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Vu JA, Thompson WS, Klinkner DB, Chattha A, Wick M, Case EJ, Collura C, Kumar A. Risk reduction for small cell cancer of the ovary, hypercalcemic type in prepubertal patient: A clinical and bioethical perspective. Gynecol Oncol Rep 2023; 49:101261. [PMID: 37663174 PMCID: PMC10474132 DOI: 10.1016/j.gore.2023.101261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023] Open
Abstract
Loss of heterozygosity in the SMARCA4 gene is a hallmark feature of small cell carcinoma of the ovary, hypercalcemic type (SCCOHT), an aggressive ovarian cancer occurring in young adults and adolescents with an average age of 23 years and a median survival of less than fifteen months following diagnosis. Patients with germline pathogenic variants of SMARCA4 have a genetic predisposition to developing this aggressive ovarian cancer, a condition called rhabdoid tumor predisposition syndrome type 2 (RTPS2). Given the limited efficacy of surveillance imaging for ovarian neoplasm and the absence of an identified biomarker for the progression of this disease, asymptomatic patients who are found to possess pathogenic variants of the SMARCA4 gene following genetic testing are advised to consider risk-reducing bilateral salpingo-oophorectomy to eliminate the risk of SCCOHT. Given the reproductive impacts of this procedure, bioethical consultation must be considered when counseling patients with RTPS2, particularly for those who have not completed their desired course of family planning. In this report, we describe the bioethical considerations and outcomes for the case of a 6-year-old female with a pathogenic variant of SMARCA4 who underwent risk-reducing bilateral salpingo-oophorectomy (RRBSO). To our knowledge, this is the first time that this procedure has been reported in a prepubertal individual for cancer prevention in a patient with RTPS2.
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Affiliation(s)
- John A. Vu
- Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Whitney S. Thompson
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Department Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Denise B. Klinkner
- Department of Surgery, Division of Pediatric Surgery, Mayo Clinic, Rochester, MN, USA
| | - Asma Chattha
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Myra Wick
- Department Clinical Genomics, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Ellen J. Case
- Office of Clinical Ethics, Mayo Clinic, Rochester, MN, USA
| | - Christopher Collura
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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Grant CN, Rhee D, Tracy ET, Aldrink JH, Baertschiger RM, Lautz TB, Glick RD, Rodeberg DA, Ehrlich PF, Christison-Lagay E. Pediatric solid tumors and associated cancer predisposition syndromes: Workup, management, and surveillance. A summary from the APSA Cancer Committee. J Pediatr Surg 2022; 57:430-442. [PMID: 34503817 DOI: 10.1016/j.jpedsurg.2021.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/11/2021] [Accepted: 08/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE Cancer predisposition syndromes (CPS) are a heterogeneous group of inherited disorders that greatly increase the risk of developing malignancies. CPS are particularly relevant to pediatric surgeons since nearly 10% of cancer diagnoses are due to inherited genetic traits, and CPS often contribute to cancer development during childhood. MATERIALS/METHODS The English language literature was searched for manuscripts, practice guidelines, and society statements on "cancer predisposition syndromes in children". Following review of these manuscripts and cross-referencing of their bibliographies, tables were created to summarize findings of the most common CPS associated with surgically treated pediatric solid malignancies. RESULTS Pediatric surgeons should be aware of CPS as the identification of one of these syndromes can completely change the management of certain tumors, such as WT. The most common CPS associated with pediatric solid malignancies are outlined, with an emphasis on those most often encountered by pediatric surgeons: neuroblastoma, Wilms' tumor, hepatoblastoma, and medullary thyroid cancer. Frequently associated non-tumor manifestations of these CPS are also included as a guide to increase surgeon awareness. Screening and management guidelines are outlined, and published genetic testing and counseling guidelines are included where available. CONCLUSION Pediatric surgeons play an important role as surgical oncologists and are often the first point of contact for children with solid tumors. In their role of delivering a diagnosis and developing a follow-up and treatment plan as part of a multidisciplinary team, familiarity with common CPS will ensure evidence-based practices are followed, including important principles such as organ preservation and intensified surveillance plans. This review defines and summarizes the CPS associated with common childhood solid tumors encountered by the pediatric surgeon, as well as common non-cancerous disease stigmata that may help guide diagnosis. TYPE OF STUDY Summary paper. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Christa N Grant
- Division of Pediatric Surgery, Penn State Children's Hospital, Milton S. Hershey Medical Center, Hershey, PA, United States.
| | - Daniel Rhee
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, United States
| | - Richard D Glick
- Division of Pediatric Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, United States
| | - David A Rodeberg
- Division of Pediatric Surgery, East Carolina Medical Center, Greenville, NC, United States
| | - Peter F Ehrlich
- Division of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, United States
| | - Emily Christison-Lagay
- Division of Pediatric Surgery, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven, CT, United States
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Deibert B, Ferris L, Sanchez N, Weishaar P. The link between colon cancer and congenital hypertrophy of the retinal pigment epithelium (CHRPE). Am J Ophthalmol Case Rep 2019; 15:100524. [PMID: 31384696 PMCID: PMC6661422 DOI: 10.1016/j.ajoc.2019.100524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/10/2019] [Accepted: 07/21/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Clarify the differences between Familial Adenomatous Polyposis (FAP)-associated Congenital Hypertrophy of the Retinal Epithelium (CHRPE) and benign variants with regards to lesion characteristics and associated risk. OBSERVATIONS An eighteen-year-old man with no past medical history was found to have multiple lesions in both eyes that were consistent with FAP-associated CHRPE. Although family history was negative for colon cancer, a colonoscopy was performed, and hundreds of polyps were found extending from the rectum to the distal colon with pathological findings of tubular adenoma. Genetic testing was consistent with a possible de novo Adenomatous Polyposis Coli (APC) mutation. CONCLUSIONS FAP is an autosomal dominant syndrome that causes colorectal cancer by age thirty-five in ninety-five percent of cases. There has been no established relationship between the benign variants of CHRPE and FAP, and patients with benign variants have no increased risk of colon cancer. While the lack of distinction in nomenclature and similar lesion appearance often leads to misdiagnosis and overtreatment, there are distinct ocular exam features that can provide the correct diagnosis. The exam findings that distinguish FAP-associated CHRPE lesions are (1) bilateralism, (2) occurrence in multiple quadrants, (3) pisiform shape, and (4) irregular borders. Knowing these features can be of great aid, especially in the setting of suspected de novo Familial Adenomatous Polyposis.
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Affiliation(s)
- Brent Deibert
- University of Kansas Medical Center – Wichita, 1010 North Kansas, Wichita, KS, USA
- University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, USA
| | - Letisha Ferris
- University of Kansas Medical Center – Wichita, 1010 North Kansas, Wichita, KS, USA
- University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, USA
| | - Noel Sanchez
- University of Kansas Medical Center – Wichita, 1010 North Kansas, Wichita, KS, USA
| | - Paul Weishaar
- University of Kansas Medical Center – Wichita, 1010 North Kansas, Wichita, KS, USA
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Bussières V, Roy S, Deladoey J, Rousseau É, St-Vil D, Piché N. Prophylactic thyroidectomies in MEN2 syndrome: Management and outcomes. J Pediatr Surg 2018; 53:283-285. [PMID: 29336779 DOI: 10.1016/j.jpedsurg.2017.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/08/2017] [Indexed: 11/15/2022]
Abstract
AIM OF THE STUDY The aim of the study was to evaluate the outcomes of prophylactic thyroidectomies performed in an academic setting in the context of multiple endocrine neoplasia type 2 (MEN2) syndrome. METHODS A chart review of patients <18years old who underwent prophylactic thyroidectomy for a MEN2 syndrome at a children's hospital between 2006 and 2015 was performed. MAIN RESULTS The study included 21 patients (57% female) with a mean age of 6.2±2.5years. All patients were asymptomatic at first evaluation. Nineteen had MEN2A syndrome with RET proto-oncogene mutations identified. The remaining two were RET-negative with familial medullary thyroid cancer (FMTC). One patient had a concomitant Hirschsprung disease. Of the 11 patients who had RET proto-oncogene mutations ranked as Moderate Risk for medullary thyroid cancer (MTC) (American Thyroid Association), one had a microcarcinoma on the resected specimen, and the others had C-Cell Hyperplasia. Among the 8 patients who had RET proto-oncogene mutations ranked as High Risk level for MTC, all had microcarcinoma. Of the nine patients with microcarcinoma, three underwent surgery after 5years of age. No microcarcinoma exceeded 6mm. There were no permanent complications. Six patients experienced transient hypocalcemia, of which only one was symptomatic. No patients had lymph node involvement, and no recurrence was noted during the follow-up period. CONCLUSIONS Of 21 children with familial thyroid cancer syndrome who underwent a prophylactic thyroidectomy, nine had microcarcinoma. This study highlights the need for a complete familial history, including FMTC history and mandatory preventive surgical approach. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Shreyas Roy
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Surgery, Division of Pediatric Surgery, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Johnny Deladoey
- Department of Pediatrics, Division of Pediatric Endocrinology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | | | - Dickens St-Vil
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Surgery, Division of Pediatric Surgery, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Nelson Piché
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Surgery, Division of Pediatric Surgery, CHU Sainte-Justine, Montreal, Quebec, Canada.
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Angeborene Lungenfehlbildungen. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0154-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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