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Walenciak J, Urbanska Z, Pastorczak A, Babol-Pokora K, Wypyszczak K, Bien E, Gawlowska-Marciniak A, Kobos J, Grajkowska W, Smyczynska J, Mlynarski W, Janczar S. An Asymptomatic, Ectopic Mass as a Presentation of Adrenocortical Carcinoma Due to a Novel Germline TP53 p.Phe338Leu Tetramerisation Domain Variant. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1793. [PMID: 38002884 PMCID: PMC10670401 DOI: 10.3390/children10111793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/20/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
Adrenocortical carcinoma (ACC) is a rare cancer in childhood. ACC is frequently associated with germline TP53 variants, with founder effects especially due to the p.Arg337His mutation. ACC leads to the secretion of adrenocortical hormones, resulting in endocrine syndromes, which is the usual trigger for establishing the diagnosis. We present a surprising ACC pathology in a non-secreting, ectopic retroperitoneal tumour in a 4-year-old boy, successfully controlled with chemotherapy and mitotane after microscopically incomplete tumour resection with spillage. Genomic analysis (gene panel sequencing and copy-number microarray) demonstrated a novel p.Phe338Leu tetramerisation domain (TD) TP53 variant in the proband and his cancer-free mother and a monoallelic deletion encompassing the TP53 locus in cancer tissue, consistent with cancer-predisposition syndrome. While the recurrent p.Arg337His variant translates into high ACC risk, residue 338 and, in general, TD domain variants drive heterogeneous clinical scenarios, despite generally being considered less disruptive than TP53 DNA-binding domain mutations.
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Affiliation(s)
- Justyna Walenciak
- Department of Pediatrics, Oncology and Haematology, Medical University of Lodz, 91-738 Lodz, Poland; (J.W.); (Z.U.); (A.P.); (K.B.-P.); (K.W.); (W.M.)
| | - Zuzanna Urbanska
- Department of Pediatrics, Oncology and Haematology, Medical University of Lodz, 91-738 Lodz, Poland; (J.W.); (Z.U.); (A.P.); (K.B.-P.); (K.W.); (W.M.)
| | - Agata Pastorczak
- Department of Pediatrics, Oncology and Haematology, Medical University of Lodz, 91-738 Lodz, Poland; (J.W.); (Z.U.); (A.P.); (K.B.-P.); (K.W.); (W.M.)
| | - Katarzyna Babol-Pokora
- Department of Pediatrics, Oncology and Haematology, Medical University of Lodz, 91-738 Lodz, Poland; (J.W.); (Z.U.); (A.P.); (K.B.-P.); (K.W.); (W.M.)
| | - Kamila Wypyszczak
- Department of Pediatrics, Oncology and Haematology, Medical University of Lodz, 91-738 Lodz, Poland; (J.W.); (Z.U.); (A.P.); (K.B.-P.); (K.W.); (W.M.)
| | - Ewa Bien
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Aleksandra Gawlowska-Marciniak
- Department of Pediatric Surgery and Oncology, Central University Hospital, Medical University of Lodz, 91-738 Lodz, Poland;
| | - Jozef Kobos
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, 92-213 Lodz, Poland;
| | - Wieslawa Grajkowska
- Department of Pathology, The Children’s Memorial Health Institute, 04-736 Warsaw, Poland;
| | - Joanna Smyczynska
- Department of Pediatrics, Endocrinology, Diabetology and Nephrology, Medical University of Lodz, 91-738 Lodz, Poland;
| | - Wojciech Mlynarski
- Department of Pediatrics, Oncology and Haematology, Medical University of Lodz, 91-738 Lodz, Poland; (J.W.); (Z.U.); (A.P.); (K.B.-P.); (K.W.); (W.M.)
| | - Szymon Janczar
- Department of Pediatrics, Oncology and Haematology, Medical University of Lodz, 91-738 Lodz, Poland; (J.W.); (Z.U.); (A.P.); (K.B.-P.); (K.W.); (W.M.)
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Hofstedter R, Sanabria-Salas MC, Di Jiang M, Ezzat S, Mete O, Kim RH. FLCN-Driven Functional Adrenal Cortical Carcinoma with High Mitotic Tumor Grade: Extending the Endocrine Manifestations of Birt-Hogg-Dubé Syndrome. Endocr Pathol 2023:10.1007/s12022-023-09748-2. [PMID: 36701047 DOI: 10.1007/s12022-023-09748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/27/2023]
Abstract
Adrenal cortical carcinoma is an aggressive and rare malignancy of steroidogenic cells of the adrenal gland. Most adult adrenal cortical carcinomas are sporadic, but a small fraction may be associated with inherited tumor syndromes, such as Li-Fraumeni, multiple endocrine neoplasia 1, Lynch syndrome, and Beckwith-Wiedemann syndrome, as well as isolated case reports of non-syndromic manifestations occurring in the context of other pathogenic germline variants. Birt-Hogg-Dubé (BHD) is a rare autosomal dominant syndrome caused by germline pathogenic variants in the FLCN gene. BHD syndrome causes a constellation of symptoms, including cutaneous manifestations, pulmonary cysts and pneumothorax, and risk of renal tumors. With the exception of a single case of adrenal cortical carcinoma, very few reports on the occurrence of adrenal cortical neoplasia in patients with BHD syndrome have been described. However, information on variant allele fraction in the tumor was not available in the index case, which precludes any mechanism supporting loss of heterozygosity. Here we present a case of an adult-onset adrenal cortical carcinoma in a 50-year-old female, found to harbor a germline likely pathogenic variant in the FLCN gene, denoted as c.694C > T (p.Gln232Ter). Genetic testing on the tumor revealed the same FLCN variant at an allele fraction of 83%, suggesting a contributory role to the pathogenesis of the adrenal cortical carcinoma. This case further supports the expansion of the clinical presentation and tumor spectrum of BHD syndrome and the need to consider germline FLCN testing in the clinical genetic workup of patients with adrenal cortical carcinomas.
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Affiliation(s)
- Renee Hofstedter
- Bhalwani Familial Cancer Clinic, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - María Carolina Sanabria-Salas
- Department of Medicine, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, M5G 2C1, Canada
| | - Maria Di Jiang
- Department of Medicine, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, M5G 2C1, Canada
| | - Shereen Ezzat
- Endocrine Oncology Site Group, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Ozgur Mete
- Department of Pathology, University Health Network, Toronto General Hospital, 11th floor, Toronto, ON, M5G 2C4, Canada.
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Raymond H Kim
- Bhalwani Familial Cancer Clinic, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
- Department of Medicine, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, M5G 2C1, Canada.
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Ontario Institute for Cancer Research, Toronto, ON, Canada.
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Grisanti S, Cosentini D, Sigala S, Berruti A. Molecular genotyping of adrenocortical carcinoma: a systematic analysis of published literature 2019-2021. Curr Opin Oncol 2022; 34:19-28. [PMID: 34669649 PMCID: PMC10863665 DOI: 10.1097/cco.0000000000000799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW comprehensive molecular characterization of adrenocortical carcinoma (ACC) through next-generation sequencing and bioinformatics analyses is expanding the number of targets with potential prognostic and therapeutic value. We performed a critical review of recent published literature on genotyping of ACC. RECENT FINDINGS 423 studies were published between 2019 and 2021. After manual curation we summarized selected evidence in two thematic areas: germline deoxyribonucleic acid (DNA) variations, genomic alterations and prognosis. SUMMARY the evolving genomic landscape of ACC requires target validation in terms of prognostic and predictive value within scientific consortia. Although the existing multiple driver genes are difficult targets in the perspective of precision oncology, alterations in DNA damage repair genes or in promoter hypermethylation could open new venues for repurposing of existing drugs in ACC.
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Affiliation(s)
- Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili
| | - Deborah Cosentini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili
| | - Sandra Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili
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