocytic leukemia ; Long philtrum ; Low-set ears ; Lymphedema ; Macrotia[mousephenotype.org]
Frontal Bossing
  • bossing Hypertelorism Long philtrum Thick vermilion border Triangular face Abnormality of limbs ... ...[familydiagnosis.com]
  • […] dominant inheritance ; Bicuspid aortic valve ; Cafe-au-lait spot ; Chylothorax ; Cryptorchidism ; Cubitus valgus ; Deep philtrum ; Delayed speech and language development ; Depressed nasal bridge ; Downslanted palpebral fissures ; Epicanthus ; Fine hair ; Frontal[mousephenotype.org]
Widely Spaced Nipples
  • Clinical features are highly variable, including facial dysmorphism, short neck, developmental delay, hyperextensible joints and thorax abnormalities with widely spaced nipples.[uniprot.org]
Withdrawn
  • […] symbols: CBL2, RNF55, c-Cbl ) Mouse Orthologs Cbl (Withdrawn symbols: 4732447J05Rik, Cbl-2, cbl ) Source OMIM:613563 (names, synonyms, disease associated genes), Orphanet (disease classes), HGNC, Ensembl, MGI (gene symbols, gene orthology) HPO (phenotypes[mousephenotype.org]
Delayed Speech and Language Development
  • speech and language development ; Depressed nasal bridge ; Downslanted palpebral fissures ; Epicanthus ; Fine hair ; Frontal bossing ; Generalized hypotonia ; Global developmental delay ; Hypertelorism ; Joint hypermobility ; Joint laxity ; Juvenile[mousephenotype.org]

Workup

  • Moreover, before any patient with Noonan syndrome can undergo a surgical procedure, a full hematologic workup must be performed. If full phenotypic expression is not apparent, karyotyping may be necessary.[misc.medscape.com]
  • There is no recommendation for tumor surveillance at this time, but clinical vigilance and workup of potential tumor-related symptoms, especially for NBL, are suggested ( 61, 65 ).[clincancerres.aacrjournals.org]
  • […] pallor, fever and skin rash, peripheral blood monocyte counts 1x109/L, bone marrow blast counts 20% and the absence of BCR-ABL1 rearrangements are usually indicative of JMML [2], yet diagnosis can be established with certainty only after laboratory workup[clinmedjournals.org]
  • Clinical Testing and Workup A complete blood count (CBC) can be taken to evaluate the size, number, and maturity of blood cells. In JMML, the CBC frequently reveals high levels of white blood cells and low levels of red blood cells and platelets.[rarediseases.org]

Treatment

  • See also the following treatment articles: Treatments for Noonan syndrome Treatments for Juvenile myelomonocytic leukemia Causes See also causal information: Causes of Noonan syndrome Causes of Juvenile myelomonocytic leukemia Similar Topic Articles[familydiagnosis.com]
  • It is not in any way intended to be used as a substitute for professional medical advice, diagnosis, treatment or care. Our staff consists of biologists and biochemists that are not trained to give medical advice .[uniprot.org]
  • Features sweeping content updates throughout, including basic science research which serves as a foundation for modern hematology, recent advances in stem cell transplantation, clinical advances in the treatment of each of the hematologic malignancies[books.google.de]
  • The final chapter covers the critical area of treatment including prospects emerging from an improved understanding of the pathophysiology of these disorders.[books.google.de]
  • […] photographs of normal and abnormal skin conditions including images of rare conditions, this easily accessible resource is essential for pediatricians, neonatologists, and dermatologists as well as other healthcare professionals involved in the diagnosis and treatment[books.google.com]

Prognosis

  • Prognosis [ edit ] Prognosis refers to how well a patient is expected to respond to treatment based on their individual characteristics at time of diagnosis.[en.wikipedia.org]
  • Detailed discussion of the specific treatment and prognosis of each RASopathy can be found in the individual articles (see above). Related Radiopaedia articles Promoted articles (advertising)[radiopaedia.org]
  • Prognosis Adverse factors include: Age at diagnosis: 2 years or more High fetal hemoglobin level at diagnosis Platelet count below 33,000/mm3 at diagnosis (considered to be the strongest indicator of prognosis).[78stepshealth.us]
  • Subclonal mutations in SETBP1 confer a poor prognosis in juvenile myelomonocytic leukemia. Blood. 2015;125:516-524. Cseh A, Niemeyer CM, Yoshimi A, et al.[hematology.org]
  • At the beginning, the prognosis looked good. We remember optimistic words from doctors like, “He looks great! This all will probably clear up on its own.”[stbaldricks.org]

Etiology

  • Publication type, MeSH terms Publication type Review MeSH terms Humans Leukemia, Myelomonocytic, Chronic/classification* Leukemia, Myelomonocytic, Chronic/diagnosis Leukemia, Myelomonocytic, Chronic/drug therapy Leukemia, Myelomonocytic, Chronic/etiology[ncbi.nlm.nih.gov]
  • RIT1 represents a minor etiology for NS, explaining about 3% of cases.[nature.com]

Epidemiology

  • Epidemiological studies from Denmark and British Columbia show a JMML incidence of 1.2 cases per million children per year. A lower incidence of 0.6 cases per million children per year has been reported in the United Kingdom.[jmmlfoundation.org]
  • Juvenile Myelomonocytic Leukemia Last Updated on Tue, 20 Sep 2016 Bone Marrow Epidemiology Incidence: 1.2 per million children per year Median age at diagnosis: 1.8 years; 35% below 1 year of age, and only 4% above 5 years of age Male:female ratio of[78stepshealth.us]
  • EPIDEMIOLOGY Noonan syndrome is characterized by marked variable expressivity, which makes it difficult to identify mildly affected individuals. The overall incidence is believed to be between 1/1000 and 1/2500 live births.[flipper.diff.org]
  • References Epidemiology Frequency United States The incidence of Noonan syndrome is estimated to be 1 case per 1000 to 1 case per 2500 live births. International The incidence of Noonan syndrome appears to be consistent worldwide.[misc.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • The final chapter covers the critical area of treatment including prospects emerging from an improved understanding of the pathophysiology of these disorders.[books.google.de]
  • Skeletal, neurologic, genitourinary, lymphatic, eye, and skin findings may be present to varying degrees. [1, 2] References Pathophysiology The pathophysiology of Noonan syndrome is not fully understood but is associated with mutations in genes that are[misc.medscape.com]
  • The first clue to this pathophysiology was the identification of gain-of-function mutations in the PTPN11 gene (OMIM 176876) in 40% of NS patients. 6 Several other genes involved in the RAS/MAPK cascade were later found to explain smaller subgroups of[nature.com]

Prevention

  • It’s important to understand that there’s nothing you could have done or avoided doing that would have prevented your child’s cancer from developing.[danafarberbostonchildrens.org]
  • After bone marrow transplant, reducing ongoing immunosuppressive therapy has worked successfully to reverse the course of a bone marrow with a dropping donor percentage [ clarification needed ] and to prevent a relapse.[en.wikipedia.org]
  • For example, antibiotics may be given to help prevent or fight infections. Investigational Therapies Targeted therapies are being studied for the treatment of children with JMML.[rarediseases.org]
  • Finally, cancer prevention strategies remain an objective for future research. Disclosure of Potential Conflicts of Interest No potential conflicts of interest were disclosed. Received March 3, 2017. Revision received April 24, 2017.[clincancerres.aacrjournals.org]
  • References Deterrence/Prevention If a causative mutation is found in patients, parental studies should be offered in order to distinguish familial cases from sporadic ones.[misc.medscape.com]

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