Summary:
Neurofibromatosis von Recklinghausen type 1 (NF1) is the most frequent disease from the group of
neurocutaneous syndromes, resulting from disturbances of tissue differentiation (primarily neuroectoderm).
NF1 has autosomal dominant inheritance, with a 40–50 % incidence of new mutations and
prevalence in the population 1:3000–4000. The gene is localized on chromosome17 (17q11.2), its product
neurofibromin reduces cell proliferation through acceleration of hydrolysis of the active GTP-Ras to
inactive GDP-Ras and so plays a role of a negative growth regulator and tumor suppressor. Loss of
neurofibromin in the Schwann cell leads to accelerated proliferation of this cell (together with
influencing proliferation of fibroblasts and mastocytes) and to tumor generation. Diagnosis of NF1 is
determined using the following diagnostic criteria: café au lait spots, axillar and/or inguinal freckling,
neurofibromas and/or plexiform neurofibroma, optic glioma, Lisch nodules, characteristic bone lesions
(sphenoidal dysplasia, anomaly of long bones), first-degree relative with a confirmed diagnosis of NF1.
To make diagnosis of NF1, it is necessary to fulfill at least two diagnostic criteria. Among other typical
clinical findings in NFl, there are hypersignal foci in T2-weighted brain MR images, microcephaly,
scoliosis, small stature, specific developmental disorders of learning, disorders of attention and behavior,
systemic hypertension with fibromuscular dysplasia of renal arteries. Endocrinologic disturbances
arc less frequent, rarely, ischemic strokes occur when cerebral vasculature is affected. Neoplastic
processes are usually benign, malignant transformation is described in 2–6 % of cases. Therapy is
primarily symptomatic, in progressive lesions also surgical, in malignant tumors oncological. Regime
and education precautions are significant in specific developmental disorders. Prenatal diagnostics is
currently possible using indirect DNA analysis in informative families, direct DNA analysis is being
developed.
Key words:
neurofibromatosis von Recklinghausen type 1, neurofibromin, diagnostic criteria, clinical
findings
|