1
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Lalvani S, Brown RM. Neurofibromatosis Type 1: Optimizing Management with a Multidisciplinary Approach. J Multidiscip Healthc 2024; 17:1803-1817. [PMID: 38680880 PMCID: PMC11055545 DOI: 10.2147/jmdh.s362791] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/09/2024] [Indexed: 05/01/2024] Open
Abstract
Neurofibromatosis Type I (NF1) is a complex genetic condition that affects multiple organ systems and presents a unique set of challenges for clinicians in its management. NF1 is a tumor predisposition syndrome that primarily affect the peripheral and central nervous systems via the impact of haploinsufficiency upon neural crest lineage cells including Schwann cells, melanocytes, fibroblasts, etc. NF1 can further lead to pathology of the skin, bones, visual system, and cardiovascular system, all of which can drastically reduce a patient's quality of life (QOL). This review provides a comprehensive examination of the many specialties required for the care of patients with Neurofibromatosis Type 1 (NF1). We delve into the pathogenesis and clinical presentation of NF1, highlighting its diverse manifestations and the challenges they pose in management. The review underscores the importance of a multidisciplinary approach to NF1, emphasizing how such an approach can significantly improve patient outcomes and overall QOL. Central to this approach is the role of the NF expert, who guides a multidisciplinary team (MDT) comprising healthcare professionals from many areas of expertise. The MDT collaboratively addresses the multifaceted needs of NF1 patients, ensuring comprehensive and personalized care. This review highlights the need for further investigation to optimize the workflow for NF1 patients in an MDT setting, and to improve implementation and efficacy.
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Affiliation(s)
- Shaan Lalvani
- Department of Neurology, The Mount Sinai Hospital, New York, NY, USA
| | - Rebecca M Brown
- Department of Neurology, The Mount Sinai Hospital, New York, NY, USA
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2
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Wang C, Yantiss RK, Lieberman MD, Tubito-Massarano F, Qin L, Yemelyanova A, Solomon JP, Hissong E. A Rare PDGFRA Exon 15 Germline Mutation Identified in a Patient With Phenotypic Manifestations Concerning for GIST-Plus Syndrome: A Case Report and Review of Literature. Int J Surg Pathol 2023; 31:1139-1145. [PMID: 36802986 DOI: 10.1177/10668969231152588] [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] [Indexed: 02/22/2023]
Abstract
Molecular alterations in PDGFRA are well-described as drivers of sporadic gastrointestinal stromal tumors (GISTs) and inflammatory fibroid polyps (IFPs). However, a small number of families with germline PDGFRA mutations in exons 12, 14, and 18 have been reported, forming the basis of an autosomal dominant inherited disorder with incomplete penetrance and variable expressivity, now referred to as PDGFRA-mutant syndrome or GIST-plus syndrome. Phenotypic manifestations of this rare syndrome include multiple gastrointestinal GISTS, IFPs, fibrous tumors, and other variable features. Herein, we report the case of a 58-year-old female who presented with a gastric GIST and numerous small intestinal IFPs, found to harbor a previously undescribed germline PDGFRA exon 15 p.G680R mutation. Somatic tumor testing was performed on the GIST, a duodenal IFP, and an ileal IFP utilizing a targeted next-generation sequencing panel, revealing additional and distinct secondary PDGFRA exon 12 somatic mutations in each of the 3 tumors. Our findings raise important considerations regarding mechanisms of tumor development in patients with underlying germline PDGFRA alterations and highlight the potential utility of expanding currently available germline and somatic testing panels to include exons outside the typical hotspot regions.
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Affiliation(s)
- Chiyun Wang
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Rhonda K Yantiss
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Lihui Qin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Anna Yemelyanova
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - James P Solomon
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Erika Hissong
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
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3
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Kosteniuk SE, Michaiel G, Dunham C. A Case of Primary Intracranial Sarcoma, DICER1-Mutant, in a Child with a Germline DICER1 Mutation. Brain Sci 2023; 13:1040. [PMID: 37508972 PMCID: PMC10377263 DOI: 10.3390/brainsci13071040] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
DICER1 syndrome is a tumor predisposition syndrome caused by abnormal micro-RNA processing which leads to a variety of benign and malignant neoplasms in many organ systems, including the central nervous system. This paper reports the case of a primary intracranial sarcoma, DICER1-mutant, in a patient with a germline DICER1 variant thought most likely to be de novo. The patient is a ten-year-old boy who presented acutely with altered level of consciousness, emesis, and left-sided weakness. Imaging revealed a large right frontal hemorrhagic lesion, which was urgently debulked. Histology demonstrated a high-grade sarcomatous lesion. Molecular studies revealed compound heterozygous DICER1 variants (a frame shift insertion and a missense mutation), and a KRAS missense mutation. The final pathologic diagnosis was rendered to be "primary intracranial sarcoma, DICER1-mutant". Germline genetic testing revealed that the patient possessed a germline DICER1 variant (parental testing was negative). A dramatic reduction in tumor size was precipitated via chemotherapy (ifosfamide, carboplatin, and etoposide) and radiotherapy (focal proton beam therapy). There was no evidence of residual disease at the primary site at the end of the therapy.
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Affiliation(s)
| | - George Michaiel
- Division of Hematology/Oncology/BMT, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC V6H 3N1, Canada
| | - Christopher Dunham
- Division of Anatomic Pathology, British Columbia Children's Hospital, Vancouver, BC V6H 3N1, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada
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4
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Byrjalsen A, Roos L, Diemer T, Karstensen JG, Løssl K, Jelsig AM. Preimplantation genetic testing in two Danish couples affected by Peutz-Jeghers syndrome. Scand J Gastroenterol 2023; 58:314-318. [PMID: 36200740 DOI: 10.1080/00365521.2022.2129031] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Guidelines from the European Hereditary Tumor Group as well as The Danish National Guidelines for Peutz-Jeghers Syndrome (PJS) state that both prenatal diagnosis and preimplantation genetic testing for monogenic disorders (PGT-M) should be offered to patients with PJS. However, only a few cases resulting in viable pregnancies have been published. OBJECTIVE We present two cases of PJS patients going through PGT-M for PJS. We highlight the awareness of this possibility and discuss the technical and ethical challenges of performing PGT-M for PJS. METHODS AND RESULTS Case 1: A 36-year-old male with PJS and his partner were referred for genetic counseling. The patient carried a pathogenic de novo variant in STK11. After a terminated pregnancy of a fetus carrying the same pathogenic variant, microsatellite polymorphic marker analysis was established, and the patient was offered PGT-M. The female partner of the patient gave birth to a healthy boy after five years of fertility treatment. Case 2: A 35-year-old female with PJS and her partner were referred for genetic counseling. She carried an inherited pathogenic STK11 variant. The couple was offered PGT-M. Genetic testing of the embryos was performed using microsatellite polymorphic markers. After two rounds of oocyte extraction a blastocyst predicted not to be affected by PJS was identified. The blastocyst was transferred; however, this did not result in a viable pregnancy. CONCLUSIONS PGT-M can be offered to patients with PJS. The process may be long and filled with ethical dilemmas requiring patients to be motivated and persistent.
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Affiliation(s)
- Anna Byrjalsen
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Laura Roos
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tue Diemer
- Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark.,Center for Preimplantation Genetic Testing, Aalborg University Hospital, Aalborg, Denmark
| | - John Gásdal Karstensen
- Danish Polyposis Registry, Hvidovre Hospital, Gastro Unit, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Løssl
- The Fertility Department, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Marie Jelsig
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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5
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Levy AS, Sakellakis A, Luther E, Morell AA, Rosenberg A, Saad AG, Ivan M, Komotar RJ. Concurrent intraventricular intracranial myxoid mesenchymal tumor and ependymoma in a long-term Ewing sarcoma survivor. Neuropathology 2022; 42:534-539. [PMID: 35734886 DOI: 10.1111/neup.12844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/01/2022] [Accepted: 06/05/2022] [Indexed: 12/15/2022]
Abstract
Intracranial myxoid mesenchymal tumor, FET::CREB fusion positive is a rare, recently described central nervous system neoplasm. It is characterized by EWSR1::CREB family transcription factor fusion, typically arises in children and adolescents, and is locally aggressive even after gross total resection. Currently, there are little data available to guide management and gauge long-term prognosis. Furthermore, there have been no reports of these lesions occurring simultaneously with other intracranial neoplasms or in patients with a history of malignancy. Here we describe the first case of a very unusual patient with intracranial myxoid mesenchymal tumor of the right lateral ventricle with a concurrent fourth ventricular ependymoma who had a remote history of Ewing sarcoma of the right fibula.
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Affiliation(s)
- Adam S Levy
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ana Sakellakis
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Evan Luther
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alexis A Morell
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andrew Rosenberg
- Department of Pathology, University of Miami Health System, Miami, Florida, USA
| | - Ali G Saad
- Department of Pathology, University of Miami Health System, Miami, Florida, USA
| | - Michael Ivan
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Cancer Center, University of Miami Health System, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Cancer Center, University of Miami Health System, Miami, Florida, USA
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6
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Perafan-Valdes L, Giraldo-Ocampo S, Lores J, Pachajoa H. Neurofibromatosis Type 1 and Hypospadias in a Male 46, XY with a Mutation in the NF1 Gene and a Mutation in NR5A1. Pharmgenomics Pers Med 2022; 15:873-878. [PMCID: PMC9617560 DOI: 10.2147/pgpm.s380796] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
Neurofibromatosis type 1 is one of the most common genetic autosomal dominant disorders described, with a prevalence of 1 in 2000 to 1 in 3000 individuals. It is characterized by skin, nerves, and bone abnormalities. Non-related to NF1, hypospadias is a displacement in the urethral opening which in the majority of patients has an idiopathic cause. Here, we describe a patient with neurofibromatosis type 1, hypospadias, and unilateral cryptorchidism. The heterozygous variants c.6789_6792delTTAC, p.(Tyr2264Thrfs*5) and c.140A>G, p.(Tyr47Cys) were found in the NF1 and NR5A1 genes, respectively. This case contributes to the phenotypical characterization of patients with NF1 but also with hypospadias caused by a mutation in the NR5A1 gene, which usually leads to severe sex disorders.
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Affiliation(s)
- Lina Perafan-Valdes
- Universidad Libre, Programa de Maestría en Epidemiología, Cali, Colombia,Fundación Valle del Lili, Genetics Division, Cali, Colombia
| | | | - Juliana Lores
- Fundación Valle del Lili, Genetics Division, Cali, Colombia
| | - Harry Pachajoa
- Fundación Valle del Lili, Genetics Division, Cali, Colombia,Universidad Icesi, Centro de Investigaciones en Anomalías Congénitas y Enfermedades Raras (CIACER), Cali, Colombia,Correspondence: Harry Pachajoa, Fundación Valle del Lili, Genetics Division, Carrera 98 # 18-49, Cali, Colombia, Tel +57 5552334 ext 7653, Email
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7
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Azzollini J, Ferrari A, Stracuzzi A, Chiaravalli S, Terenziani M, Spreafico F, Grasso M, Collini P, Pensotti V, Massimino M, Arbustini E, Manoukian S. Clinical heterogeneity and reduced penetrance in DICER1 syndrome: a report of three families. Tumori 2021; 107:NP144-NP148. [PMID: 34761719 DOI: 10.1177/03008916211058788] [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: 11/16/2022]
Abstract
INTRODUCTION DICER1 syndrome is characterized by increased susceptibility to malignancies, mostly occurring in childhood. The range of phenotypic effects of DICER1 variants is under investigation, and the syndrome's phenotypic spectrum is steadily widening. We report on three Italian families showing heterogeneous clinical presentation and reduced penetrance in family members. CASE DESCRIPTIONS Patient 1 is a 10-year-old girl with a Sertoli-Leydig cell tumor. Although family history was unremarkable, genetic testing identified a DICER1 germline variant, inherited from her healthy father. Benign thyroid nodules were subsequently diagnosed in both the proband and her father. Patient 2 is an 8-month-old boy with type 1 pleuropulmonary blastoma. His sister developed a nephroblastoma at age 2 years. A DICER1 novel variant was identified in both siblings and their healthy father. Patient 3 is a 22-year-old man who developed a spinal extramedullary intradural mass diagnosed as rhabdomyosarcoma with a peculiar tubular, gland-like component. Tumor testing revealed two pathogenic DICER1 variants, one of which was confirmed to be germline and identified in his 17-year-old healthy brother and in his father, who showed multiple thyroid nodules. CONCLUSIONS Among our patients, three developed tumors most frequently associated with DICER1 syndrome (i.e. pleuropulmonary blastoma, nephroblastoma, and Sertoli-Leydig cell tumor). One developed a peculiar sarcoma of the spinal cord not previously described in DICER1 syndrome. Genetic testing in relatives highlighted the paternal origin and reduced penetrance in all families, with thyroid benign lesions as the most common features in otherwise unaffected individuals.
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Affiliation(s)
- Jacopo Azzollini
- Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Stracuzzi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maurizia Grasso
- Centre for Inherited Cardiovascular Diseases, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Paola Collini
- Soft Tissue and Bone Pathology, Histopathology and Pediatric Pathology Unit, Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Pensotti
- Cancer Genetics Test Laboratory, Cogentech s.r.l. Società Benefit a Socio Unico, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Siranoush Manoukian
- Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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8
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Grisham EA, Tadros J, Smith E. Unique Dermoscopic and Histopathologic Features of Melanoma Arising in a Patient With BAP1 Tumor Predisposition Syndrome. Cureus 2021; 13:e17485. [PMID: 34646590 PMCID: PMC8478628 DOI: 10.7759/cureus.17485] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/22/2022] Open
Abstract
Breast cancer gene 1 (BRCA1)-Associated Protein Tumor Predisposition Syndrome (BAP1-TPDS) is a relatively newly discovered syndrome that may develop a variety of malignancies, including atypical melanoma resembling Spitz nevi. Dermoscopic and molecular findings aid in diagnosing melanoma in BAP1-TPDS, and clinicians should have a high index of suspicion and a low threshold for screening and diagnostic testing for cutaneous malignancies in these patients. We describe an atypical, amelanotic melanoma in a 45-year-old male with a history of BAP1-TPDS and nodular melanoma. The patient presented with a rapidly evolving lesion on the right arm. Given the patient's prior history of melanoma and of heterozygous BAP1 gene mutation, histopathological and molecular analysis was performed on the lesion, revealing a diffuse loss of BAP1 expression and multiple chromosomal aberrancies. In these cases, histopathological and molecular analysis remain the keys to diagnosis, but astute dermoscopic evaluation may help clinicians avoid initial diagnostic confusion and delays in treatment. Melanoma should always be considered in patients with BAP1-TPDS, even in the absence of classic gross, dermoscopic, histopathological, and molecular characteristics of typical melanoma.
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Affiliation(s)
- Eric A Grisham
- Dermatology, University of Missouri, Columbia, USA.,Internal Medicine, Providence Sacred Heart, Spokane, USA
| | | | - Emily Smith
- Dermatology, University of Missouri, Columbia, USA
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9
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Zaayman M, Nguyen P, Silfvast-Kaiser A, Frieder J, West C, Tumminello K, Paek SY. BAPoma presenting as an incidental scalp papule: case report, literature review, and screening recommendations for BAP1 tumor predisposition syndrome. J DERMATOL TREAT 2021; 33:1855-1860. [PMID: 34106034 DOI: 10.1080/09546634.2021.1939847] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE BRCA1-associated protein 1 (BAP1) tumor predisposition syndrome (BAP1-TPDS) is associated with an increased risk for aggressive cancers. BAP1-inactivated melanocytic tumors (BIMTs) are observed in 75% of BAP1-TPDS, often presenting as early as the second decade of life. These lesions may serve as a predictive marker to identify patients who carry germline BAP1 mutations and thus are at higher risk of developing associated cancers. Early diagnosis for these malignancies is crucial for curative treatment. METHODS We report a patient who presented with an incidental scalp papule for which biopsy was consistent with a BIMT. A review of literature was conducted by accessing the PubMed database to delineate present knowledge of BIMTs, assess recommendations for screening of germline BAP1 mutations, and evaluate cancer surveillance strategies for BAP1-TPDS associated cancers. RESULTS Consensus in literature indicates that genetic evaluation should be encouraged in patients presenting with multiple BIMTs or a new BIMT with significant family history of BAP1-TPDS related cancers. If positive for a germline BAP1 mutation, cancer surveillance should be recommended for early diagnosis and timely intervention. CONCLUSIONS Further workup should be encouraged in patients who meet the proposed screening criteria for germline BAP1 mutations. Patients could benefit from cancer surveillance for earlier diagnosis, management, and improved outcomes.
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Affiliation(s)
- Marcus Zaayman
- Division of Dermatology, Baylor Scott & White, Dallas, TX, USA
| | - Peter Nguyen
- College of Medicine, Texas A&M University, Dallas, TX, USA
| | | | - Jillian Frieder
- Division of Dermatology, Baylor Scott & White, Dallas, TX, USA
| | | | | | - So Yeon Paek
- Division of Dermatology, Baylor Scott & White, Dallas, TX, USA.,College of Medicine, Texas A&M University, Dallas, TX, USA
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10
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Hülsenbeck I, Frank M, Biewald E, Kanber D, Lohmann DR, Ketteler P. Introduction of a Variant Classification System for Analysis of Genotype-Phenotype Relationships in Heritable Retinoblastoma. Cancers (Basel) 2021; 13:cancers13071605. [PMID: 33807189 PMCID: PMC8037437 DOI: 10.3390/cancers13071605] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Heritable retinoblastoma is a genetic disease that predisposes to develop multiple retinoblastomas in childhood and other extraocular tumors later in life. It is caused by genetic variants in the RB1 gene. Here we present a new classification for genetic variants in the RB1 gene (REC) that focuses on the variant’s effect. The different classes, REC-I to -V, correlate with different risks of tumor predisposition. REC correlated with different clinical courses when applied in our study cohort. REC aims to facilitate risk estimation for physicians, patients and their families, and researchers and to improve the definition of the necessity of screening examination. Abstract Constitutional haploinsufficiency of the RB1 gene causes heritable retinoblastoma, a tumor predisposition syndrome. Patients with heritable retinoblastoma develop multiple retinoblastomas early in childhood and other extraocular tumors later in life. Constitutional pathogenic variants in RB1 are heterogeneous, and a few genotype-phenotype correlations have been described. To identify further genotype-phenotype relationships, we developed the retinoblastoma variant effect classification (REC), which considers each variant’s predicted effects on the common causal mediator, RB1 protein pRB. For validation, the RB1 variants of 287 patients were grouped according to REC. Multiple aspects of phenotypic expression were analyzed, known genotype-phenotype associations were revised, and new relationships were explored. Phenotypic expression of patients with REC-I, -II, and -III was distinct. Remarkably, the phenotype of patients with variants causing residual amounts of truncated pRB (REC-I) was more severe than patients with complete loss of RB1 (REC-II). The age of diagnosis of REC-I variants appeared to be distinct depending on truncation’s localization relative to pRB structure domains. REC classes identify genotype-phenotype relationships and, therefore, this classification framework may serve as a tool to develop tailored tumor screening programs depending on the type of RB1 variant.
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Affiliation(s)
- Isabel Hülsenbeck
- Department of Pediatric Hematology and Oncology, University Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany;
- Eye Oncogenetics Research Group, University Hospital Essen, 45122 Essen, Germany; (D.K.); (D.R.L.)
| | - Mirjam Frank
- Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, University Hospital Essen, 45122 Essen, Germany;
| | - Eva Biewald
- Department of Ophthalmology, University Duisburg-Essen, University Hospital Essen, 45122 Essen, Germany;
| | - Deniz Kanber
- Eye Oncogenetics Research Group, University Hospital Essen, 45122 Essen, Germany; (D.K.); (D.R.L.)
- Institute of Human Genetics, University Duisburg-Essen, 45122 Essen, Germany
| | - Dietmar R. Lohmann
- Eye Oncogenetics Research Group, University Hospital Essen, 45122 Essen, Germany; (D.K.); (D.R.L.)
- Institute of Human Genetics, University Duisburg-Essen, 45122 Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, 69120 Heidelberg, Germany
| | - Petra Ketteler
- Department of Pediatric Hematology and Oncology, University Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany;
- Eye Oncogenetics Research Group, University Hospital Essen, 45122 Essen, Germany; (D.K.); (D.R.L.)
- Institute of Human Genetics, University Duisburg-Essen, 45122 Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, 69120 Heidelberg, Germany
- Correspondence:
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11
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Postema FAM, Oosterwijk JC, Hennekam RC. Genetic control of tumor development in malformation syndromes. Am J Med Genet A 2020; 185:324-335. [PMID: 33141500 DOI: 10.1002/ajmg.a.61947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 02/01/2023]
Abstract
One of the questions that arises frequently when caring for an individual with a malformation syndrome, is whether some form of tumor surveillance is indicated. In some syndromes there is a highly variable increased risk to develop tumors, while in others this is not the case. The risks can be hard to predict and difficult to explain to affected individuals and their families, and often also to caregivers. The queries arise especially if syndrome causing mutations are also known to occur in tumors. It needs insight in the mechanisms to understand and explain differences of tumor occurrence, and to offer optimal care to individuals with syndromes. Here we provide a short overview of the major mechanisms of the control for tumor occurrences in malformation syndromes.
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Affiliation(s)
- Floor A M Postema
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan C Oosterwijk
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Raoul C Hennekam
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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12
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Kline CN, Joseph NM, Grenert JP, van Ziffle J, Yeh I, Bastian BC, Mueller S, Solomon DA. Inactivating MUTYH germline mutations in pediatric patients with high-grade midline gliomas. Neuro Oncol 2016; 18:752-3. [PMID: 26902849 DOI: 10.1093/neuonc/now013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/20/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cassie N Kline
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, California (C.N.K., S.M.); Clinical Cancer Genomics Laboratory, University of California, San Francisco, California (N.M.J., J.P.G., J.v.Z., I.Y., B.C.B.); Departments of Neurology and Neurosurgery, University of California, San Francisco, California (S.M.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, California (D.A.S.)
| | - Nancy M Joseph
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, California (C.N.K., S.M.); Clinical Cancer Genomics Laboratory, University of California, San Francisco, California (N.M.J., J.P.G., J.v.Z., I.Y., B.C.B.); Departments of Neurology and Neurosurgery, University of California, San Francisco, California (S.M.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, California (D.A.S.)
| | - James P Grenert
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, California (C.N.K., S.M.); Clinical Cancer Genomics Laboratory, University of California, San Francisco, California (N.M.J., J.P.G., J.v.Z., I.Y., B.C.B.); Departments of Neurology and Neurosurgery, University of California, San Francisco, California (S.M.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, California (D.A.S.)
| | - Jessica van Ziffle
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, California (C.N.K., S.M.); Clinical Cancer Genomics Laboratory, University of California, San Francisco, California (N.M.J., J.P.G., J.v.Z., I.Y., B.C.B.); Departments of Neurology and Neurosurgery, University of California, San Francisco, California (S.M.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, California (D.A.S.)
| | - Iwei Yeh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, California (C.N.K., S.M.); Clinical Cancer Genomics Laboratory, University of California, San Francisco, California (N.M.J., J.P.G., J.v.Z., I.Y., B.C.B.); Departments of Neurology and Neurosurgery, University of California, San Francisco, California (S.M.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, California (D.A.S.)
| | - Boris C Bastian
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, California (C.N.K., S.M.); Clinical Cancer Genomics Laboratory, University of California, San Francisco, California (N.M.J., J.P.G., J.v.Z., I.Y., B.C.B.); Departments of Neurology and Neurosurgery, University of California, San Francisco, California (S.M.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, California (D.A.S.)
| | - Sabine Mueller
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, California (C.N.K., S.M.); Clinical Cancer Genomics Laboratory, University of California, San Francisco, California (N.M.J., J.P.G., J.v.Z., I.Y., B.C.B.); Departments of Neurology and Neurosurgery, University of California, San Francisco, California (S.M.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, California (D.A.S.)
| | - David A Solomon
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, California (C.N.K., S.M.); Clinical Cancer Genomics Laboratory, University of California, San Francisco, California (N.M.J., J.P.G., J.v.Z., I.Y., B.C.B.); Departments of Neurology and Neurosurgery, University of California, San Francisco, California (S.M.); Division of Neuropathology, Department of Pathology, University of California, San Francisco, California (D.A.S.)
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McDonnell KJ, Gallanis GT, Heller KA, Melas M, Idos GE, Culver JO, Martin SE, Peng DH, Gruber SB. A novel BAP1 mutation is associated with melanocytic neoplasms and thyroid cancer. Cancer Genet 2015; 209:75-81. [PMID: 26774355 DOI: 10.1016/j.cancergen.2015.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/11/2015] [Accepted: 12/12/2015] [Indexed: 12/28/2022]
Abstract
Germline mutations in the tumor suppressor gene, BRCA-1 associated protein (BAP1), underlie a tumor predisposition syndrome characterized by increased risk for numerous cancers including uveal melanoma, melanocytic tumors and mesothelioma, among others. In the present study we report the identification of a novel germline BAP1 mutation, c.1777C>T, which produces a truncated BAP1 protein product and segregates with cancer. Family members with this mutation demonstrated a primary clinical phenotype of autosomal dominant, early-onset melanocytic neoplasms with immunohistochemistry (IHC) of these tumors demonstrating lack of BAP1 protein expression. In addition, family members harboring the BAP1 c.1777C>T germline mutation developed other neoplastic disease including thyroid cancer. IHC analysis of the thyroid cancer, as well, demonstrated loss of BAP1 protein expression. Our investigation identifies a new BAP1 mutation, further highlights the relevance of BAP1 as a clinically important tumor suppressor gene, and broadens the range of cancers associated with BAP1 inactivation. Further study will be required to understand the full scope of BAP1-associated neoplastic disease.
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Affiliation(s)
- Kevin J McDonnell
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Gregory T Gallanis
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Kathleen A Heller
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Marilena Melas
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Gregory E Idos
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Julie O Culver
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Sue-Ellen Martin
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA; Keck School of Medicine, Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - David H Peng
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA; Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stephen B Gruber
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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