PIK3CA-related overgrowth spectrum
A group of disorders characterized by overgrowth and vascular anomalies
PIK3CA-related overgrowth spectrum (PROS) is a group of rare disorders caused by mutations in the PIK3CA gene. These disorders are characterized by abnormal growth and development of various tissues in the body, leading to a wide range of clinical manifestations. The PIK3CA gene plays a crucial role in the PI3K/AKT/mTOR pathway, which is involved in cell growth, proliferation, and survival.
Genetics
The PIK3CA gene provides instructions for making a protein that is part of the phosphatidylinositol 3-kinase (PI3K) enzyme. This enzyme is involved in signaling pathways that regulate cell growth and division. Mutations in the PIK3CA gene lead to overactivation of the PI3K/AKT/mTOR pathway, resulting in uncontrolled cell growth and the development of overgrowth syndromes.
Clinical Features
Individuals with PIK3CA-related overgrowth spectrum can present with a variety of symptoms, which may include:
- Asymmetric overgrowth of limbs or other body parts
- Vascular malformations, such as capillary malformations or venous malformations
- Skin abnormalities, including epidermal nevi
- Neurological issues, such as developmental delay or seizures
- Skeletal abnormalities, including scoliosis or limb length discrepancies
The severity and combination of symptoms can vary widely among affected individuals, even within the same family.
Diagnosis
Diagnosis of PIK3CA-related overgrowth spectrum is based on clinical evaluation and genetic testing. Genetic testing can identify mutations in the PIK3CA gene, confirming the diagnosis. Imaging studies, such as MRI or CT scans, may be used to assess the extent of overgrowth and vascular anomalies.
Management
Management of PIK3CA-related overgrowth spectrum is multidisciplinary and may involve:
- Surgical interventions to correct or manage overgrowth and vascular anomalies
- Physical therapy to improve mobility and function
- Medications to manage symptoms, such as sirolimus for vascular anomalies
- Regular monitoring and follow-up to address complications and assess growth
Prognosis
The prognosis for individuals with PIK3CA-related overgrowth spectrum varies depending on the severity of the condition and the specific symptoms present. Early diagnosis and appropriate management can improve outcomes and quality of life for affected individuals.
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Contributors: Prab R. Tumpati, MD