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Ripke A, Münchau A, von Bubnoff N, Jendrek S, Kopelke S, Kümpers C, Parschke P, Schinke S, Khandanpour C. [B symptoms in unexplained mediastinal lymphadenopathy : Case report of a 72-year-old male patient with VEXAS syndrome]. Inn Med (Heidelb) 2023:10.1007/s00108-023-01543-9. [PMID: 37336829 DOI: 10.1007/s00108-023-01543-9] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/21/2023]
Abstract
The case of a 72-year-old male patient who presented to our centre for rare diseases with recurrent fever, night sweats and weight loss with initially confirmed mediastinal lymphadenopathy is reported. Investigation of lymph node material was unrevealing. As an additional finding, the patient had a myelodysplastic syndrome. VEXAS syndrome (vacuoles, E1 enzyme, X‑linked, autoinflammatory, somatic) could be confirmed on the basis of a bone marrow biopsy and genetic testing.
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Affiliation(s)
- A Ripke
- Zentrum für Seltene Erkrankungen Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - A Münchau
- Zentrum für Seltene Erkrankungen Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - N von Bubnoff
- Klinik für Hämatologie und Onkologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - S Jendrek
- Klinik für Rheumatologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - S Kopelke
- Klinik für Hämatologie und Onkologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - C Kümpers
- Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - P Parschke
- Klinik für Pneumologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - S Schinke
- Klinik für Rheumatologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - C Khandanpour
- Klinik für Hämatologie und Onkologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
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Latteyer S, Klein-Hitpass L, Khandanpour C, Zwanziger D, Poeppel TD, Schmid KW, Führer D, Moeller LC. A 6-Base Pair in Frame Germline Deletion in Exon 7 Of RET Leads to Increased RET Phosphorylation, ERK Activation, and MEN2A. J Clin Endocrinol Metab 2016; 101:1016-22. [PMID: 26765577 DOI: 10.1210/jc.2015-2948] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Multiple endocrine neoplasia type 2 (MEN2) is usually caused by missense mutations in the proto-oncogene, RET. OBJECTIVE This study aimed to determine the mutation underlying MEN2A in a female patient diagnosed with bilateral pheochromocytoma at age 31 years and with medullary thyroid carcinoma (MTC) 6 years later. METHODS Leukocyte DNA was used for exome and Sanger sequencing. Wild-type (WT) RET and mutants were expressed in HEK293 cells. Activation of MAPK/ERK and PI3K/AKT was analyzed by Western blotting and luciferase assay. The effect of RET mutants on cell proliferation was tested in a colony forming assay. RESULTS Exome sequencing revealed a 6-nucleotide/2-amino acid in-frame deletion in exon 7 of RET (c.1512_1517delGGAGGG, p.505_506del). In vitro expression showed that phosphorylation of the crucial tyrosine 905 was much stronger in the p.505_506del RET mutant compared with WT RET, indicating ligand-independent autophosphorylation. Furthermore, the p.505_506del RET mutant induced a strong activation of the MAPK/ERK pathway and the PI3K/AKT pathway. Consequently, the p.505_506del RET mutant cells increased HEK293 colony formation 4-fold compared with WT RET. CONCLUSION The finding of bilateral pheochromocytoma and MTC in our patient was highly suspicious of a RET mutation. Exome sequencing revealed a 6-base-pair deletion in exon 7 of RET, an exon not yet associated with MEN2. Increased ligand-independent phosphorylation of the p.505_506del RET mutant, increased activation of downstream pathways, and stimulation of cell proliferation demonstrated the pathogenic nature of the mutation. We therefore recommend screening the whole sequence of RET in MTC and pheochromocytoma patients with red flags for a genetic cause.
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Affiliation(s)
- S Latteyer
- Department of Endocrinology and Metabolism (S.L., C.K., D.Z., D.F., L.C.M.), Institute of Cell Biology (Cancer Research) Faculty of Medicine (L.K.-H.), Department of Hematology (C.K.), Department of Nuclear Medicine (T.D.P.), and Institute of Pathology (K.W.S.), University of Duisburg-Essen, 45141 Essen, Germany
| | - L Klein-Hitpass
- Department of Endocrinology and Metabolism (S.L., C.K., D.Z., D.F., L.C.M.), Institute of Cell Biology (Cancer Research) Faculty of Medicine (L.K.-H.), Department of Hematology (C.K.), Department of Nuclear Medicine (T.D.P.), and Institute of Pathology (K.W.S.), University of Duisburg-Essen, 45141 Essen, Germany
| | - C Khandanpour
- Department of Endocrinology and Metabolism (S.L., C.K., D.Z., D.F., L.C.M.), Institute of Cell Biology (Cancer Research) Faculty of Medicine (L.K.-H.), Department of Hematology (C.K.), Department of Nuclear Medicine (T.D.P.), and Institute of Pathology (K.W.S.), University of Duisburg-Essen, 45141 Essen, Germany
| | - D Zwanziger
- Department of Endocrinology and Metabolism (S.L., C.K., D.Z., D.F., L.C.M.), Institute of Cell Biology (Cancer Research) Faculty of Medicine (L.K.-H.), Department of Hematology (C.K.), Department of Nuclear Medicine (T.D.P.), and Institute of Pathology (K.W.S.), University of Duisburg-Essen, 45141 Essen, Germany
| | - T D Poeppel
- Department of Endocrinology and Metabolism (S.L., C.K., D.Z., D.F., L.C.M.), Institute of Cell Biology (Cancer Research) Faculty of Medicine (L.K.-H.), Department of Hematology (C.K.), Department of Nuclear Medicine (T.D.P.), and Institute of Pathology (K.W.S.), University of Duisburg-Essen, 45141 Essen, Germany
| | - K W Schmid
- Department of Endocrinology and Metabolism (S.L., C.K., D.Z., D.F., L.C.M.), Institute of Cell Biology (Cancer Research) Faculty of Medicine (L.K.-H.), Department of Hematology (C.K.), Department of Nuclear Medicine (T.D.P.), and Institute of Pathology (K.W.S.), University of Duisburg-Essen, 45141 Essen, Germany
| | - D Führer
- Department of Endocrinology and Metabolism (S.L., C.K., D.Z., D.F., L.C.M.), Institute of Cell Biology (Cancer Research) Faculty of Medicine (L.K.-H.), Department of Hematology (C.K.), Department of Nuclear Medicine (T.D.P.), and Institute of Pathology (K.W.S.), University of Duisburg-Essen, 45141 Essen, Germany
| | - L C Moeller
- Department of Endocrinology and Metabolism (S.L., C.K., D.Z., D.F., L.C.M.), Institute of Cell Biology (Cancer Research) Faculty of Medicine (L.K.-H.), Department of Hematology (C.K.), Department of Nuclear Medicine (T.D.P.), and Institute of Pathology (K.W.S.), University of Duisburg-Essen, 45141 Essen, Germany
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Latteyer S, Klein-Hitpass L, Khandanpour C, Zwanziger D, Schmid KW, Führer D, Moeller L. A 6 BP in frame germline deletion in exon 7 of the RET gene leads to increased autophosphorylation, MAPK activation and MEN2. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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