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Tuberous sclerosis complex for the pulmonologist

机译:肺部学家的肺结核骨质复合体

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Tuberous sclerosis complex (TSC) is a rare multisystem genetic disorder affecting almost all organs with no sex predominance. TSC has an autosomal-dominant inheritance and is caused by a heterozygous mutation in either the TSC1 or TSC2 gene leading to hyperactivation of the mammalian target of rapamycin (mTOR). TSC is associated with several pulmonary manifestations including lymphangioleiomyomatosis (LAM), multifocal micronodular pneumocyte hyperplasia (MMPH) and chylous effusions. LAM is a multisystem disorder characterised by cystic destruction of lung parenchyma, and may occur in either the setting of TSC (TSC-LAM) or sporadically (S-LAM). LAM occurs in 30–40% of adult females with TSC at childbearing age and is considered a nonmalignant metastatic neoplasm of unknown origin. TSC-LAM is generally milder and, unlike S-LAM, may occur in males. It manifests as multiple, bilateral, diffuse and thin-walled cysts with normal intervening lung parenchyma on chest computed tomography. LAM is complicated by spontaneous pneumothoraces in up to 70% of patients, with a high recurrence rate. mTOR inhibitors are the treatment of choice for LAM with moderately impaired lung function or chylous effusion. MMPH, manifesting as multiple solid and ground-glass nodules on high-resolution computed tomography, is usually harmless with no need for treatment.
机译:结核硬化症复合体(TSC)是一种罕见的多系统遗传疾病,影响几乎所有没有性卓越的器官。 TSC具有常染色体显性遗传,并且是由TSC1或TSC2基因中的杂合突变引起,导致雷帕霉素(MTOR)的哺乳动物靶标的血管活化。 TSC与几种肺部表现有关,包括淋巴管霉素症(LAM),多焦点微颗粒肺细胞增生(MMPH)和甲基湿法。 LAM是一种多系统障碍,其特征在于肺检子的囊性破坏,并且可以在TSC(TSC-LAM)或偶像(S-LAM)的凝固中发生。 LAM发生在30-40%的成年女性中,在生育年龄的TSC,被认为是未成根性的非正常转移性肿瘤。 TSC-LAM通常与S-LAM不同,可能发生在雄性中。它表现为具有正常中间肺实质上的多重,双侧,弥漫性和薄壁囊肿上胸部计算机断层扫描。 LAM通过高达70%的患者的自发性气体复杂化,复发率高。 MTOR抑制剂是用中等受损肺功能或甲基积液的林的选择。 MMPH,在高分辨率计算断层扫描上表现为多个固体和地面玻璃结节,通常是无害的,无需治疗。

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