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van Poppelen NM, Cassoux N, Turunen JA, Naus NC, Verdijk RM, Vaarwater J, Cohen V, Papastefanou VP, Kiratli H, Saakyan SV, Tsygankov AY, Rospond-Kubiak I, Mudhar HS, Salvi SM, Kiilgaard JF, Heegaard S, Moulin AP, Saornil MA, Garciá-Alvarez C, Fili M, Eide NA, Meyer P, Kivelä TT, de Klein A, Kilic E, Al-Jamal RT. The Pediatric and Young Adult Choroidal and Ciliary Body Melanoma Genetic Study, A Survey by the European Ophthalmic Oncology Group. Invest Ophthalmol Vis Sci 2024; 65:12. [PMID: 38573618 PMCID: PMC10996971 DOI: 10.1167/iovs.65.4.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/28/2023] [Indexed: 04/05/2024] Open
Abstract
Purpose To explore the genetic background of choroidal and ciliary body melanoma among children and young adults, with special focus on BAP1 germline variants in this age group. Methods Patients under the age of 25 and with confirmed choroidal or ciliary body melanoma were included in this retrospective, multicenter observational study. Nuclear BAP1 immunopositivity was used to evaluate the presence of functional BAP1 in the tumor. Next-generation sequencing using Ion Torrent platform was used to determine pathogenic variants of BAP1, EIF1AX, SF3B1, GNAQ and GNA11 and chromosome 3 status in the tumor or in DNA extracted from blood or saliva. Survival was analyzed using Kaplan-Meier estimates. Results The mean age at diagnosis was 17 years (range 5.0-24.8). A germline BAP1 pathogenic variant was identified in an 18-year-old patient, and a somatic variant, based mainly on immunohistochemistry, in 13 (42%) of 31 available specimens. One tumor had a somatic SF3B1 pathogenic variant. Disomy 3 and the absence of a BAP1 pathogenic variant in the tumor predicted the longest metastasis-free survival. Males showed longer metastasis-free survival than females (P = 0.018). Conclusions We did not find a stronger-than-average BAP1 germline predisposition for choroidal and ciliary body melanoma among children and young adults compared to adults. Males had a more favorable survival and disomy 3, and the absence of a BAP1 mutation in the tumor tissue predicted the most favorable metastasis-free survival. A BAP1 germline pathogenic variant was identified in one patient (1%), and a somatic variant based mainly on immunohistochemistry in 13 (42%).
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Affiliation(s)
- Natasha M. van Poppelen
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nathalie Cassoux
- Department of Ophthalmology, Curie Institute, Université Paris Cité UFR Médecine, Paris, France
| | - Joni A. Turunen
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Eye Genetics Group, Folkhälsan Research Center, Helsinki, Finland
| | - Nicole C. Naus
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert M. Verdijk
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pathology, Leiden Universital Medical Center, Leiden, The Netherlands
| | - Jolanda Vaarwater
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Victoria Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
| | | | - Hayyam Kiratli
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Svetlana V. Saakyan
- Department of Ophthalmology, Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia
| | - Alexander Y. Tsygankov
- Department of Ophthalmology, Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia
| | - Iwona Rospond-Kubiak
- Department of Ophthalmology, Poznan University of Medical Sciences, Poznán, Poland
| | - Hardeep S. Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Sachin M. Salvi
- Sheffield Ocular Oncology Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Jens F. Kiilgaard
- Department of Ophthalmology, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, University of Copenhagen, Copenhagen, Denmark
- Department of Pathology, University of Copenhagen, Copenhagen, Denmark
| | - Alexandre P. Moulin
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Lausanne University, Lausanne, Switzerland
| | - Maria A. Saornil
- Department of Ophthalmology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Ciro Garciá-Alvarez
- Department of Ophthalmology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Maria Fili
- Department of Ophthalmology, St. Erik Eye Hospital, Stockholm, Sweden
| | - Nils A. Eide
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Peter Meyer
- Department of Ophthalmology, Basel University Hospital, Basel, Switzerland
| | - Tero T. Kivelä
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Annelies de Klein
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Emine Kilic
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rana'a T. Al-Jamal
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
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2
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Bauwens M, Celik E, Zur D, Lin S, Quinodoz M, Michaelides M, Webster AR, Van Den Broeck F, Leroy BP, Rizel L, Moye AR, Meunier A, Tran HV, Moulin AP, Mahieu Q, Van Heetvelde M, Arno G, Rivolta C, De Baere E, Ben-Yosef T. Mutations in SAMD7 cause autosomal-recessive macular dystrophy with or without cone dysfunction. Am J Hum Genet 2024; 111:393-402. [PMID: 38272031 PMCID: PMC10870129 DOI: 10.1016/j.ajhg.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 01/27/2024] Open
Abstract
Sterile alpha motif domain containing 7 (SAMD7) is a component of the Polycomb repressive complex 1, which inhibits transcription of many genes, including those activated by the transcription factor Cone-Rod Homeobox (CRX). Here we report bi-allelic mutations in SAMD7 as a cause of autosomal-recessive macular dystrophy with or without cone dysfunction. Four of these mutations affect splicing, while another mutation is a missense variant that alters the repressive effect of SAMD7 on CRX-dependent promoter activity, as shown by in vitro assays. Immunostaining of human retinal sections revealed that SAMD7 is localized in the nuclei of both rods and cones, as well as in those of cells belonging to the inner nuclear layer. These results place SAMD7 as a gene crucial for human retinal function and demonstrate a significant difference in the role of SAMD7 between the human and the mouse retina.
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Affiliation(s)
- Miriam Bauwens
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium; Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Elifnaz Celik
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), 4031 Basel, Switzerland; Department of Ophthalmology, University Hospital Basel, 4031 Basel, Switzerland
| | - Dinah Zur
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Siying Lin
- National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital and the Institute of Ophthalmology, London, UK; Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Mathieu Quinodoz
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), 4031 Basel, Switzerland; Department of Ophthalmology, University Hospital Basel, 4031 Basel, Switzerland; Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, UK
| | - Michel Michaelides
- National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital and the Institute of Ophthalmology, London, UK; Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Andrew R Webster
- National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital and the Institute of Ophthalmology, London, UK; Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Filip Van Den Broeck
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium; Department of Head & Skin, Ghent University, 9000 Ghent, Belgium
| | - Bart P Leroy
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium; Department of Head & Skin, Ghent University, 9000 Ghent, Belgium; Department of Ophthalmology, Ghent University Hospital, 9000 Ghent, Belgium; The Division of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Leah Rizel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel
| | - Abigail R Moye
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), 4031 Basel, Switzerland; Department of Ophthalmology, University Hospital Basel, 4031 Basel, Switzerland
| | - Audrey Meunier
- Department of Ophthalmology, Centre Hospitalier Universitaire Saint-Pierre, 1000 Brussels, Belgium
| | - Hoai Viet Tran
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, 1004 Lausanne, Switzerland; Centre for Gene Therapy and Regenerative Medicine, King's College London, London, UK
| | - Alexandre P Moulin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, 1004 Lausanne, Switzerland
| | - Quinten Mahieu
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium; Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Mattias Van Heetvelde
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium; Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Gavin Arno
- National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital and the Institute of Ophthalmology, London, UK; Institute of Ophthalmology, University College London, London EC1V 9EL, UK; North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3BH, UK
| | - Carlo Rivolta
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), 4031 Basel, Switzerland; Department of Ophthalmology, University Hospital Basel, 4031 Basel, Switzerland; Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, UK
| | - Elfride De Baere
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium; Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Tamar Ben-Yosef
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel.
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Stathopoulos C, Beck-Popovic M, Moulin AP, Munier FL. Ten-year experience with intracameral chemotherapy for aqueous seeding in retinoblastoma: long-term efficacy, safety and toxicity. Br J Ophthalmol 2023; 108:124-130. [PMID: 36379686 PMCID: PMC10803962 DOI: 10.1136/bjo-2022-322492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022]
Abstract
AIMS To report long-term results of intracameral chemotherapy (ICC) for aqueous seeding (AS) in retinoblastoma. METHODS Retrospective study including 20 patients with primary (n=4) or secondary non-iatrogenic (n=16) AS treated with ICC according to a previously described technique between 2011 and 2020 with at least 1-year follow-up. RESULTS AS control was initially achieved in all cases with a mean 5 injections of melphalan (n=13) or topotecan (n=7). Three eyes had an isolated AS relapse at a mean interval of 8 months after the first ICC course, which regressed with a second course of intracameral melphalan. Concomitant interciliary process seed implantation was treated with additional brachytherapy if sectorial (n=3) or proton therapy if annular (n=1). Other therapies including systemic, intra-arterial chemotherapy and/or focal treatments were given in 15 eyes to treat concomitant tumour sites. Eye preservation was achieved in 85% of the eyes (n=17/20) at a mean event-free follow-up of 45 months for aqueous disease, and 40 months for any other intraocular tumour activity. Three cases were enucleated due to refractory non-aqueous disease. All patients are alive without metastasis (mean follow-up of 48 months after first ICC). ICC-related intraocular toxicity included iris atrophy (n=5), cataract (n=4), posterior synechiae (n=2) and iris heterochromia (n=1). No patient suffered irreversible vision loss. Useful to normal vision was found in 82% of the cases (n=14/17). CONCLUSION ICC appears to be safe and efficient for AS without irreversible vision-threatening adverse effects. More data are needed to determine any superiority in efficiency/toxicity of topotecan versus melphalan.
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Affiliation(s)
- Christina Stathopoulos
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Maja Beck-Popovic
- Paediatric Haemato-Oncology Unit, Department of Paediatrics, CHUV, Lausanne, Switzerland
| | - Alexandre P Moulin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
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4
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Moulin AP, Stathopoulos C, Marcelli F, Schoumans Pouw J, Beck-Popovic M, Munier FL. Secondary enucleated retinoblastoma with MYCN amplification. Ophthalmic Genet 2021; 42:354-359. [PMID: 33870828 DOI: 10.1080/13816810.2021.1897847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Absence of RB1 mutation is rare in retinoblastoma and MYCN amplifications were recently identified in a subset of aggressive retinoblastomas occurring in infants. Here we describe not only the clinical phenotype of MYCN retinoblastoma at presentation, but also the tumor response to the first attempt of conservative management in this context.Methods: Interventional retrospective case reportResults: A 6-month-old boy was referred with right leukocoria. Examination under anesthesia revealed a group D unilateral retinoblastoma with an extensive whitish mass and total retinal detachment. Despite partial response following combined sequential intravenous and intra-arterial chemotherapy, tumor relapse in the aqueous humor occurred with posterior chamber involvement over 360°, this transiently controlled by intracameral and intravitreal melphalan injections. Eleven months post-diagnosis the eye was enucleated due to diffuse retinal recurrence invading the ciliary body and obscuring the optic nerve, associated with neovascular glaucoma. Histopathology revealed a poorly differentiated retinoblastoma with diffuse retinal invasion, extending from the superior ciliary body to the inferior equatorial choroid. There was post laminar optic nerve extension without involvement of the surgical margin. RB1 and diffuse MYCN nuclear expression were identified. FISH and SNP-array confirmed MYCN amplification. At 65 months follow-up the patient remained in good health without local recurrence or metastasis.Conclusions: To the best of our knowledge, this study is the first to attempt conservative management of an MYCN retinoblastoma, although secondary enucleation could not be avoided due to highly aggressive recurrence resisting all targeted modalities of chemotherapy.
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Affiliation(s)
| | | | | | | | | | - Francis L Munier
- Jules-Gonin Eye Hospital, Lausanne University, Lausanne, Switzerland
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5
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El Zaoui I, Bucher M, Rimoldi D, Nicolas M, Kaya G, Pescini Gobert R, Bedoni N, Schalenbourg A, Sakina E, Zografos L, Leyvraz S, Riggi N, Rivolta C, Moulin AP. Conjunctival Melanoma Targeted Therapy: MAPK and PI3K/mTOR Pathways Inhibition. ACTA ACUST UNITED AC 2019; 60:2764-2772. [DOI: 10.1167/iovs.18-26508] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Ikram El Zaoui
- Department of Computational Biology, Unit of Medical Genetics, Lausanne University, Lausanne, Switzerland
| | - Maya Bucher
- Dermatology Unit, CHUV, Lausanne University, Lausanne, Switzerland
| | - Donata Rimoldi
- Ludwig Institute for Cancer Research, Epalinges, Switzerland
| | - Michael Nicolas
- Jules-Gonin Eye Hospital, Lausanne University, FAA, Lausanne, Switzerland
| | - Gurkan Kaya
- Dermatology and Venerology Division, Dermatopathology Laboratory, Geneva University Hospital, Geneva, Switzerland
| | | | - Nicola Bedoni
- Department of Computational Biology, Unit of Medical Genetics, Lausanne University, Lausanne, Switzerland
| | - Ann Schalenbourg
- Jules-Gonin Eye Hospital, Lausanne University, FAA, Lausanne, Switzerland
| | - Ezziat Sakina
- Jules-Gonin Eye Hospital, Lausanne University, FAA, Lausanne, Switzerland
| | - Leonidas Zografos
- Jules-Gonin Eye Hospital, Lausanne University, FAA, Lausanne, Switzerland
| | - Serge Leyvraz
- Charité Cancer Comprehensive Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nicolo Riggi
- Experimental Pathology, Lausanne University Pathology Institute, Lausanne, Switzerland
| | - Carlo Rivolta
- Department of Computational Biology, Unit of Medical Genetics, Lausanne University, Lausanne, Switzerland
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
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6
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Larivé E, Nicolas M, Kaya G, Riggi N, Moulin AP. β-Catenin Expression and Activation in Conjunctival Melanoma. Dermatopathology (Basel) 2019; 6:50-62. [PMID: 31700844 PMCID: PMC6827456 DOI: 10.1159/000500682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose To assess the role of the canonical Wnt pathway via activation of β-catenin in tumor progression of conjunctival melanoma. Methods β-Catenin localization was assessed by immunohistochemistry in 43 conjunctival nevi, 48 primary acquired melanoses (PAM; conjunctival melanocytic intraepithelial neoplasia), and 44 conjunctival melanomas. Activation of the canonical or the noncanonical Wnt pathway was tested in vitro in 4 conjunctival melanoma cell lines with stimulation of either Wnt5a or Wnt3a. Wound healing assays were performed with Wnt5a. Results Nuclear β-catenin expression was found in 16% of the nevi, in 15% of the melanomas, and in 4% of the PAM. Membranous β-catenin expression was identified in all the nevi and PAM and in 97.7% of the melanomas. In vitro, Wnt5a stimulation in the 4 conjunctival melanomas and in 1 skin melanoma cell line did not induce nuclear translocation of β-catenin, nor did it increase cell motility in the wound healing assays. Wnt3a stimulation did not induce nuclear localization of β-catenin in any of the cell lines tested. Conclusions In conjunctival melanoma, nuclear localization and activation of β-catenin appear to be limited, suggesting that inhibition of ARF6, responsible for β-catenin activation, in subsets of skin melanoma may not represent a treatment option for this tumor. In vitro, Wnt3a or Wnt5a did not induce nuclear β-catenin localization.
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Affiliation(s)
| | - Michael Nicolas
- Jules-Gonin Eye Hospital, Lausanne University, FAA, Lausanne, Switzerland
| | - Gürkan Kaya
- Dermatopathology Unit, Department of Dermatology, University Hospital of Geneva, Geneva, Switzerland
| | - Nicolo Riggi
- Experimental Pathology, Lausanne University Pathology Institute, Lausanne, Switzerland
| | - Alexandre P Moulin
- Jules-Gonin Eye Hospital, Lausanne University, FAA, Lausanne, Switzerland
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7
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Royer-Bertrand B, Torsello M, Rimoldi D, El Zaoui I, Cisarova K, Pescini-Gobert R, Raynaud F, Zografos L, Schalenbourg A, Speiser D, Nicolas M, Vallat L, Klein R, Leyvraz S, Ciriello G, Riggi N, Moulin AP, Rivolta C. Comprehensive Genetic Landscape of Uveal Melanoma by Whole-Genome Sequencing. Am J Hum Genet 2016; 99:1190-1198. [PMID: 27745836 PMCID: PMC5097942 DOI: 10.1016/j.ajhg.2016.09.008] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/15/2016] [Indexed: 02/07/2023] Open
Abstract
Uveal melanoma (UM) is a rare intraocular tumor that, similar to cutaneous melanoma, originates from melanocytes. To gain insights into its genetics, we performed whole-genome sequencing at very deep coverage of tumor-control pairs in 33 samples (24 primary and 9 metastases). Genome-wide, the number of coding mutations was rather low (only 17 variants per tumor on average; range 7-28), thus radically different from cutaneous melanoma, where hundreds of exonic DNA insults are usually detected. Furthermore, no UV light-induced mutational signature was identified. Recurrent coding mutations were found in the known UM drivers GNAQ, GNA11, BAP1, EIF1AX, and SF3B1. Other genes, i.e., TP53BP1, CSMD1, TTC28, DLK2, and KTN1, were also found to harbor somatic mutations in more than one individual, possibly indicating a previously undescribed association with UM pathogenesis. De novo assembly of unmatched reads from non-coding DNA revealed peculiar copy-number variations defining specific UM subtypes, which in turn could be associated with metastatic transformation. Mutational-driven comparison with other tumor types showed that UM is very similar to pediatric tumors, characterized by very few somatic insults and, possibly, important epigenetic changes. Through the analysis of whole-genome sequencing data, our findings shed new light on the molecular genetics of uveal melanoma, delineating it as an atypical tumor of the adult for which somatic events other than mutations in exonic DNA shape its genetic landscape and define its metastatic potential.
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Affiliation(s)
- Beryl Royer-Bertrand
- Department of Computational Biology, Unit of Medical Genetics, University of Lausanne, 1011 Lausanne Switzerland; Center for Molecular Diseases, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Matteo Torsello
- Experimental Pathology, Institute of Pathology, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Donata Rimoldi
- Ludwig Cancer Research, Department of Oncology, University of Lausanne, 1066 Epalinges, Switzerland
| | - Ikram El Zaoui
- Department of Computational Biology, Unit of Medical Genetics, University of Lausanne, 1011 Lausanne Switzerland
| | - Katarina Cisarova
- Department of Computational Biology, Unit of Medical Genetics, University of Lausanne, 1011 Lausanne Switzerland
| | - Rosanna Pescini-Gobert
- Department of Computational Biology, Unit of Medical Genetics, University of Lausanne, 1011 Lausanne Switzerland
| | - Franck Raynaud
- Department of Computational Biology, Computational Systems Oncology, University of Lausanne, 1011 Lausanne, Switzerland; Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Leonidas Zografos
- Jules-Gonin Eye Hospital, Department of Ophthalmology, Fondation Asile des Aveugles, University of Lausanne, 1004 Lausanne, Switzerland
| | - Ann Schalenbourg
- Jules-Gonin Eye Hospital, Department of Ophthalmology, Fondation Asile des Aveugles, University of Lausanne, 1004 Lausanne, Switzerland
| | - Daniel Speiser
- Ludwig Cancer Research, Department of Oncology, University of Lausanne, 1066 Epalinges, Switzerland
| | - Michael Nicolas
- Jules-Gonin Eye Hospital, Department of Ophthalmology, Fondation Asile des Aveugles, University of Lausanne, 1004 Lausanne, Switzerland
| | - Laureen Vallat
- Jules-Gonin Eye Hospital, Department of Ophthalmology, Fondation Asile des Aveugles, University of Lausanne, 1004 Lausanne, Switzerland
| | - Robert Klein
- Formerly Complete Genomics, Mountain View, CA 94043, USA
| | - Serge Leyvraz
- Department of Oncology, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Giovanni Ciriello
- Department of Computational Biology, Computational Systems Oncology, University of Lausanne, 1011 Lausanne, Switzerland; Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Nicolò Riggi
- Experimental Pathology, Institute of Pathology, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Alexandre P Moulin
- Jules-Gonin Eye Hospital, Department of Ophthalmology, Fondation Asile des Aveugles, University of Lausanne, 1004 Lausanne, Switzerland
| | - Carlo Rivolta
- Department of Computational Biology, Unit of Medical Genetics, University of Lausanne, 1011 Lausanne Switzerland.
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8
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Moulin AP, Oberic A, Lechneitner Y, Spahn B, Letovanec I, Ikonomidis C. Primary mucinous carcinoma of the skin with orbital invasion. Klin Monbl Augenheilkd 2015; 232:506-8. [PMID: 25902109 DOI: 10.1055/s-0035-1545787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A P Moulin
- Jules-Gonin Eye Hospital, Department of Ophthalmology, University of Lausanne, Renens, Switzerland
| | - A Oberic
- Jules-Gonin Eye Hospital, Department of Ophthalmology, University of Lausanne, Renens, Switzerland
| | - Y Lechneitner
- Dermatology Private Practice, Avenue du 14 Avril, 12, 1020 Renens, Switzerland
| | - B Spahn
- Dermatology Private Practice, Avenue du 14 Avril, 12, 1020 Renens, Switzerland
| | - I Letovanec
- Institut Universitaire de pathologie, Lausanne, Switzerland
| | - C Ikonomidis
- Otolaryngology, Head and Neck Surgery Department, CHUV, University Hospital of Lausanne, Switzerland
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Moulin AP, Zografos L, Schalenbourg A. RPE adenocarcinoma arising from a congenital hypertrophy of the RPE (CHRPE) treated with proton therapy. Klin Monbl Augenheilkd 2014; 231:411-3. [PMID: 24771179 DOI: 10.1055/s-0034-1368287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A P Moulin
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, FAA, Lausanne, Switzerland
| | - L Zografos
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, FAA, Lausanne, Switzerland
| | - A Schalenbourg
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, FAA, Lausanne, Switzerland
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Sarode B, Nowell CS, Ihm J, Kostic C, Arsenijevic Y, Moulin AP, Schorderet DF, Beermann F, Radtke F. Notch signaling in the pigmented epithelium of the anterior eye segment promotes ciliary body development at the expense of iris formation. Pigment Cell Melanoma Res 2014; 27:580-9. [DOI: 10.1111/pcmr.12236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 03/12/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Bhushan Sarode
- School of Life Science; Ecole Polytechnique Fédérale de Lausanne (EPFL); Lausanne Switzerland
- Swiss Institute for Experimental Cancer Research (ISREC); Lausanne Switzerland
| | - Craig S. Nowell
- School of Life Science; Ecole Polytechnique Fédérale de Lausanne (EPFL); Lausanne Switzerland
- Swiss Institute for Experimental Cancer Research (ISREC); Lausanne Switzerland
| | - JongEun Ihm
- School of Life Science; Ecole Polytechnique Fédérale de Lausanne (EPFL); Lausanne Switzerland
| | - Corinne Kostic
- Unit of Gene Therapy and Stem Cell Biology; Jules-Gonin Eye Hospital; University of Lausanne; Lausanne Switzerland
- Eye Pathology Laboratory; Jules-Gonin Eye Hospital; University of Lausanne; Lausanne Switzerland
| | - Yvan Arsenijevic
- Unit of Gene Therapy and Stem Cell Biology; Jules-Gonin Eye Hospital; University of Lausanne; Lausanne Switzerland
- Eye Pathology Laboratory; Jules-Gonin Eye Hospital; University of Lausanne; Lausanne Switzerland
| | - Alexandre P. Moulin
- Eye Pathology Laboratory; Jules-Gonin Eye Hospital; University of Lausanne; Lausanne Switzerland
| | - Daniel F. Schorderet
- School of Life Science; Ecole Polytechnique Fédérale de Lausanne (EPFL); Lausanne Switzerland
- Eye Pathology Laboratory; Jules-Gonin Eye Hospital; University of Lausanne; Lausanne Switzerland
- IRO - Institute for Research in Ophthalmology; Sion Switzerland
| | - Friedrich Beermann
- School of Life Science; Ecole Polytechnique Fédérale de Lausanne (EPFL); Lausanne Switzerland
- Swiss Institute for Experimental Cancer Research (ISREC); Lausanne Switzerland
| | - Freddy Radtke
- School of Life Science; Ecole Polytechnique Fédérale de Lausanne (EPFL); Lausanne Switzerland
- Swiss Institute for Experimental Cancer Research (ISREC); Lausanne Switzerland
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Moulin AP, Védy D, Guex-Crosier Y, Zografos L, Schalenbourg A. Conjunctival extrascleral extension of a myeloid sarcoma: a clinicopathological case report. Klin Monbl Augenheilkd 2013; 230:443-4. [PMID: 23629803 DOI: 10.1055/s-0032-1328389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A P Moulin
- Jules-Gonin Eye Hospital, University of Lausanne, Switzerland.
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Shetye NG, Mataftsi A, Maeder P, Moulin AP, Gaillard MC, Balmer A, Popovic MB, Munier FL. Post-chemoreduction cryptic optic nerve relapse in a patient with bilateral retinoblastoma. Br J Ophthalmol 2012; 97:233, 245-6. [PMID: 23172878 DOI: 10.1136/bjophthalmol-2012-302384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Nandan G Shetye
- Department of Ophthalmology, Jules Gonin Eye Hospital, Av.de France 15, Lausanne 1004, Switzerland
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Papadopoulou D, Moulin AP, Zografos L, Schalenbourg A. How would you manage this small melanocytic choroidal tumour? Small choroidal melanoma hiding a large extrascleral extension. Br J Ophthalmol 2012; 96:1530, 1539-40. [PMID: 23018423 PMCID: PMC3512345 DOI: 10.1136/bjophthalmol-2012-302329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Munier FL, Gaillard MC, Balmer A, Soliman S, Podilsky G, Moulin AP, Beck-Popovic M. Intravitreal chemotherapy for vitreous disease in retinoblastoma revisited: from prohibition to conditional indications. Br J Ophthalmol 2012; 96:1078-83. [PMID: 22694968 DOI: 10.1136/bjophthalmol-2011-301450] [Citation(s) in RCA: 224] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Tumour control of vitreous seeds remains challenging owing to their resistance to radiation and systemic chemotherapy. OBJECTIVE To describe the short-term efficacy of intravitreal melphalan for vitreous disease in retinoblastoma using a new injection technique and dose. METHODS This study is a retrospective non-comparative review of 23 consecutive heavily pretreated patients (23 eyes) with active vitreous seeding and eligible for intravitreous chemotherapy (IViC). They received a total of 122 intravitreal injections of melphalan (20-30 μg) given every 7-10 days. The ocular status was objectively monitored under anaesthesia with fundus photography. RESULTS All patients are alive without evidence of extraocular spread (95% CI 82.19% to 100%). Concomitant treatments, including other chemotherapeutic modalities, were used until complete sterilisation of the retinal seeding source and subretinal seeds. Globe retention was achieved in 87% (20/23) of cases. All retained eyes were in complete remission after a median follow-up period of 22 months (range 9-31 months). The Kaplan-Meier estimate of ocular survival rates at 2 years was 84.14% (95% CI 62.48% to 95.28%). A localised peripheral salt-and-pepper retinopathy was noted in 10 eyes (43%) at the site of injection. CONCLUSIONS This study reports the first clinically documented case series of patients with retinoblastoma treated with IViC. Despite a possible confounding effect of concomitant chemotherapy prescription using other routes of administration in four of the successfully treated eyes (20%), IViC achieved an unprecedented success rate of tumour control in the presence of vitreous seeding. Of note, none of the treated eyes required external beam irradiation to control the vitreous seeding. Further studies are required to assess IViC retinal toxicity and to better delineate its role in the management of retinoblastoma.
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Affiliation(s)
- Francis L Munier
- Unit of Pediatric Ocular Oncology, Jules-Gonin Eye Hospital, University of Lausanne, Avenue de France 15, Lausanne 1004, Switzerland.
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Munier FL, Soliman S, Moulin AP, Gaillard MC, Balmer A, Beck-Popovic M. Profiling safety of intravitreal injections for retinoblastoma using an anti-reflux procedure and sterilisation of the needle track. Br J Ophthalmol 2012; 96:1084-7. [PMID: 22368262 DOI: 10.1136/bjophthalmol-2011-301016] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The preservation of globe integrity has always been a major concern during the treatment of retinoblastoma for fear of extraocular or metastatic spread. Intravitreal chemotherapy has been attempted as a desperate salvage therapy only for eyes with refractory retinoblastoma. Published data on the safety and efficacy of this route are, however, limited. METHODS A modified technique of intravitreal injection in eyes with retinoblastoma is described. All children with retinoblastoma who received one or more intravitreal injections using this technique were retrospectively reviewed concerning ocular complications of the injection procedure as well as clinical or histopathological evidence of tumour spread. RESULTS 30 eyes of 30 children with retinoblastoma received a total of 135 intravitreal injections, with a median follw-up duration of 13.5 months. No extraocular spread was seen on clinical follow-up in any patients and there was no tumour contamination of the retrieved entry sites histopathologically analysed among the five enucleated eyes. No significant ocular side effects were observed except transient localised vitreous haemorrhage (3/135). CONCLUSION This technique is potentially safe and effective at a low cost and may play a promising role, especially in the treatment of recurrent and/or resistant vitreous disease in retinoblastoma, as an alternative to enucleation and/or external beam radiotherapy. However, this treatment should not replace the primary standard of care of retinoblastoma and should not be considered in group E eyes. Its application should be approved by an ophthalmological-oncological team and it should be performed by an experienced eye surgeon in a tertiary referral centre after careful selection of a tumour-free injection site.
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Affiliation(s)
- Francis L Munier
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Lausanne, Switzerland.
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Venturini G, Moulin AP, Deprez M, Uffer S, Bottani A, Zografos L, Rivolta C. Clinicopathologic and molecular analysis of a choroidal pigmented schwannoma in the context of a PTEN hamartoma tumor syndrome. Ophthalmology 2012; 119:857-64. [PMID: 22281088 DOI: 10.1016/j.ophtha.2011.09.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 08/30/2011] [Accepted: 09/29/2011] [Indexed: 10/14/2022] Open
Abstract
PURPOSE To report the first case of choroidal schwannoma in a patient affected by PTEN hamartoma tumor syndrome (PHTS) and investigate the molecular involvement of the phosphatase and tensin homolog (PTEN) and neurofibromin 2 (NF2) genes in this rare intraocular tumor. DESIGN Observational case report. PARTICIPANT A 10-year-old girl diagnosed with PHTS. METHODS The enucleated specimen underwent histologic, immunohistochemical, and transmission electronic microscopy. The expression of PTEN and NF2 and their protein products were evaluated by reverse transcription-polymerase chain reaction and immunohistochemistry. Somatic mutations of PTEN and NF2, as well as allelic loss, were investigated by direct sequencing of DNA extracted from the tumor. PTEN epigenetic silencing was investigated by pyrosequencing. MAIN OUTCOME MEASURES Histopathologic and molecular characterization of a choroidal pigmented schwannoma. RESULTS Histopathologic, immunohistochemical, and electron microscopic analysis demonstrated features consistent with a pigmented cellular schwannoma of the choroid. We found no loss of heterozygosity at the genomic level for the PTEN germline mutation and no promoter hypermethylation or other somatic intragenic mutations. However, we observed an approximate 40% reduction of PTEN expression at both the mRNA and the protein level, indicating that the tumor was nonetheless functionally deficient for PTEN. Although DNA sequencing of NF2 failed to identify any pathologic variants, its expression was abolished within the tumor. CONCLUSIONS We report the first description of a pigmented choroidal schwannoma in the context of a PHTS. This rare tumor showed a unique combination of reduction of PTEN and absence of NF2 expression.
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Affiliation(s)
- Giulia Venturini
- Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland
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Moulin AP, Gaillard MC, Balmer A, Munier FL. Ultrasound biomicroscopy evaluation of anterior extension in retinoblastoma: a clinicopathological study. Br J Ophthalmol 2011; 96:337-40. [PMID: 21606465 DOI: 10.1136/bjophthalmol-2011-300051] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Extension of retinoblastoma cells into the posterior chamber is a criterion for group E according to the international classification of intraocular retinoblastoma. Currently, the anterior extension of retinoblastoma is based on the presence of tumour cells in the anterior chamber assessed by biomicroscopy. AIM To determine the value of ultrasound biomicroscopy (UBM) in the assessment of posterior chamber involvement in advanced retinoblastoma. METHODS Retrospective review of all retinoblastoma cases enucleated at the Jules Gonin Eye Hospital from January 1996 to December 2009 for which UBM (35 MHz) evaluation was available. The patients' records were reviewed for patient and tumour features and histopathological findings. UBM findings were compared with histopathological features. RESULTS UBM documentation was available in 31 cases. Retinoblastoma was detected by UBM in the posterior chamber in 18 cases and was absent in 13 cases while histopathological analysis demonstrated its presence in the posterior chamber in 22 cases and its absence in 9 cases. Among the 18 UBM-positive cases, 7 had biomicroscopic detectable involvement of the anterior chamber. There was a significant correlation between echodensities consistent with retinoblastoma on UBM in the posterior chamber and histopathological tumorous involvement of the posterior chamber (p=0.0001). The sensitivity of UBM in the assessment of posterior chamber invasion by retinoblastoma was 81% and the specificity was 100%. CONCLUSION In selected cases of advanced retinoblastoma, UBM appears to represent a valuable tool in the precise evaluation of anterior extension of disease, with good sensitivity and specificity for the assessment of posterior chamber involvement. UBM may provide useful criteria governing the indication for enucleation.
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Moulin AP, Hamedani M, Majo F, Schaefer F, Guex-Crosier Y. Mucoepidermoid carcinoma as a masquerade syndrome of scleral melting and granulomatous kerato-uveitis. Klin Monbl Augenheilkd 2011; 228:347-9. [PMID: 21484645 DOI: 10.1055/s-0031-1273241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A P Moulin
- Jules Gonin Eye Hospital, Lausanne University, Switzerland
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Vaudaux JD, Moulin AP, Olivier F, Guex-Crosier Y. Parotid gland fine-needle aspiration biopsy in the diagnosis of ocular sarcoidosis. Klin Monbl Augenheilkd 2010; 227:328-9. [PMID: 20408089 DOI: 10.1055/s-0029-1245210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J D Vaudaux
- Ophthalmology, Jules Gonin Eye Hospital, Lausanne, Switzerland.
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Abstract
BACKGROUND Inactivation of tumour-related genes by promoter hypermethylation is a common epigenetic event in the development of a variety of tumours. AIM To investigate in primary uveal melanoma the status of promoter methylation of genes thought to be involved in tumour development: p16, TIMP3, RASSF1, RARB, FHIT, hTERT and APC. METHODS Gene promoter methylation was studied by methylation-sensitive single-strand conformation analysis and dot-blot assay in a series of 23 primary uveal melanomas. All DNA samples were obtained from paraffin-embedded formalin-fixed tissue blocks. RESULTS hTERT promoter methylation was found with a relatively high frequency (52%). Promoter methylation of p16, TIMP3, RASSF1, RARB, FHIT and APC was a rare event. For none of these genes did promoter methylation exceed 15% of tumour samples, and, for some genes (FHIT and APC), no methylation was found at all. Furthermore, promoter methylation was absent in 39% (9/23) of cases. In only 22% (5/23) of cases was hypermethylation of at least two promoters observed. CONCLUSIONS Promoter methylation of hTERT is a regular event in uveal melanoma. Hypermethylation of the other genes studied does not seem to be an essential element in the development of this tumour. As promoter methylation of APC, RASSF1 and RARB is often observed in cutaneous melanoma, these results suggest that different epigenetic events occur in the development of cutaneous and uveal melanoma.
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Affiliation(s)
- A P Moulin
- Institute of Pathology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Bugnon 25, 1011 Lausanne, Switzerland
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Mandeville JTH, Roh JH, Woog JJ, Gonnering RS, Levin PS, Mazzoli RA, Ainbinder DJ, Older JJ, Moulin AP, Kiel R, Kim YD, Dryja TP. Cutaneous benign mixed tumor (chondroid syringoma) of the eyelid: clinical presentation and management. Ophthalmic Plast Reconstr Surg 2004; 20:110-6. [PMID: 15083078 DOI: 10.1097/01.iop.0000117337.65340.e5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the clinical presentation of cutaneous benign mixed tumor of the eyelid and its management options. METHODS Periocular cases of cutaneous benign mixed tumor were gathered from members of an oculoplastics specialty Internet discussion group. A total of 9 patients are described in this retrospective, interventional case series. The clinical presentation, histopathology, and management of these lesions is reviewed. RESULTS Patients were typically asymptomatic, presenting with a slowly enlarging, nontender nodule of 2 to 8 years' duration. The lesions ranged from 4 mm to 17 mm in greatest dimension. Four of the lesions were on the eyelid margin, three in the sub-brow area of the upper eyelid, and two in the central lids. All six cases not involving the brow were fixed to the tarsus; one brow lesion was believed to be adherent to the skin. None of the lesions was associated with significant changes of the overlying epidermis, although one lesion showed overlying pigmentation. All patients underwent excisional biopsy for diagnostic or cosmetic reasons. On histopathologic examination, the tumors were biphasic, with an epithelial component exhibiting apocrine or hair follicle differentiation and a myxoid, adipocytic, chondroid, and/or fibrous stroma. The pathologic diagnoses were all consistent with cutaneous benign mixed tumor (chondroid syringoma, pleomorphic adenoma). Follow-up ranged from 2 weeks to 12 months, although several patients failed to keep scheduled follow-up appointments. No clinical recurrences were identified. CONCLUSIONS Cutaneous benign mixed tumor may occur in the eyelid, and, although uncommon, should be included in the differential diagnosis of firm, nodular eyelid tumors. The histopathologic features are similar to those seen in this tumor type arising in other areas of the body. Preoperative consideration of this diagnostic possibility may allow the surgeon to plan for complete excision, thereby reducing the possibility of recurrence or malignant transformation.
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