Rare Diseases: Cowden Syndrome
Saturday, October 30, 2010
Cowden Syndrome is a rare hereditary condition characterized by multiple noncancerous nodules called hamartomas and an increased risk of certain forms of cancer. It is also known as Cowden's disease or Multiple hamartoma syndrome and was named after the family in which it was first reported. The disease can be difficult to diagnose and the exact prevalence is unknown, but it is thought it occurs in 1 in 200,000 people. Cowden disease is caused in more than 80% of cases by mutations in the PTEN (phosphatase and tensin homolog) tumor suppressor gene. The mutations prevent the PTEN protein from effectively regulating cell survival and division, which can lead to the formation of tumors. Approximately 18% of patients are negative for PTEN mutations and what causes the disease in these cases is yet unknown.
The onset of clinical manifestations varies in age, ranging from birth to age 46 years. Signs and symptoms for Cowden's syndrome include: breast cancer, thyroid cancer, meningioma, café au lait spots (macules of a light brown color located on the skin), small skin bumps on the face, uterine (endometrial) cancer, goiters, polyposis in the gastrointestinal tract, mental retardation, enlarged head, skin lumps, mucous membrane lumps and Lhermitte - Duclos disease (noncancerous brain tumor). Almost every person with Cowden syndrome develops hamartomas. The cutaneous manifestations of the disease are similar in both sexes, but the incidence of malignancies varies depending on the sex: females are more likely to develop breast cancer and males are at greater risk for thyroid cancer.
Almost 50% of Cowden disease patients have at least 1 malignant primary tumor. If detected early, many of the cancers are curable. Because of the complex nature of the disease patients are usually managed by a multidisciplinary team including surgeon, endocrinologist, gynecologist, dermatologist and neurologist. Systemic therapy with retinoids can temporarily control some of the cutaneous lesions of Cowden disease. The effect of Rapamycin (Sirolimus), an immunosuppressant drug usually used to prevent rejection in organ transplantation, on syndromes with PTEN mutations is currently being studied.

















































