Invitae Cardio-Facio-Cutaneous Syndrome Panel


Test description

The Invitae Cardio-Facio-Cutaneous Syndrome Panel analyzes six genes that are associated with cardio-facio-cutaneous (CFC) syndrome. CFC syndrome is one of the RASopathies, which are a class of pediatric disorders associated with genes that are members of the mitogen-activated protein kinase (Ras/MAPK) pathway. This pathway is involved in a signal transduction cascade that is necessary for the proper formation of several types of tissue during embryonic and postnatal development.

CFC syndrome is characterized by failure to thrive, feeding difficulties, congenital heart defects, distinctive facial features, curly sparse hair, skin rashes, neurologic complications (e.g., hypotonia, motor delay), and developmental delay; however, the RASopathies have several overlapping phenotypic features due to their common underlying Ras/MAPK pathway dysregulation.

CFC syndrome is a multisystemic disorder whose expression is highly variable. Proper management by specialists across a variety of disciplines is critical because CFC syndrome must be correctly identified and comprehensively managed. Distinguishing CFC syndrome from other phenotypically similar syndromes, such as Noonan syndrome or Costello syndrome, is important for proper medical management.

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Primary panel (6 genes)


Alternative tests to consider

The RASopathies are multisystemic disorders whose expressions are highly variable, even among family members. Many of the clinical features that can differentiate RASopathy conditions manifest later in childhood or change with age, making accurate clinical diagnosis difficult. The phenotypes of many RASopathy conditions are expanding: Individuals are being discovered with a molecular genetic finding in a RASopathy gene but clinical findings that are not typically described in the specific condition associated with that gene. Additionally, some genes are associated with more than one RASopathy syndrome.

Testing for Noonan syndrome is also included in the broader Invitae RASopathies Comprehensive Panel. Depending on the individual’s clinical and family history, this broader panel may be appropriate. This broader panel can be ordered at no additional charge.

Cardio-facio-cutaneous (CFC) syndrome

Cardio-facio-cutaneous (CFC) syndrome is a multi-system pediatric developmental syndrome that most commonly affects the heart, face, and skin. It is a member of a class of pediatric disorders called the RASopathies. CFC is a phenotypically variable disorder; not all affected individuals will present with every finding. Further, some findings may be evident at birth while others may present later.

The most commonly observed cardiac anomalies are pulmonic stenosis and other valvular defects, septal defects, hypertrophic cardiomyopathy, and arrhythmia.

Classic facial dysmorphology comprises macrocephaly, broad forehead, bitemporal narrowing, hypoplasia of the supraorbital ridges, downslanting palpebral fissures, ptosis, short nose with depressed nasal bridge and anteverted nares, high-arched palate, and low-set, posteriorly rotated ears.

Cutaneous findings usually include sparse, curly hair with sparse eyebrows and lashes, hyperkeratosis, keratosis pilaris, hemangioma, ichthyosis, progressively forming nevi, and flat, broad nails.

Other anomalies are also frequently observed, such as short stature, pectus deformity, kyphosis/scoliosis, and ocular abnormalities (strabismus, nystagmus, myopia,hyperopia, and astigmatism). Failure to thrive during infancy is typical, as are gastrointestinal complications such as reflux, vomiting, oral aversion, and constipation. Neurologic complications are observed in all patients to varying degrees and include hypotonia, hydrocephalus, motor delay, seizures, speech delay, and mild-to-severe developmental delay (there are a few individuals with IQs in the normal range). CFC syndrome is not associated with the increased risk of malignancy that has been observed in such phenotypically similar syndromes as Noonan and Costello, but some malignancies have been reported.

BRAF mutations are the most common and account for an estimated 75% of individuals with CFC syndrome. Mutations in MAP2K1 and MAP2K2 have been reported in nearly 25% of individuals with a clinical diagnosis of CFC syndrome. KRAS mutations have been observed in less than 5% of CFC syndrome individuals. Individuals with pathogenic variants in SHOC2 and SOS1 have been reported with clinical manifestations that overlap with typical Noonan or CFC syndrome features . The Invitae Cardio-Facio-Cutaneous Syndrome panel will identify mutations in nearly 100% of individuals with a clinical diagnosis of CFC syndrome.

Individuals with CFC syndrome rarely reproduce, so cases are generally a result of spontaneous de novo mutation; however, autosomal dominant transmission has been reported.

CFC syndrome is fully penetrant with phenotypic variability.

The exact incidence of CFC syndrome is not known; based on historic accounts, an estimated 200-300 people are affected worldwide. It is possible that CFC syndrome has been under- or misdiagnosed: A nationwide prevalence study conducted in Japan found CFC syndrome in 1 person per 810,000 Japanese individuals. CFC syndrome affects males and females equally and has no ethnic predilection.

Cardio-facio-cutaneous (CFC) syndrome testing may be indicated for any individual with a family history of CFC in a first-degree relative or a suspected diagnosis in a proband due to clinical features consistent with CFC Syndrome (see the clinical description above).

CFC testing may also be indicated in cases where the clinical phenotype is consistent with Noonan syndrome or Costello syndrome, but results from previous molecular testing for these conditions are negative.

Assay and technical information

Invitae is a College of American Pathologists (CAP)-accredited and Clinical Laboratory Improvement Amendments (CLIA)-certified clinical diagnostic laboratory performing full-gene sequencing and deletion/duplication analysis using next-generation sequencing technology (NGS).

Our sequence analysis covers clinically important regions of each gene, including coding exons, +/- 10 base pairs of adjacent intronic sequence, and select noncoding variants. Our assay provides a Q30 quality-adjusted mean coverage depth of 350x (50x minimum, or supplemented with additional analysis). Variants classified as pathogenic or likely pathogenic are confirmed with orthogonal methods, except individual variants that have high quality scores and previously validated in at least ten unrelated samples.

Our analysis detects most intragenic deletions and duplications at single exon resolution. However, in rare situations, single-exon copy number events may not be analyzed due to inherent sequence properties or isolated reduction in data quality. If you are requesting the detection of a specific single-exon copy number variation, please contact Client Services before placing your order.

Gene Transcript reference Sequencing analysis Deletion/Duplication analysis
BRAF NM_004333.4
KRAS NM_004985.4
MAP2K1 NM_002755.3
MAP2K2 NM_030662.3
SHOC2 NM_007373.3
SOS1 NM_005633.3