P2-13-11: Follow Up of BRCA1/2 Carriers: The Spectrum of Cancer Diagnoses in Healthy at Risk Individuals (HTR), and in Cancer Survivors (CS)

Introduction and Objective: Data from long term follow up of BRCA1/2 carriers is scarce and is mainly related to BRCA1 women. Our multidisciplinary program targets both women and men for counselling towards BRCA1/2 screening and inclusion in clinical follow up. In here we review all cancer diagnoses observed in our BRCA1/2 cohort during follow up.

Methods: Review of individual records of BRCA1/2 carriers registered from January 2000 to December 2010. Follow up was calculated since BRCA1/2 post-test counselling until the last visit to the Clinic. All new cancer diagnoses and preventive surgeries were registered.

Results: Two-hundred and fifty nine BRCA1/2 carriers (206 females and 53 males) were diagnosed with BRCA1/2 mutations (42 BRCA1 and 217 BRCA2). Medium follow up for all population is 25 months (1-98). At the date of initial BRCA1/2 diagnosis 99 women and 14 men were CS.

Female population: Eighty-eight female CS had been previously diagnosed with breast cancer (18 bilateral cases), 18 with ovarian cancer, and 1 with biliary tract cancer. Preventive surgeries in the CS female population were: bilateral adnexectomy (33 pts) and prophylactic contralateral mastectomy (10 pts). In this CS female population, new cancers, during follow up were: Contralateral breast cancer (4 cases), peritoneal cancer (2 cases in pts with previous prophylactic surgery) and skin non-melanoma cancers (2 cases). In female HTR, 23 preventive bilateral adnexectomies and 20 bilateral mastectomies were performed. Cancer diagnoses during follow up were: breast (11), peritoneum (1 in a pt with previous prophylactic surgery), gastric (1) and M3 leukemia (1). Global failure of prophylactic adnexectomy, so far (CS+HTR): 3/56 (5%).

Male population: The medium age for male CS is 73 yrs and for male HTR is 52 yrs. Male CS had mostly been previously diagnosed with BC (12; 4 bilateral) and prostate cancer (4). Other previous cancers: gastric (2), skin (2: 1Melanoma, 1 non-Melanoma), colorectal (1). One BRCA2 man with gynecomastia and prostate cancer was submitted to reduction mastectomy, as a preventive surgery. During follow up, we diagnosed second and third cancers in male CS: breast (2), prostate (6) and gastric (1). Only 1 male HTR was diagnosed with cancer: skin non-melanoma.

Conclusion: The proportion of second and third cancer diagnoses in the male BRCA2 CS population is higher than in the female BRCA1/2 CS population. Small numbers and the availability of preventive surgery for women influence this observation. No data from preventive mastectomy exists for males (we have one case). The low frequency of cancer in male HTR may be due to younger age and other unknown modifier factors. Longer follow is needed.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-13-11.

Solid pseudopapillary tumor of the pancreas: a rare and probably misdiagnosed neoplasm

Solid Pseudopapillary Tumor of the pancreas is a rare nonfunctioning tumor. It is considered a low-grade malignancy that is apparently curable with surgical complete excision in most instances. We present a case of solid pseudopapillary pancreatic tumor that represented a challenge to the radiologists. This case highlights its possible various appearances and the need to the radiologist to be familiar with them.

Neuron-specific proteotoxicity of mutant ataxin-3 in C. elegans: rescue by the DAF-16 and HSF-1 pathways

The risk of developing neurodegenerative diseases increases with age. Although many of the molecular pathways regulating proteotoxic stress and longevity are well characterized, their contribution to disease susceptibility remains unclear. In this study, we describe a new Caenorhabditis elegans model of Machado-Joseph disease pathogenesis. Pan-neuronal expression of mutant ATXN3 leads to a polyQ-length dependent, neuron subtype-specific aggregation and neuronal dysfunction. Analysis of different neurons revealed a pattern of dorsal nerve cord and sensory neuron susceptibility to mutant ataxin-3 that was distinct from the aggregation and toxicity profiles of polyQ-alone proteins. This reveals that the sequences flanking the polyQ-stretch in ATXN3 have a dominant influence on cell-intrinsic neuronal factors that modulate polyQ-mediated pathogenesis. Aging influences the ATXN3 phenotypes which can be suppressed by the downregulation of the insulin/insulin growth factor-1-like signaling pathway and activation of heat shock factor-1.

HPLC method for simultaneous detection of aflatoxins and cyclopiazonic acid

Aspergillus species in section Flavi are among the most relevant mycotoxigenic fungi. The organisms are well-known producers of the highly carcinogenic aflatoxins and of other mycotoxins, such as cyclopiazonic acid. Aflatoxins and cyclopiazonic acid analyses can be routinely used for identification purposes within the section. Two separate chromatographic runs with distinct columns and detectors for each toxin were required in previous reports. A straightforward high performance liquid chromatography (HPLC) procedure for the simultaneous detection of these compounds in fungal cultures was developed in the present work using a methanol/water mobile phase, postcolumn photochemical derivatisation and fluorescence detection. The proposed method was tested with standards and fungal extracts of 24 Aspergillus section Flavi strains and compared to the common individual detection of these mycotoxins by HPLC analyses.

Screening of the Portuguese BRCA2 Founder Mutation in Breast Cancer Patients Unselected for Family History

Background and Objective: The identification of BRCA2 c.156_157insAlu as a founder mutation of Portuguese origin and the optimization of its screening method, allows for fast genetic diagnosis in positive families. Although prevalent in Portuguese families with hereditary breast cancer risk (45% of the families with identified mutations in our Institute are positive for BRCA2 c.156_157insAlu), its prevalence in the general population of Portuguese breast cancer patients unselected for family history is unknown. Our objective was to determine the frequency of c.156_157insAlu in general Portuguese breast cancer (BC) population.Material and methods: After Ethics approval, recruitment started in April 2008.Two centres started the study: the Cancer Institute in Lisbon that observes patients from the Centre and South of the country, and the Hospital of Terceira Island in Azores (patients recruited in Terceira Island were originated from all Azorean Islands). All these patients had the diagnosis of invasive breast cancer, and after counselling a peripheral blood sample was collected and BRCA2 c.156_157insAlu screened by a three-step PCR method (Machado PM et al; J Clin Oncol 25:2027-2034, 2007). Post-test counselling was given at the Breast Cancer Risk Evaluation Clinic, where all patients had their family history analyzed. If at high risk for hereditary cancer, women were advised to enter general screening of BRCA1/2 mutations, when negative for BRCA2 c.156_157insAlu.Results: Three hundred twenty three BC patients (226 from Azores; 97 from the Continent) were recruited for this study and have already been screened. Eighty-three patients from Azores met criteria for familial breast cancer (37%). In the Continent only 10 high-risk patients have been identified so far. Average age at diagnosis was 55.8 yrs; 13 patients had bilateral BC (4%); 18 (6%) patients (all from Azores) had a second cancer diagnosis. Two women (1% of all, and 2% of the patients from the Continent) were positive for the BRCA2 c.156_157insAlu mutation: 1- breast cancer diagnosis at age 45 and a maternal aunt with breast cancer at age 60; 2- bilateral BC (ages 35 and 37), no family history for breast and/or ovarian cancer. The 10 high-risk patients BRCA2 c.156_157insAlu negative accepted to proceed with general BRCA1/2 screening.Patient recruitment is still open.Conclusions: Although we cannot conclude that c.156_157insAlu screening is relevant in the unselected population, one of the positive patients did not meet criteria for counselling outside this study. Our data also suggest that, even for familial BC, c.156_157insAlu may not be as prevalent in the Azorean population.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3061.

Seasonal and gender variation of peroxisome proliferator activated receptors expression in brown trout liver

PPAR isotypes have been previously identified in the teleost brown trout (Salmo trutta f. fario) and their organ distribution pattern established. Being that the liver is a vital metabolic organ presenting expression of all isotypes and also knowing that estrogens/estrogen receptors seem to interact with PPARs, we hypothesized that the latter may very well change seasonally. So, we studied the expression of these receptors in the liver, along the annual reproductive cycle and in both genders. According to real-time RT-PCR, PPARalpha mRNA expression in females was significantly higher in May and lower in September than in other seasons. No significant variation was observed along the year in males. A significant difference between genders occurred in May, when PPARalpha expression was higher for females. PPARbeta expression showed little variation along the reproductive cycle in females, but in males it was significantly higher in December than in the other seasons. No significant differences existed between genders. PPARgamma was more expressed in February than in September and December, for females. As to males, it was more expressed in February than in all other seasons. No significant differences were observed between genders. The study proved our hypothesis that PPARs gene expression varies along the year. Moreover, PPARalpha expression in females followed the same annual variation pattern as peroxisome volumes and enzyme activities, and an inverse pattern relatively to the salmonid type annual plasma estradiol levels. The data agrees with the idea that PPARalpha is under estradiol modulation and that cross-talk between this receptor and the estrogen receptor possibly exists.

Analysis of a band 7/MEC-2 family gene of Porphyromonas gingivalis

In vivo-induced antigen technology has previously been used to identify 115 genes induced in Porphyromonas gingivalis W83 during human infection. The aim of this study was to determine if one of these genes, PG1334, was important for the virulence of P. gingivalis. Analysis of plaque samples from persons with periodontitis revealed that PG1334 was expressed in 88.0% of diseased sites, compared with 42.1% of healthy sites, even though P. gingivalis was detected in equal numbers from both sites. A mutant of PG1334 was found to adhere to and to invade better than the parent strain, but did not persist as well in human coronary artery endothelial cells. Additionally, the mutant did not persist as well in a mouse abscess model. This gene appears to be important for the virulence of P. gingivalis, both in vivo and in vitro.