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Evaluation of Clinical Findings and NF1 Genetic Variants in Patients Diagnosed with Neurofibromatosis Type 1: A Single-Center Experience

Year 2025, Volume: 7 Issue: 3, 314 - 322, 13.10.2025
https://doi.org/10.52827/hititmedj.1624747

Abstract

Objective: Neurofibromatosis type 1 (NF1) is a common neurocutaneous syndrome with multisystemic involvement that facilitates tumour formation. The aim of this study was to evaluate the demographic and clinical characteristics as well as genetic results of pediatric patients diagnosed with neurofibromatosis type 1.

Materials and Methods: This retrospective, cross-sectional descriptive study included 23 patients. Main disease criteria, clinical features, and genetic results obtained using next-generation sequencing and multiple-ligation probe amplification techniques were recorded. Information on zygosity, mutation types, variant positions, ACMG classification and inheritance models were analysed.

Results: Café-au-lait spots were present in all patients. Inguinal/axillary freckling was the second most common finding seen in 60.9% of patients. Lisch nodules were observed in patients older than six years, whereas choroidal abnormalities were common in younger patients. Optic glioma was found in 13% of patients and cutaneous neurofibromas in 21.7% of patients, which is lower than that observed in adult patients. Focal signal intensity image was more common in patients with cognitive impairment (OR: 4.50, CI 95% 0.659-30.715, p=0.02). Epilepsy was diagnosed in two patients and treated with a single drug. Macrocephaly (30.4%) was the most common cranial deformity. Missense mutations (43.5%) were the most common, while one frameshift novel mutation (c.6771del. K2257Nfs*8) was identified.

Conclusion: The emergence of new genetic technologies and advances in health care may facilitate earlier diagnosis of neurofibromatosis and the prediction and treatment of complications that may develop.

Ethical Statement

This study was approved by Ethics committee of Samsun University Clinical Research (Approval number: GOKAEK/2024/12/6, Date: 01.07.2024).

Supporting Institution

None

Thanks

We would like to express our gratitude to all our colleagues who contributed to this study, as well as to our esteemed patients and their families.

References

  • Ly KI, Blakeley JO. The Diagnosis and Management of Neurofibromatosis Type 1. Med Clin North Am. 2019;103(6):1035-1054.
  • Kehrer-Sawatzki H, Cooper DN. Challenges in the diagnosis of neurofibromatosis type 1 (NF1) in young children facilitated by means of revised diagnostic criteria including genetic testing for pathogenic NF1 gene variants. Hum Genet. 2022;141(2):177-191.
  • Cimino PJ, Gutmann DH. Neurofibromatosis type 1. Handb Clin Neurol. 2018; 148:799-811.
  • Legius E, Messiaen L, Wolkenstein P, et al. Revised diagnostic criteria for neurofibromatosis type 1 and Legius syndrome: an international consensus recommendation. Genet Med. 2021;23(8):1506-1513.
  • Jett K, Friedman JM. Clinical and genetic aspects of neurofibromatosis 1. Genet Med. 2010;12(1):1-11.
  • Sabatini C, Milani D, Menni F, Tadini G, Esposito S. Treatment of neurofibromatosis type 1. Curr Treat Options Neurol. 2015;17(6):355.
  • Abdel-Aziz N, Y El-Kamah G, A Khairat R, et al. Mutational spectrum of NF1 gene in 24 unrelated Egyptian families with neurofibromatosis type 1. Mol Genet Genomic Med. 2021;9(12): e1631.
  • Mao B, Chen S, Chen X, et al. Clinical characteristics and spectrum of NF1 mutations in 12 unrelated Chinese families with neurofibromatosis type 1. BMC Med Genet. 2018;19(1):101.
  • Viskochil D, Buchberg AM, Xu G, et al. Deletions and a translocation interrupt a cloned gene at the neurofibromatosis type 1 locus. Cell. 1990;62(1):187-192.
  • Jafry M, Sidbury R. RASopathies. Clin Dermatol. 2020;38(4):455-461.
  • Anderson JL, Gutmann DH. Neurofibromatosis type 1. Handb Clin Neurol. 2015; 132:75-86.
  • Mudau MM, Dillon B, Smal C, et al. Mutation analysis and clinical profile of South African patients with Neurofibromatosis type 1 (NF1) phenotype. Front Genet. 2024; 15:1331278.
  • Mautner VF, Kluwe L, Friedrich RE, et al. Clinical characterization of 29 neurofibromatosis type-1 patients with molecularly ascertained 1.4 Mb type-1 NF1 deletions. J Med Genet. 2010;47(9):623-630.
  • Jha SK, Mendez MD. Cafe Au Lait Macules. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 31, 2023.
  • Lalvani S, Brown RM. Neurofibromatosis Type 1: Optimizing Management with a Multidisciplinary Approach. J Multidiscip Healthc. 2024; 17:1803-1817.
  • Pinti E, Nemeth K, Staub K, Lengyel A, Fekete G, Haltrich I. Diagnostic difficulties and possibilities of NF1-like syndromes in childhood. BMC Pediatr. 2021;21(1):331.
  • Târtea AE, Mocanu CL, Ștefănescu Dima AȘ, et al. Neurofibromatosis Type 1-Retinal Alterations Detectable with Optical Coherence Tomography Angiography. Diagnostics (Basel). 2024;14(13):1447.
  • Landry JP, Schertz KL, Chiang YJ, et al. Comparison of Cancer Prevalence in Patients with Neurofibromatosis Type 1 at an Academic Cancer Center vs in the General Population From 1985 to 2020. JAMA Netw Open. 2021;4(3):e210945.
  • Sur ML, Armat I, Sur G, et al. Neurofibromatosis in Children: Actually, and Perspectives. Children (Basel). 2022;9(1):40.
  • Sellmer L, Farschtschi S, Marangoni M, et al. Serial MRIs provide novel insight into natural history of optic pathway gliomas in patients with neurofibromatosis 1. Orphanet J Rare Dis. 2018;13(1):62.
  • Pannu AK, Sharma N. Neurofibromatosis type 1 and disseminated malignant peripheral nerve sheath tumor. QJM. 2017;110(9):583-584.
  • Peduto C, Zanobio M, Nigro V, Perrotta S, Piluso G, Santoro C. Neurofibromatosis Type 1: Pediatric Aspects and Review of Genotype-Phenotype Correlations. Cancers (Basel). 2023;15(4):1217.
  • Elefteriou F, Kolanczyk M, Schindeler A, et al. Skeletal abnormalities in neurofibromatosis type 1: approaches to therapeutic options. Am J Med Genet A. 2009;149A(10):2327-2338.
  • Leppävirta J, Kallionpää RA, Uusitalo E, et al. Neurofibromatosis type 1 of the child increases birth weight. Am J Med Genet A. 2019;179(7):1173-1183.
  • Chauvel-Picard J, Lion-Francois L, Beuriat PA, et al. Craniofacial bone alterations in patients with neurofibromatosis type 1. Childs Nerv Syst. 2020;36(10):2391-2399. doi:10.1007/s00381-020-04749-6
  • Naran S, Swanson JW, Ligh CA, Shubinets V, Taylor JA, Bartlett SP. Sphenoid Dysplasia in Neurofibromatosis: Patterns of Presentation and Outcomes of Treatment. Plast Reconstr Surg. 2018;142(4):518e-526e. doi:10.1097/PRS.0000000000004779
  • Clementi M, Milani S, Mammi I, Boni S, Monciotti C, Tenconi R. Neurofibromatosis type 1 growth charts. Am J Med Genet. 1999;87(4):317-323.
  • North KN, Riccardi V, Samango-Sprouse C, et al. Cognitive function and academic performance in neurofibromatosis. 1: consensus statement from the NF1 Cognitive Disorders Task Force. Neurology. 1997;48(4):1121-1127.
  • Eijk S, Mous SE, Dieleman GC, et al. autism spectrum disorder in an Unselected Cohort of Children with Neurofibromatosis Type 1 (NF1). J Autism Dev Disord. 2018;48(7):2278-2285.
  • Khair AM, Falchek S, Nikam R, Kaur G. Epilepsy and Electroencephalogram Characteristics in Children with Neurofibromatosis Type 1, What We Have Learned from a Tertiary Center Five Years' Experience. Child Neurol Open. 2022; 9: 2329048 X221131445.
  • Pinna V, Daniele P, Calcagni G, et al. Prevalence, Type, and Molecular Spectrum of NF1 Mutations in Patients with Neurofibromatosis Type 1 and congenital heart disease. Genes (Basel). 2019;10(9):675.
  • Mentzel HJ, Seidel J, Fitzek C, et al. Pediatric brain MRI in neurofibromatosis type I. Eur Radiol. 2005;15(4):814-822.
  • Denckla MB, Hofman K, Mazzocco MM, et al. Relationship between T2-weighted hyperintensities (unidentified bright objects) and lower IQs in children with neurofibromatosis-1. Am J Med Genet. 1996;67(1):98-102.
  • North K, Joy P, Yuille D, et al. Specific learning disability in children with neurofibromatosis type 1: significance of MRI abnormalities. Neurology. 1994;44(5):878-883.
  • Koczkowska M, Chen Y, Callens T, et al. Genotype-Phenotype Correlation in NF1: Evidence for a More Severe Phenotype Associated with Missense Mutations Affecting NF1 Codons 844-848. Am J Hum Genet. 2018;102(1):69-87.
  • Koczkowska M, Callens T, Chen Y, et al. Clinical spectrum of individuals with pathogenic NF1 missense variants affecting p.Met1149, p.Arg1276, and p.Lys1423: genotype-phenotype study in neurofibromatosis type 1. Hum Mutat. 2020;41(1):299-315.
  • Napolitano F, Dell'Aquila M, Terracciano C, et al. Genotype-Phenotype Correlations in Neurofibromatosis Type 1: Identification of Novel and Recurrent NF1 Gene Variants and Correlations with Neurocognitive Phenotype. Genes (Basel). 2022;13(7):1130.

Nörofibromatozis Tip 1 Tanılı Hastalarda Klinik Bulgular ve NF1 Genetik Varyantlarının Değerlendirilmesi: Tek Merkez Deneyimi

Year 2025, Volume: 7 Issue: 3, 314 - 322, 13.10.2025
https://doi.org/10.52827/hititmedj.1624747

Abstract

Amaç: Nörofibromatozis tip 1 (NF1), tümör oluşumunu kolaylaştıran multisistemik tutulumu olan yaygın bir nörokutanöz sendromdur. Bu çalışmanın amacı, nörofibromatozis tip 1 tanısı alan çocuk hastaların demografik ve klinik özelliklerinin yanı sıra genetik sonuçlarını değerlendirmektir.

Gereç ve Yöntemler: Çalışmaya katılan toplam 23 hasta retrospektif olarak incelendi. Başlıca elde edilen sonuçlar analiz edildi. Buna zigosite, mutasyon tipleri, varyant pozisyonları, ACMG sınıflandırması ve kalıtım modellerine ilişkin bilgiler eklendi.

Bu retrospektif, kesitsel tanımlayıcı çalışmaya 23 hasta dahil edildi. Hastalık ana kriterleri, klinik özellikleri, yeni nesil dizileme ve çoklu ligasyona bağlı prob amplifikasyon teknikleri kullanılarak elde edilen genetic sonuçları kaydedildi. Zigosite, mutasyon tipleri, varyant pozisyonları, ACMG sınıflandırması ve kalıtım modellerine ilişkin bilgiler analiz edildi.

Bulgular: Café-au-lait lekeleri tüm hastalarda mevcuttu. Kasık/aksiller çillenme, hastaların %60,9'unda görülen ikinci en yaygın bulguydu. Lisch nodülleri altı yaşından büyük hastalarda gözlenirken, koroidal anormallikler daha küçük hastalarda yaygındı. Optik glioma hastaların %13'ünde, kutanöz nörofibromlar ise hastaların %21,7'sinde tespit edilmiş olup bu oran yetişkin hastalarda gözlenenden daha düşüktür. Bilişsel bozukluğu olan hastalarda fokal sinyal yoğunluğu görüntüsü daha yaygındı (OR: 4.50, CI 95 %0.659-30.715, p=0.02). İki hastada epilepsi tanısı konmuş ve tek bir ilaçla tedavi edilmiştir. Makrosefali (%30,4) en sık görülen kraniyal deformite idi. Missense mutasyonlar (%43,5) en sık görülürken, bir çerçeve kayması yeni mutasyon (c.6771del. K2257Nfs*8) tanımlanmıştır.

Sonuç: Yeni genetik teknolojilerin ortaya çıkması ve sağlık hizmetlerindeki ilerlemeler nörofibromatozisin daha erken tanı almasını ve gelişebilecek komplikasyonların öngörülmesini ve tedavisini kolaylaştırabilir.

Ethical Statement

Çalışma için 26/06/2024 tarihinde Samsun Üniversitesi Girişimsel Olmayan Araştırmalar Etik Kurulu’ndan onay alınmıştır. Karar no:2024/12/6

References

  • Ly KI, Blakeley JO. The Diagnosis and Management of Neurofibromatosis Type 1. Med Clin North Am. 2019;103(6):1035-1054.
  • Kehrer-Sawatzki H, Cooper DN. Challenges in the diagnosis of neurofibromatosis type 1 (NF1) in young children facilitated by means of revised diagnostic criteria including genetic testing for pathogenic NF1 gene variants. Hum Genet. 2022;141(2):177-191.
  • Cimino PJ, Gutmann DH. Neurofibromatosis type 1. Handb Clin Neurol. 2018; 148:799-811.
  • Legius E, Messiaen L, Wolkenstein P, et al. Revised diagnostic criteria for neurofibromatosis type 1 and Legius syndrome: an international consensus recommendation. Genet Med. 2021;23(8):1506-1513.
  • Jett K, Friedman JM. Clinical and genetic aspects of neurofibromatosis 1. Genet Med. 2010;12(1):1-11.
  • Sabatini C, Milani D, Menni F, Tadini G, Esposito S. Treatment of neurofibromatosis type 1. Curr Treat Options Neurol. 2015;17(6):355.
  • Abdel-Aziz N, Y El-Kamah G, A Khairat R, et al. Mutational spectrum of NF1 gene in 24 unrelated Egyptian families with neurofibromatosis type 1. Mol Genet Genomic Med. 2021;9(12): e1631.
  • Mao B, Chen S, Chen X, et al. Clinical characteristics and spectrum of NF1 mutations in 12 unrelated Chinese families with neurofibromatosis type 1. BMC Med Genet. 2018;19(1):101.
  • Viskochil D, Buchberg AM, Xu G, et al. Deletions and a translocation interrupt a cloned gene at the neurofibromatosis type 1 locus. Cell. 1990;62(1):187-192.
  • Jafry M, Sidbury R. RASopathies. Clin Dermatol. 2020;38(4):455-461.
  • Anderson JL, Gutmann DH. Neurofibromatosis type 1. Handb Clin Neurol. 2015; 132:75-86.
  • Mudau MM, Dillon B, Smal C, et al. Mutation analysis and clinical profile of South African patients with Neurofibromatosis type 1 (NF1) phenotype. Front Genet. 2024; 15:1331278.
  • Mautner VF, Kluwe L, Friedrich RE, et al. Clinical characterization of 29 neurofibromatosis type-1 patients with molecularly ascertained 1.4 Mb type-1 NF1 deletions. J Med Genet. 2010;47(9):623-630.
  • Jha SK, Mendez MD. Cafe Au Lait Macules. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 31, 2023.
  • Lalvani S, Brown RM. Neurofibromatosis Type 1: Optimizing Management with a Multidisciplinary Approach. J Multidiscip Healthc. 2024; 17:1803-1817.
  • Pinti E, Nemeth K, Staub K, Lengyel A, Fekete G, Haltrich I. Diagnostic difficulties and possibilities of NF1-like syndromes in childhood. BMC Pediatr. 2021;21(1):331.
  • Târtea AE, Mocanu CL, Ștefănescu Dima AȘ, et al. Neurofibromatosis Type 1-Retinal Alterations Detectable with Optical Coherence Tomography Angiography. Diagnostics (Basel). 2024;14(13):1447.
  • Landry JP, Schertz KL, Chiang YJ, et al. Comparison of Cancer Prevalence in Patients with Neurofibromatosis Type 1 at an Academic Cancer Center vs in the General Population From 1985 to 2020. JAMA Netw Open. 2021;4(3):e210945.
  • Sur ML, Armat I, Sur G, et al. Neurofibromatosis in Children: Actually, and Perspectives. Children (Basel). 2022;9(1):40.
  • Sellmer L, Farschtschi S, Marangoni M, et al. Serial MRIs provide novel insight into natural history of optic pathway gliomas in patients with neurofibromatosis 1. Orphanet J Rare Dis. 2018;13(1):62.
  • Pannu AK, Sharma N. Neurofibromatosis type 1 and disseminated malignant peripheral nerve sheath tumor. QJM. 2017;110(9):583-584.
  • Peduto C, Zanobio M, Nigro V, Perrotta S, Piluso G, Santoro C. Neurofibromatosis Type 1: Pediatric Aspects and Review of Genotype-Phenotype Correlations. Cancers (Basel). 2023;15(4):1217.
  • Elefteriou F, Kolanczyk M, Schindeler A, et al. Skeletal abnormalities in neurofibromatosis type 1: approaches to therapeutic options. Am J Med Genet A. 2009;149A(10):2327-2338.
  • Leppävirta J, Kallionpää RA, Uusitalo E, et al. Neurofibromatosis type 1 of the child increases birth weight. Am J Med Genet A. 2019;179(7):1173-1183.
  • Chauvel-Picard J, Lion-Francois L, Beuriat PA, et al. Craniofacial bone alterations in patients with neurofibromatosis type 1. Childs Nerv Syst. 2020;36(10):2391-2399. doi:10.1007/s00381-020-04749-6
  • Naran S, Swanson JW, Ligh CA, Shubinets V, Taylor JA, Bartlett SP. Sphenoid Dysplasia in Neurofibromatosis: Patterns of Presentation and Outcomes of Treatment. Plast Reconstr Surg. 2018;142(4):518e-526e. doi:10.1097/PRS.0000000000004779
  • Clementi M, Milani S, Mammi I, Boni S, Monciotti C, Tenconi R. Neurofibromatosis type 1 growth charts. Am J Med Genet. 1999;87(4):317-323.
  • North KN, Riccardi V, Samango-Sprouse C, et al. Cognitive function and academic performance in neurofibromatosis. 1: consensus statement from the NF1 Cognitive Disorders Task Force. Neurology. 1997;48(4):1121-1127.
  • Eijk S, Mous SE, Dieleman GC, et al. autism spectrum disorder in an Unselected Cohort of Children with Neurofibromatosis Type 1 (NF1). J Autism Dev Disord. 2018;48(7):2278-2285.
  • Khair AM, Falchek S, Nikam R, Kaur G. Epilepsy and Electroencephalogram Characteristics in Children with Neurofibromatosis Type 1, What We Have Learned from a Tertiary Center Five Years' Experience. Child Neurol Open. 2022; 9: 2329048 X221131445.
  • Pinna V, Daniele P, Calcagni G, et al. Prevalence, Type, and Molecular Spectrum of NF1 Mutations in Patients with Neurofibromatosis Type 1 and congenital heart disease. Genes (Basel). 2019;10(9):675.
  • Mentzel HJ, Seidel J, Fitzek C, et al. Pediatric brain MRI in neurofibromatosis type I. Eur Radiol. 2005;15(4):814-822.
  • Denckla MB, Hofman K, Mazzocco MM, et al. Relationship between T2-weighted hyperintensities (unidentified bright objects) and lower IQs in children with neurofibromatosis-1. Am J Med Genet. 1996;67(1):98-102.
  • North K, Joy P, Yuille D, et al. Specific learning disability in children with neurofibromatosis type 1: significance of MRI abnormalities. Neurology. 1994;44(5):878-883.
  • Koczkowska M, Chen Y, Callens T, et al. Genotype-Phenotype Correlation in NF1: Evidence for a More Severe Phenotype Associated with Missense Mutations Affecting NF1 Codons 844-848. Am J Hum Genet. 2018;102(1):69-87.
  • Koczkowska M, Callens T, Chen Y, et al. Clinical spectrum of individuals with pathogenic NF1 missense variants affecting p.Met1149, p.Arg1276, and p.Lys1423: genotype-phenotype study in neurofibromatosis type 1. Hum Mutat. 2020;41(1):299-315.
  • Napolitano F, Dell'Aquila M, Terracciano C, et al. Genotype-Phenotype Correlations in Neurofibromatosis Type 1: Identification of Novel and Recurrent NF1 Gene Variants and Correlations with Neurocognitive Phenotype. Genes (Basel). 2022;13(7):1130.
There are 37 citations in total.

Details

Primary Language English
Subjects Dermatology, Clinical Oncology, Medical Genetics (Excl. Cancer Genetics)
Journal Section Research Articles
Authors

Ünal Akça 0000-0001-5480-1805

Aslıhan Sanrı 0000-0003-1898-0898

Emre Sanrı 0000-0003-2192-3229

Elif Pekmezci Yazgı 0009-0007-6944-6501

Gülfer Akça 0000-0002-7139-3521

Publication Date October 13, 2025
Submission Date January 22, 2025
Acceptance Date April 28, 2025
Published in Issue Year 2025 Volume: 7 Issue: 3

Cite

AMA Akça Ü, Sanrı A, Sanrı E, Pekmezci Yazgı E, Akça G. Evaluation of Clinical Findings and NF1 Genetic Variants in Patients Diagnosed with Neurofibromatosis Type 1: A Single-Center Experience. Hitit Medical Journal. October 2025;7(3):314-322. doi:10.52827/hititmedj.1624747