To the best of our knowledge, this is the first report on PEComa in GGS, and this finding also raises the potential relevance of PTCH1 mutations and altered sonic hedgehog signalling in PEComa pathogenesis. The presence of the same somatic mutation in the bilateral tumours might indicate the possibility of a postzygotic somatic mutation that along with the germline mutation of the same gene could represent an intriguing genetic phenomenon (type 2 segmental mosaicism).
A genotype-first approach may help clarify the true prevalence of Gorlin syndrome in the population. In addition, the advent of genetic sequencing may facilitate a necessary expansion beyond clinical criteria in the diagnosis of Gorlin syndrome.