Mild errors of morphogenesis in malignancy: macroscopic manifestation of genetic instability?

Childhood cancer and birthmarks in the Collaborative Perinatal Project

OBJECTIVE

Three previous retrospective studies noted a positive association between birthmarks and childhood cancer. The objective of this study was to determine whether the incidence of cancer is increased in children with birthmarks relative to those without birthmarks using data from the Collaborative Perinatal Project cohort, a large, prospective study.

METHODS

Our study population comprised 49,503 US children who were born between 1959 and 1968. Birthmarks were documented as definite or suspected during the first year through history or medical examinations and included hemangiomas (port-wine, strawberry, or cavernous), pigmented nevi, lymphangiomas, and café-au-lait spots. The association between birthmarks and childhood cancer was determined using Cox proportional hazards regression.

RESULTS

In the Collaborative Perinatal Project, 2505 individuals had a documented definite or suspected birthmark, including 7 of 47 children who developed cancer. Birthmarks were associated with a significant increase in the risk for cancer. There was a slight attenuation of the risk estimate when cases that were diagnosed in the first year of life were excluded. No specific childhood malignancies were notably affected by birthmarks.

CONCLUSIONS

Although this study was based on a small number of cases, we found birthmarks to be in excess in children who received a diagnosis of cancer using prospective data. These findings provide additional support for the possibility of a shared etiology between birthmarks and childhood cancer that could offer insight into the pathogenesis of pediatric malignancy.

Clinical manifestations of genetic instability overlap one another

Cancer syndromes are characteristic associations of specific malignancies with various congenital anomalies. In addition to such diseases, an increased prevalence in general of chromosomal instability, malformations, immunodeficiencies, altered growth and development, and reproductive loss has been observed in both childhood leukemias and solid tumors. The overlap among these congenital disorders suggests their common prenatal, possibly genetic origin and thus the existence of a nonspecific genetic instability leading to various clinical manifestations of disturbances in cell division. Seeking for related features in family members of a patient with malignancy may be of clinical value in detecting predisposition to cancer.

Auricular mild errors of morphogenesis: epidemiological study with application of a targeted computer program

Mild errors of morphogenesis (MEMs) are findings of great importance in multiple fields because of their predictive value in identification of major malformations, specific genetic syndromes, mental retardation and childhood malignancy. In order to evaluate the contribution of auricular MEMs, we constructed a computerized program, especially designed for the recording of auricular MEMs in connection with nonauricular MEMs, personal data, family, pregnancy and birth history, presence of major malformation and postural defects. The program is easy to use and delivers, at request, immediate information regarding prevalence of each auricular MEM and percentage associations between all variables. In the period from January 1, 1999 to December 31, 1999, we screened 3107 consecutively born neonates and recorded auricular and nonauricular MEMs, detected by surface examination. The general prevalence of auricular MEMs was 43.2% and the most frequent MEMs and their associates were of postural-type. This computerized program offers many advantages for the study of ear MEMs.

Association of nonsyndromic Wilms tumor with premature centromere division (PCD)

Wilms tumor was discovered in a 22-month-old otherwise healthy girl. Her pretreatment karyotype proved to be normal 46,XX with total premature division (PCD) in 21% of her lymphocyte mitoses. This phenomenon was not seen in the parents. PCD was found in less than 4% of lymphocyte mitoses of five other children with Wilms tumor. The individual finding provides further evidence for a relation of PCD to tumorigenesis; however, elucidation of the question needs further systematic studies.