Proteus syndrome is a rare genetic disorder that can cause tissue overgrowth involving all three embryonic lineages. Patients with Proteus syndrome tend to have an increased risk of embryonic tumor development. The clinical symptoms and radiographic findings of Proteus syndrome are highly variable, as are its orthopedic manifestations.

Just over 200 cases have been confirmed worldwide, with estimates that about 120 people are currently alive with the condition. As attenuated forms of the disease may exist, there could be many people with Proteus syndrome who remain undiagnosed. Those most readily diagnosed are also the most severely disfigured.

The syndrome is named after the Greek sea god Proteus, who could change his shape. The condition appears to have been first described in the American medical literature by Samia Temtamy and John Rogers in 1976. American-born, Canadian Michael Cohen described what is now considered Proteus syndrome in 1979.

Signs and symptoms

thumb|[[Portugal|Portuguese illustration of a foreign woman with deformities indicative of Proteus syndrome, 1695]]

Proteus syndrome causes an overgrowth of skin, bones, muscles, fatty tissues, and blood and lymphatic vessels. Proteus syndrome is a progressive condition wherein children are usually born without any obvious deformities. Tumors of skin and bone growths appear as they age typically in early childhood. The musculoskeletal manifestations are cardinal for the diagnosis of Proteus syndrome. In addition, the presence of visible deformity hurts the social experiences of the affected individual, causing emotional difficulties, social rejection and stigma.

Affected individuals are at increased risk for developing certain tumors including unilateral ovarian cystadenomas, testicular tumors, meningiomas, and monomorphic adenomas of the parotid gland.

Hemimegalencephaly is often found to be associated.

Orthopaedic features

The musculoskeletal manifestations of Proteus syndrome are frequent and recognizable. Patients tend to demonstrate a unique pattern of skeletal abnormalities. The orthopaedic features are usually bilateral, asymmetrical, and progressive, and involve all four limbs and the spine. Affected patients usually have localized periarticular limb distortions, limb length discrepancy, and spine deformity. Patients with Proteus syndrome can have regular bone configuration and contours despite the bone enlargement. Patients can also exhibit deformation of the skull in the form of dolichocephaly or elongated skull and facial abnormalities. Because of the rarity of the syndrome and the variability of signs, orthopaedic management should be individualized.

Previous research had suggested the condition was linked to PTEN on chromosome 10, while other research pointed to chromosome 16. Before the findings regarding AKT1 in 2011, other researchers expressed doubt regarding the involvement of PTEN or GPC3, which codes for glypican 3 and may play a role in regulating cell division and growth regulation.

Diagnosis

Differential diagnosis

  • Macrodystrophia lipomatosa
  • Fibrolipomatous hamartoma
  • Neurofibromatosis type 1
  • Klippel–Trénaunay syndrome
  • Parkes Weber syndrome
  • Sotos syndrome
  • Hemangiomas
  • Beckwith-Wiedemann syndrome

Classification

Many sources classify Proteus syndrome as a type of nevus syndrome. The lesions appear to be distributed in a mosaic manner. It has been confirmed that the disorder is an example of genetic mosaicism. However, the diagnosis of Proteus syndrome in this patient has been questioned by others.

The Arqule Corporation developed the AKT1 inhibitor ARQ 092, which is being tested by a research team in the National Human Genome Research Institute at the United States National Institutes of Health in a Phase 0 dose-finding trial. In earlier tests on tissue and cell samples obtained from patients, ARQ 092 reduced phosphorylation of AKT and downstream targets of AKT in as little as two hours. The Phase 0 trial opened in November 2015. This trial is based on in vitro data showing inhibition of AKT1 in cell lines from patients with Proteus syndrome.

Notable cases

In a 1986 article in the British Medical Journal, Michael Cohen and J.A.R. Tibbles proposed the idea that Joseph Merrick, an Englishman known as the "Elephant Man", had Proteus syndrome. However, the exact condition Merrick had is still not known with certainty.

Mandy Sellars has been diagnosed by some doctors as having this condition.

See also

  • Epidermal nevus syndrome
  • Mosaic (genetics)
  • Overgrowth syndrome
  • List of radiographic findings associated with cutaneous conditions

References

  • GeneReviews/NCBI/NIH/UW entry on PTEN Hamartoma Tumor Syndrome (PHTS)