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PIK3CA Activating Mutations in Facial Infiltrating Lipomatosis

Maclellan, Reid A. M.D., M.M.Sc.; Luks, Valerie L. B.S.; Vivero, Matthew P. B.A.; Mulliken, John B. M.D.; Zurakowski, David Ph.D.; Padwa, Bonnie L. D.M.D., M.D.; Warman, Matthew L. M.D.; Greene, Arin K. M.D., M.M.Sc.; Kurek, Kyle C. M.D., M.M.Sc.

Plastic and Reconstructive Surgery: January 2014 - Volume 133 - Issue 1 - p 12e–19e
doi: 10.1097/01.prs.0000436822.26709.7c
Experimental: Original Articles

Background: Facial infiltrating lipomatosis is a nonheritable disorder characterized by hemifacial soft-tissue and skeletal overgrowth, precocious dental development, macrodontia, hemimacroglossia, and mucosal neuromas. The authors tested the hypothesis that this condition is caused by a somatic mutation in the phosphatidylinositide-3 kinase (PI3K) signaling pathway, which has been indicted in other anomalies with overgrowth.

Methods: The authors extracted DNA from abnormal tissue in six individuals, generated sequencing libraries, enriched the libraries for 26 genes involved in the PI3K pathway, and designed and applied a sequential filtering strategy to analyze the sequence data for mosaic mutations.

Results: Unfiltered sequence data contained variant reads affecting ~12 percent of basepairs in the targeted genes. Filtering reduced the fraction of targeted basepairs containing variant reads to ~0.008 percent, allowing the authors to identify causal missense mutations in PIK3CA (p.E453K, p.E542K, p.H1047R, or p.H1047L) in each affected tissue sample.

Conclusions: Affected tissue from individuals with facial infiltrating lipomatosis contains PIK3CA mutations that have previously been reported in cancers and in affected tissue from other nonheritable, overgrowth disorders, including congenital lipomatous overgrowth, vascular, epidermal, and skeletal anomalies syndrome, Klippel-Trenaunay syndrome, hemimegalencephaly, fibroadipose overgrowth, and macrodactyly. Because PIK3CA encodes a catalytic subunit of PI3K, and in vitro studies have shown that the overgrowth-associated mutations increase this enzyme’s activity, PI3K inhibitors currently in clinical trials for patients with cancer may have a therapeutic role in patients with facial infiltrating lipomatosis. The strategy used to identify somatic mutations in patients with facial infiltrating lipomatosis is applicable to other somatic mosaic disorders that have allelic heterogeneity.

Boston, Mass.

From the Departments of Plastic and Oral Surgery, Orthopaedic Surgery, and Pathology and Howard Hughes Medical Institute, Boston Children’s Hospital; and the Department of Genetics, Harvard Medical School.

Received for publication June 17, 2013; accepted July 12, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Arin K. Greene, M.D., M.M.Sc., Department of Plastic and Oral Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Mass. 02115,

©2014American Society of Plastic Surgeons