Gastrointestinal manifestations in PTEN hamartoma tumor syndrome

Screening at the scope: enhancing the role of pathologists in diagnosing gastrointestinal polyposis syndromes

Only a minority of patients at high likelihood of a gastrointestinal polyposis syndrome (GPS) are appropriately referred for workup. This proof-of-concept study evaluates a GPS screening rubric based exclusively on information in prior pathology reports and intended to facilitate pathologist engagement in GPS screening and referral. We sought to (1) identify patients who would benefit from further GPS workup, (2) assign a probable polyposis syndrome category (adenomatous, hamartomatous, serrated, or mixed), and (3) suggest a specific syndrome, such as familial adenomatous polyposis, whenever possible. We retrospectively tested the rubric against the pathology records of 108 patients (median, 6 reports/patient) with an established clinical diagnosis of GPS (adenomatous (N = 88), hamartomatous (N = 18), and mixed (N = 2) polyposis syndromes). Records were reviewed chronologically (mean, 4.4 min/patient) by a GI pathologist blinded to clinical history. Ninety-five patients (88%) had a positive GPS screen (N = 76 with an adenomatous polyposis syndrome, N = 17 with a hamartomatous polyposis syndrome, N = 2 with a mixed polyposis syndrome); all were assigned to the correct syndrome category. In a subset of cases, the histopathologic record suggested a specific syndrome (correct in 28 of 30 instances). Of 13 patients with a negative screen (failure to meet any rubric parameters), N = 6 (46.2%) had incomplete records. These findings demonstrate that when robust records are available, structured review of pathology reports is a sensitive and efficient tool for the identification of patients with a high suspicion of a GPS. While prospective studies are necessary, pathologists are indeed well positioned to play an expanded role in GPS screening.

Causal relationship between green tea intake and gastrointestinal disorders: a two-sample Mendelian randomization study

Background

The precise association between green tea intake and gastrointestinal disorders remains controversial. This study aimed to investigate the potential causal association between green tea intake and gastrointestinal disorders through a two-sample Mendelian randomization (MR) study.

Methods

Utilizing publicly accessible data from genome-wide association studies (GWAS), we identified SNPs strongly linked with the study variables from multiple large databases to serve as instrumental variables (IVs). MR analyses were executed utilizing the inverse variance weighting (IVW) method, with the resultant effect estimates serving as the primary outcome measure. In addition, a multivariate MR design was performed to adjust for smoking and alcohol consumption. To ensure the robustness of our findings, a series of sensitivity analyses were conducted to assess reliability.

Results

Univariable MR analysis revealed suggestive associations between green tea intake and gastroesophageal reflux (OR = 0.9950, 95% CI 0.9900-1.0000, p IVW = 0.047), diverticulosis (OR = 0.9998, 95% CI 0.9996-1.0000, p IVW = 0.030), Crohn's disease (OR = 1.0001, 95% CI 1.0000-1.0002, p IVW = 0.019), and cholangitis was observed (OR = 1.0440, 95% CI 1.0100-1.0790, p IVW = 0.011). Multivariate MR analysis indicated after controlling for potential confounders, greater green tea consumption was suggestively associated with the decreased risk of oesophagitis (OR = 0.9667, 95% CI: 0.9405-0.9936, p IVW = 0.016) and gastric cancer (OR = 0.9810, 95% CI: 0.9628-0.9996, p IVW = 0.046). Nevertheless, multivariate MR analysis also showed that greater green tea consumption was suggestively associated with the increased risk of Crohn's disease (OR = 1.0001, 95% CI: 1.0000-1.0002, p IVW = 0.007). Sensitivity analyses confirmed that these results were reliable.

Conclusion

Our study provides suggestive evidence that genetically predicted green tea intake is causally associated with the risk of oesophagitis, gastric cancer and Crohn's disease, but a larger GWAS database is needed for validation.

A systematic review of Bannayan - Riley - Ruvalcaba syndrome

Bannayan-Riley-Ruvalcaba syndrome (BRRS) is a rare overgrowth condition caused by a pathogenic variant in the phosphatase and tensin homolog (PTEN) gene and belongs to a group of disorders called PTEN hamartoma tumor syndrome (PHTS). The diagnosis is often complicated by great phenotypic diversity. Furthermore, to this date treatment options are limited. Here we performed a systematic review using PubMed, Cochrane, and Scopus databases to identify cases of pediatric patients diagnosed with BRRS and summarized information about the clinical presentation, treatment, and long-term patient care. A total of 83 pediatric patients with BRRS were identified. The most common clinical findings were macrocephaly (77%) and developmental disorders (63%). Surgical interventions were the treatment of choice, described in 19 articles. Patient surveillance was proposed in 15 case reports and mostly aimed at periodic cancer screening. Recognition of BRRS clinical symptoms and early referral to a geneticist is important for better disease control and overall prognosis. As targeted treatment is still lacking, symptom relief and long-term surveillance remain the main management strategies.

A comprehensive review of the PTEN/PI3K/Akt axis in multiple myeloma: From molecular interactions to potential therapeutic targets

Phosphatase and tensin homolog (PTEN), phosphatidylinositol 3-kinase (PI3K), and protein kinase B (Akt) signaling pathways contribute to the development of several cancers, including multiple myeloma (MM). PTEN is a tumor suppressor that influences the PI3K/Akt/mTOR pathway, which in turn impacts vital cellular processes like growth, survival, and treatment resistance. The current study aims to present the role of PTEN and PI3K/Akt/mTOR signaling in the development of MM and its response to treatment. In addition, the molecular interactions in MM that underpin the PI3K/Akt/mTOR pathway and address potential implications for the development of successful treatment plans are also discussed in detail. We investigate their relationship to both upstream and downstream regulators, highlighting new developments in combined therapies that target the PTEN/PI3K/Akt axis to overcome drug resistance, including the use of PI3K and mitogen-activated protein kinase (MAPK) inhibitors. We also emphasize that PTEN/PI3K/Akt pathway elements may be used in MM diagnosis, prognosis, and therapeutic targets.

Preventive strategies in familial and hereditary colorectal cancer

Colorectal cancer is a leading cause of cancer-related deaths worldwide. While most cases are sporadic, a significant proportion of cases are associated with familial and hereditary syndromes. Individuals with a family history of colorectal cancer have an increased risk of developing the disease, and those with hereditary syndromes such as Lynch syndrome or familial adenomatous polyposis have a significantly higher risk. In these populations, preventive strategies are critical for reducing the incidence and mortality of colorectal cancer. This review provides an overview of current preventive strategies for individuals at increased risk of colorectal cancer due to familial or hereditary factors. The manuscript includes a discussion of risk assessment and genetic testing, highlighting the importance of identifying at-risk individuals and families. This review describes various preventive measures, including surveillance colonoscopy, chemoprevention, and prophylactic surgery, and their respective benefits and limitations. Together, this work highlights the importance of preventive strategies in familial and hereditary colorectal cancer.

PTEN hamartoma tumour syndrome: case report based on data from the Iranian hereditary colorectal cancer registry and literature review

BACKGROUND

PTEN hamartoma tumour syndrome (PHTS) is a rare hereditary disorder caused by germline pathogenic mutations in the PTEN gene. This study presents a case of PHTS referred for genetic evaluation due to multiple polyps in the rectosigmoid area, and provides a literature review of PHTS case reports published between March 2010 and March 2022.

CASE PRESENTATION

A 39-year-old Iranian female with a family history of gastric cancer in a first-degree relative presented with minimal bright red blood per rectum and resistant dyspepsia. Colonoscopy revealed the presence of over 20 polyps in the rectosigmoid area, while the rest of the colon appeared normal. Further upper endoscopy showed multiple small polyps in the stomach and duodenum, leading to a referral for genetic evaluation of hereditary colorectal polyposis. Whole-exome sequencing led to a PHTS diagnosis, even though the patient displayed no clinical or skin symptoms of the condition. Further screenings identified early-stage breast cancer and benign thyroid nodules through mammography and thyroid ultrasound.

METHOD AND RESULTS OF LITERATURE REVIEW

A search of PubMed using the search terms "Hamartoma syndrome, Multiple" [Mesh] AND "case report" OR "case series" yielded 43 case reports, predominantly in women with a median age of 39 years. The literature suggests that patients with PHTS often have a family history of breast, thyroid and endometrial neoplasms along with pathogenic variants in the PTEN/MMAC1 gene. Gastrointestinal polyps are one of the most common signs reported in the literature, and the presence of acral keratosis, trichilemmomas and mucocutaneous papillomas are pathognomonic characteristics of PHTS.

CONCLUSION

When a patient presents with more than 20 rectosigmoid polyps, PHTS should be considered. In such cases, it is recommended to conduct further investigations to identify other potential manifestations and the phenotype of PHTS. Women with PHTS should undergo annual mammography and magnetic resonance testing for breast cancer screening from the age of 30, in addition to annual transvaginal ultrasounds and blind suction endometrial biopsies.

Benign goiters requiring thyroidectomy as the signal for PTEN hamartoma tumor syndrome diagnosis

PTEN hamartoma tumor syndrome (PHTS) is a rare genetic cancer and tumor predisposition syndrome. Due to the wide spectrum of clinical manifestations and variable age at onset, the pathways leading to a PHTS diagnosis are difficult and highly variable. Many patients were found to have PHTS after a cancer diagnosis, missing the opportunity of prevention or enhanced cancer screening. This retrospective study evaluated a PHTS cohort followed in a high-risk surveillance clinic in a comprehensive cancer institution. A significant portion of the patients (60.9%, 14/23) had at least one cancer diagnosis (average age 34.6 years at diagnosis). A significant portion (78.3%, 18/23) were affected with clinically significant goiters (age 27.9 years), and many (60.9%, 14/23) had partial or total thyroidectomy (age 27.1 years). The average age at goiter diagnosis or thyroidectomy is younger than a cancer diagnosis. In 12 individuals who were affected with clinically significant goiter and cancer, all cancers were diagnosed after the thyroid disease (6.3 years). As clinically significant thyroid nodules in childhood or early young adulthood are common in PHTS, but uncommon for general population, these early onset thyroid nodules may alert the clinician to initiate PHTS-targeted evaluation and genetic testing.