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      Non-Oncological Neuroradiological Manifestations in NF1 and Their Clinical Implications

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          Abstract

          Simple Summary

          Central nervous system involvement (CNS) is a common finding in Neurofibromatosis type 1 (NF1). Beside tumor-related manifestations, NF1 is also characterized by a wide spectrum of CNS alterations with variable impacts on functioning and life quality. Here, we propose an overview of non-oncological neuroradiological findings in NF1, with an insight on pathophysiological and embryological clues for a better understanding of the development of these specific alterations.

          Abstract

          Neurofibromatosis type 1 (NF1), the most frequent phakomatosis and one of the most common inherited tumor predisposition syndromes, is characterized by several manifestations that pervasively involve central and peripheral nervous system structures. The disorder is due to mutations in the NF1 gene, which encodes for the ubiquitous tumor suppressor protein neurofibromin; neurofibromin is highly expressed in neural crest derived tissues, where it plays a crucial role in regulating cell proliferation, differentiation, and structural organization. This review article aims to provide an overview on NF1 non-neoplastic manifestations of neuroradiological interest, involving both the central nervous system and spine. We also briefly review the most recent MRI functional findings in NF1.

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          Clinical and genetic aspects of neurofibromatosis 1.

          Neurofibromatosis 1 is an autosomal dominant disorder characterized by multiple café-au-lait spots, axillary and inguinal freckling, multiple cutaneous neurofibromas, and iris Lisch nodules. Learning disabilities are present in at least 50% of individuals with neurofibromatosis 1. Less common but potentially more serious manifestations include plexiform neurofibromas, optic nerve and other central nervous system gliomas, malignant peripheral nerve sheath tumors, scoliosis, tibial dysplasia, and vasculopathy. The diagnosis of neurofibromatosis 1 is usually based on clinical findings. Neurofibromatosis 1, one of the most common Mendelian disorders, is caused by heterozygous mutations of the NF1 gene. Almost one half of all affected individuals have de novo mutations. Molecular genetic testing is available clinically but is infrequently needed for diagnosis. Disease management includes referral to specialists for treatment of complications involving the eye, central or peripheral nervous system, cardiovascular system, spine, or long bones. Surgery to remove both benign and malignant tumors or to correct skeletal manifestations is sometimes warranted. Annual physical examination by a physician familiar with the disorder is recommended. Other recommendations include ophthalmologic examinations annually in children and less frequently in adults, regular developmental assessment in children, regular blood pressure monitoring, and magnetic resonance imaging for follow-up of clinically suspected intracranial and other internal tumors.
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            NF1 tumor suppressor gene function: narrowing the GAP.

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              Neurofibromatosis type 1: a multidisciplinary approach to care.

              Neurofibromatosis type 1 is a relatively common inherited disorder. Patients have a high predisposition to develop both benign and malignant tumours. Although many manifestations of neurofibromatosis type 1 affect the nervous system, other organs and tissues can also be affected. Because of the varying features and clinical heterogeneity inherent to this disorder, patients can present to different medical and surgical specialists and, therefore, the association of clinical symptoms with neurofibromatosis type 1 might not be appreciated. Thus, for prompt diagnosis and to provide optimum care for patients with neurofibromatosis type 1, clinicians must be aware of the diverse clinical features of this disorder. We advocate a multidisciplinary approach to care, entailing a dedicated team of specialists throughout the lifetime of the patient. As our understanding of this disorder deepens through basic laboratory and clinical investigations, swift implementation of new effective treatments becomes feasible.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Cancers (Basel)
                Cancers (Basel)
                cancers
                Cancers
                MDPI
                2072-6694
                12 April 2021
                April 2021
                : 13
                : 8
                : 1831
                Affiliations
                [1 ]Department of Electrical Engineering and Information Technology (DIETI), University of Naples “Federico II”, 80125 Naples, Italy
                [2 ]Pediatric Neuroradiology Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; c.russo@ 123456santobonopausilipon.it (C.R.); d.cascone@ 123456santobonopausilipon.it (D.C.); f.mazio@ 123456santobonopausilipon.it (F.M.); e.covelli@ 123456santobonopausilipon.it (E.M.C.)
                [3 ]Neurofibromatosis Referral Center, Department of Woman, Child, General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; claudia.santoro@ 123456unicampania.it
                [4 ]Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
                [5 ]Pediatric Neurosurgery Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; g.cinalli@ 123456santobonopausilipon.it
                Author notes
                [* ]Correspondence: camilla.russo@ 123456unina.it ; Tel.: +39-333-7050711
                Author information
                https://orcid.org/0000-0002-7522-2711
                https://orcid.org/0000-0002-7797-8483
                Article
                cancers-13-01831
                10.3390/cancers13081831
                8070534
                33921292
                34c07475-fe8d-4572-b7b7-d83c6be6b7da
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 28 February 2021
                : 06 April 2021
                Categories
                Review

                phakomatosis,neurofibromatosis type 1,central nervous system,spine,computed tomography,magnetic resonance imaging

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