Sindrome di Gorlin OMIM 109400

Sindrome di Gorlin   OMIM 109400


La sindrome di Gorlin o del Carcinoma Nevo Basocellulare (NBCCS) è una malattia autosomica dominante a penetranza completa ed espressività variabile, dovuta a mutazioni del gene PTCH1 che mappa in 9q22.3. 
La sindrome è caratterizzata da una serie di anomalie dello sviluppo e dalla predisposizione a sviluppare tumori di vario tipo. 
Le manifestazioni più frequenti sono : 
  • carcinomi basocellulari, 
  • cheratocisti odontogenetiche, 
  • Pits palmo-plantari (sono fossette poco profonde presenti nell'87% dei casi), 
  • calcificazioni falce cerebrale (presenti nel 90% dei casi), 
  • anomalie cranio-facciali (macrocrania con bozze frontali prominenti, fronte alta e larga, naso a sella, ipertelorismo). 
Manifestazioni meno frequenti sono: 
  • labiopalatoschisi, 
  • anomalie oculari, 
  • neoplasie (medulloblastoma, meningioma, fibroma cardiaco), 
  • fibromi e cisti ovariche. 
La diagnosi prenatale è difficilissima, i segni ecografici da ricercare sono: 
  1. ventricolomegalia, 
  2. anomalie facciali (bozze frontali, ipertelorismo, naso a sella), 
  3. macrocefalia, 
  4. tumori multipli. 
Essendo trasmessa con carattere autosomico dominante a penetranza completa, il 70/80% dei casi eredita il gene mutato da un genitore; il 20/30% è dovuto a mutazioni de novo. Il test molecolare può quindi essere proposto laddove sia nota la mutazione causale presente in consanguinei; l'assenza di mutazioni nei genitori orienta verso un verosimile caso sporadico dovuto quindi a mutazioni de novo. 

Bibliografia
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