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Raygada M, Raffeld M, Bernstein A, Miettinen M, Glod J, Hughes MS, Reilly K, Widemann B, Del Rivero J. Case report of adrenocortical carcinoma associated with double germline mutations in MSH2 and RET. Am J Med Genet A 2021; 185:1282-1287. [PMID: 33615670 PMCID: PMC7986073 DOI: 10.1002/ajmg.a.62099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/27/2020] [Accepted: 01/09/2021] [Indexed: 12/25/2022]
Abstract
Adrenocortical carcinoma (ACC) is a rare aggressive malignancy that originates in the outer layer of the adrenal gland. Most ACCs are sporadic, but a small percentage of cases are due to hereditary cancer syndromes such as Li-Fraumeni syndrome (LFS), Lynch syndrome (LS), and familial adenomatous polyposis (FAP). Multiple endocrine neoplasia type 2A (MEN2A) is an inherited disorder that predisposes to medullary thyroid cancer, pheochromocytoma, and parathyroid hyperplasia. We present here a case of ACC with both LS and MEN2A; the family and medical history were consistent with Lynch. This is, to our knowledge, the first report of a patient with ACC associated with germline mutations in RET and MSH2, and no phenotypical characteristics of MEN2A.
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Affiliation(s)
- Margarita Raygada
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Clinical Center, National Institutes of Health, Bethesda, Maryland, DC, USA
| | - Mark Raffeld
- Laboratory of Pathology, National Cancer Institute, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrew Bernstein
- George Washington School of Medicine, George Washington University, Washington, DC, USA
| | - Markku Miettinen
- Laboratory of Pathology, National Cancer Institute, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - John Glod
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Clinical Center, National Institutes of Health, Bethesda, Maryland, DC, USA
| | - Marybeth S Hughes
- Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Karlyne Reilly
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Clinical Center, National Institutes of Health, Bethesda, Maryland, DC, USA
| | - Brigitte Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Clinical Center, National Institutes of Health, Bethesda, Maryland, DC, USA
| | - Jaydira Del Rivero
- Developmental Therapeutics Branch, National Cancer Institute, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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Schrader KA, Cheng DT, Joseph V, Prasad M, Walsh M, Zehir A, Ni A, Thomas T, Benayed R, Ashraf A, Lincoln A, Arcila M, Stadler Z, Solit D, Hyman DM, Hyman D, Zhang L, Klimstra D, Ladanyi M, Offit K, Berger M, Robson M. Germline Variants in Targeted Tumor Sequencing Using Matched Normal DNA. JAMA Oncol 2016; 2:104-11. [PMID: 26556299 DOI: 10.1001/jamaoncol.2015.5208] [Citation(s) in RCA: 249] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Tumor genetic sequencing identifies potentially targetable genetic alterations with therapeutic implications. Analysis has concentrated on detecting tumor-specific variants, but recognition of germline variants may prove valuable as well. OBJECTIVE To estimate the burden of germline variants identified through routine clinical tumor sequencing. DESIGN, SETTING, AND PARTICIPANTS Patients with advanced cancer diagnoses eligible for studies of targeted agents at Memorial Sloan Kettering Cancer Center are offered tumor-normal sequencing with MSK-IMPACT, a 341-gene panel. We surveyed the germline variants seen in 187 overlapping genes with Mendelian disease associations in 1566 patients who had undergone tumor profiling between March and October 2014. MAIN OUTCOMES AND MEASURES The number of presumed pathogenic germline variants (PPGVs) and variants of uncertain significance per person in 187 genes associated with single-gene disorders and the proportions of individuals with PPGVs in clinically relevant gene subsets, in genes consistent with known tumor phenotypes, and in genes with evidence of second somatic hits in their tumors. RESULTS The mean age of the 1566 patients was 58 years, and 54% were women. Presumed pathogenic germline variants in known Mendelian disease-associated genes were identified in 246 of 1566 patients (15.7%; 95% CI, 14.0%-17.6%), including 198 individuals with mutations in genes associated with cancer susceptibility. Germline findings in cancer susceptibility genes were concordant with the individual's cancer type in only 81 of 198 cases (40.9%; 95% CI, 34.3%-47.9%). In individuals with PPGVs retained in the tumor, somatic alteration of the other allele was seen in 39 of 182 cases (21.4%; 95% CI, 16.1%-28.0%), of which 13 cases did not show a known correlation of the germline mutation and a known syndrome. Mutations in non-cancer-related Mendelian disease genes were seen in 55 of 1566 cases (3.5%; 95% CI, 27.1%-45.4%). Almost every individual had more than 1 variant of uncertain significance (1565 of 1566 patients; 99.9%; 95% CI, 99.6%-99.9%). CONCLUSIONS AND RELEVANCE Germline variants are common in individuals undergoing tumor-normal sequencing and may reveal otherwise unsuspected syndromic associations.
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Affiliation(s)
- Kasmintan A Schrader
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York2Department of Molecular Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada3Department of Medical Genetics, University of British Columbia, Vancouver, British C
| | - Donavan T Cheng
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vijai Joseph
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York5Cancer Biology and Genetics Program, Sloan Kettering Institute, New York, New York
| | - Meera Prasad
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Walsh
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering, New York, New York7Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ahmet Zehir
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ai Ni
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tinu Thomas
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering, New York, New York
| | - Ryma Benayed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Asad Ashraf
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Annie Lincoln
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maria Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zsofia Stadler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York6Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering, New York, New York
| | - David Solit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York9Weill Cornell Medical College, New York, New York10Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York11Center for Molecular
| | | | - David Hyman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Liying Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Klimstra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York10Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kenneth Offit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York5Cancer Biology and Genetics Program, Sloan Kettering Institute, New York, New York6Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering, New York, Ne
| | - Michael Berger
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York9Weill Cornell Medical College, New York, New York10Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York11Center for Molecula
| | - Mark Robson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York6Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering, New York, New York9Weill Cornell Medical College, New York, New York
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Koch CA, Brouwers FM, Vortmeyer AO, Tannapfel A, Libutti SK, Zhuang Z, Pacak K, Neumann HPH, Paschke R. Somatic VHL gene alterations in MEN2-associated medullary thyroid carcinoma. BMC Cancer 2006; 6:131. [PMID: 16707008 PMCID: PMC1483898 DOI: 10.1186/1471-2407-6-131] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Accepted: 05/17/2006] [Indexed: 11/17/2022] Open
Abstract
Background Germline mutations in RET are responsible for multiple endocrine neoplasia type 2 (MEN2), an autosomal dominantly inherited cancer syndrome that is characterized by medullary thyroid carcinoma (MTC), pheochromocytoma, and parathyroid hyperplasia/adenoma. Recent studies suggest a "second hit" mechanism resulting in amplification of mutant RET. Somatic VHL gene alterations are implicated in the pathogenesis of MEN2 pheochromocytomas. We hypothesized that somatic VHL gene alterations are also important in the pathogenesis of MEN2-associated MTC. Methods We analyzed 6 MTCs and 1 C-cell hyperplasia (CCH) specimen from 7 patients with MEN2A and RET germline mutations in codons 609, 618, 620, or 634, using microdissection, microsatellite analysis, phosphorimage densitometry, and VHL mutation analysis. Results First, we searched for allelic imbalance between mutant and wild-type RET by using the polymorphic markers D10S677, D10S1239, and RET on thyroid tissue from these patients. Evidence for RET amplification by this technique could be demonstrated in 3 of 6 MTCs. We then performed LOH analysis using D3S1038 and D3S1110 which map to the VHL gene locus at 3p25/26. VHL gene deletion was present in 3 MTCs. These 3 MTCs also had an allelic imbalance between mutant and wild-type RET. Mutation analysis of the VHL gene showed a somatic frameshift mutation in 1 MTC that also demonstrated LOH at 3p25/26. In the 2 other MTCs with allelic imbalance of RET and somatic VHL gene deletion, no somatic VHL mutation could be detected. The CCH specimen did neither reveal RET imbalance nor somatic VHL gene alterations. Conclusion These data suggest that a RET germline mutation is necessary for development of CCH, that allelic imbalance between mutant and wild-type RET may set off tumorigenesis, and that somatic VHL gene alterations may not play a major role in tumorigenesis of MEN2A-associated MTC.
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Affiliation(s)
- Christian A Koch
- Division of Endocrinology and Nephrology, University of Leipzig, Philipp-Rosenthalstr. 27, 04103 Leipzig, Germany
- Division of Endocrinology, University of Mississippi Medical Center, 2500 N State Str, Jackson, MS 39216, USA
| | - Frederieke M Brouwers
- Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, National Institutes of Health, Center Drive, Building 10, Bethesda, MD 20892, USA
| | - Alexander O Vortmeyer
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Center Drive, Building 10, Rm 5D37, Bethesda, MD 20892, USA
| | - Andrea Tannapfel
- Institute of Pathology, Ruhr-Universität Bochum an den BG Kliniken Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44 789 Bochum, Germany
| | - Steven K Libutti
- Surgery Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Room 4W-5940, Bethesda, MD 20892, USA
| | - Zhengping Zhuang
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Center Drive, Building 10, Rm 5D37, Bethesda, MD 20892, USA
| | - Karel Pacak
- Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, National Institutes of Health, Center Drive, Building 10, Bethesda, MD 20892, USA
| | - Hartmut PH Neumann
- Division of Nephrology and Hypertension, Albert-Ludwigs-Universitaet of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Ralf Paschke
- Division of Endocrinology and Nephrology, University of Leipzig, Philipp-Rosenthalstr. 27, 04103 Leipzig, Germany
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