Thyroid neoplasia and familial adenomatous polyposis/Gardner's syndrome

This study was conducted to clarify the actual morbidity and clinicopathologic features of thyroid neoplasia in patients with familial adenomatous polyposis. We analyzed the clinical records of 49 Japanese patients with familial adenomatous polyposis diagnosed at our institute. Six of these patients had thyroid neoplasias (3 carcinomas, 2 adenomas, and 1 of unknown histology). Among 17 patients (11 men and 6 women) who had been examined by thyroid ultrasonography or in whom postmortem examination was performed; we categorized 6 patients with thyroid tumor as the TT group, and the remaining 11 without thyroid tumor as the NTT group. The clinical features of the two groups were compared. Thyroid neoplasia was detected by physical examination in 2.3% of 43 patients so examined and was detected in 25% of 8 patients examined by thyroid ultrasonography, and in 44% of the 9 patients subjected to postmortem examination. There were no significant differences between the TT and NTT groups in gender; age at first admission, colectomy, and last follow-up visit; number of colonic polyps; or in presence of colorectal cancers, gastroduodenal adenomas, gastric fundic gland polyposis, retinal pigmented lesions, or extraintestinal tumors. The thyroid gland is frequently affected in patients with familial adenomatous polyposis, but there may be no association between thyroid neoplasia and other clinical manifestations.

Association of extracolonic manifestations of familial adenomatous polyposis with acetylation phenotype in a large FAP kindred

Familial adenomatous polyposis coli (FAP) has been shown to be associated with germline mutations of the adenomatous polyposis gene (APC) on chromosome 5. Extra-colonic manifestations also occur in FAP and include desmoid tumors, epidermoid cysts and osteomas. The combination of FAP with extracolonic symptoms is commonly referred to as Gardner's syndrome. It remains difficult, however, to predict which patients may have a propensity to develop extracolonic manifestations. The rapid acetylation phenotype is believed to be associated with an increased likelihood of sporadic colorectal cancer, whereas the slow acetylation phenotype is recognized as a predisposing factor for bladder cancer. The slow acetylation phenotype is caused by mutant alleles of the cytosolic enzyme N-acetyltransferase (NAT2). In this study, we determined the NAT2 genotype in members of one large FAP family and three smaller ones all of which had been shown to harbor the same germline APC gene mutation. We observed a significant correlation between slow acetylation genotypes and extracolonic manifestations of the disease. Rapid acetylation genotypes were not overrepresented in colorectal cancer cases in this family as compared to the frequency of this genotype in the normal Caucasian population.

[Gardner syndrome and thyroid gland carcinoma]

We report on the case of a 23-year-old female with a 5-year history of Gardner's syndrome, who developed a bifocal, papillary carcinoma of the thyroid. The combination of familial adenomatous polyposis with a thyroid cancer is a rare but well-documented association. Typically, histology reveals a multifocal, papillary tumour with a predominantly good prognosis. This type of carcinoma is almost exclusively confined to females in their second decade of life, and it may, in fact, precede the onset of the polyposis manifestation. Patients suffering from familial adenomatous polyposis should therefore undergo regular clinical examination of the thyroid gland. If a neoplastic lesion is suspected, immediate scintigraphic evaluation should be carried out, with fine-needle aspiration of equivocal foci if necessary, and/or intraoperative frozen section. When a carcinoma is found, total thyroidectomy with dissection of the central lymph compartments should be considered the treatment of choice because of the high likelihood of the tumour being multicentric.

Oncogene expression in patients with familial polyposis coli/Gardner's syndrome

We evaluated whether c-myc and ras P-21 oncogene expression could identify familial polyposis coli/Gardner's syndrome patients at risk for colon cancer. Monoclonal antibodies recognizing c-myc and ras P-21 proteins were used in immunohistochemistry to stain 26 paraffin-embedded tissue specimens collected over 12 years from 5 familial polyposis coli/Gardner's syndrome patients at various stages of their disease. Differences in staining intensity between specimens were noted with each of the two tissues markers; however, c-myc showed also a distinct cellular staining pattern in patients with advanced histologic features. The c-myc oncogene exhibited strong homogeneous cytoplasmic staining in all adenocarcinoma specimens; weak cytoplasmic staining was found in normal biopsies and in 5/10 familial polyposis coli/Gardner's syndrome specimens in the early stage of disease. In contrast, a heterogeneous staining pattern with a strong supranuclear and weak nuclear and cytoplasmic staining was demonstrated in specimens with advanced histologic features of familial polyposis coli/ Gardner's syndrome and also in postoperative ileal specimens. Anti-ras P-21 antibody, on the other hand, demonstrated a homogeneous cytoplasmic staining pattern in all specimens. We feel that the c-myc oncogene expression, in distinction to that of ras P-21, has potential as a genetic tissue marker to distinguish early from more progressive disease.

Gardner's syndrome in several family members

This article describes chronologically a case of a fatal hereditary disease, which manifests itself in multiple polyps in the large intestine, accompanied by the appearance of numerous mesenchymal tumors on and under the skin and in the bones. In the Internal Department of the General Hospital Murska Sobota, we diagnosed the disease in one member of the family; in another, we ascertained the illness was retrograde. We confirmed the two cases in our dispensary; one of them remains under the constant surveillance of a gastroenterologist. The disease was in an advanced stage in the two family members at the time of discovery, so the treatment was radical. Nevertheless it terminated fatally. We expect to undertake future radical surgical measures on the other member in whom the disease was diagnosed. In this article, we illustrate the course of Gardner's Syndrome (GS), where in spite of early diagnoses, which now begin with molecular genetics and continues to endoscope examinations, and radical operative intervention, the quality of life of the patient is not improved to any great degree. The patient represents an exceptionally high risk group for the development of other mesenchymal tumors growths and colorectal cancer. The open question is also what is surgical treatment: total colectomy or proctocolectomy and what to do with the ileum when it is full of polyps.

Polyposis coli, craniofacial exostosis and astrocytoma: the concomitant occurrence of the Gardner's and Turcot syndromes

BACKGROUND

Up to 60% of the patients with known adenomatous polyposis coli may present hyperostosis of the skull and facial bones, and/or a susceptibility to fibromas. This is known as the Gardner's syndrome, and is considered as an allelic variant of familial adenomatous polyposis (FAP). Also, although very rare, an adenomatous polyposis coli may occur with malignant tumors of the central nervous system, known as Turcot syndrome. If both syndromes are different phenotypic presentation of FAP, this would explain a simultaneous occurrence.

METHOD

We report the history of a patient who showed clinical signs of the simultaneous occurrence of both Gardner's and Turcot syndromes. The syndromes are compared, and in view of the literature, a genetic explanation for the concomitant occurrence is discussed.

RESULTS

Evidence obtained from the literature to consider Turcot syndrome as a phenotype of FAB is as follows: (1) The occurrence of Gardner's and Turcot syndromes in one family, but in different members; (2) The presence of congenital hypertrophic retinal pigmented epithelium (CHRPE), which correlates with the expression of polyps in FAP patients, in both syndromes; (3) Linkage of the Turcot phenotype to the adenomatous polyposis coli locus by genetic markers. Evidence obtained from this case report indicates that there is a manifestation of both syndromes in one patient together with a positive family history for FAP.

CONCLUSION

This concomitant occurrence of both Gardner's and Turcot syndromes in one patient clinically supports genetic and ophthalmic investigation to consider Turcot syndrome (like Gardner's syndrome) as a phenotypic variant of FAP. Patients with FAP should be examined for the presence of Gardner's syndrome. In case a Gardner's syndrome is suspected, a computed tomography scan of the brain is recommended because of the possible existence of a simultaneous Turcot syndrome.

Uretric obstruction in Gardener's syndrome

Desmoid tumours in Gardener's syndrome are a rare cause of ureteric obstruction. We report two cases of ureteric obstruction caused by desmoids, in a mother and daughter.

A tale of four syndromes: familial adenomatous polyposis, Gardner syndrome, attenuated APC and Turcot syndrome

Familial adenomatous polyposis (FAP), Gardner syndrome (polyposis, osteomas and epitheliomas), flat adenoma syndrome (attenuated APC) and Turcot syndrome (colorectal polyposis with brain tumours) are distinctive clinical syndromes. Each is caused by mutations in the adenomatous polyposis coli (APC) gene on chromosome 5q21, although Turcot syndrome may have other causes. A variety of APC mutations are recognized, which can be associated with the character and severity of the clinical syndromes.

Severe Gardner syndrome in families with mutations restricted to a specific region of the APC gene

Familial adenomatous polyposis (FAP) is associated with a number of extraintestinal manifestations, which include osteomas, epidermoid cysts, and desmoid tumors, often referred to as "Gardner syndrome." Recent studies have suggested that some of the phenotypic features of FAP are dependent on the position of the mutation within the APC gene. In particular, the correlation between congenital hypertrophy of the retinal pigment epithelium (CHRPE) and APC genotype indicates that affected families may be divided into distinct groups. We have investigated the association between the dentoosseous features of GS on dental panoramic radiographs (DPRs) and APC genotype in a regional cohort of FAP families. DPRs were performed on 84 affected individuals from 36 families, and the dento-osseous features of FAP were quantified by a weighted scoring system. Significant DPR abnormalities were present in 69% of affected individuals. The APC gene mutation was identified in 27 of these families, and for statistical analysis these were subdivided into three groups. Group 1 comprised 18 affected individuals from seven families with mutations 5' of exon 9; these families (except one) did not express CHRPE. Groups 2 comprised 38 individuals from 16 families with mutations between exon 9 and codon 1444, all of whom expressed CHRPE. Group 3 comprised 11 individuals from four families with mutations 3' of codon 1444, none of whom expressed CHRPE. Families with mutations 3' of codon 1444 had significantly more lesions on DPRs (P < .001) and appeared to have a higher incidence of desmoid tumors. These results suggest that the severity of some of the features of Gardner syndrome may correlate with genotype in FAP.

[Gardner syndrome]

The observation of Gardner's syndrome case, in a six year old girl, referred to the hospital for seizures, provides the Authors with the opportunity of reviewing that important subject of the medical and surgical clinical pathology. The diagnostic features and differential diagnosis are described. The current criteria for diagnosis and surveillance of the affected or at risk subjects are outlined. Today the molecular, and, thereafter, the prenatal, neonatal and preclinical diagnosis of the disease, is possible.

[Gardner syndrome: diagnostic, clinical and genetic questions in the light of 2 case reports]

The authors on the base of two cases of Gardner's syndrome recently observed, proceed to a wide review of literature on this subject so as to stress the peculiar aspects of this syndrome, so complex and uncommon. The greatest emphasis is given to the role of genetics as regarding to diagnosis and screening programs, as well as to the more recent acquisitions about diagnosis, therapy and follow up of risk lesions, such as colorectal and duodenal adenomas, as well as of intrabdominal desmoid tumours, which, although not histologically malignant, may often influence prognosis negatively, because of their remarkable local invasiveness and tendency to recurrence.

Perspectives on craniofacial asymmetry. VI. The hamartoses

The hamartoses are a large group of disorders with autosomal dominant inheritance or sporadic occurrence. The genes responsible for some have been localized to specific chromosomes and in several instances, genetic heterogeneity has been established. Thus neurofibromatosis and tuberous sclerosis are no longer single entities. For example, the gene for Type I neurofibromatosis is on chromosome 17 and the gene for Type II is on chromosome 22. In this paper, genetic aspects of the hamartoses are updated and asymmetry is discussed in Sturge-Weber angiomatosis, epidermal nevus syndrome, Gardner syndrome, neurofibromatosis, and Proteus syndrome.

Gardner's syndrome

Gardner's syndrome is an autosomal dominant genodermatosis. Familial polyposis of the colon, osteomas, and cutaneous epidermoid cysts are characteristic features. Colon cancer will develop in all affected individuals unless prophylactic colectomy is performed. The follow-up and management of patients with Gardner's syndrome require a coordinated effort by physicians with expertise in gastroenterology, general surgery, oral surgery, radiology, endocrinology, neurology, ophthalmology, and dermatology. Genetic and psychological counseling should also be available for these patients.

Deletion (5q) in a desmoid tumor of a patient with Gardner's syndrome

Desmoid tumors are associated with as many as 20% of cases of familial adenomatous polyposis (FAP) and Gardner's syndrome. In the present study, four specimens from different regions of a massive intraabdominal desmoid tumor from a 23-year-old white male with Gardner's syndrome were analyzed cytogenetically. Two different clonal abnormalities were observed. Two of the four specimens analyzed showed a del(5)(q14q31), which involves the region q21-->22 where the familial adenomatous polyposis gene is localized. In the two other specimens, a balanced translocation involving chromosomes 3 and 4 and an inv(4) was detected. Our findings confirm previous reports about the importance of chromosome defects on 5q in development of desmoid tumors, particularly in patients with Gardner's syndrome.

[A case of Gardner's syndrome associated with thyroid carcinoma]

We report a 22-year-old female who was diagnosed as familial adenomatous polyposis (FAP) associated with thyroid carcinoma. Total thyroidectomy and bilateral neck lymph nodes dissection were performed. Gardner's syndrome was pointed out after an investigation of her family. Total colectomy and ileo-rectal anastomosis were carried out. Colon cancer was not found pathologically. We reviewed 10 cases of FAP with thyroid carcinoma in Japan. Ten out of 11 cases including this patient were female. Thus it is important to pay careful attention to the presence of thyroid carcinoma in the case of FAP or Gardner's syndrome.

Gardner's syndrome. Case report and discussion of the manifestations of the disorder

Extracolonic manifestations of Gardner's syndrome are common and may precede the detection of colonic polyps. Tc-MDP bone scintigraphy performed on a patient with Gardner's syndrome demonstrated intense uptake of radiotracer within the maxilla and mandible as a result of the dental anomalies associated with this disorder. Nuclear scintigraphy has a role in the imaging of these patients for skeletal anomalies, the detection of thyroid carcinoma, and for skeletal metastases when colon carcinoma is detected.

Cytogenetic characterization of a periampullary adenocarcinoma of the pancreas, its liver metastasis, and a cell line established from the metastasis and a cell line established from the metastasis in a patient with Gardner's syndrome

A cell line was established from a liver metastasis of a periampullary pancreatic carcinoma in a patient with Gardner's syndrome. The primary tumor, the liver metastasis, and passages 6 and 15 of the cell line were characterized cytogenetically. The only aberration common to all samples was a der(15)t(8;15); this was probably the primary chromosomal abnormality. Loss of the short arm of chromosome 19 was also found in all samples but was brought about by different aberrations in the primary tumor and the metastasis. The secondary aberrations characteristic of clonal evolution often included further gain of 8q material but losses from 1p, 6q, and chromosomes 17 and 18, all of which have been seen before in sporadic pancreatic and colorectal carcinomas. This is the first cell line established from a tumor in a Gardner's syndrome patient and also the first characterization of an abnormal tumor karyotype associated with this autosomal dominant cancer syndrome.

Turcot's syndrome: evidence for linkage to the adenomatous polyposis coli (APC) locus

OBJECTIVE

To investigate the possibility that neuroepithelial tumors in Turcot's syndrome are caused by pleiotropic mutations in the gene for adenomatous polyposis coli (APC), a tumor-suppressor gene implicated in colonic cancer.

METHODS

We studied the inheritance patterns of genetic markers for the chromosome 5q21 region in 12 members of a Turcot's syndrome kindred with five affected members. We performed linkage analysis to detect linkage between the disease phenotype and DNA markers.

RESULTS

Marker D5S346, located 30 to 70 kilobases from the APC locus, showed evidence highly suggestive of linkage to the disease phenotype (lod score = 1.92).

CONCLUSIONS

The data provide evidence that the tumor-suppressor gene implicated in APC and sporadic colon cancers may also cause malignant neuroepithelial tumors in Turcot's syndrome.

Gene-specific DNA repair of UV-induced cyclobutane pyrimidine dimers in some cancer-prone and premature-aging human syndromes

We have examined the gene-specific DNA repair of UV-induced cyclobutane pyrimidine dimers (CPDs) in fibroblasts from the following cancer prone syndromes: familial dysplastic nevus syndrome (DNS), Gardner's syndrome (GS), and Bloom's syndrome (BS). These heritable human syndromes are associated with DNA damage hypersensitivity and have been considered as potentially DNA repair deficient. Previous determinations of DNA repair in these cell strains have been done solely at the level of the overall genome. That approach is not sensitive enough to detect deficiencies in repair at the level of the gene. Defective preferential repair of active genes may impair survival and affect genomic stability. This is exemplified by the disorder Cockayne's syndrome (CS) which is associated with a selective deficiency in the preferential repair of active genes. In this study, we have used a Cockayne's syndrome cell strain and also a normal human fibroblast cell line as a control. Repair was studied in the transcriptionally active gene dihydrofolate reductase (DHFR), the inactive delta globin gene, and in the c-myc protooncogene. In the DNS, GS and BS cell lines, we find preferential repair similar to that in normal cells. In Cockayne's syndrome cells, there is no preferential repair of the DHFR gene.

Use of doxorubicin and dacarbazine for the management of unresectable intra-abdominal desmoid tumors in Gardner's syndrome

PURPOSE

The aim of this study was to describe the natural history and management of surgically unresectable intra-abdominal desmoid tumors in two patients with Gardner's syndrome from two unrelated families, where each had failed on conventional therapy.

METHODS

Two patients with Gardner's syndrome were placed on a chemotherapy regimen which included doxorubicin (90 mg/m2) and dacarbazine (900 mg/m2) in divided doses over four days of continuous infusion. Their progress on chemotherapy was assessed by abdominal computerized tomography and laparoscopy.

RESULTS

The computerized abdominal tomography scans proved difficult to interpret because of adhesions and matted small bowel resulting from the patients original colectomies. These findings made it difficult to differentiate postoperative changes from residual desmoid tumor. Second-look laparotomy in such patients was contraindicated as this may predispose to further desmoid production. Laparoscopy disclosed a complete response to this chemotherapy. Nevertheless, we had an iatrogenic small bowel perforation in one of these patients. Each patient showed a complete response to chemotherapy.

CONCLUSION

Surgical resection remains the first-line treatment of intraabdominal desmoid tumors. However, doxorubicin/dacarbazine chemotherapy on a clinical trial basis may be indicated in patients whose intra-abdominal desmoid is unresectable, or who have failed to respond to treatment with hormones (tamoxifen, Toremifene), steroids (prednisone), and nonsteroidal anti-inflammatory agents (Clinoril; Merck & Co., Inc., West Point, PA).

[Obstructive uropathy in Gardner syndrome: a new case and an alternative therapeutic option]

Gardner's Syndrome comprises numerous pathological entities, one of which is the intraabdominal desmoid tumour which can provoke obstructive uropathy through ureteral trapping. Contribution of one case treated with resection of the trapped ureter, reanastomosis and plasty with peritoneal flap. Discussion of the diagnosis, evolution, and the different therapeutical choices found in the literature.

[Molecular genetics of colorectal cancer and carcinogenesis]

Genetic and environmental aspects play an important role in the development of colorectal cancer. However, the common molecular alteration in both hereditary and sporadic colon cancer is localized in the APC gene. the APC gene maps in the long arm of chromosome 5 and was discovered in patients with familial adenomatous polyposis (FAP). The search for the APC gene led to the identification of restriction fragment length polymorphisms (RFLPs) in FAP patients. Using these RFLPs in relatives of FAP patients it is possible to make the presymptomatic and prenatal diagnosis. The FAP syndrome is an interesting model of carcinogenesis in vivo. Thus the different stages involved in the FAP syndrome which include hyperproliferative epithelium, adenoma, adenocarcinoma and metastases, have allowed the analysis of molecular alterations in oncogenes and tumor suppressor genes. The APC gene alteration if not inherited, occurs as the earliest molecular alteration in the development of colorectal cancer whereas structural alterations of the genes myc, ras, p53, MCC and DCC are considered to be late events. All these investigations have lead to 1) a better understanding of the ethiology of cancer and 2) early diagnosis of colorectal cancer in both the hereditary and sporadic forms of the disease.

Carcinoma of the thyroid gland and Gardner's syndrome

A patient known to be suffering from Gardner's syndrome who developed carcinoma of the thyroid gland is presented. A review of the literature reveals that this relationship is not fortuitous and that it has the following characteristics: female predominance (89%), youth (< 30 years in 78%), papillary form (88%), multicentricity (70%) and thyroid carcinoma preceding diagnosis of hereditary polyposis in 30%. Hereditary polyposis patients affected by familial polyposis coli are at significant risk of developing extracolonic malignant tumours, and require life-long surveillance. Palpation of the thyroid gland and possibly ultrasound examination of the neck should be part of the routine follow up of these patients.

Population genetics of colonic cancer

BACKGROUND

There are several well known but rare syndromes of inherited colonic cancer. Genetic epidemiologic studies also have demonstrated that relatives of individuals with colonic cancer in general exhibit an excess risk for this malignancy.

METHODS

This report reviews the literature pertinent to genetic and familial risk for colonic cancer with emphasis on the recent work that suggests that inherited susceptibility to colonic neoplasms is common.

RESULTS

The adenomatous polyposis syndromes are rare inherited colonic cancer conditions caused by a mutant gene which recently has been characterized. Hereditary nonpolyposis colorectal cancer is likewise inherited and may account for up to 5% of cases. The molecular genetics of this disease remain to be clarified. The majority of colonic cancer cases are considered sporadic but are known to often cluster in families. Recent work suggests that inherited susceptibility may be the basis of this familial occurrence. Screening strategies based on inherited and familial risk are suggested.

CONCLUSIONS

Knowledge of the familial and inherited risk for colonic cancer is leading to a better understanding of this disease and is suggesting more directed preventive strategies.

[Gardner syndrome: possibility of early detection of carriers by examination of the ocular fundus?]

Through indirect ophthalmoscopic examination it was possible to analyse three families originated from the same Swiss alpine valley (Poschiavo) and carrying Gardner syndrome (SdG) to check if their members with SdG were presenting hypertrophic changes of the retinal epithelium which is supposed to be an early symptom of that syndrome. This lesion was found to be present only in two out of 11 patients (18%) with at least one symptom of SdG. Because of its lacking sensitivity, ophthalmoscopic examination is not able to substitute colonoscopy as a valid screening method to find out which members of a SdG-family are at risk to develop colonic poliposis and cancer.

Cell and molecular biology of gastrointestinal tract cancer

The gene for familial adenomatous polyposis coli (APC or FAP), which has previously been linked to chromosome 5q21 has been identified. The APC gene has been found to be altered by point mutations in the germ line of both adenomatous polyposis coli and Gardner's syndrome patients and somatically in tumors from sporadic colorectal cancer patients. During the hunt for the APC gene, the closely linked MCC (mutated in colorectal cancer) gene was identified and found to be altered somatically in tumors from sporadic cancer patients. These data suggest that more than one gene on chromosome 5q21 may contribute to colorectal carcinogenesis and that mutations at the APC gene can cause both adenomatous polyposis coli and Gardner's syndrome. The identification of these genes should aid in the counseling of patients with genetic predispositions to colorectal cancer. Progress has also been made in identifying specific genetic changes that occur in other gastrointestinal cancers. A mutational "hotspot" in the p53 gene in human hepatocellular carcinomas has been identified that could reflect exposure to a specific carcinogen, one candidate being aflatoxin B1.

Incidence and significance of congenital hypertrophy of the retinal pigment epithelium (CHRPE) in familial adenomatous polyposis coli (FAPC)

As part of a population based study of familial colorectal cancer 33 affected patients with familial adenomatous polyposis coli (FAPC) and 33 relatives, at 50% risk of inheriting FAPC, from 24 kindreds, were identified and examined. Fourteen of the affected patients had extracolonic manifestations of the FAPC gene. Twenty-five of the 33 affected patients had one or more areas of congenital hypertrophy of the retinal pigment epithelium (CHRPE) and 20 had more than three CHRPEs, all having bilateral lesions. There were significant interfamilial differences in the ocular findings. Because of this interfamilial difference in the predisposition to develop CHRPEs it is important to establish the CHRPE status of individual FAPC families before the results of ophthalmoscopy can be used to predict the carrier status of at risk relatives.

Clonal chromosomal abnormalities in desmoid tumors. Implications for histopathogenesis

Desmoid tumors (aggressive fibromatosis) are regarded as lesions of uncertain histopathogenesis. Cytogenetic analyses of 26 desmoid tumor specimens from abdominal or extraabdominal sites of 22 patients with or without Gardner's syndrome (GS) showed clonal karyotypic abnormalities in 7 cases, random abnormalities in 14 cases, and striking telomeric fusion in 5 cases. Loss of chromosome Y, a reported feature of fibromatosis in penile and palmar locations, was detected as a clonal aberration in two patients. Additionally, involvement of 5q was observed in six patients, two of whom had GS. Clonal interstitial deletions of 5q were observed in three patients, one with and two without GS. These findings confirm a clonal and probable neoplastic origin for desmoid tumor and suggest that abnormalities of the Y chromosome and 5q may be important in the genesis of this neoplasm.

[Gardner's syndrome: a case report]

The Gardner syndrome (GS) is a dysplasia in which neoformations in the intestines, soft tissue and osseous tissue are associated. Since extra-intestinal manifestations, in particularly osteomas, appear promptly even in infants, and above all in the light of the possibility of malignant degeneration, the presence of mandibular osteomas indicates the necessity of carrying out investigations in order to ascertain the eventual existence of an intestinal polyposis typical of GS. This study describes a typical case of GS diagnosed merely upon suspicion of the existence of the syndrome in a patient who came to our Department with a mandibular osteoma. The study underlines the importance not only of carrying out investigations in order to ascertain the presence of GS (rectocolonoscopy), but also that of studying the relatives of the patient in light of the fact that this particular dysplasia is transmitted genetically.

Gardner syndrome in a boy with interstitial deletion of the long arm of chromosome 5

We described a 15-year-old boy with Gardner syndrome (GS), mental retardation, and craniofacial abnormalities. High-resolution banding analysis showed an interstitial deletion of the long arm of chromosome 5 (q22.1----q31.1). The breakpoints in the present case and in 3 previously reported 5q- patients with adenomatous polyposis coli suggest that the gene responsible for GS/or familial polyposis coli (FPC) is in the 5q22 region, a result consistent with the findings of linkage studies.

Identification of colon cancer-predisposed individuals: a cytogenetic analysis

Peripheral blood lymphocyte cultures from 23 individuals with polyps and 10 age-matched controls were cytogenetically studied. Of 23 individuals with polyps, 13 were males and 10 females. The age distribution of these patients was between 22 and 84 yr, with a medium age of 49.6 yr. Chromosome 5 was involved in structural rearrangements in 10 of the 18 patients with adenomatous polyps (55.5%). All those who showed involvement of chromosome 5 alterations had either adenomatous polyps or Gardner's syndrome, and two had colon adenocarcinoma. Of the remainder who did not show involvement of chromosome 5, eight had adenomatous polyps and five had hyerplastic polyps (non-neoplastic). Of the 10 control samples, only one showed alteration of chromosome 5. Of the 10 adenomatous polyp subjects that showed chromosome 5 defects, two had translocations of chromosome 5 and the short arm of 17. Chromosome 5 was broken 13 times (5 times in the q arm and 8 times in the p arm). Based on our present cytogenetic data, we tentatively conclude that lymphocyte metaphases may be used to identify colon cancer-predisposed individuals.

The UK Northern region genetic register for familial adenomatous polyposis coli: use of age of onset, congenital hypertrophy of the retinal pigment epithelium, and DNA markers in risk calculations

A polyposis register has been established in the Northern Region of England. A total of 48 families with 71 living affected subjects has been identified during the first three years of operation, a prevalence of 2.29 x 10(-5). Indirect ophthalmoscopy identifies the majority of gene carriers by showing multiple areas of congenital hypertrophy of the retinal pigment epithelium (CHRPE). The absence of this sign in families limits its value where a relative with CHRPE has not been identified. Combining eye examination with data on age of onset and linked DNA markers is highly effective in carrier exclusion; 38% of 528 first, second, and third degree relatives had their carrier risk reduced to less than 1 in 1000. Even with such assurance many subjects will request continued bowel screening at a reduced frequency. Little interest has been shown in prenatal diagnosis. The principal value of a genetic register with domiciliary nurse visiting is the reduction in early mortality among unrecognised gene carriers.

Extracolonic manifestations of the familial adenomatous polyposis syndromes

The classic prototypes of the gastrointestinal polyposis syndromes are familial polyposis coli and Gardner syndrome. Extracolonic manifestations have been described in both diseases, and the distinction between them has become less clear. In fact, some authorities have suggested that familial polyposis coli and Gardner syndrome may represent a spectrum of the same disease. In both conditions, extracolonic expressions are the rule rather than the exception, and familiarity with them is essential for accurate diagnosis and correct patient management. In this pictorial essay, we discuss familial polyposis coli and Gardner syndrome together under the heading familial adenomatous polyposis syndromes. The colonic characteristics of these syndromes will be reviewed briefly, followed by examples of the most common extracolonic manifestations.

Persistence of chromatid damage after G2 phase X-irradiation in lymphoblastoid cells from Gardner's syndrome

Previous reports showed that skin fibroblasts or peripheral blood lymphocytes from individuals with hereditary cancer or with a genetic disorder predisposing to cancer show an abnormally high frequency of chromatid damage after X-irradiation in G2 phase. The reproducibility of this response suggested that it could provide the basis of an assay for genetic predisposition to cancer. The present blind study tested whether lymphoblastoid cell lines could also be used in this assay. Lymphoblastoid cell lines from patients with Gardner's syndrome (GS) were compared with those from clinically normal controls. In metaphase cells collected during the first 30 min after X-irradiation (58R), frequencies of chromatid breaks and gaps were similar in GS and normal cells. However, in metaphase cells collected from 0.5 to 1.5 h and 1.5 to 2.5 h after X-irradiation, the total unrepaired damage for each GS cell line was greater than that observed in any of the lines from clinically normal controls. The persistence of chromatid damage in the GS cells after X-irradiation suggests a deficiency or imbalance in the repair or processing of the radiation-induced DNA damage. The results show that lymphoblastoid cell lines in early passage can be used in this cytogenetic assay to identify members in a GS family who have the GS gene(s) or other individuals with a genetic predisposition to cancer.

High-resolution karyotypes of eighteen Norwegian polyposis patients

High-resolution karyotypes were analyzed from lymphocyte cultures of 18 Norwegian polyposis patients, of whom two had classic Gardner syndrome (GS). We focused on possible rearrangements of the long arm of chromosome 5. Previously the gene for familial adenomatous polyposis (FAP) was localized to the region 5q21-22 by linkage analysis. A patient with a constitutional deletion in this region would be of great value in the course of cloning the gene. At the level of high-resolution G-banding, however, none of these patients showed any interstitial deletion or other rearrangement on chromosome 5 or any other chromosome.

Multiple polyposis coli associated with Gardner's syndrome and chromosomal mosaicism: a family analysis

A family in which the proband (father) has multiple polyposis coli associated with Gardner's syndrome and his only son, also with multiple polyps, has been studied cytogenetically. The karyotypes of the proband and the son have shown deletion in the short arm of one chromosome 12 in a small percentage of cells. Normal cells and cells with a deletion of a 12p were noted, not only in the lymphocytes, but also in the skin fibroblast culture of the son. The karyotypes of the asymptomatic mother and their unaffected daughter were considered to be normal.

[Gardner syndrome]

A syndrome going with skin-bone signs and precancerous gastrointestinal polyposis is presented. Interest of our case is given by the extension of polyposis onto the whole digestive canal, early appearances of abdominal signs accompanying polyposis, and as a new symptom polycystic lung and extended superficial naevus lipomatosus.

[Gardner syndrome with pilomatrixoma-like hair follicle cysts]

Gardner's syndrome is accompanied by numerous cutaneous neoplasias, cysts of hair follicles being the most frequent. We report a case of Gardner's syndrome with multiple hair follicle cysts. Histologically, parts of the cyst linings showed features of pilomatricomas. We discuss the histopathological findings and their significance as possible markers for the disease.

A constitutional 5q23 deletion

A 14 month old girl was found to have a deletion of the whole of band 5q23. By comparing 19 other cases monosomic for a part of the 5q13-q31 segment, the constitutional 5q interstitial deletions fall into two groups: adult patients with Gardner-like symptoms and mental retardation associated with deletion 5q21-q22, and patients (mostly children) with unspecific signs and symptoms and different deletions.

Sulindac suppression of colorectal polyps in Gardner's syndrome

Sulindac causes both regression and suppression of colorectal polyps in patients with Gardner's syndrome and familial polyposis coli. Three patients with Gardner's syndrome and multiple colonic polyps had complete regression of polyps after two to three months of sulindac therapy. The implication that sulindac may prevent colorectal cancer and prophylactic surgery in patients with hereditary polyps of the colon is intriguing but has not yet been substantiated.