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Gupta S, Zhang J, Erickson LA. Composite Pheochromocytoma/Paraganglioma-Ganglioneuroma: A Clinicopathologic Study of Eight Cases with Analysis of Succinate Dehydrogenase. Endocr Pathol 2017; 28:269-275. [PMID: 28752484 DOI: 10.1007/s12022-017-9494-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ganglioneuromas represent the most well-differentiated spectrum of neoplasia arising from the sympathetic nervous system, while neuroblastomas represent the most poorly differentiated counterpart, and ganglioneuroblastomas represent intermediate stages of differentiation. Small series of cases have documented the co-occurrence of ganglioneuroma with a pheochromocytoma (Pheo)/paraganglioma (PGL) component. We report the clinicopathologic features of eight such cases, diagnosed between 2003 and 2015 with a mean follow-up of 22 months (1-47), which were evaluated for syndrome associations, SDHB expression, and clinical outcome. Mutations of the succinate dehydrogenase (SDH) complex subunits (A, B, C, D, and SDHAF2) have been implicated in predicting metastatic behavior and in identifying possible paraganglioma syndromes. The proliferative index was calculated by manual quantification of Ki-67-positive cells at selected hot-spots using ImageJ (NIH). In our series, composite Pheo/PGL-ganglioneuromas predominantly involved the adrenal gland (Pheo 7, PGL 1). The cases had an equal gender distribution (males 4, females 4), with a mean age at diagnosis of 67 years (range 53 to 86 years), an average size of 5.2 cm (range 2 to 8.2 cm), an average weight of 49.3 g (7.8 to 144.7 g, n = 6), and the majority were functionally active (7 of 8, 88%). The mean Ki67 proliferation rate was 2% (range 0.3 to 3%), and all cases retained SDHB expression (8/8, 100%). No patient (0/8, 0%) developed metastatic disease on follow-up. One patient had a retroperitoneal composite PGL-ganglioneuroma in the setting of neurofibromatosis type 1. No recurrent disease or other associations were identified. In our study, composite Pheo/PGL-ganglioneuromas predominantly affected the adrenal gland in older patients, showed no loss of SDHB, and no disease recurrence was identified.
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Affiliation(s)
- Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jun Zhang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Zhou XP, Marsh DJ, Morrison CD, Chaudhury AR, Maxwell M, Reifenberger G, Eng C. Germline inactivation of PTEN and dysregulation of the phosphoinositol-3-kinase/Akt pathway cause human Lhermitte-Duclos disease in adults. Am J Hum Genet 2003; 73:1191-8. [PMID: 14566704 PMCID: PMC1180498 DOI: 10.1086/379382] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Accepted: 08/29/2003] [Indexed: 01/17/2023] Open
Abstract
Lhermitte-Duclos disease (LDD), or dysplastic gangliocytoma of the cerebellum, is an unusual hamartomatous overgrowth disorder. LDD can be familial or, more commonly, sporadic. It has been only recently recognized that LDD may be associated with Cowden syndrome (CS). Over 80% of patients with CS carry germline mutations in PTEN. It remains unclear whether all cases of LDD, even without features of CS, are caused by germline PTEN mutation and whether somatic PTEN mutation occurs in sporadic LDD. We obtained paraffin-embedded LDD lesions from 18 unselected, unrelated patients and performed mutational analysis of PTEN. Overall, 15 (83%) of 18 samples were found to carry a PTEN mutation. All individuals with mutations were adult-onset patients, but the three without mutations were diagnosed at the ages of 1, 3, and 11 years. Germline DNA was available from six adult-onset cases, and all had germline PTEN mutations. Of these six, two had CS features, one did not have CS features, and three were of unknown CS status. Immunohistochemistry revealed that 75% of the LDD samples had complete or partial loss of PTEN expression accompanied by elevated phosphorylated Akt, specifically in the dysplastic gangliocytoma cells. These data suggest that the loss of PTEN function is sufficient to cause LDD. The high frequency and spectrum of germline PTEN mutations in patients ascertaining by LDD alone confirm that LDD is an important defining feature of CS. Individuals with LDD, even without apparent CS features, should be counseled as in CS.
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Affiliation(s)
- Xiao-Ping Zhou
- Clinical Cancer Genetics and Human Cancer Genetics Programs, Comprehensive Cancer Center, Division of Human Cancer Genetics, Department of Molecular Virology, Immunology, and Medical Genetics, and the Division of Human Genetics, Department of Internal Medicine, and Department of Pathology, The Ohio State University, Columbus; Translational Research Laboratory, Department of Adult Oncology, Charles A. Dana Human Cancer Genetics Unit, Dana-Farber Cancer Institute, Boston; Neurosurgical Service, Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston; Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, and the Department of Molecular Medicine, University of Sydney, Sydney, Australia; Institut für Neuropathologie, Heinrich Heine Universität Düsseldorf, Düsseldorf; and Cancer Research UK, Human Cancer Genetics Research Group, University of Cambridge, Cambridge
| | - Deborah J. Marsh
- Clinical Cancer Genetics and Human Cancer Genetics Programs, Comprehensive Cancer Center, Division of Human Cancer Genetics, Department of Molecular Virology, Immunology, and Medical Genetics, and the Division of Human Genetics, Department of Internal Medicine, and Department of Pathology, The Ohio State University, Columbus; Translational Research Laboratory, Department of Adult Oncology, Charles A. Dana Human Cancer Genetics Unit, Dana-Farber Cancer Institute, Boston; Neurosurgical Service, Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston; Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, and the Department of Molecular Medicine, University of Sydney, Sydney, Australia; Institut für Neuropathologie, Heinrich Heine Universität Düsseldorf, Düsseldorf; and Cancer Research UK, Human Cancer Genetics Research Group, University of Cambridge, Cambridge
| | - Carl D. Morrison
- Clinical Cancer Genetics and Human Cancer Genetics Programs, Comprehensive Cancer Center, Division of Human Cancer Genetics, Department of Molecular Virology, Immunology, and Medical Genetics, and the Division of Human Genetics, Department of Internal Medicine, and Department of Pathology, The Ohio State University, Columbus; Translational Research Laboratory, Department of Adult Oncology, Charles A. Dana Human Cancer Genetics Unit, Dana-Farber Cancer Institute, Boston; Neurosurgical Service, Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston; Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, and the Department of Molecular Medicine, University of Sydney, Sydney, Australia; Institut für Neuropathologie, Heinrich Heine Universität Düsseldorf, Düsseldorf; and Cancer Research UK, Human Cancer Genetics Research Group, University of Cambridge, Cambridge
| | - Abhik R. Chaudhury
- Clinical Cancer Genetics and Human Cancer Genetics Programs, Comprehensive Cancer Center, Division of Human Cancer Genetics, Department of Molecular Virology, Immunology, and Medical Genetics, and the Division of Human Genetics, Department of Internal Medicine, and Department of Pathology, The Ohio State University, Columbus; Translational Research Laboratory, Department of Adult Oncology, Charles A. Dana Human Cancer Genetics Unit, Dana-Farber Cancer Institute, Boston; Neurosurgical Service, Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston; Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, and the Department of Molecular Medicine, University of Sydney, Sydney, Australia; Institut für Neuropathologie, Heinrich Heine Universität Düsseldorf, Düsseldorf; and Cancer Research UK, Human Cancer Genetics Research Group, University of Cambridge, Cambridge
| | - Marius Maxwell
- Clinical Cancer Genetics and Human Cancer Genetics Programs, Comprehensive Cancer Center, Division of Human Cancer Genetics, Department of Molecular Virology, Immunology, and Medical Genetics, and the Division of Human Genetics, Department of Internal Medicine, and Department of Pathology, The Ohio State University, Columbus; Translational Research Laboratory, Department of Adult Oncology, Charles A. Dana Human Cancer Genetics Unit, Dana-Farber Cancer Institute, Boston; Neurosurgical Service, Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston; Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, and the Department of Molecular Medicine, University of Sydney, Sydney, Australia; Institut für Neuropathologie, Heinrich Heine Universität Düsseldorf, Düsseldorf; and Cancer Research UK, Human Cancer Genetics Research Group, University of Cambridge, Cambridge
| | - Guido Reifenberger
- Clinical Cancer Genetics and Human Cancer Genetics Programs, Comprehensive Cancer Center, Division of Human Cancer Genetics, Department of Molecular Virology, Immunology, and Medical Genetics, and the Division of Human Genetics, Department of Internal Medicine, and Department of Pathology, The Ohio State University, Columbus; Translational Research Laboratory, Department of Adult Oncology, Charles A. Dana Human Cancer Genetics Unit, Dana-Farber Cancer Institute, Boston; Neurosurgical Service, Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston; Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, and the Department of Molecular Medicine, University of Sydney, Sydney, Australia; Institut für Neuropathologie, Heinrich Heine Universität Düsseldorf, Düsseldorf; and Cancer Research UK, Human Cancer Genetics Research Group, University of Cambridge, Cambridge
| | - Charis Eng
- Clinical Cancer Genetics and Human Cancer Genetics Programs, Comprehensive Cancer Center, Division of Human Cancer Genetics, Department of Molecular Virology, Immunology, and Medical Genetics, and the Division of Human Genetics, Department of Internal Medicine, and Department of Pathology, The Ohio State University, Columbus; Translational Research Laboratory, Department of Adult Oncology, Charles A. Dana Human Cancer Genetics Unit, Dana-Farber Cancer Institute, Boston; Neurosurgical Service, Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston; Cancer Genetics Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, and the Department of Molecular Medicine, University of Sydney, Sydney, Australia; Institut für Neuropathologie, Heinrich Heine Universität Düsseldorf, Düsseldorf; and Cancer Research UK, Human Cancer Genetics Research Group, University of Cambridge, Cambridge
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