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Dehghani Soufi M, Rezaei Hachesu P, Ferdousi R. Oncology Informatics for Lynch Syndrome Research and Care: A Literature Review. JCO Clin Cancer Inform 2022; 6:e2200087. [DOI: 10.1200/cci.22.00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE This study aims to review and evaluate available informatics platforms for research and management purposes of Lynch syndrome (LS) to identify gaps and needs for future development. METHODS LS informatics tools were identified through literature search in four publication databases (1 and Scopus). First, the LS and functional elements of every informatics tools for LS were introduced. Then, current existing LS informatics tools were reviewed and explained. RESULTS A detailed review of implemented studies shows that many types of informatics platforms are available for LS management (ie, prediction model, clinical decision support system, database website, and other tools for research and management purposes of LS). Moreover, several dimensions of existing LS informatics tools were discussed and features and positive findings were reported. CONCLUSION Reviewing the literature reveals that several LS informatics tools were focused on gene-specific estimate, cancer risk prediction, identifying/screening patients, supporting personalized care of individuals with LS, and storing mismatch repair mutations information. Nevertheless, these platforms do not fully cover the care and research purposes. For instance, future developments of LS tools require more attention to dynamic knowledgebase, extra-colonic lynch–related cancers on the basis of precision medicine, variants of unknown significance, and support from diagnosis to surveillance for patient follow-up. Insights and recommendations provided in this study could help researchers and developers to meet the existing challenges in future developments.
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Affiliation(s)
- Mahsa Dehghani Soufi
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Peyman Rezaei Hachesu
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Ferdousi
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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2
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Kamburova Z, Popovska S, Kovacheva K, Petrov K, Nikolova S. Familial Lynch syndrome with early age of onset and confirmed splice site mutation in MSH2: A case report. Biomed Rep 2022; 16:39. [DOI: 10.3892/br.2022.1522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/09/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Zornitsa Kamburova
- Department of Medical Genetics, Medical University‑Pleven, Center of Medical Genetics in University Hospital ‘Dr. Georgi Stranski’, 5800 Pleven, Bulgaria
| | - Savelina Popovska
- Department of Pathoanatomy, Medical University‑Pleven, University Hospital ‘Dr. Georgi Stranski’, 5800 Pleven, Bulgaria
| | - Katya Kovacheva
- Department of Medical Genetics, Medical University‑Pleven, Center of Medical Genetics in University Hospital ‘Dr. Georgi Stranski’, 5800 Pleven, Bulgaria
| | - Krasimir Petrov
- Department of Pathoanatomy, Medical University‑Pleven, University Hospital ‘Dr. Georgi Stranski’, 5800 Pleven, Bulgaria
| | - Slavena Nikolova
- Department of Medical Genetics, Medical University‑Pleven, Center of Medical Genetics in University Hospital ‘Dr. Georgi Stranski’, 5800 Pleven, Bulgaria
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3
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Lindner AK, Schachtner G, Tulchiner G, Thurnher M, Untergasser G, Obrist P, Pipp I, Steinkohl F, Horninger W, Culig Z, Pichler R. Lynch Syndrome: Its Impact on Urothelial Carcinoma. Int J Mol Sci 2021; 22:E531. [PMID: 33430305 PMCID: PMC7825811 DOI: 10.3390/ijms22020531] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 12/21/2022] Open
Abstract
Lynch syndrome, known as hereditary nonpolyposis colorectal cancer (HNPCC), is an autosomal-dominant familial cancer syndrome with an increased risk for urothelial cancer (UC). Mismatch repair (MMR) deficiency, due to pathogenic variants in MLH1, MSH2, MSH6, and PMS2, and microsatellite instability, are known for development of Lynch syndrome (LS) associated carcinogenesis. UC is the third most common cancer type in LS-associated tumors. The diversity of germline variants in the affected MMR genes and their following subsequent function loss might be responsible for the variation in cancer risk, suggesting an increased risk of developing UC in MSH2 mutation carriers. In this review, we will focus on LS-associated UC of the upper urinary tract (UUT) and bladder, their germline profiles, and outcomes compared to sporadic UC, the impact of genetic testing, as well as urological follow-up strategies in LS. In addition, we present a case of metastatic LS-associated UC of the UUT and bladder, achieving complete response during checkpoint inhibition since more than 2 years.
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Affiliation(s)
- Andrea Katharina Lindner
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.K.L.); (G.S.); (G.T.); (M.T.); (W.H.); (Z.C.)
| | - Gert Schachtner
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.K.L.); (G.S.); (G.T.); (M.T.); (W.H.); (Z.C.)
| | - Gennadi Tulchiner
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.K.L.); (G.S.); (G.T.); (M.T.); (W.H.); (Z.C.)
| | - Martin Thurnher
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.K.L.); (G.S.); (G.T.); (M.T.); (W.H.); (Z.C.)
- Immunotherapy Unit, Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Gerold Untergasser
- Department of Internal Medicine V, Medical University Innsbruck, 6020 Innsbruck, Austria;
- Experimental Oncogenomic Group, Tyrolean Cancer Research Institute, 6020 Innsbruck, Austria
| | - Peter Obrist
- Pathology Laboratory Obrist and Brunhuber, 6511 Zams, Austria;
| | - Iris Pipp
- Clinical Pathology and Cytodiagnostics, tirol-kliniken, 6020 Innsbruck, Austria;
| | - Fabian Steinkohl
- Department of Radiology, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - Wolfgang Horninger
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.K.L.); (G.S.); (G.T.); (M.T.); (W.H.); (Z.C.)
| | - Zoran Culig
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.K.L.); (G.S.); (G.T.); (M.T.); (W.H.); (Z.C.)
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, 6020 Innsbruck, Austria; (A.K.L.); (G.S.); (G.T.); (M.T.); (W.H.); (Z.C.)
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4
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Colorectal carcinoma with double somatic mismatch repair gene inactivation: clinical and pathological characteristics and response to immune checkpoint blockade. Mod Pathol 2019; 32:1551-1562. [PMID: 31175329 PMCID: PMC6849386 DOI: 10.1038/s41379-019-0289-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 02/07/2023]
Abstract
Double somatic mismatch-repair-gene mutation/alteration is a recently recognized molecular mechanism that underlies microsatellite instability-high in some colorectal carcinomas. It remains to be determined whether and how microsatellite instability-high tumors with this molecular defect differ from their counterparts caused by other mechanisms, specifically, Lynch syndrome-associated and MLH1-promoter hypermethylated. In this study, we evaluated the clinical and pathological characteristics of a series of 15 double somatic mutation/alteration-associated microsatellite instability-high colorectal carcinomas identified from our genetics service and 68 such cases reported in the literature. We observed that these cases presented at an age similar to MLH1-promoter hypermethylated (n = 20) and microsatellite-stable (n = 39) cases but older than Lynch syndrome-associated cases (n = 20, p < 0.05). While these tumors simulated other microsatellite instability-high tumors in their prevalent right-sided location, they appeared to differ in TNM stages at presentation (73% stage III/IV versus 25% stage III/IV in other microsatellite instability-high tumors, p = 0.04). Histologically, 40% of them had a dominant solid growth pattern. Inter-tumoral heterogeneity was a striking feature, spanning the spectrum from medullary type (with a tumor-infiltrating-lymphocyte/high-power-field count as high as 59) to conventional-type with only few tumor-infiltrating-lymphocytes (1/high-power-filed). As a group, these tumors seemed less likely to show robustly high lymphocytic infiltration than other microsatellite instability-high tumors (only 20% had ≥10 tumor-infiltrating-lymphocytes/high-power-filed, whereas this rate in Lynch syndrome-associated and MLH1-promoter hypermethylated tumors was 60% and 75%, respectively). Three double somatic mutation/alteration-associated tumors were treated with a PD1/PD-L1 checkpoint inhibitor. While all three had an elevated tumor-mutation-burden (>47 mut/megabase), only one had tumor-infiltrating-lymphocytes >10/high-power-field, yet all three exhibited measurable response. In summary, microsatellite instability-high colorectal carcinomas caused by double somatic mismatch-repair-gene mutation/alteration may have varied clinical and pathological characteristics, and some may have relatively low tumor-infiltrating-lymphocytes; response to immune checkpoint inhibitors can be achieved in this group even when the lymphocytic infiltration is not abundant.
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5
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Abstract
Lynch syndrome is the hereditary disorder that most frequently predisposes to colorectal cancer as well as predisposing to a number of extracolonic cancers, most prominently endometrial cancer. It is caused by germline mutations in the mismatch repair genes. Both its phenotype and genotype show marked heterogeneity. This review gives a historical overview of the syndrome, its heterogeneity, its genomic landscape, and its implications for complex diagnosis, genetic counseling and putative implications for immunotherapy.
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6
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Wadee R, Grayson W. A potpourri of pathogenetic pathways in endometrial carcinoma with a focus on Lynch Syndrome. Ann Diagn Pathol 2019; 39:92-104. [PMID: 30798077 DOI: 10.1016/j.anndiagpath.2019.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/08/2019] [Indexed: 11/27/2022]
Abstract
Endometrial carcinoma is the most frequently occurring female genital tract malignancy in developed nations, with a rising annual incidence. Endometrioid endometrial carcinoma (EEC), the most common histological variant, differs in morphologic and molecular characteristics from serous carcinomas but morphological distinction of high-grade EECs from serous carcinomas may prove difficult. Thus, molecular categorization of tumors may allow for better tumor classification with greater insight into the underlying biology of endometrial carcinomas with new therapeutic options. Microsatellite instability (MSI) is a commonly occurring molecular aberration in EECs and has been identified in most Lynch Syndrome (LS) associated tumors. This tumor syndrome predisposes afflicted individuals to a myriad of tumors including endometrial carcinoma. Herein, the molecular signature of endometrial tumors as well as LS, and its clinical manifestations are reviewed. Understanding of the pathogenetic pathways allows for greater comprehension of occurrences at a molecular level which are then appreciated at a cellular and tissue level, by the histopathologist. The molecular classification of endometrial tumors allows for further targeted therapeutic options for affected patients. Screening tests for patients with suspected LS enables surveillance of other tumors in the affected patient and her family with the potential to decrease morbidity and mortality. It is envisioned that this overview will allow for enhanced comprehension of genetic pathways by practicing pathologists, oncologists, gynecologists and other members of the multidisciplinary team, all of whom are involved in the management of the patient with an endometrial malignancy.
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Affiliation(s)
- Reubina Wadee
- University of the Witwatersrand/National Health Laboratory Services (NHLS), South Africa.
| | - Wayne Grayson
- University of the Witwatersrand, Ampath National Laboratories, South Africa.
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7
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Duraturo F, Liccardo R, De Rosa M, Izzo P. Genetics, diagnosis and treatment of Lynch syndrome: Old lessons and current challenges. Oncol Lett 2019; 17:3048-3054. [PMID: 30867733 PMCID: PMC6396136 DOI: 10.3892/ol.2019.9945] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 12/20/2018] [Indexed: 12/17/2022] Open
Abstract
Lynch syndrome (LS) is an autosomal dominant genetic disorder associated with germline mutations in DNA mismatch repair (MMR) genes. The carriers of pathogenic mutations in these genes have an increased risk of developing a colorectal cancer and/or LS-associated cancer. The LS-associated cancer types include carcinomas of the endometrium, small intestine, stomach, pancreas and biliary tract, ovary, brain, upper urinary tract and skin. The criteria for the clinical diagnosis of LS and the procedures of the genetic testing for identification of pathogenetic mutations carriers in MMR genes have long been known. A crucial point in the mutation detection analysis is the correct definition of the pathogenecity associated with MMR genetic variants, especially in order to include the mutation carriers in the endoscopy surveillance programs more suited to them. Therefore, this may help to improve the LS-associated cancer prevention programs. In the present review, we also report the recent discoveries in molecular genetics of LS, such as the new roles of MMR protein and immune response of MMR repair deficiency in colorectal cancer. Finally, we discuss the main therapeutic approaches, including immunotherapy, which represent a valid alternative to traditional therapeutic methods and extend the life expectancy of patients that have already developed LS-associated colorectal cancer.
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Affiliation(s)
- Francesca Duraturo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples 'Federico II', Naples I-80131, Italy
| | - Raffaella Liccardo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples 'Federico II', Naples I-80131, Italy
| | - Marina De Rosa
- Department of Molecular Medicine and Medical Biotechnology, University of Naples 'Federico II', Naples I-80131, Italy
| | - Paola Izzo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples 'Federico II', Naples I-80131, Italy.,CEINGE Biotecnologie Avanzate, University of Naples 'Federico II', Naples I-80131, Italy
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8
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Engel C, Vasen HF, Seppälä T, Aretz S, Bigirwamungu-Bargeman M, de Boer SY, Bucksch K, Büttner R, Holinski-Feder E, Holzapfel S, Hüneburg R, Jacobs MAJM, Järvinen H, Kloor M, von Knebel Doeberitz M, Koornstra JJ, van Kouwen M, Langers AM, van de Meeberg PC, Morak M, Möslein G, Nagengast FM, Pylvänäinen K, Rahner N, Renkonen-Sinisalo L, Sanduleanu S, Schackert HK, Schmiegel W, Schulmann K, Steinke-Lange V, Strassburg CP, Vecht J, Verhulst ML, de Vos Tot Nederveen Cappel W, Zachariae S, Mecklin JP, Loeffler M. No Difference in Colorectal Cancer Incidence or Stage at Detection by Colonoscopy Among 3 Countries With Different Lynch Syndrome Surveillance Policies. Gastroenterology 2018; 155:1400-1409.e2. [PMID: 30063918 DOI: 10.1053/j.gastro.2018.07.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 07/16/2018] [Accepted: 07/26/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Patients with Lynch syndrome are at high risk for developing colorectal cancer (CRC). Regular colonoscopic surveillance is recommended, but there is no international consensus on the appropriate interval. We investigated whether shorter intervals are associated with lower CRC incidence and detection at earlier stages by comparing the surveillance policies in Germany, which evaluates patients by colonoscopy annually, in the Netherlands (patients evaluated at 1-2-year intervals), and Finland (patients evaluated at 2-3-year intervals). METHODS We collected data from 16,327 colonoscopic examinations (conducted from 1984 through 2015) of 2747 patients with Lynch syndrome (pathogenic variants in the MLH1, MSH2, or MSH6 genes) from the German HNPCC Consortium, the Dutch Lynch Syndrome Registry, and the Finnish Lynch Syndrome Registry. Our analysis included 23,309 person-years of cumulative observation time. Time from the index colonoscopy to incident CRC or adenoma was analyzed using the Kaplan-Meier method; groups were compared using the log-rank test. We performed multivariable Cox regression analyses to identify factors associated with CRC risk (diagnosis of CRC before the index colonoscopy, sex, mutation, age, and presence of adenoma at the index colonoscopy). RESULTS The 10-year cumulative CRC incidence ranged from 4.1% to 18.4% in patients with low- and high-risk profiles, respectively, and varied with age, sex, mutation, and prior detection of CRC or adenoma. Observed colonoscopy intervals were largely in accordance with the country-specific recommendations. We found no significant differences in cumulative CRC incidence or CRC stage at detection among countries. There was no significant association between CRC stage and time since last colonoscopy. CONCLUSIONS We did not find a significant reduction in CRC incidence or stage of detection in Germany (annual colonoscopic surveillance) than in countries with longer surveillance intervals (the Netherlands, with 1-2-year intervals, and Finland, with 2-3-year intervals). Overall, we did not find a significant association of the interval with CRC risk, although age, sex, mutation, and prior neoplasia were used to individually modify colonoscopy intervals. Studies are needed to develop and validate risk-adapted surveillance strategies and to identify patients who benefit from shorter surveillance intervals.
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Affiliation(s)
- Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany.
| | - Hans F Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Toni Seppälä
- Department of Abdominal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Stefan Aretz
- Institute of Human Genetics, University of Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
| | | | - Sybrand Y de Boer
- Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, The Netherlands
| | - Karolin Bucksch
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | | | - Elke Holinski-Feder
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany; Center of Medical Genetics, Munich, Germany
| | - Stefanie Holzapfel
- Institute of Human Genetics, University of Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
| | - Robert Hüneburg
- Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Maarten A J M Jacobs
- Department of Gastroenterology and Hepatology, Free University Medical Centre, Amsterdam, The Netherlands
| | - Heikki Järvinen
- Department of Abdominal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Matthias Kloor
- Department of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Cooperation Unit Applied Tumour Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Magnus von Knebel Doeberitz
- Department of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Cooperation Unit Applied Tumour Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan J Koornstra
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Mariette van Kouwen
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Alexandra M Langers
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Paul C van de Meeberg
- Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, The Netherlands
| | - Monika Morak
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany; Center of Medical Genetics, Munich, Germany
| | - Gabriela Möslein
- Center for Hereditary Tumors, HELIOS Klinikum Wuppertal, University Witten-Herdecke, Wuppertal, Germany
| | - Fokko M Nagengast
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kirsi Pylvänäinen
- Department of Education and Research, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Nils Rahner
- Institute of Human Genetics, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Silvia Sanduleanu
- Department of Gastroenterology and Hepatology, University Medical Centre Maastricht, Maastricht, The Netherlands
| | - Hans K Schackert
- Department of Surgical Research, Technische Universität Dresden, Dresden, Germany
| | - Wolff Schmiegel
- Department of Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Karsten Schulmann
- Department of Internal Medicine, Hematology and Oncology, Klinikum Arnsberg, Arnsberg, Germany
| | - Verena Steinke-Lange
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany; Center of Medical Genetics, Munich, Germany
| | - Christian P Strassburg
- Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Juda Vecht
- Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands
| | - Marie-Louise Verhulst
- Department of Gastroenterology and Hepatology, Maxima Medical Centre, Eindhoven, The Netherlands
| | | | - Silke Zachariae
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Jukka-Pekka Mecklin
- Departments of Education and Research and Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland; Sports and Health Sciences, Jyväskylä University, Jyväskylä, Finland
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
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9
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Therkildsen C, Eriksson P, Höglund M, Jönsson M, Sjödahl G, Nilbert M, Liedberg F. Molecular subtype classification of urothelial carcinoma in Lynch syndrome. Mol Oncol 2018; 12:1286-1295. [PMID: 29791078 PMCID: PMC6068353 DOI: 10.1002/1878-0261.12325] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/27/2018] [Accepted: 05/17/2018] [Indexed: 12/21/2022] Open
Abstract
Lynch syndrome confers an increased risk for urothelial carcinoma (UC). Molecular subtypes may be relevant to prognosis and therapeutic possibilities, but have to date not been defined in Lynch syndrome‐associated urothelial cancer. We aimed to provide a molecular description of Lynch syndrome‐associated UC. Thus, Lynch syndrome‐associated UCs of the upper urinary tract and the urinary bladder were identified in the Danish hereditary nonpolyposis colorectal cancer (HNPCC) register and were transcriptionally and immunohistochemically profiled and further related to data from 307 sporadic urothelial carcinomas. Whole‐genome mRNA expression profiles of 41 tumors and immunohistochemical stainings against FGFR3, KRT5, CCNB1, RB1, and CDKN2A (p16) of 37 tumors from patients with Lynch syndrome were generated. Pathological data, microsatellite instability, anatomic location, and overall survival data were analyzed and compared with sporadic bladder cancer. The 41 Lynch syndrome‐associated UC developed at a mean age of 61 years with 59% women. mRNA expression profiling and immunostaining classified the majority of the Lynch syndrome‐associated UC as urothelial‐like tumors with only 20% being genomically unstable, basal/SCC‐like, or other subtypes. The subtypes were associated with stage, grade, and microsatellite instability. Comparison to larger datasets revealed that Lynch syndrome‐associated UC shares molecular similarities with sporadic UC. In conclusion, transcriptomic and immunohistochemical profiling identifies a predominance of the urothelial‐like molecular subtype in Lynch syndrome and reveals that the molecular subtypes of sporadic bladder cancer are relevant also within this hereditary, mismatch‐repair defective subset.
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Affiliation(s)
- Christina Therkildsen
- The HNPCC register, Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark
| | - Pontus Eriksson
- Division of Oncology and Pathology, Institution of Clinical Sciences, Lund University, Sweden
| | - Mattias Höglund
- Division of Oncology and Pathology, Institution of Clinical Sciences, Lund University, Sweden
| | - Mats Jönsson
- Division of Oncology and Pathology, Institution of Clinical Sciences, Lund University, Sweden
| | - Gottfrid Sjödahl
- Division of Urological Research, Institution of Translational Medicine, Lund University, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Mef Nilbert
- The HNPCC register, Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark.,Division of Oncology and Pathology, Institution of Clinical Sciences, Lund University, Sweden.,Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Fredrik Liedberg
- Division of Urological Research, Institution of Translational Medicine, Lund University, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
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10
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Anyla M, Lefevre JH, Creavin B, Colas C, Svrcek M, Lascols O, Debove C, Chafai N, Tiret E, Parc Y. Metachronous colorectal cancer risk in Lynch syndrome patients-should the endoscopic surveillance be more intensive? Int J Colorectal Dis 2018. [PMID: 29532206 DOI: 10.1007/s00384-018-3004-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Regular follow-up for patients with Lynch syndrome (LS) is vital due to the increased risk of colorectal (50-80%), endometrial (40-60%), and other cancers. However, there is an ongoing debate concerning the best interval between colonoscopies. Currently, no specific endoscopic follow-up has been decided for LS patients who already have an index colorectal cancer (CRC). The aim of this study was to evaluate the risk of metachronous cancers (MC) after primary CRC in a LS population and to determinate if endoscopic surveillance should be more intensive. METHODS A prospective cohort of patients with a confirmed diagnosis of hereditary CRC since 2009 was included. Patients with LS and a primary CRC were the cohort of choice. RESULTS One hundred twenty-one patients were included with a median age of 44 years(16-70). At least one MC occurred in 39 patients (32.2%), with a median interval of 67 months (6-300) from index cancer. Fifteen (38.5%) developed two or more MCs during follow-up, with a median number of two (2-6) tumors occurring. Metachronous CRC were diagnosed after a median interval of 24 (6-57) months since last colonoscopy and were more commonly seen in MSH2 mutation carriers (58 vs. 35%, p = 0.001). After a median follow-up of 52.9 (3-72) months, no cancer-related deaths were recorded. CONCLUSION Patients with LS have an increased risk of MC, especially CRCs. With a median time period of 24 months between colonoscopy and metachronous CRC, the interval between surveillance colonoscopies following primary CRC should not exceed 18 months, especially in patients with MSH2 mutation.
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Affiliation(s)
- Morgan Anyla
- Department of Digestive Surgery, St Antoine Hospital (AP-HP), Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Jérémie H Lefevre
- Department of Digestive Surgery, St Antoine Hospital (AP-HP), Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France. .,Equipe "Instabilité des Microsatellites et Cancers", Equipe labellisée par la Ligue Nationale contre le Cancer, INSERM, UMRS 938 - Centre de Recherche Saint-Antoine, 75012, Paris, France.
| | - Ben Creavin
- Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Chrystelle Colas
- Department of Oncogenetics and Angiogenetics, Pitie-Salpetriere Hospital, Sorbonne Université, Paris, France.,Department of Pathology, St Antoine Hospital (AP-HP), Sorbonne Université, Paris, France
| | - Magali Svrcek
- Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,Department of Pathology, St Antoine Hospital (AP-HP), Sorbonne Université, Paris, France
| | - Olivier Lascols
- Department of Molecular Biology, St Antoine Hospital (AP-HP), Sorbonne Université, Paris, France
| | - Clotilde Debove
- Department of Digestive Surgery, St Antoine Hospital (AP-HP), Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Najim Chafai
- Department of Digestive Surgery, St Antoine Hospital (AP-HP), Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Emmanuel Tiret
- Department of Digestive Surgery, St Antoine Hospital (AP-HP), Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Yann Parc
- Department of Digestive Surgery, St Antoine Hospital (AP-HP), Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.,Equipe "Instabilité des Microsatellites et Cancers", Equipe labellisée par la Ligue Nationale contre le Cancer, INSERM, UMRS 938 - Centre de Recherche Saint-Antoine, 75012, Paris, France
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11
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Wiksyk B, Joe H, Fenton D, Kelly JK, Truong PT. Resolution of Metastatic Colon Cancer upon Withdrawal of Anti-TNF Therapy for Crohn's Disease. J Gastrointest Cancer 2018; 50:665-667. [PMID: 29682686 DOI: 10.1007/s12029-018-0107-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Bradley Wiksyk
- Department of Radiation Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada
| | - Howard Joe
- Department of Radiation Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada
| | - David Fenton
- Department of Medical Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada
| | - James K Kelly
- Department of Pathology, Vancouver Island Health Authority, Victoria, BC, Canada
| | - Pauline T Truong
- Department of Radiation Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada. .,Department of Radiation Oncology, Vancouver Island Centre, British Columbia Cancer Agency, 2410 Lee Avenue, Victoria, BC, V8R6V5, Canada.
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12
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Binder H, Hopp L, Schweiger MR, Hoffmann S, Jühling F, Kerick M, Timmermann B, Siebert S, Grimm C, Nersisyan L, Arakelyan A, Herberg M, Buske P, Loeffler-Wirth H, Rosolowski M, Engel C, Przybilla J, Peifer M, Friedrichs N, Moeslein G, Odenthal M, Hussong M, Peters S, Holzapfel S, Nattermann J, Hueneburg R, Schmiegel W, Royer-Pokora B, Aretz S, Kloth M, Kloor M, Buettner R, Galle J, Loeffler M. Genomic and transcriptomic heterogeneity of colorectal tumours arising in Lynch syndrome. J Pathol 2017; 243:242-254. [DOI: 10.1002/path.4948] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/01/2017] [Accepted: 07/14/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Hans Binder
- Interdisciplinary Centre for Bioinformatics; Leipzig University; Leipzig Germany
| | - Lydia Hopp
- Interdisciplinary Centre for Bioinformatics; Leipzig University; Leipzig Germany
| | - Michal R Schweiger
- Institute of Pathology, Centre for Integrated Oncology; University Hospital Cologne; Cologne Germany
- Translational Epigenomics; University Hospital Cologne; Cologne Germany
- Max Planck Institute for Molecular Genetics; Berlin Germany
| | - Steve Hoffmann
- Interdisciplinary Centre for Bioinformatics; Leipzig University; Leipzig Germany
| | - Frank Jühling
- Interdisciplinary Centre for Bioinformatics; Leipzig University; Leipzig Germany
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques; Strasbourg France
- Université de Strasbourg; Strasbourg France
| | - Martin Kerick
- Institute of Pathology, Centre for Integrated Oncology; University Hospital Cologne; Cologne Germany
- Translational Epigenomics; University Hospital Cologne; Cologne Germany
- Max Planck Institute for Molecular Genetics; Berlin Germany
| | | | - Susann Siebert
- Institute of Pathology, Centre for Integrated Oncology; University Hospital Cologne; Cologne Germany
- Translational Epigenomics; University Hospital Cologne; Cologne Germany
- Max Planck Institute for Molecular Genetics; Berlin Germany
| | - Christina Grimm
- Institute of Pathology, Centre for Integrated Oncology; University Hospital Cologne; Cologne Germany
- Translational Epigenomics; University Hospital Cologne; Cologne Germany
- Max Planck Institute for Molecular Genetics; Berlin Germany
| | - Lilit Nersisyan
- Group of Bioinformatics, Institute of Molecular Biology; National Academy of Sciences; Yerevan Armenia
| | - Arsen Arakelyan
- Group of Bioinformatics, Institute of Molecular Biology; National Academy of Sciences; Yerevan Armenia
| | - Maria Herberg
- Interdisciplinary Centre for Bioinformatics; Leipzig University; Leipzig Germany
| | - Peter Buske
- Interdisciplinary Centre for Bioinformatics; Leipzig University; Leipzig Germany
| | - Henry Loeffler-Wirth
- Interdisciplinary Centre for Bioinformatics; Leipzig University; Leipzig Germany
| | - Maciej Rosolowski
- Institute for Medical Informatics, Statistics and Epidemiology; Leipzig University; Leipzig Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology; Leipzig University; Leipzig Germany
| | - Jens Przybilla
- Interdisciplinary Centre for Bioinformatics; Leipzig University; Leipzig Germany
| | - Martin Peifer
- Institute of Pathology, Centre for Integrated Oncology; University Hospital Cologne; Cologne Germany
| | - Nicolaus Friedrichs
- Institute of Pathology, Centre for Integrated Oncology; University Hospital Cologne; Cologne Germany
| | - Gabriela Moeslein
- Department of Hereditary Tumour Syndromes; Surgical Centre, HELIOS Clinic, University Witten/Herdecke; Wuppertal Germany
| | - Margarete Odenthal
- Institute of Pathology, Centre for Integrated Oncology; University Hospital Cologne; Cologne Germany
| | - Michelle Hussong
- Institute of Pathology, Centre for Integrated Oncology; University Hospital Cologne; Cologne Germany
- Translational Epigenomics; University Hospital Cologne; Cologne Germany
- Max Planck Institute for Molecular Genetics; Berlin Germany
| | - Sophia Peters
- Institute of Human Genetics, University Hospital Bonn; Centre for Hereditary Tumour Syndromes, University of Bonn; Bonn Germany
| | - Stefanie Holzapfel
- Institute of Human Genetics, University Hospital Bonn; Centre for Hereditary Tumour Syndromes, University of Bonn; Bonn Germany
| | - Jacob Nattermann
- Department of Internal Medicine I, University Hospital Bonn; Centre for Hereditary Tumour Syndromes, University of Bonn; Bonn Germany
| | - Robert Hueneburg
- Department of Internal Medicine I, University Hospital Bonn; Centre for Hereditary Tumour Syndromes, University of Bonn; Bonn Germany
| | - Wolff Schmiegel
- Department of Medicine, Haematology and Oncology; Ruhr-University of Bochum, Knappschaftskrankenhaus; Bochum Germany
| | - Brigitte Royer-Pokora
- Institute of Human Genetics and Anthropology; Heinrich-Heine University; Düsseldorf Germany
| | - Stefan Aretz
- Institute of Human Genetics, University Hospital Bonn; Centre for Hereditary Tumour Syndromes, University of Bonn; Bonn Germany
| | - Michael Kloth
- Institute of Pathology, Centre for Integrated Oncology; University Hospital Cologne; Cologne Germany
| | - Matthias Kloor
- Department of Applied Tumour Biology, Institute of Pathology; University Hospital Heidelberg; Heidelberg Germany
- Clinical Cooperation Unit of Applied Tumour Biology; DKFZ (German Cancer Research Centre) Heidelberg; Germany
- Molecular Medicine Partnership Unit; University Hospital Heidelberg and EMBL Heidelberg; Heidelberg Germany
| | - Reinhard Buettner
- Institute of Pathology, Centre for Integrated Oncology; University Hospital Cologne; Cologne Germany
| | - Jörg Galle
- Interdisciplinary Centre for Bioinformatics; Leipzig University; Leipzig Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology; Leipzig University; Leipzig Germany
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13
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Czink E, Kloor M, Goeppert B, Fröhling S, Uhrig S, Weber TF, Meinel J, Sutter C, Weiss KH, Schirmacher P, Doeberitz MVK, Jäger D, Springfeld C. Successful immune checkpoint blockade in a patient with advanced stage microsatellite-unstable biliary tract cancer. Cold Spring Harb Mol Case Stud 2017; 3:mcs.a001974. [PMID: 28619747 PMCID: PMC5593153 DOI: 10.1101/mcs.a001974] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/06/2017] [Indexed: 12/12/2022] Open
Abstract
Cancers acquire multiple somatic mutations that can lead to the generation of immunogenic mutation-induced neoantigens. These neoantigens can be recognized by the host's immune system. However, continuous stimulation of immune cells against tumor antigens can lead to immune cell exhaustion, which allows uncontrolled outgrowth of tumor cells. Recently, immune checkpoint inhibitors have emerged as a novel approach to overcome immune cell exhaustion and reactivate antitumor immune responses. In particular, antibodies blocking the exhaustion-mediating programmed death receptor (PD-1)/programmed death receptor ligand (PD-L1) pathway have shown clinical efficacy. The effects were particularly pronounced in tumors with DNA mismatch repair (MMR) deficiency and a high mutational load, which typically occur in the colon and endometrium. Here, we report on a 24-yr-old woman diagnosed with extrahepatic cholangiocarcinoma who showed strong and durable response to the immune checkpoint inhibitor pembrolizumab, although treatment was initiated at an advanced stage of disease. The patient's tumor displayed DNA MMR deficiency and microsatellite instability (MSI) but lacked other features commonly discussed as predictors of response toward checkpoint blockade, such as PD-L1 expression or dense infiltration with cytotoxic T cells. Notably, high levels of HLA class I and II antigen expression were detected in the tumor, suggesting a potential causal relation between functionality of the tumor's antigen presentation machinery and the success of immune checkpoint blockade. We suggest determining MSI status in combination with HLA class I and II antigen expression in tumors potentially eligible for immune checkpoint blockade even in the absence of conventional markers predictive for anti-PD-1/PD-L1 therapy and in entities not commonly linked to the MSI phenotype. Further studies are required to determine the value of these markers for predicting the success of immune checkpoint blockade.
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Affiliation(s)
- Elena Czink
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany.,Liver Cancer Center Heidelberg, 69120 Heidelberg, Germany
| | - Matthias Kloor
- Department of Applied Tumor Biology, Institute of Pathology, 69120 Heidelberg, Germany
| | - Benjamin Goeppert
- Liver Cancer Center Heidelberg, 69120 Heidelberg, Germany.,Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Stefan Fröhling
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany.,Department of Translational Oncology, National Center for Tumor Diseases and German Cancer Research Center, 69120 Heidelberg, Germany.,German Cancer Consortium, 69120 Heidelberg, Germany
| | - Sebastian Uhrig
- Division of Applied Bioinformatics, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Tim F Weber
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Jörn Meinel
- Institute of Pathology, University Hospital Carl Gustav Carus at the Technical University of Dresden, 01307 Dresden, Germany
| | - Christian Sutter
- Institute of Human Genetics, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Karl Heinz Weiss
- Liver Cancer Center Heidelberg, 69120 Heidelberg, Germany.,Department of Gastroenterology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Peter Schirmacher
- Liver Cancer Center Heidelberg, 69120 Heidelberg, Germany.,Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | | | - Dirk Jäger
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany.,Liver Cancer Center Heidelberg, 69120 Heidelberg, Germany
| | - Christoph Springfeld
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany.,Liver Cancer Center Heidelberg, 69120 Heidelberg, Germany
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14
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Basso G, Bianchi P, Malesci A, Laghi L. Hereditary or sporadic polyposis syndromes. Best Pract Res Clin Gastroenterol 2017; 31:409-417. [PMID: 28842050 DOI: 10.1016/j.bpg.2017.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 05/31/2017] [Indexed: 01/31/2023]
Abstract
Polyposis syndromes are encountered in endoscopy practice, and are considered rare entities, accounting for ≤1% of colorectal cancer. Polyposis can occur within inherited syndromes or as "sporadic" cases of unknown etiology. Their proper characterization is relevant for patient management, and should nowadays drive appropriate genetic tests which have a key role in clinical practice for driving surveillance and colorectal cancer prevention, enlarged to relatives. Polyposis classification is based upon polyp number and histology, familial and personal history. This review will explore the polyposis nosology and their genetic determinants in the emerging scenario of Next Generation Sequencing which allow testing multiples genes in parallel. This capability will likely continue to increase the range of polyposis predisposing genes, contributing to define new clinical entities.
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Affiliation(s)
- Gianluca Basso
- Laboratory of Molecular Gastroenterology, Department of Gastroenterology, Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Paolo Bianchi
- Laboratory of Molecular Gastroenterology, Department of Gastroenterology, Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Alberto Malesci
- Department of Biotechnologies and Translational Medicine, University of Milan, Via Vanvitelli 32, 20133 Milan, Italy; Department of Gastroenterology, Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Luigi Laghi
- Laboratory of Molecular Gastroenterology, Department of Gastroenterology, Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano (Milan), Italy; Department of Gastroenterology, Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano (Milan), Italy; Hereditary Cancer Genetics Clinic, Humanitas Cancer Center, Humanitas Clinical and Research Center, Via Manzoni 56, 20089 Rozzano (Milan), Italy.
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