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François P, Thibaud V, Pierre VP, Marion J, Delphine B, Frederic C, Christine C, Janick S, Rosine G, Nadim F. Special features of sarcomas developed in patients with Lynch syndrome: a systematic review. Crit Rev Oncol Hematol 2023:104055. [PMID: 37301271 DOI: 10.1016/j.critrevonc.2023.104055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023] Open
Abstract
Lynch syndrome (LS) is a genetic predisposition leading to colorectal and non-colorectal tumors such as endometrial, upper urinary tract, small intestine, ovarian, gastric, biliary duct cancers and glioblastoma. Though not classically associated with LS, growing literature suggests that sarcomas might develop in patients with LS. This systematic review of literature identified 44 studies (N=95) of LS patients who developed sarcomas. It seems that most sarcomas developed in patients with a germline mutation of MSH2 (57%) exhibit a dMMR (81%) or MSI (77%) phenotype, as in other LS-tumors. Although undifferentiated pleomorphic sarcoma (UPS), leiomyosarcoma, and liposarcoma remain the most represented histologic subtype, a higher proportion of rhabdomyosarcoma (10%, especially pleomorphic rhabdomyosarcoma) is reported. Further studies are required to better characterize this sub-population.
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Affiliation(s)
- Poumeaud François
- Department of Digestive Oncology, University Hospital of Toulouse (IUCT Rangueil Larrey), France; Department of Oncology, Toulouse Cancer Center (IUCT - Oncopole), France
| | - Valentin Thibaud
- Department of Oncology, Toulouse Cancer Center (IUCT - Oncopole), France; OncoSarc, INSERM U1037, Toulouse Cancer Research Center (CRCT), France
| | - Vande Perre Pierre
- Department of oncogenetic, Toulouse Cancer Center (IUCT - Oncopole), France
| | - Jaffrelot Marion
- Department of Digestive Oncology, University Hospital of Toulouse (IUCT Rangueil Larrey), France; Department of oncogenetic, Toulouse Cancer Center (IUCT - Oncopole), France
| | - Bonnet Delphine
- Department of oncogenetic, Toulouse Cancer Center (IUCT - Oncopole), France; Department of Internal medicine and Immunology, University Hospital of Toulouse (IUCT Rangueil Larrey), France
| | - Chibon Frederic
- OncoSarc, INSERM U1037, Toulouse Cancer Research Center (CRCT), France
| | - Chevreau Christine
- Department of Oncology, Toulouse Cancer Center (IUCT - Oncopole), France
| | - Selves Janick
- OncoSarc, INSERM U1037, Toulouse Cancer Research Center (CRCT), France; Department of Pathology, University Hospital of Toulouse ( IUCT- Oncopole) France
| | - Guimbaud Rosine
- Department of Digestive Oncology, University Hospital of Toulouse (IUCT Rangueil Larrey), France; OncoSarc, INSERM U1037, Toulouse Cancer Research Center (CRCT), France; Department of oncogenetic, Toulouse Cancer Center (IUCT - Oncopole), France
| | - Fares Nadim
- Department of Digestive Oncology, University Hospital of Toulouse (IUCT Rangueil Larrey), France; OncoSarc, INSERM U1037, Toulouse Cancer Research Center (CRCT), France.
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Liu J, Chang X, Xiao G, Zhong J, Huang B, Zhang J, Gao B, Peng G, Nie X. Case report: Undifferentiated sarcoma with multiple tumors involved in Lynch syndrome: Unexpected favorable outcome to sintilimab combined with chemotherapy. Front Oncol 2022; 12:1014859. [DOI: 10.3389/fonc.2022.1014859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
BackgroundPatients with Lynch syndrome are at an increased risk of developing simultaneous or metachronous tumors, while sarcomas have been occasionally reported. Sarcomas are generally not considered part of the common Lynch syndrome tumor spectrum. However, more and more studies and case reports suggested that sarcoma could be a rare clinical manifestation of Lynch syndrome, leading to new treatment strategies for sarcoma.Case summaryWe report the case of a 74-year-old male patient with Lynch syndrome who had rectal mucinous adenocarcinoma and prostate adenocarcinoma and then developed undifferentiated sarcoma of the left neck two years later. Mismatch repair deficiency (dMMR) was confirmed by immunohistochemical staining for the mismatch repair proteins MSH2, MSH6, MLH1 and PMS2. The result of polymerase chain reaction (PCR) microsatellite instability (MSI) testing of sarcoma showed high-level microsatellite instability (MSI-H). Additionally, a pathogenic germline mutation in MSH2 (c.2459-12A>G) was detected by next-generation sequencing (NGS). Taking into account HE morphology, immunohistochemical phenotype, MSI status, NGS result, medical history and germline MSH2 gene mutation, the pathological diagnosis of left neck biopsy tissue was Lynch syndrome related undifferentiated sarcoma with epithelioid morphology. The patient has been receiving immunotherapy (sintilimab) combined with chemotherapy (tegafur, gimeracil and oteracil potassium capsules) and currently has stable disease. We also reviewed the literature to understand the association between sarcoma and Lynch syndrome.ConclusionSarcoma may now be considered a rare clinical manifestation of Lynch syndrome. Attention and awareness about the association between Lynch syndrome and sarcoma need to be increased. Therefore, timely detection of MMR proteins and validation at the gene level for suspicious patients are the keys to avoiding missed or delayed diagnosis and to identifying patients suited for immunotherapy, which may also help to provide appropriate genetic counseling and follow-up management for patients.
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de Angelis de Carvalho N, Niitsuma BN, Kozak VN, Costa FD, de Macedo MP, Kupper BEC, Silva MLG, Formiga MN, Volc SM, Aguiar Junior S, Palmero EI, Casali-da-Rocha JC, Carraro DM, Torrezan GT. Clinical and Molecular Assessment of Patients with Lynch Syndrome and Sarcomas Underpinning the Association with MSH2 Germline Pathogenic Variants. Cancers (Basel) 2020; 12:E1848. [PMID: 32659967 PMCID: PMC7408879 DOI: 10.3390/cancers12071848] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/07/2020] [Indexed: 12/18/2022] Open
Abstract
Lynch syndrome (LS) is a hereditary cancer-predisposing syndrome associated most frequently with epithelial tumors, particularly colorectal (CRC) and endometrial carcinomas (EC). The aim of this study was to investigate the relationship between sarcomas and LS by performing clinical and molecular characterization of patients presenting co-occurrence of sarcomas and tumors from the LS spectrum. We identified 27 patients diagnosed with CRC, EC, and other LS-associated tumors who had sarcomas in the same individuals or families. Germline genetic testing, mismatch repair (MMR) protein immunohistochemistry, microsatellite instability (MSI), and other molecular analyses were performed. Five LS patients presenting personal or family history of sarcomas were identified (3 MSH2 carriers and 2 MLH1), with 2 having Muir-Torre phenotypes. For two MSH2 carriers we confirmed the etiology of the sarcomas (one liposarcoma and two osteosarcomas) as LS-related, since the tumors were MSH2/MSH6-deficient, MSI-high, or presented a truncated MSH2 transcript. Additionally, we reviewed 43 previous reports of sarcomas in patients with LS, which revealed a high frequency (58%) of MSH2 alterations. In summary, sarcomas represent a rare clinical manifestation in patients with LS, especially in MSH2 carriers, and the analysis of tumor biological characteristics can be useful for definition of tumor etiology and novel therapeutic options.
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Affiliation(s)
- Nathália de Angelis de Carvalho
- Genomics and Molecular Biology Group, International Research Center/CIPE, A.C.Camargo Cancer Center, São Paulo 01508-010, Brazil; (N.d.A.d.C.); (B.N.N.); (D.M.C.)
| | - Bianca Naomi Niitsuma
- Genomics and Molecular Biology Group, International Research Center/CIPE, A.C.Camargo Cancer Center, São Paulo 01508-010, Brazil; (N.d.A.d.C.); (B.N.N.); (D.M.C.)
| | - Vanessa Nascimento Kozak
- Oncogenetics Service, Hospital Erasto Gaertner, Curitiba 81520-060, Brazil; (V.N.K.); (J.C.C.-d.-R.)
- Postgraduate Program in Genetics, Federal University of Parana, Curitiba 81530-000, Brazil
| | - Felipe D’almeida Costa
- Anatomic Pathology Department, A.C.Camargo Cancer Center, São Paulo 01509-900, Brazil; (F.D.C.); (M.P.d.M.)
| | - Mariana Petaccia de Macedo
- Anatomic Pathology Department, A.C.Camargo Cancer Center, São Paulo 01509-900, Brazil; (F.D.C.); (M.P.d.M.)
| | - Bruna Elisa Catin Kupper
- Colorectal Cancer Department, A.C.Camargo Cancer Center, São Paulo 01509-900, Brazil; (B.E.C.K.); (S.A.J.)
| | | | | | - Sahlua Miguel Volc
- Faculdades Pequeno Principe, Curitiba 80230-020, Brazil; (S.M.V.); (E.I.P.)
- Oncogenetics Department, Barretos Cancer Hospital, Barretos 14784-400, Brazil
| | - Samuel Aguiar Junior
- Colorectal Cancer Department, A.C.Camargo Cancer Center, São Paulo 01509-900, Brazil; (B.E.C.K.); (S.A.J.)
| | - Edenir Inez Palmero
- Faculdades Pequeno Principe, Curitiba 80230-020, Brazil; (S.M.V.); (E.I.P.)
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos 14784-384, Brazil
- Instituto de Pesquisa Pelé Pequeno Principe, Curitiba 80250-060, Brazil
| | - José Cláudio Casali-da-Rocha
- Oncogenetics Service, Hospital Erasto Gaertner, Curitiba 81520-060, Brazil; (V.N.K.); (J.C.C.-d.-R.)
- Oncogenetics Department, A.C.Camargo Cancer Center, São Paulo 01509-900, Brazil;
| | - Dirce Maria Carraro
- Genomics and Molecular Biology Group, International Research Center/CIPE, A.C.Camargo Cancer Center, São Paulo 01508-010, Brazil; (N.d.A.d.C.); (B.N.N.); (D.M.C.)
- National Institute of Science and Technology in Oncogenomics (INCITO), São Paulo 01508-010, Brazil
| | - Giovana Tardin Torrezan
- Genomics and Molecular Biology Group, International Research Center/CIPE, A.C.Camargo Cancer Center, São Paulo 01508-010, Brazil; (N.d.A.d.C.); (B.N.N.); (D.M.C.)
- National Institute of Science and Technology in Oncogenomics (INCITO), São Paulo 01508-010, Brazil
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Bryer E, Hartner L. The Heart of the Matter: A Unique Convergence of Cardiac Neoplasm, Hereditary Nonpolyposis Colorectal Cancer, and Spindle Cell Sarcoma. EUROPEAN MEDICAL JOURNAL 2019. [DOI: 10.33590/emj/10313115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Primary cardiac tumours are exceedingly unusual and aggressive; they often develop in younger patients and present with advanced disease. The rarity and heterogeneity of primary cardiac tumours challenge the standardisation of therapeutic guidelines. Undifferentiated primary cardiac spindle cell sarcomas, a distinct subset of primary cardiac sarcomas, are especially unique with <20 cases reported worldwide, the majority of which are of left atrial origin. This article presents a review of the aetiology, pathophysiology, and therapy of undifferentiated primary cardiac spindle cell sarcomas. In conjunction, the authors present a unique case of a woman with hereditary nonpolyposis colorectal cancer (Lynch syndrome) who presented with a primary cardiac spindle cell sarcoma of left ventricular origin; this is the first case of this type and location of cardiac tumour reported in a patient with Lynch syndrome.
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Affiliation(s)
- Emily Bryer
- Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Lee Hartner
- Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Lobo J, Pinto C, Freitas M, Pinheiro M, Vizcaino R, Oliva E, Teixeira MR, Jerónimo C, Bartosch C. Ovarian metastasis from uveal melanoma with MLH1/PMS2 protein loss in a patient with germline MLH1 mutated Lynch syndrome: consequence or coincidence? Virchows Arch 2016; 470:347-352. [DOI: 10.1007/s00428-016-2052-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/21/2016] [Indexed: 01/08/2023]
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Moat M, O'Donnell RL, McCluggage WG, Ralte A, Edmondson RJ. Gastric-type adenocarcinoma of the cervix in a patient with Lynch syndrome: A case report. Gynecol Oncol Rep 2014; 10:41-3. [PMID: 26082936 PMCID: PMC4458744 DOI: 10.1016/j.gynor.2014.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 03/05/2014] [Indexed: 11/17/2022] Open
Abstract
Lynch syndrome (LS) is an uncommon, genetic disorder which predisposes affected individuals to colorectal, endometrial and ovarian malignancies. We report a case of cervical gastric-type adenocarcinoma in a patient with LS. Immunohistochemistry for mismatch repair proteins is a useful screening tool in tumours suspected to be associated with LS.
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Affiliation(s)
- M Moat
- Northern Institute for Cancer Research, Newcastle University Medical School, Newcastle Upon Tyne NE2 4HH, UK
| | - R L O'Donnell
- Northern Institute for Cancer Research, Newcastle University Medical School, Newcastle Upon Tyne NE2 4HH, UK ; Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead NE6 9SX, UK
| | - W G McCluggage
- Department of Pathology, Royal Group of Hospitals Trust, Grosvenor Road, Belfast BT12 6BL, UK
| | - A Ralte
- Department of Pathology, Queen Elizabeth Hospital, Gateshead NE6 9SX, UK
| | - R J Edmondson
- University of Manchester, St Mary's Hospital, Oxford Road, Manchester, UK
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Shia J, Holck S, Depetris G, Greenson JK, Klimstra DS. Lynch syndrome-associated neoplasms: a discussion on histopathology and immunohistochemistry. Fam Cancer 2014; 12:241-60. [PMID: 23435936 DOI: 10.1007/s10689-013-9612-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
It was a century ago that Warthin, a pathologist, first described the clinical condition now known as Lynch syndrome. One hundred years later, our understanding of this syndrome has advanced significantly. Much of the progress took place over the last 25 years and was marked by a series of interacting developments from the disciplines of clinical oncology, pathology, and molecular genetics, with each development serving to guide or enhance the next. The advancement of our understanding about the pathology of Lynch syndrome associated tumors exemplifies such intimate interplay among disciplines. Today, accumulative knowledge has enabled surgical pathologists to detect tumors that are likely to be associated with Lynch syndrome, and the pathologist is playing an increasingly more important role in the care of these patients. The pathologist's ability is afforded primarily by information gained from tumor histopathology and by DNA mismatch repair protein immunohistochemistry. It is therefore pertinent both for the pathologists to accurately ascertain this morphologic information, and for all that are involved in the care of these patients to thoroughly understand the implications of such information. This article provides an overview of the development of histopathology and immunohistochemistry in Lynch syndrome-associated tumors, particularly in colorectal and endometrial cancers, and outlines the issues and current status of these specific pathologic aspects in not only the major tumors but also those less commonly seen or only newly reported in Lynch syndrome patients.
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Affiliation(s)
- Jinru Shia
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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Yousef I, Siyam F, Layfield L, Freter C, Sowers JR. Cervical neuroendocrine tumor in a young female with Lynch Syndrome. NEURO ENDOCRINOLOGY LETTERS 2014; 35:89-94. [PMID: 24878972 PMCID: PMC4308043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/15/2014] [Indexed: 06/03/2023]
Abstract
Neuroendocrine tumors rarely occur in the cervix or other components of the reproductive system. These tumors have been associated with microsatellite instability, are very aggressive and often associated with poor outcome. Lynch syndrome is an inherited cancer syndrome that has also been associated with microsatellite instability. Here we report a 34-year-old female with Lynch syndrome and a family history of loss of DNA mismatch of the hereditary non-polyposis colorectal cancer repair gene expression who presented with a neuroendocrine tumor of her cervix as the first manifestation of Lynch syndrome. This is the first case reported of a neuroendocrine tumor of the cervix in a patient with Lynch syndrome. We also review the relationship between Lynch Syndrome and neuroendocrine tumors.
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Affiliation(s)
- Ibraheem Yousef
- Department of Medicine, Internal Medicine, University of Missouri, Columbia, MO, USA
| | - Fadi Siyam
- Diabetes and Cardiovascular Center, University of Missouri, Columbia, MO, USA
| | - Lester Layfield
- Department of Pathology, University of Missouri, Columbia, MO, USA
| | - Carl Freter
- Division of Hematology and Oncology, University of Missouri, Columbia, MO, USA
| | - James R. Sowers
- Department of Medicine, Internal Medicine, University of Missouri, Columbia, MO, USA
- Diabetes and Cardiovascular Center, University of Missouri, Columbia, MO, USA
- Harry S Truman Memorial Veterans’ Hosptial, Columbia, MO, USA
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Win AK, Lindor NM, Jenkins MA. Risk of breast cancer in Lynch syndrome: a systematic review. Breast Cancer Res 2013; 15:R27. [PMID: 23510156 PMCID: PMC3672741 DOI: 10.1186/bcr3405] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 03/18/2013] [Indexed: 12/11/2022] Open
Abstract
Introduction Lynch syndrome is an autosomal dominantly inherited disorder of cancer susceptibility caused by germline mutations in the DNA mismatch repair (MMR) genes. Mutation carriers have a substantial burden of increased risks of cancers of the colon, rectum, endometrium and several other organs which generally occur at younger ages than for the general population. The issue of whether breast cancer risk is increased for MMR gene mutation carriers has been debated with evidence for and against this association. Methods Using the PUBMED, we identified all relevant studies of breast cancer associated with Lynch syndrome that were published by 15 December 2012. In the review, we included: (i) molecular studies that reported microsatellite instability and/or immunohistochemistry in breast cancer tumors of MMR gene mutation carriers; and (ii) risk studies that investigated risk of breast cancer for confirmed MMR gene mutation carriers or families or clinically and/or pathologically defined Lynch syndrome families. Results We identified 15 molecular studies and, when combined, observed 62 of 122 (51%; 95% CI 42 to 60%) breast cancers in MMR gene mutation carriers were MMR-deficient. Of the 21 risk studies identified, 13 did not observe statistical evidence for an association of breast cancer risk with Lynch syndrome while 8 studies found an increased risk of breast cancer ranging from 2- to 18-fold compared with the general population (or non-carriers). There is only one prospective study demonstrating an elevated risk of breast cancer for MMR gene mutation carriers compared with the general population (standardized incidence ratio 3.95; 95% CI 1.59, 8.13). Conclusions Since breast cancer is a relatively common disease in the general population, more precise estimates of risk and gene-specific risks will need to utilize large prospective cohort studies with a long follow-up. While current data are inconclusive at a population level, individual tumor testing results suggest that MMR deficiency is involved with breast cancers in some individuals with Lynch syndrome.
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Karamurzin Y, Zeng Z, Stadler ZK, Zhang L, Ouansafi I, Al-Ahmadie HA, Sempoux C, Saltz LB, Soslow RA, O'Reilly EM, Paty PB, Coit DG, Shia J, Klimstra DS. Unusual DNA mismatch repair-deficient tumors in Lynch syndrome: a report of new cases and review of the literature. Hum Pathol 2012; 43:1677-87. [PMID: 22516243 DOI: 10.1016/j.humpath.2011.12.012] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 12/09/2011] [Accepted: 12/14/2011] [Indexed: 12/24/2022]
Abstract
Immunohistochemical detection of DNA mismatch repair proteins and polymerase chain reaction detection of microsatellite instability have enhanced the recognition of mismatch repair-deficient neoplasms in patients with Lynch syndrome and, consequently, led to the identification of tumors that have not been included in the currently known Lynch syndrome tumor spectrum. Here, we report 4 such unusual tumors. Three of the 4, a peritoneal mesothelioma, a pancreatic acinar cell carcinoma, and a pancreatic well-differentiated neuroendocrine tumor, represented tumor types that, to the best of our knowledge, have not been previously reported in Lynch syndrome. The fourth tumor was an adrenocortical carcinoma, which has rarely been reported previously in Lynch syndrome. Three of our 4 patients carried a pathogenic germ-line mutation in a mismatch repair gene. The unusual tumor in each of the 3 patients showed loss of the mismatch repair protein corresponding to the mutation. The fourth patient did not have mutation information but had a history of colonic and endometrial carcinomas; both lacked MSH2 and MSH6 proteins. Interestingly, none of the 4 unusual tumors revealed microsatellite instability on polymerase chain reaction testing, whereas an appendiceal carcinoma from 1 of the study patients who was tested simultaneously did. The recognition of such tumors expands the repertoire of usable test samples for the workup of high-risk families. As yet, however, there are no data to support the inclusion of these tumors into general screening guidelines for detecting Lynch syndrome, nor are there data to warrant surveillance for these tumors in patients with Lynch syndrome.
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Affiliation(s)
- Yevgeniy Karamurzin
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Leisibach P, Weder W, Soltermann A, Jungraithmayr W. Primary Sclerosing Epithelioid Fibrosarcoma of the Lung in a Patient with Lynch Syndrome. Lung 2012; 190:691-5. [DOI: 10.1007/s00408-012-9401-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 06/13/2012] [Indexed: 11/29/2022]
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Synchronous breast cancers with different morphologic and molecular phenotypes occurring in Lynch syndrome: what does the heterogeneity imply? Am J Surg Pathol 2011; 35:1743-8. [PMID: 21997695 DOI: 10.1097/pas.0b013e3182320cff] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The increasingly widespread use of immunohistochemistry in the detection of DNA mismatch repair proteins has led to the observation of various unusual tumor types that occur in Lynch syndrome and exhibit mismatch repair protein deficiency. Understanding the clinical significance of such unusual tumors has become increasingly desirable. Here, we report a case of 2 synchronous breast cancers occurring in a 74-year-old woman who carried a deleterious germline mutation in MSH2 and who survived an endometrial and a colonic carcinoma. Both breast cancers were of lobular type with similar expression patterns for estrogen receptor, progesterone receptor, and Her2/neu. However, the 2 cancers differed in other characteristics. One tumor showed a solid alveolar histologic pattern with prominent tumor-infiltrating lymphocytes and loss of MSH2 and MSH6 protein on immunohistochemical staining. In contrast, the other tumor was of classic type with no apparent lymphocytic infiltration and no loss of mismatch repair protein. Such a case carries practical implications as it suggests that certain breast cancers may serve as tissue samples for the detection of mismatch repair deficiency in families at high risk for Lynch syndrome, thus expanding the test sample repertoire for genetic workup in these families. Furthermore, the case exemplifies the complexity of tumorigenesis in Lynch syndrome patients. The observation that, of the 2 breast cancers, increased tumor-infiltrating lymphocytes were present only in the tumor that showed mismatch repair protein abnormality is in keeping with what has been observed in the colon and other sites. Such persistent genotype-phenotype correlation across different organs affords the promise that molecular classification may allow identification of biologically distinct tumor subsets beyond the confines of the tumor's primary anatomic location.
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