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Lac V, Verhoef L, Aguirre-Hernandez R, Nazeran TM, Tessier-Cloutier B, Praetorius T, Orr NL, Noga H, Lum A, Khattra J, Prentice LM, Co D, Köbel M, Mijatovic V, Lee AF, Pasternak J, Bleeker MC, Krämer B, Brucker SY, Kommoss F, Kommoss S, Horlings HM, Yong PJ, Huntsman DG, Anglesio MS. Iatrogenic endometriosis harbors somatic cancer-driver mutations. Hum Reprod 2019; 34:69-78. [PMID: 30428062 DOI: 10.1093/humrep/dey332] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 11/01/2018] [Indexed: 12/17/2022] Open
Abstract
STUDY QUESTION Does incisional endometriosis (IE) harbor somatic cancer-driver mutations? SUMMARY ANSWER We found that approximately one-quarter of IE cases harbor somatic-cancer mutations, which commonly affect components of the MAPK/RAS or PI3K-Akt-mTor signaling pathways. WHAT IS KNOWN ALREADY Despite the classification of endometriosis as a benign gynecological disease, it shares key features with cancers such as resistance to apoptosis and stimulation of angiogenesis and is well-established as the precursor of clear cell and endometrioid ovarian carcinomas. Our group has recently shown that deep infiltrating endometriosis (DE), a form of endometriosis that rarely undergoes malignant transformation, harbors recurrent somatic mutations. STUDY DESIGN, SIZE, DURATION In a retrospective study comparing iatrogenically induced and endogenously occurring forms of endometriosis unlikely to progress to cancer, we examined endometriosis specimens from 40 women with IE and 36 women with DE. Specimens were collected between 2004 and 2017 from five hospital sites in either Canada, Germany or the Netherlands. IE and DE cohorts were age-matched and all women presented with histologically typical endometriosis without known history of malignancy. PARTICIPANTS/MATERIALS, SETTING, METHODS Archival tissue specimens containing endometriotic lesions were macrodissected and/or laser-capture microdissected to enrich endometriotic stroma and epithelium and a hypersensitive cancer hotspot sequencing panel was used to assess for presence of somatic mutations. Mutations were subsequently validated using droplet digital PCR. PTEN and ARID1A immunohistochemistry (IHC) were performed as surrogates for somatic events resulting in functional loss of respective proteins. MAIN RESULTS AND THE ROLE OF CHANCE Overall, we detected somatic cancer-driver events in 11 of 40 (27.5%) IE cases and 13 of 36 (36.1%) DE cases, including hotspot mutations in KRAS, ERBB2, PIK3CA and CTNNB1. Heterogeneous PTEN loss occurred at similar rates in IE and DE (7/40 vs 5/36, respectively), whereas ARID1A loss only occurred in a single case of DE. While rates of detectable somatic cancer-driver events between IE and DE are not statistically significant (P > 0.05), KRAS activating mutations were more prevalent in DE. LIMITATIONS, REASONS FOR CAUTION Detection of somatic cancer-driver events were limited to hotspots analyzed in our panel-based sequencing assay and loss of protein expression by IHC from archival tissue. Whole genome or exome sequencing, or epigenetic analysis may uncover additional somatic alterations. Moreover, because of the descriptive nature of this study, the functional roles of identified mutations within the context of endometriosis remain unclear and causality cannot be established. WIDER IMPLICATIONS OF THE FINDINGS The alterations we report may be important in driving the growth and survival of endometriosis in ectopic regions of the body. Given the frequency of mutation in surgically displaced endometrium (IE), examination of similar somatic events in eutopic endometrium, as well as clinically annotated cases of other forms of endometriosis, in particular endometriomas that are most commonly linked to malignancy, is warranted. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by a Canadian Cancer Society Impact Grant [701603, PI Huntsman], Canadian Institutes of Health Research Transitional Open Operating Grant [MOP-142273, PI Yong], the Canadian Institutes of Health Research Foundation Grant [FDN-154290, PI Huntsman], the Canadian Institutes of Health Research Project Grant [PJT-156084, PIs Yong and Anglesio], and the Janet D. Cottrelle Foundation through the BC Cancer Foundation [PI Huntsman]. D.G. Huntsman is a co-founder and shareholder of Contextual Genomics Inc., a for profit company that provides clinical reporting to assist in cancer patient treatment. R. Aguirre-Hernandez, J. Khattra and L.M. Prentice have a patent MOLECULAR QUALITY ASSURANCE METHODS FOR USE IN SEQUENCING pending and are current (or former) employees of Contextual Genomics Inc. The remaining authors have no competing interests to declare. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- V Lac
- Department of Molecular Oncology, BC Cancer Research Centre, Room 3-218, 675 West 10th Ave, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Rm G227, 2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada
| | - L Verhoef
- Department of Pathology of Antoni van Leeuwenhoek, Netherlands Cancer Institute, Plesmanlaan 121, CX Amsterdam, The Netherlands
| | - R Aguirre-Hernandez
- Contextual Genomics, 2389 Health Sciences Mall #204, Vancouver, British Columbia, Canada
| | - T M Nazeran
- Department of Molecular Oncology, BC Cancer Research Centre, Room 3-218, 675 West 10th Ave, Vancouver, British Columbia, Canada.,Department of Anatomical Pathology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, British Columbia, Canada
| | - B Tessier-Cloutier
- Department of Pathology and Laboratory Medicine, Rm G227, 2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Anatomical Pathology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, British Columbia, Canada
| | - T Praetorius
- Department of Molecular Oncology, BC Cancer Research Centre, Room 3-218, 675 West 10th Ave, Vancouver, British Columbia, Canada.,Department of Women's Health, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, Germany
| | - N L Orr
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, British Columbia, Canada.,BC Women's Centre for Pelvic Pain & Endometriosis, BC Women's Hospital and Health Centre, Women' Health Centre, F2-4500 Oak St, Vancouver, British Columbia, Canada
| | - H Noga
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, British Columbia, Canada.,BC Women's Centre for Pelvic Pain & Endometriosis, BC Women's Hospital and Health Centre, Women' Health Centre, F2-4500 Oak St, Vancouver, British Columbia, Canada
| | - A Lum
- Department of Molecular Oncology, BC Cancer Research Centre, Room 3-218, 675 West 10th Ave, Vancouver, British Columbia, Canada
| | - J Khattra
- Contextual Genomics, 2389 Health Sciences Mall #204, Vancouver, British Columbia, Canada
| | - L M Prentice
- Contextual Genomics, 2389 Health Sciences Mall #204, Vancouver, British Columbia, Canada
| | - D Co
- Department of Molecular Oncology, BC Cancer Research Centre, Room 3-218, 675 West 10th Ave, Vancouver, British Columbia, Canada
| | - M Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta, Canada
| | - V Mijatovic
- Academic Endometriosis Center VUmc, Department of Reproductive Medicine, VU University Medical Center, De Boelelaan 1117, HV Amsterdam, The Netherlands
| | - A F Lee
- Department of Pathology and Laboratory Medicine, Rm G227, 2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Pasternak
- Department of Women's Health, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, Germany
| | - M C Bleeker
- Academic Endometriosis Center VUmc, Department of Reproductive Medicine, VU University Medical Center, De Boelelaan 1117, HV Amsterdam, The Netherlands
| | - B Krämer
- Department of Women's Health, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, Germany
| | - S Y Brucker
- Department of Women's Health, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, Germany
| | - F Kommoss
- Institute of Pathology, Medizin Campus Bodensee, Roentgenstrasse 2, Friedrichshafen, Germany
| | - S Kommoss
- Department of Women's Health, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, Germany
| | - H M Horlings
- Department of Pathology of Antoni van Leeuwenhoek, Netherlands Cancer Institute, Plesmanlaan 121, CX Amsterdam, The Netherlands
| | - P J Yong
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, British Columbia, Canada.,BC Women's Centre for Pelvic Pain & Endometriosis, BC Women's Hospital and Health Centre, Women' Health Centre, F2-4500 Oak St, Vancouver, British Columbia, Canada
| | - D G Huntsman
- Department of Molecular Oncology, BC Cancer Research Centre, Room 3-218, 675 West 10th Ave, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Rm G227, 2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Anatomical Pathology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, British Columbia, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, British Columbia, Canada
| | - M S Anglesio
- Department of Molecular Oncology, BC Cancer Research Centre, Room 3-218, 675 West 10th Ave, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, Rm G227, 2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, British Columbia, Canada
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Lac V, Praetorius TH, Verhoef L, Aguirre-Hernandez R, Nazeran TM, Tessier-Cloutier B, Orr N, Noga H, Khattra J, Koebel M, Horlings HM, Kommoss F, Brucker SY, Pasternak J, Yong PJ, Huntsman DG, Kommoss S, Anglesio MS, Krämer B. Iatrogenic endometriosis harbors somatic cancer-driver mutations. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671405] [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: 10/28/2022] Open
Affiliation(s)
- V Lac
- British Columbia Cancer Agency, Department of Molecular Oncology, Vancouver, Kanada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, Kanada
| | - TH Praetorius
- Universitätsklinikum Tübingen, Department für Frauengesundheit, Tübingen, Deutschland
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, Kanada
| | - L Verhoef
- Netherlands Cancer Institute, Amsterdam, Niederlande
| | | | - TM Nazeran
- British Columbia Cancer Agency, Department of Molecular Oncology, Vancouver, Kanada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, Kanada
| | - B Tessier-Cloutier
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, Kanada
- Vancouver General Hospital, Department of Anatomical Pathology, Vancouver, Kanada
| | - N Orr
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, Kanada
| | - H Noga
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, Kanada
- British Columbia Women's Hospital and Health Centre, BC Women's Centre for Pelvic Pain & Endometriosis, Vancouver, Kanada
| | - J Khattra
- Contextual Genomics, Vancouver, Kanada
| | - M Koebel
- University of Calgary, Department of Pathology and Laboratory Medicine, Calgary, Kanada
| | - HM Horlings
- Netherlands Cancer Institute, Amsterdam, Niederlande
| | - F Kommoss
- Medizin Campus Bodensee, Institut für Pathologie, Friedrichshafen, Deutschland
| | - SY Brucker
- Universitätsklinikum Tübingen, Department für Frauengesundheit, Tübingen, Deutschland
| | - J Pasternak
- Universitätsklinikum Tübingen, Department für Frauengesundheit, Tübingen, Deutschland
| | - PJ Yong
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, Kanada
- British Columbia Women's Hospital and Health Centre, BC Women's Centre for Pelvic Pain & Endometriosis, Vancouver, Kanada
| | - DG Huntsman
- British Columbia Cancer Agency, Department of Molecular Oncology, Vancouver, Kanada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, Kanada
- Contextual Genomics, Vancouver, Kanada
| | - S Kommoss
- Universitätsklinikum Tübingen, Department für Frauengesundheit, Tübingen, Deutschland
| | - MS Anglesio
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, Kanada
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, Kanada
| | - B Krämer
- Universitätsklinikum Tübingen, Department für Frauengesundheit, Tübingen, Deutschland
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Praetorius TH, Lac V, Aguirre-Hernandez R, Mason MC, Tessier-Cloutier B, Nazeran TM, Khattra J, Koebel M, Grube M, Goth M, Staebler A, Pasternak J, Andress J, Brucker SY, Yong PJ, Krämer B, Anglesio MS, Kommoss S. Hypersensitive Cancer hotspot sequencing panel in patients with two or more subtypes of endometriosis. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671404] [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: 10/28/2022] Open
Affiliation(s)
- TH Praetorius
- Universitätsklinikum Tübingen, Department für Frauengesundheit, Tübingen, Deutschland
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, Kanada
| | - V Lac
- British Columbia Cancer Agency, Department of Molecular Oncology, Vancouver, Kanada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, Kanada
| | | | - MC Mason
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, Kanada
| | - B Tessier-Cloutier
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, Kanada
- Vancouver General Hospital, Department of Anatomical Pathology, Vancouver, Kanada
| | - TM Nazeran
- British Columbia Cancer Agency, Department of Molecular Oncology, Vancouver, Kanada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, Kanada
| | - J Khattra
- Contextual Genomics, Vancouver, Kanada
| | - M Koebel
- University of Calgary, Department of Pathology and Laboratory Medicine, Calgary, Kanada
| | - M Grube
- Universitätsklinikum Tübingen, Department für Frauengesundheit, Tübingen, Deutschland
| | - M Goth
- Universitätsklinikum Tübingen, Department für Frauengesundheit, Tübingen, Deutschland
| | - A Staebler
- Universitätsklinikum Tübingen, Institut für Pathologie und Neuropathologie, Tübingen, Deutschland
| | - J Pasternak
- Universitätsklinikum Tübingen, Department für Frauengesundheit, Tübingen, Deutschland
| | - J Andress
- Universitätsklinikum Tübingen, Department für Frauengesundheit, Tübingen, Deutschland
| | - SY Brucker
- Universitätsklinikum Tübingen, Department für Frauengesundheit, Tübingen, Deutschland
| | - PJ Yong
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, Kanada
- British Columbia Women's Hospital and Health Centre, BC Women's Centre for Pelvic Pain & Endometriosis, Vancouver, Kanada
| | - B Krämer
- Universitätsklinikum Tübingen, Department für Frauengesundheit, Tübingen, Deutschland
| | - MS Anglesio
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, Kanada
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, Kanada
| | - S Kommoss
- Universitätsklinikum Tübingen, Department für Frauengesundheit, Tübingen, Deutschland
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Goth M, Grube M, Praetorius T, Kommoss S, Grimm J, Hoffmann S, Neis F, Tsaousidis C, Brucker SY, Krämer B, Andress J. Surgical treatment in a large single center cohort of patients with deep infiltrating endometriosis (DIE). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671096] [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: 10/28/2022] Open
Affiliation(s)
- M Goth
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - M Grube
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - T Praetorius
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - S Kommoss
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - J Grimm
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - S Hoffmann
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - F Neis
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - C Tsaousidis
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - SY Brucker
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - B Krämer
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - J Andress
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
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Grube M, Goth M, Praetorius T, Andress J, Grimm J, Hoffmann S, Neis F, Tsaousidis C, Brucker SY, Krämer B, Kommoss S. Deep Infiltrating Endometriosis (DIE): Patient characteristics, medical history and indications for surgical treatment in a large single centre patient cohort. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671097] [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: 10/28/2022] Open
Affiliation(s)
- M Grube
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - M Goth
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - T Praetorius
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - J Andress
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - J Grimm
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - S Hoffmann
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - F Neis
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - C Tsaousidis
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - SY Brucker
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - B Krämer
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - S Kommoss
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Deutschland
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