Maffucci Syndrome

Maffucci Syndrome

National Organization for Rare Disorders, Inc.

Important

It is possible that the main title of the report Maffucci Syndrome is not the name you expected.

Disorder Subdivisions

  • None

General Discussion

Maffucci syndrome is an extremely rare disorder characterized by benign overgrowths of cartilage (enchondromas), skeletal deformities and skin lesions composed of abnormal blood vessels. Enchondromas arise in bones, most frequently in the hands and feet and less often in the legs and long bones of the arm.

Symptoms

Maffucci syndrome is not seen at birth. Lesions usually develop early in childhood, most often between 1-5 years of age. The severity of the disorder is variable. Some patients have a very mild course, whereas others can develop serious complications.



The first sign of Maffucci syndrome is usually the growth of an enchondroma in a long bone. Enchondromas distort and weaken the affected bones, thus presentation with a pathologic fracture is common. These cartilaginous tumors cause bulging of the bones, bowing of the arms and legs, and often disproportionate (asymmetric) growth (different lengths of the arms or legs). The patient may exhibit short stature in adulthood. Enchondromas only affect one side of the body in approximately 40 per cent of patients.



Vascular lesions on the skin also usually appear in early childhood (around 4-5 years of age) and are often progressive. These lesions do not necessarily occur near the bones that have enchondromas. These vascular lesions begin as compressible, round, bluish spots. In time, they become firm, knotty, warty, and often contain calcium stones (phleboliths). The hand is the most common location; however vascular lesions can also occur in internal structures, such as the membranes that cover the brain and spinal cord (meninges), the tongue and the oral mucosa.



These vascular lesions used to be called "cavernous hemangiomas". Microscopic studies have shown that they are comprised of abnormally-formed veins so that the more modern term is "venous malformation." A benign vascular tumor, designated as "spindle cell hemangioma," often arises in these malformed veins.



Patients with Maffucci syndrome are at risk to developing a malignant tumor, particularly a tumor of cartilage known as "chondrosarcoma." The more enchondromas, the higher the risk of malignancy. The frequency has been estimated to be between 15-40 per cent; however, some investigators believe that chondrosarcoma in Maffucci is over-reported. Less frequently, other malignant, non-skeletal connective tissue neoplasms can occur in patients with Maffucci syndrome.

Causes

In 2011, the cause of Maffucci syndrome was discovered to be a mutation in a gene known as IDH1 (rarely IDH2). The same mutations were found in the related disorder Ollier disease. Since the defect occurs after fertilization (called a somatic mutation), Maffucci syndrome is not considered to be hereditary, that is, it cannot be passed along in a family. The cases occur randomly and there are no known pedigrees of affected family members.

Affected Populations

Maffucci syndrome occurs in all ethnic groups and equally affects both sexes.

Standard Therapies

Diagnosis

The diagnosis of Maffucci syndrome is made by a detailed history, thorough physical examination and radiologic assessment. Surgical removal and microscopic study of the bony lesions confirm the presence of enchondroma and distinguish the tumor from chondrosarcoma.



Treatment

Management of Maffucci syndrome is focused on the specific signs/symptoms in the particular affected individual. No intervention is needed for asymptomatic patients.

Treatment requires coordinated efforts of a team of specialists (multidisciplinary care).



The warty (verrucous) vascular lesions can be injected with a drug that shrinks and hardens the area (sclerosing agent); however, often surgical removal is also needed. Enchondromas can be surgically removed (resected) if necessary. A specialist in hand surgery is needed to correct the skeletal abnormalities of the hand that cause loss of function or recurrent fracture. An orthopedic surgeon addresses leg length discrepancy, abnormal curvature of the spine (scoliosis) or other skeletal abnormalities.



A patient with Maffucci syndrome should be regularly monitored because of the risk of malignant transformation of an enchondroma or development of a tumor elsewhere.

If a malignancy does not occur, patients with Maffucci syndrome have an otherwise normal life expectancy.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.



For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com



Contact for additional information about Maffucci syndrome:



John B. Mulliken, MD,

Co-Director, Vascular Anomalies Center

Director, Craniofacial Centre

Boston Children's Hospital

300 Longwood Avenue

Boston, MA 02115

617-355-7686

References

TEXTBOOKS

Biesecker LG. Proteus syndrome. In: Cassidy SB, Allanson JE, editors. Management of Genetic Syndromew. New York, NY: Wiley; 2005: 449-456.



Biesecker L. Proteus Syndrome. NORD Guide to Rare Disorders. Philadelphia, PA: Lippincott Williams & Wilkins; 2003:239.



JOURNAL ARTICLES

Pansuriza TC, van Eijk R, D'Amato P, et al. Somatic mosaic IDH1 and IDH2 mutationis are associated with enchondromas and spindle cell hemangioma in Ollier disease and Maffucci syndrome. Nature Genet. 2011;43:1256-61.



Amary MF, Damato S, Halai D. Ollier disease and Maffucci syndrome are caused by somatic mutations in IDH1 and IDH1. Nature Genet 2011; 43:1262-65.



Couvineau A, Wouters V, Bertrand G, et al. PTHR1 mutations associated with Ollier disease result in receptor loss of function. Hum Mol Genet. 2008;17:2766-75.



INTERNET

Kuwahara RT, Rasberry R. Maffucci Syndrome. Emedicine. http://emedicine.medscape.com/article/1111804-overview. Updated March 28, 2012. Accessed July 12, 2012.



Online Mendelian Inheritance in Man (OMIM). The Johns Hopkins University. Enchondromatosis, Multiple, Ollier Type. Entry No: 166000. Last Edited April 17, 2012. Available at: http://www.ncbi.nlm.nih.gov/omim/. Accessed July 12, 2012.

Resources

NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases

Information Clearinghouse

One AMS Circle

Bethesda, MD 20892-3675

USA

Tel: (301)495-4484

Fax: (301)718-6366

Tel: (877)226-4267

TDD: (301)565-2966

Email: NIAMSinfo@mail.nih.gov

Internet: http://www.niams.nih.gov/



NIH/National Heart, Lung and Blood Institute

P.O. Box 30105

Bethesda, MD 20892-0105

Tel: (301)592-8573

Fax: (301)251-1223

Email: nhlbiinfo@rover.nhlbi.nih.gov

Internet: http://www.nhlbi.nih.gov/



Rare Cancer Alliance

1649 North Pacana Way

Green Valley, AZ 85614

USA

Internet: http://www.rare-cancer.org



Genetic and Rare Diseases (GARD) Information Center

PO Box 8126

Gaithersburg, MD 20898-8126

Tel: (301)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223

Internet: http://rarediseases.info.nih.gov/GARD/



Madisons Foundation

PO Box 241956

Los Angeles, CA 90024

Tel: (310)264-0826

Fax: (310)264-4766

Email: getinfo@madisonsfoundation.org

Internet: http://www.madisonsfoundation.org



For a Complete Report

This is an abstract of a report from the National Organization for Rare Disorders, Inc.® (NORD). Cigna members can access the complete report by logging into myCigna.com. For non-Cigna members, a copy of the complete report can be obtained for a small fee by visiting the NORD website. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational treatments (if available), and references from medical literature. For a full-text version of this topic, see http://www.rarediseases.org/search/rdblist.html.

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