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Perlman syndrome
Perlman syndrome
Other names	Nephroblastomatosis-fetal ascites-macrosomia-Wilms tumor syndrome
Specialty	Medical genetics, pediatric oncology
Symptoms	Overgrowth, kidney dysplasia, facial dysmorphisms
Complications	Wilms' tumor
Usual onset	Prenatal or at birth
Duration	Lifelong
Causes	DIS3L2 mutation
Differential diagnosis	Beckwith–Wiedemann syndrome, Simpson–Golabi–Behmel syndrome
Prognosis	High neonatal mortality
Frequency	30 reported cases
Named after	Max Perlman

Perlman syndrome (PS), also known as nephroblastomatosis-fetal ascites-macrosomia-Wilms tumor syndrome, is a rare overgrowth syndrome caused by autosomal recessive mutations in the DIS3L2 gene. PS is characterized by macrocephaly, neonatal macrosomia, nephromegaly, renal dysplasia, dysmorphic facial features, and increased risk for Wilms' tumor. The syndrome is associated with high neonatal mortality.^[1]^[2]

Signs and symptoms

Perlman syndrome may be detected as early as gestational week 18 by prenatal ultrasound. In the first trimester, cystic hygroma and thickened nuchal translucency may be observed. Macrosomia, macrocephaly, enlarged kidneys, macroglossia, cardiac abnormalities, and visceromegaly may become evident by the second and third trimesters.^[1]^[3] Polyhydramnios is frequently observed.^[2]

Characteristic facial features of Perlman syndrome include a hypotonic appearance with an open mouth, macrocephaly, upsweeping anterior scalp line, deep-set eyes, depressed nasal bridge, everted upper lip, and mild micrognathia.^[4]

Diagnosis is made based on the individual's phenotypic features and confirmed by histologic examination of the kidneys and/or molecular genetic testing.^[2] Bilateral kidney hamartomas with or without nephroblastomatosis are commonly observed.^[4]^[5]

Genetics

Perlman syndrome is caused by mutations in the DIS3L2 gene found on chromosome 2 at 2q37.2. DIS3L2 is involved in RNA degradation and cell cycle control.^[6] PS is genetically distinct from Beckwith–Wiedemann syndrome and Simpson–Golabi–Behmel syndrome, which are caused by mutations in 11p15.5 and GPC3 respectively.^[1] It is inherited in an autosomal recessive manner.^[7]

Management and prognosis

Perlman syndrome is associated with a high neonatal death rate due to renal failure and/or refractory hypoxemia.^[8] Most individuals who survive beyond the neonatal period develop a Wilms' tumor; nearly all display some degree of developmental delay.^[2]^[9] Treatment is supportive in nature.^[1]

Epidemiology

Perlman syndrome is a rare disease with an estimated incidence of less than 1 in 1,000,000. As of 2008, fewer than 30 patients had ever been reported in the world literature.^[1] PS has been described in both consanguineous and non-consanguineous couplings. The observed sex ratio is 2 males : 1 female.^[10]

References

^ ^a ^b ^c ^d ^e ^f "Perlman syndrome". Orphanet. May 2008. Retrieved 2010-10-21.
^ ^a ^b ^c ^d Alessandri JL, Cuillier F, Ramful D, Ernould S, Robin S, de Napoli-Cocci S; et al. (2008). "Perlman syndrome: report, prenatal findings and review". Am J Med Genet A. 146A (19): 2532–7. doi:10.1002/ajmg.a.32391. PMID 18780370. S2CID 205309637.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Benacerraf, Beryl R. (2007), Ultrasound of fetal syndromes (2 ed.), Elsevier Health Sciences, p. 147, ISBN 978-0-443-06641-2
^ ^a ^b Perlman M (December 1986). "Perlman syndrome: familial renal dysplasia with Wilms tumor, fetal gigantism, and multiple congenital anomalies". Am J Med Genet. 25 (Pt 4): 793–5. doi:10.1002/ajmg.1320250418. PMID 3024486.
^ Liban E, Kozenitzky IL (1970). "Metanephric hamartomas and nephroblastomatosis in siblings". Cancer. 25 (4): 885–8. doi:10.1002/1097-0142(197504)35:4<1212::AID-CNCR2820350427>3.0.CO;2-2. PMID 4315293.
^ Astuti D, Morris MR, Cooper WN, Staals RH, Wake NC, Fews GA; et al. (2012). "Germline mutations in DIS3L2 cause the Perlman syndrome of overgrowth and Wilms tumor susceptibility". Nat Genet. 44 (3): 277–84. doi:10.1038/ng.1071. PMID 22306653. S2CID 5363560.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Neri G, Martini-Neri ME, Katz BE, Opitz JM (1984). "The Perlman syndrome: familial renal dysplasia with Wilms tumor, fetal gigantism and multiple congenital anomalies". Am J Med Genet. 19 (1): 195–207. doi:10.1002/ajmg.1320190120. PMID 6093533.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Rimoin DL, Emery AEH (2007). Emery and Rimoin's Principles and Practice of Medical Genetics. Vol. 2 (5 ed.). Churchill Livingstone Elsevier. p. 1522. ISBN 978-0-443-06870-6.
^ Piccione M, Cecconi M, Giuffrè M, Lo Curto M, Malacarne M, Piro E; et al. (2005). "Perlman syndrome: clinical report and nine-year follow-up". Am J Med Genet A. 139A (2): 131–5. doi:10.1002/ajmg.a.30994. PMID 16278893. S2CID 26889314.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Piccione, Maria; Corsello, Giovanni (2006-12-01). "Perlman syndrome (renal hamartomas, nephroblastomatosis and fetal gigantism)". Atlas of Genetics and Cytogenetics in Oncology and Haematology. Institute for Biomedical Research of Salamanca. Retrieved 2024-01-10.