Women should undergo chest CT scans at least once on reaching adulthood. In a family with only one child affected, evaluation of parents is more important than siblings or relatives. Echocardiography - This is not recommended unless compelling cardiac symptoms persuade otherwise, as cardiac rhabdomyomas commonly disappear by adulthood. Molecular diagnosis - Though this is not yet commercially available, it should soon be feasible to identify some patients with tuberous sclerosis complex who do not fulfill clinical diagnostic criteria. Angiofibromas show atrophic sebaceous glands with dermal fibrosis and dilation of some of the capillaries.
Elastic tissue is absent in the angiofibromas.
The ungual fibromas show mainly fibrosis, rarely capillary dilation. The shagreen patches show increased dense sclerotic mass of broad collagenous bundles. Normal collagen bundles sometimes may be arranged in an interwoven pattern. The elastic tissue is reduced. The hypopigmented ash-leaf macule shows normal melanocyte numbers with decreased pigmentation.