Cowden syndrome physical examination: Difference between revisions

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==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Common [[physical examination]] findings of [[cowden syndrome]] include [[Trichilemmoma|trichilemmomas]], acral [[keratoses]], and [[facial]] [[papules]]. The presence of [[Trichilemmoma|trichilemmomas]] on physical examination is highly suggestive of [[cowden syndrome]].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [[cowden syndrome]] usually appear normal.  
*Patients with [[cowden syndrome]] usually appear normal.  
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===Skin===
===Skin===
{|align="right"
|
{|
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[[File:Desmoplastic trichilemmoma.gif|alt=Desmoplastic trichilemmoma|center|thumb|'''Desmoplastic trichilemmoma''' '''in cowden syndromeCase-''' Case courtesy Daniela Tiemi Sano Et Al<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC41|title=A rare clinical presentation of Desmoplastic Trichilemmoma mimicking Invasive Carcinoma|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]
|-
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[[File:Multiple papules may also be noticed on the lower labial mucosa in Cowden syndrome.gif|alt=Multiple papules may also be noticed on the lower labial mucosa in Cowden syndrome|center|thumb|Multiple papules may also be noticed on the lower labial mucosa in Cowden syndrome- Case courtesy Prashanthi Chippagiri<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3787619/|title=Multiple papules may also be noticed on the lower labial mucosa in Cowden syndrome|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> ]]
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[[File:Trichilemmoma in Cowden Syndrome.gif|alt=Trichilemmoma in Cowden Syndrome|thumb|<nowiki/>'''Trichilemmoma in Cowden Syndrome-''' Case courtesy Prashanthi Chippagiri et al<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3787619/|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>.|center]]
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[[File:Cobblestone appearance.gif|alt=Cobblestone appearance of multiple confluent papules on the tongue.|center|thumb|Cobblestone appearance - Cse courtesy  Prashanthi Chippagiri<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3787619/|title=Multiple Hamartoma Syndrome with Characteristic Oral and Cutaneous Manifestations|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]
|}
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{|
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[[File:Trichilemmomas in Cowden Syndrome.gif|alt=Trichilemmomas|center|thumb|'''Trichilemmomas -''' By Madhero88 - <nowiki>http://www</nowiki>.<nowiki/>dermnet.com/Cowden-Disease/picture/23110, CC BY-SA 3.0, <nowiki>https://commons.wikimedia.org/w/index.php?curid=9710350</nowiki>]]
|-
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[[File:Plantar keratosis in Cowden syndrome.gif|alt=Plantar keratosis in Cowden syndrome|center|thumb|'''Plantar keratosis''' '''in Cowden syndrome'''- Case courtesy  Author  Grendelkhan.]]
|}
|-
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[[File:Lipoma in Cowden syndrome.gif|alt=Lipoma in Cowden syndrome|center|thumb|'''Lipoma in Cowden syndrome''' - By Sikander Iqbal - Own work, CC BY 3.0, <nowiki>https://commons.wikimedia.org/w/index.php?curid=3260139</nowiki>]]
|
[[File:Epidermal nevi in Cowden syndrome.gif|alt=Epidermal nevi in Cowden syndrome|center|thumb|'''Epidermal nevi in Cowden syndrome'''- <ref>{{Cite web|url=https://en.wikipedia.org/wiki/File:Nevus_NCI.jpg#/media/File:Nevus_NCI.jpg|title=Epidermal nevi in Cowden syndrome|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]
|}
* [[Skin]] examination of patients with [[cowden syndrome]]<nowiki/> is very important and helps in the diagnosis
* [[Skin]] examination of patients with [[cowden syndrome]]<nowiki/> is very important and helps in the diagnosis
** [[Trichilemmoma|'''Trichilemmomas''']]:
** [[Trichilemmoma|'''Trichilemmomas''']]:
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*** On [[histology]] examination [[Trichilemmoma|trichilemmomas]] are conta<nowiki/>in large [[glycogen]]-rich cells.
*** On [[histology]] examination [[Trichilemmoma|trichilemmomas]] are conta<nowiki/>in large [[glycogen]]-rich cells.
*** [[Biopsy]] of the [[Trichilemmoma|trichilemmomas]] helps in the [[Diagnosis|diagnos]]<nowiki/>[[Diagnosis|is]] of the [[cowden syndrome]] .
*** [[Biopsy]] of the [[Trichilemmoma|trichilemmomas]] helps in the [[Diagnosis|diagnos]]<nowiki/>[[Diagnosis|is]] of the [[cowden syndrome]] .
[[File:Trichilemmomas in Cowden Syndrome.gif|alt=Trichilemmomas|center|thumb|'''Trichilemmomas -''' By Madhero88 - <nowiki>http://www.dermnet.com/Cowden-Disease/picture/23110</nowiki>, CC BY-SA 3.0, <nowiki>https://commons.wikimedia.org/w/index.php?curid=9710350</nowiki>]]
 
* '''Acral [[keratoses]]''':
* '''Acral [[keratoses]]''':
** Acral [[keratoses]] are verrucous [[papules]] and most commonly present in [[dorsal]] hands, [[Wrist|wrists]], or [[feet]].<ref name="pmid21886759">{{cite journal |vauthors=Masmoudi A, Chermi ZM, Marrekchi S, Raida BS, Boudaya S, Mseddi M, Jalel MT, Turki H |title=Cowden syndrome |journal=J Dermatol Case Rep |volume=5 |issue=1 |pages=8–13 |date=March 2011 |pmid=21886759 |pmc=3163352 |doi=10.3315/jdcr.2011.1063 |url=}}</ref><ref name="pmid3698331">{{cite journal |vauthors=Starink TM, van der Veen JP, Arwert F, de Waal LP, de Lange GG, Gille JJ, Eriksson AW |title=The Cowden syndrome: a clinical and genetic study in 21 patients |journal=Clin. Genet. |volume=29 |issue=3 |pages=222–33 |date=March 1986 |pmid=3698331 |doi= |url=}}</ref>
** Acral [[keratoses]] are verrucous [[papules]] and most commonly present in [[dorsal]] hands, [[Wrist|wrists]], or [[feet]].<ref name="pmid21886759">{{cite journal |vauthors=Masmoudi A, Chermi ZM, Marrekchi S, Raida BS, Boudaya S, Mseddi M, Jalel MT, Turki H |title=Cowden syndrome |journal=J Dermatol Case Rep |volume=5 |issue=1 |pages=8–13 |date=March 2011 |pmid=21886759 |pmc=3163352 |doi=10.3315/jdcr.2011.1063 |url=}}</ref><ref name="pmid3698331">{{cite journal |vauthors=Starink TM, van der Veen JP, Arwert F, de Waal LP, de Lange GG, Gille JJ, Eriksson AW |title=The Cowden syndrome: a clinical and genetic study in 21 patients |journal=Clin. Genet. |volume=29 |issue=3 |pages=222–33 |date=March 1986 |pmid=3698331 |doi= |url=}}</ref>
** On [[soles]] and [[Palms of the hands|palms]] patients with [[cowden syndrome]] may develop [[translucent]] [[Punctate keratitis|punctate]] [[keratoses]].<ref name="pmid218867592">{{cite journal |vauthors=Masmoudi A, Chermi ZM, Marrekchi S, Raida BS, Boudaya S, Mseddi M, Jalel MT, Turki H |title=Cowden syndrome |journal=J Dermatol Case Rep |volume=5 |issue=1 |pages=8–13 |date=March 2011 |pmid=21886759 |pmc=3163352 |doi=10.3315/jdcr.2011.1063 |url=}}</ref>
** On [[soles]] and [[Palms of the hands|palms]] patients with [[cowden syndrome]] may develop [[translucent]] [[Punctate keratitis|punctate]] [[keratoses]].<ref name="pmid218867592">{{cite journal |vauthors=Masmoudi A, Chermi ZM, Marrekchi S, Raida BS, Boudaya S, Mseddi M, Jalel MT, Turki H |title=Cowden syndrome |journal=J Dermatol Case Rep |volume=5 |issue=1 |pages=8–13 |date=March 2011 |pmid=21886759 |pmc=3163352 |doi=10.3315/jdcr.2011.1063 |url=}}</ref>
* '''Facial papules'''
* '''[[Facial]] [[papules]]'''
** In [[cowden syndrome]] patients [[facial]] [[papules]] are most common [[lesions]] and found in almost 86 percent of patients.<ref name="pmid36983312">{{cite journal |vauthors=Starink TM, van der Veen JP, Arwert F, de Waal LP, de Lange GG, Gille JJ, Eriksson AW |title=The Cowden syndrome: a clinical and genetic study in 21 patients |journal=Clin. Genet. |volume=29 |issue=3 |pages=222–33 |date=March 1986 |pmid=3698331 |doi= |url=}}</ref>
** In [[cowden syndrome]] patients [[facial]] [[papules]] are most common [[lesions]] and found in almost 86 percent of patients.<ref name="pmid36983312">{{cite journal |vauthors=Starink TM, van der Veen JP, Arwert F, de Waal LP, de Lange GG, Gille JJ, Eriksson AW |title=The Cowden syndrome: a clinical and genetic study in 21 patients |journal=Clin. Genet. |volume=29 |issue=3 |pages=222–33 |date=March 1986 |pmid=3698331 |doi= |url=}}</ref>
** The most common locations of [[facial]] [[papules]] are located in periorificial regions and [[nostrils]].
** The most common locations of [[facial]] [[papules]] are located in periorificial regions and [[nostrils]].
* '''Oral papules and papillomas'''
* '''Oral [[papules]] and [[papillomas]]'''
** The location of oral [[papules]] and [[papillomas]] are most commonly in [[lips]] and [[buccal]] [[mucous membranes]] which are pink in colour and 1 to 4 mm in diameter size.<ref name="pmid218867593">{{cite journal |vauthors=Masmoudi A, Chermi ZM, Marrekchi S, Raida BS, Boudaya S, Mseddi M, Jalel MT, Turki H |title=Cowden syndrome |journal=J Dermatol Case Rep |volume=5 |issue=1 |pages=8–13 |date=March 2011 |pmid=21886759 |pmc=3163352 |doi=10.3315/jdcr.2011.1063 |url=}}</ref><ref name="pmid465314">{{cite journal |vauthors=Brownstein MH, Mehregan AH, Bikowski JB, Lupulescu A, Patterson JC |title=The dermatopathology of Cowden's syndrome |journal=Br. J. Dermatol. |volume=100 |issue=6 |pages=667–73 |date=June 1979 |pmid=465314 |doi= |url=}}</ref>
** The location of oral [[papules]] and [[papillomas]] are most commonly in [[lips]] and [[buccal]] [[mucous membranes]] which are pink in colour and 1 to 4 mm in diameter size.<ref name="pmid218867593">{{cite journal |vauthors=Masmoudi A, Chermi ZM, Marrekchi S, Raida BS, Boudaya S, Mseddi M, Jalel MT, Turki H |title=Cowden syndrome |journal=J Dermatol Case Rep |volume=5 |issue=1 |pages=8–13 |date=March 2011 |pmid=21886759 |pmc=3163352 |doi=10.3315/jdcr.2011.1063 |url=}}</ref><ref name="pmid465314">{{cite journal |vauthors=Brownstein MH, Mehregan AH, Bikowski JB, Lupulescu A, Patterson JC |title=The dermatopathology of Cowden's syndrome |journal=Br. J. Dermatol. |volume=100 |issue=6 |pages=667–73 |date=June 1979 |pmid=465314 |doi= |url=}}</ref>
** When the [[papules]] coalesce they form as cobblestone appearance.
** When the [[papules]] coalesce they form as cobblestone appearance.
 
* '''[[Palmar]] [[keratosis]]'''
===Neck===
** In patients with [[cowden syndrome]] [[palmar]] [[keratosis]] presents as shiny with central dells.
* Neck examination of patients with [di<nowiki/>sease name] is usually normal.
* '''[[Lipomas]]'''
* The most common locations of
* '''[[Epidermal]] [[nevi]]'''
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
* [[Pulmonary examination]] of patients with [[cowden syndrome]] is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* [[Cardiovascular]] examination of patients with [[cowden syndrome]] is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope
 
===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
* [[Abdominal]] examination of patients with [[cowden syndrome]] is usually normal.
OR
*[[Abdominal distension]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
* Back examination of patients with [disease name] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
* [[Genitourinary]] examination of patients with [[cowden syndrome]] in women shows [[Uterine fibroids|uterine fibroid]]<nowiki/>s.<ref name="pmid">{{cite journal |vauthors=Pilarski R, Burt R, Kohlman W, Pho L, Shannon KM, Swisher E |title=Cowden syndrome and the PTEN hamartoma tumor syndrome: systematic review and revised diagnostic criteria |journal=J. Natl. Cancer Inst. |volume=105 |issue=21 |pages=1607–16 |date=November 2013 |pmid= |doi=10.1093/jnci/djt277 |url=}}</ref>
OR
* [[Genitourinary system|Genitourinary]] examination of patients with [[cowden syndrome]] in men shows multiple bilateral hyperechoic [[testicular]] [[lesions]] which are gonna confirmed by [[ultrasound]].<ref name="pmid16980675">{{cite journal |vauthors=Woodhouse J, Ferguson MM |title=Multiple hyperechoic testicular lesions are a common finding on ultrasound in Cowden disease and represent lipomatosis of the testis |journal=Br J Radiol |volume=79 |issue=946 |pages=801–3 |date=October 2006 |pmid=16980675 |doi=10.1259/bjr/50628431 |url=}}</ref><ref name="pmid15920539">{{cite journal |vauthors=Woodhouse JB, Delahunt B, English SF, Fraser HH, Ferguson MM |title=Testicular lipomatosis in Cowden's syndrome |journal=Mod. Pathol. |volume=18 |issue=9 |pages=1151–6 |date=September 2005 |pmid=15920539 |doi=10.1038/modpathol.3800448 |url=}}</ref><ref name="pmid21943449">{{cite journal |vauthors=Alnajjar HM, Sahai A, Keane A, Gordon S |title=Testicular pain as a presentation of Cowden syndrome |journal=Ann R Coll Surg Engl |volume=93 |issue=5 |pages=e51–2 |date=July 2011 |pmid=21943449 |pmc=5827217 |doi=10.1308/147870811X582819 |url=}}</ref>
*A pelvic/adnexal mass may be palpated
===Neuromuscular===
*Inflamed mucosa
* [[Macrocephaly]] <ref name="pmid17920899">{{cite journal |vauthors=Gustafson S, Zbuk KM, Scacheri C, Eng C |title=Cowden syndrome |journal=Semin. Oncol. |volume=34 |issue=5 |pages=428–34 |date=October 2007 |pmid=17920899 |doi=10.1053/j.seminoncol.2007.07.009 |url=}}</ref>
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
** [[Occipital]]-[[frontal]] head circumference greater than the 97th percentile.
* [[Dolichocephaly]]
* [[Lhermitte-Duclos disease]]<ref name="pmid25022750">{{cite journal |vauthors=Jelsig AM, Qvist N, Brusgaard K, Nielsen CB, Hansen TP, Ousager LB |title=Hamartomatous polyposis syndromes: a review |journal=Orphanet J Rare Dis |volume=9 |issue= |pages=101 |date=July 2014 |pmid=25022750 |pmc=4112971 |doi=10.1186/1750-1172-9-101 |url=}}</ref>


===Neuromuscular===
*  
* Neuromuscular examination of patients with [disease name] is usually normal.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
* [[Extremities]] examination of patients with [[cowden syndrome]] is usually normal.
OR
<br style="clear:right" />
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 14:49, 26 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Common physical examination findings of cowden syndrome include trichilemmomas, acral keratoses, and facial papules. The presence of trichilemmomas on physical examination is highly suggestive of cowden syndrome.

Physical Examination

Appearance of the Patient

Vital Signs

Skin

Desmoplastic trichilemmoma
Desmoplastic trichilemmoma in cowden syndromeCase- Case courtesy Daniela Tiemi Sano Et Al[1]
Multiple papules may also be noticed on the lower labial mucosa in Cowden syndrome
Multiple papules may also be noticed on the lower labial mucosa in Cowden syndrome- Case courtesy Prashanthi Chippagiri[2]
Trichilemmoma in Cowden Syndrome
Trichilemmoma in Cowden Syndrome- Case courtesy Prashanthi Chippagiri et al[3].
Cobblestone appearance of multiple confluent papules on the tongue.
Cobblestone appearance - Cse courtesy Prashanthi Chippagiri[4]
Trichilemmomas
Trichilemmomas - By Madhero88 - http://www.dermnet.com/Cowden-Disease/picture/23110, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9710350
Plantar keratosis in Cowden syndrome
Plantar keratosis in Cowden syndrome- Case courtesy Author Grendelkhan.
Lipoma in Cowden syndrome
Lipoma in Cowden syndrome - By Sikander Iqbal - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=3260139
Epidermal nevi in Cowden syndrome
Epidermal nevi in Cowden syndrome- [5]

Lungs

Heart

Abdomen

Genitourinary

Neuromuscular

Extremities


References

  1. ↑ "A rare clinical presentation of Desmoplastic Trichilemmoma mimicking Invasive Carcinoma".
  2. ↑ "Multiple papules may also be noticed on the lower labial mucosa in Cowden syndrome".
  3. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3787619/. Missing or empty |title= (help)
  4. ↑ "Multiple Hamartoma Syndrome with Characteristic Oral and Cutaneous Manifestations".
  5. ↑ "Epidermal nevi in Cowden syndrome".
  6. ↑ Al-Zaid T, Ditelberg JS, Prieto VG, Lev D, Luthra R, Davies MA, Diwan AH, Wang WL, Lazar AJ (May 2012). "Trichilemmomas show loss of PTEN in Cowden syndrome but only rarely in sporadic tumors". J. Cutan. Pathol. 39 (5): 493–9. doi:10.1111/j.1600-0560.2012.01888.x. PMID 22486434.
  7. ↑ Brownstein MH, Mehregan AH, Bikowski JB, Lupulescu A, Patterson JC (June 1979). "The dermatopathology of Cowden's syndrome". Br. J. Dermatol. 100 (6): 667–73. PMID 465314.
  8. ↑ Tellechea O, Cardoso JC, Reis JP, Ramos L, Gameiro AR, Coutinho I, Baptista AP (2015). "Benign follicular tumors". An Bras Dermatol. 90 (6): 780–96, quiz 797–8. doi:10.1590/abd1806-4841.20154114. PMC 4689065. PMID 26734858.
  9. ↑ Masmoudi A, Chermi ZM, Marrekchi S, Raida BS, Boudaya S, Mseddi M, Jalel MT, Turki H (March 2011). "Cowden syndrome". J Dermatol Case Rep. 5 (1): 8–13. doi:10.3315/jdcr.2011.1063. PMC 3163352. PMID 21886759.
  10. ↑ Starink TM, van der Veen JP, Arwert F, de Waal LP, de Lange GG, Gille JJ, Eriksson AW (March 1986). "The Cowden syndrome: a clinical and genetic study in 21 patients". Clin. Genet. 29 (3): 222–33. PMID 3698331.
  11. ↑ Masmoudi A, Chermi ZM, Marrekchi S, Raida BS, Boudaya S, Mseddi M, Jalel MT, Turki H (March 2011). "Cowden syndrome". J Dermatol Case Rep. 5 (1): 8–13. doi:10.3315/jdcr.2011.1063. PMC 3163352. PMID 21886759.
  12. ↑ Starink TM, van der Veen JP, Arwert F, de Waal LP, de Lange GG, Gille JJ, Eriksson AW (March 1986). "The Cowden syndrome: a clinical and genetic study in 21 patients". Clin. Genet. 29 (3): 222–33. PMID 3698331.
  13. ↑ Masmoudi A, Chermi ZM, Marrekchi S, Raida BS, Boudaya S, Mseddi M, Jalel MT, Turki H (March 2011). "Cowden syndrome". J Dermatol Case Rep. 5 (1): 8–13. doi:10.3315/jdcr.2011.1063. PMC 3163352. PMID 21886759.
  14. ↑ Brownstein MH, Mehregan AH, Bikowski JB, Lupulescu A, Patterson JC (June 1979). "The dermatopathology of Cowden's syndrome". Br. J. Dermatol. 100 (6): 667–73. PMID 465314.
  15. ↑ Pilarski R, Burt R, Kohlman W, Pho L, Shannon KM, Swisher E (November 2013). "Cowden syndrome and the PTEN hamartoma tumor syndrome: systematic review and revised diagnostic criteria". J. Natl. Cancer Inst. 105 (21): 1607–16. doi:10.1093/jnci/djt277.
  16. ↑ Woodhouse J, Ferguson MM (October 2006). "Multiple hyperechoic testicular lesions are a common finding on ultrasound in Cowden disease and represent lipomatosis of the testis". Br J Radiol. 79 (946): 801–3. doi:10.1259/bjr/50628431. PMID 16980675.
  17. ↑ Woodhouse JB, Delahunt B, English SF, Fraser HH, Ferguson MM (September 2005). "Testicular lipomatosis in Cowden's syndrome". Mod. Pathol. 18 (9): 1151–6. doi:10.1038/modpathol.3800448. PMID 15920539.
  18. ↑ Alnajjar HM, Sahai A, Keane A, Gordon S (July 2011). "Testicular pain as a presentation of Cowden syndrome". Ann R Coll Surg Engl. 93 (5): e51–2. doi:10.1308/147870811X582819. PMC 5827217. PMID 21943449.
  19. ↑ Gustafson S, Zbuk KM, Scacheri C, Eng C (October 2007). "Cowden syndrome". Semin. Oncol. 34 (5): 428–34. doi:10.1053/j.seminoncol.2007.07.009. PMID 17920899.
  20. ↑ Jelsig AM, Qvist N, Brusgaard K, Nielsen CB, Hansen TP, Ousager LB (July 2014). "Hamartomatous polyposis syndromes: a review". Orphanet J Rare Dis. 9: 101. doi:10.1186/1750-1172-9-101. PMC 4112971. PMID 25022750.

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