**Question:** Cowden disease is characterized by the following EXCEPT

A. Increased risk of breast cancer
B. Increased risk of thyroid cancer
C. Increased risk of colon cancer
D. Decreased risk of ovarian cancer

**Core Concept:**
Cowden disease is a rare autosomal dominant disorder characterized by an increased risk of multiple benign tumors in various organs, most commonly the breast, thyroid, and skin. It is caused by mutations in the PTEN gene, which is a tumor suppressor gene. The PTEN gene plays a crucial role in regulating cell growth, proliferation, and apoptosis.

**Why the Correct Answer is Right:**
D. Decreased risk of ovarian cancer is not a characteristic feature of Cowden disease because it primarily affects cells in the breast, thyroid, and skin. Ovarian cancer is unrelated to the PTEN gene mutations involved in Cowden disease.

**Why Each Wrong Option is Incorrect:**
A. Increased risk of breast cancer is a core feature of Cowden disease due to the increased occurrence of benign breast tumors, such as hamartomas, fibroadenomas, and phyllodes tumors.
B. Increased risk of thyroid cancer is another important feature of Cowden disease, as affected individuals face an elevated incidence of follicular thyroid adenomas and papillary thyroid carcinomas.
C. Increased risk of colon cancer is also relevant to Cowden disease, as these patients have a higher propensity to develop benign and malignant polyps in the colon, which can lead to colorectal cancer.

**Clinical Pearl:**
Cowden disease is a prime example of a cancer predisposition syndrome that presents with various benign and malignant tumors in different organs. Clinical suspicion and early screening for affected individuals can help in early detection and management of these tumors, leading to better outcomes. Familiarize yourself with these syndromes to identify patients and provide appropriate care.