Intestinal neurofibromatosis is a subtype of familial GIST and results from a dominant activating mutation in PDGFRA

BACKGROUND & AIMS

Intestinal neurofibromatosis (Online Mendelian inheritance in Man database number 162220) is an alternate form of neurofibromatosis. Patients present with neurofibromas limited to the intestine in the absence of any other typical features of NF1 and NF2. At present, the molecular basis of intestinal neurofibromatosis remains elusive. The aim of the present study was to find the gene responsible for intestinal neurofibromatosis and to characterize functionally the mutation.

METHODS

Three candidate genes (NF1, KIT, and PDGFRA) were screened for mutations in 3 sisters diagnosed with intestinal neurofibromatosis. Five tumors were available for pathologic examination. Activation (phosphorylation) of PDGFRalpha was subsequently tested by Western blot analysis on a transfected 293T and Ba/F3 cell line.

RESULTS

We found an inherited mutation (Y555C) in the juxtamembrane domain of PDGFRA in the affected individuals. The Y555C mutation leads to autophosphorylation and thus activation of PDGFRalpha. These observations confirm that PDGFRalpha(Y555C) is an oncogenic kinase. The clinical phenotype in the reported family resembles the syndrome of familial gastrointestinal stromal tumors (familial GIST). Somatic activating mutations in KIT and PDGFRA are frequent in sporadic GISTs, and mutations in both genes have also been described in familial GISTs. The tumors in the reported family are morphologically identical to intestinal neurofibromas, but, immunohistochemically, they do not express S100 or any of the known GIST markers.

CONCLUSIONS

The inherited PDGFRA mutation in the reported family shows that intestinal neurofibromatosis is allelic to familial GIST caused by PDGRA mutations. We therefore propose that these tumors be classified as familial KIT-negative gastrointestinal stromal tumors.

Imatinib (Gleevec®, Glivec®) tumour tissue analysis by measurement of sediment and by liquid chromatography tandem mass spectrometry

The analysis of the signal transduction inhibitor imatinib in patient tumour tissue using LC and MS/MS is described. The anticancer agent is eluted over RP-C18 within 2 mm together with its internal standard STI571-d8. Calibration curves were prepared in red blood cells (RBC). For quantitative isolation of the RBC, measurement of sediment was applied. There were no indications of signal suppression by substances originating in the biological matrix. The limit of determination in tumour tissue was in the range of those recorded for RBC and plasma. The assay is selective and sensitive, with its robustness favouring the experimental application in clinical oncology and its routine use in animal experiments. The LOD was 4.5 ng per gram in tumour tissue.

Translocation of the HMGI-C ( HMGA2) gene in a benign mesenchymoma (chondrolipoangioma)

Mesenchymomas are neoplasms in which there are at least two types of differentiated cells of mesenchymal derivation other than fibrous tissue. Chondrolipoangioma is a rare type of mesenchymoma composed predominantly of cartilage and adipose tissue with vascular elements and myxoid tissue present in lesser proportions. Cytogenetic analysis was performed on a case of chondrolipoangioma and revealed a t(12;15) (q13;q26) as the sole chromosome abnormality in 40 metaphases analyzed. However, using fluorescence in situ hybridization (FISH) analysis, a complex rearrangement was found involving chromosomes 2, 12, and 15, with a cryptic rearrangement of the gene ( HMGI-C; HMGA2) coding for high-mobility group I protein. This finding suggests a role for the HMGI-C gene also in the pathogenesis of this uncommon benign tumor type, in addition to its well-established role in the pathogenesis of common benign tumors such as lipomas, uterine leiomyomas, pulmonary chondroid hamartomas, and endometrial polyps.

Correlation between clinicopathological features and karyotype in spindle cell sarcomas. A report of 130 cases from the CHAMP study group

Soft-tissue tumors have proved to be a fruitful area for the identification of reproducible cytogenetic aberrations, especially among pediatric round-cell sarcomas and lipomatous tumors. Thus far, however, data regarding sarcomas of monomorphic spindle cell type have been limited and somewhat disappointing, with the notable exception of synovial sarcoma. As part of an ongoing international collaborative study, 130 karyotyped spindle-cell sarcomas were reviewed and classified histologically, without knowledge of the clinical and karyotypic data, with the aim of identifying objective correlations between morphology, karyotype, and clinical parameters. Clonal chromosomal abnormalities were identified in 82 cases studied (63%), but only in the group of synovial sarcomas was there clear correlation between the cytogenetic findings, in the form of a consistent t(X;18)(p11;q11), and morphology. Among leiomyosarcomas (41 cases) and malignant peripheral nerve sheath tumors (MPNSTs; 27 cases) as well as in individual examples of rarer entities, there was a general tendency for karyotypic complexity associated with frequent loss or rearrangement of chromosome arms 1p, 10p, 11q, 12q, 17p, and 22q. Rearrangements of 17q (the region of the NF1 gene) were seen in 9/27 (33%) of MPNSTs. Among nine cases of solitary fibrous tumor (in which previous cytogenetic data are very limited) no consistent aberrations were identified. We conclude that, with the exception of synovial sarcoma, most spindle-cell sarcomas share with pleomorphic sarcomas the tendency for karyotypic complexity. There was no indication (in most of these lesions) that detectable cytogenetic aberrations could either facilitate their diagnosis or help to determine prognosis. There is a clear need to further study and understand the significance of multiple chromosomal abnormalities in this group of mesenchymal neoplasms with the particular goal of determining their role in the process of tumor development.