TNF and Cowden disease: Cytokine secretion is a highly complex and tightly regulated process.17 Different cell types have been shown to possess unique activation and secretory pathways, and furthermore, multiple exocytosis pathways have been identified for individual cytokines.18 To understand the defective macrophage secretory mechanisms associated with CD we have concentrated our study on TNF-α, IFN-γ, IL-6, IL-8 and IL-10, which have been shown to be abnormal in CD9,15,19 and used transcriptomic analyses in an attempt to identify the responsible molecules.