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Vogelaar IP, Greer S, Wang F, Shin G, Lau B, Hu Y, Haraldsdottir S, Alvarez R, Hazelett D, Nguyen P, Aguirre FP, Guindi M, Hendifar A, Balcom J, Leininger A, Fairbank B, Ji H, Hitchins MP. Large Cancer Pedigree Involving Multiple Cancer Genes including Likely Digenic MSH2 and MSH6 Lynch Syndrome (LS) and an Instance of Recombinational Rescue from LS. Cancers (Basel) 2022; 15:cancers15010228. [PMID: 36612224 PMCID: PMC9818763 DOI: 10.3390/cancers15010228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Lynch syndrome (LS), caused by heterozygous pathogenic variants affecting one of the mismatch repair (MMR) genes (MSH2, MLH1, MSH6, PMS2), confers moderate to high risks for colorectal, endometrial, and other cancers. We describe a four-generation, 13-branched pedigree in which multiple LS branches carry the MSH2 pathogenic variant c.2006G>T (p.Gly669Val), one branch has this and an additional novel MSH6 variant c.3936_4001+8dup (intronic), and other non-LS branches carry variants within other cancer-relevant genes (NBN, MC1R, PTPRJ). Both MSH2 c.2006G>T and MSH6 c.3936_4001+8dup caused aberrant RNA splicing in carriers, including out-of-frame exon-skipping, providing functional evidence of their pathogenicity. MSH2 and MSH6 are co-located on Chr2p21, but the two variants segregated independently (mapped in trans) within the digenic branch, with carriers of either or both variants. Thus, MSH2 c.2006G>T and MSH6 c.3936_4001+8dup independently confer LS with differing cancer risks among family members in the same branch. Carriers of both variants have near 100% risk of transmitting either one to offspring. Nevertheless, a female carrier of both variants did not transmit either to one son, due to a germline recombination within the intervening region. Genetic diagnosis, risk stratification, and counseling for cancer and inheritance were highly individualized in this family. The finding of multiple cancer-associated variants in this pedigree illustrates a need to consider offering multicancer gene panel testing, as opposed to targeted cascade testing, as additional cancer variants may be uncovered in relatives.
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Affiliation(s)
- Ingrid P. Vogelaar
- Department of Medicine (Oncology), Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
| | - Stephanie Greer
- Department of Medicine (Oncology), Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
| | - Fan Wang
- Department of Medicine (Oncology), Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
- School of Public Health (Epidemiology), Harbin Medical University, Harbin 150088, China
| | - GiWon Shin
- Department of Medicine (Oncology), Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
| | - Billy Lau
- Department of Medicine (Oncology), Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
| | - Yajing Hu
- Department of Medicine (Oncology), Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
| | - Sigurdis Haraldsdottir
- Department of Medicine (Oncology), Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
| | - Rocio Alvarez
- Bioinformatics and Functional Genomics Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Dennis Hazelett
- Bioinformatics and Functional Genomics Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Peter Nguyen
- Bioinformatics and Functional Genomics Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Francesca P. Aguirre
- Bioinformatics and Functional Genomics Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Maha Guindi
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Andrew Hendifar
- Samuel Oschin Cancer Center, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Jessica Balcom
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA
| | | | - Beth Fairbank
- Lynch Syndrome Australia, The Summit, QLD 4377, Australia
| | - Hanlee Ji
- Department of Medicine (Oncology), Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
- Stanford Genome Technology Center West, 1050 Arastradero, Palo Alto, CA 94304, USA
| | - Megan P. Hitchins
- Department of Medicine (Oncology), Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
- Bioinformatics and Functional Genomics Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Lowy Cancer Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
- Correspondence: ; Tel.: +310-423-8785
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Vostrukhina OA, Mirlina ED, Khmelkova DN, Butrovich GM, Shakhmatova AD, Kil YV, Polyatskin YL, Artemyeva AS, Gulyaev AV, Verbenko VN. An MSH6 germline pathogenic variant p.Gly162Ter associated with Lynch syndrome. Hum Genome Var 2022; 9:37. [PMID: 36289196 PMCID: PMC9605995 DOI: 10.1038/s41439-022-00216-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 01/11/2023] Open
Abstract
We identified a three-generation Russian family with Lynch syndrome with a novel germline variant of the MSH6 gene. An 84-year-old female was diagnosed with endometrial adenocarcinoma at the age of 49 years. Her son was diagnosed with colorectal tubular adenoma at the age of 32 years. A germline nonsense variant (c.484 G > T:p.Gly162Ter) in exon 3 of the MSH6 gene was revealed by whole-exome sequencing. Sanger sequencing confirmed the cosegregation of the MSH6 nonsense variant in family members.
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Affiliation(s)
- Olga A. Vostrukhina
- grid.430219.d0000 0004 0619 3376Petersburg Nuclear Physics Institute named by B.P. Konstantinov of National Research Centre “Kurchatov Institute”, Gatchina, 188300 Russia
| | - Elena D. Mirlina
- grid.430219.d0000 0004 0619 3376Petersburg Nuclear Physics Institute named by B.P. Konstantinov of National Research Centre “Kurchatov Institute”, Gatchina, 188300 Russia
| | - Darya N. Khmelkova
- Centre of Genetics and Reproductive Medicine “Genetico”, Moscow, 119333 Russia
| | - Galina M. Butrovich
- grid.430219.d0000 0004 0619 3376Petersburg Nuclear Physics Institute named by B.P. Konstantinov of National Research Centre “Kurchatov Institute”, Gatchina, 188300 Russia
| | - Alexandra D. Shakhmatova
- grid.430219.d0000 0004 0619 3376Petersburg Nuclear Physics Institute named by B.P. Konstantinov of National Research Centre “Kurchatov Institute”, Gatchina, 188300 Russia
| | - Yury V. Kil
- grid.430219.d0000 0004 0619 3376Petersburg Nuclear Physics Institute named by B.P. Konstantinov of National Research Centre “Kurchatov Institute”, Gatchina, 188300 Russia
| | - Yliya L. Polyatskin
- grid.465337.00000 0000 9341 0551N.N. Petrov National Medical Research Centre of Oncology, St. Petersburg, 197758 Russia
| | - Anna S. Artemyeva
- grid.465337.00000 0000 9341 0551N.N. Petrov National Medical Research Centre of Oncology, St. Petersburg, 197758 Russia
| | - Alexey V. Gulyaev
- grid.465337.00000 0000 9341 0551N.N. Petrov National Medical Research Centre of Oncology, St. Petersburg, 197758 Russia
| | - Valery N. Verbenko
- grid.430219.d0000 0004 0619 3376Petersburg Nuclear Physics Institute named by B.P. Konstantinov of National Research Centre “Kurchatov Institute”, Gatchina, 188300 Russia
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Liu Y, GuLiBaHa M, Yue YB, Li MW, Cao SB, Yan M. An isolated childhood myeloid sarcoma with germline MSH6 mutation-a case report. Transl Pediatr 2021; 10:2136-2143. [PMID: 34584885 PMCID: PMC8429872 DOI: 10.21037/tp-21-326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
Myeloid sarcoma (MS) is a type of malignant tumor that originates in the bone marrow. This study reports on the treatment of an 11-year-old Uygur girl with a 15-day history of fever and paroxysmal cough, accompanied by right hip pain. During treatment, fatigue and anemia developed, physical strength decreased, and a few petechiae were seen in the lower extremities. Multiple enlarged lymph nodes were palpable in the neck, with slight congestion in the pharynx. Routine blood screening showed three major myeloid lineage abnormalities. Pathological examination revealed the presence of CD10 (-), CD99 (+), CD20 (+), CD3 (-), CD117 (weak+), CD34 (unclear location), TdT (-), Pax5 (-), Ki-67 (50%+), MPO (-), and CD43 (+). The patient was eventually diagnosed with isolated MS. After chemotherapy, no small particles were observed in bone marrow morphology. Complete remission was confirmed by flow cytometric detection of minimal residual disease. Genomic DNA was subjected to targeted sequencing of 236 gene panels to detect somatic mutations and the MSH6 c.3953_3954insAA p.R1318fs germline mutation. Unfortunately, the patient was subsequently lost to follow-up. To our knowledge, an MSH6 germline mutation had not previously been reported in children with MS, and we speculated that an MSH6 germline mutation led to genomic instability, triggering a somatic mutation in multiple genes and ultimately led to the development of MS in this patient. It is suggested that rare base abnormalities may be involved in the development of isolated myeloid sarcomas (IMS).
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Affiliation(s)
- Yu Liu
- Pediatric Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - MaiMaiTi GuLiBaHa
- Pediatric Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ying-Bin Yue
- Pediatric Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ming-Wei Li
- Pediatric Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Shan-Bo Cao
- Lab of Gene, Acornmed Biotechnology Co., Ltd. Beijing Economic and Technological Development Zone, Beijing, China
| | - Mei Yan
- Pediatric Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Pinheiro M, Francisco I, Pinto C, Peixoto A, Veiga I, Filipe B, Santos C, Maia S, Silva J, Pinto P, Santos R, Claro I, Lage P, Lopes P, Ferreira S, Rosa I, Fonseca R, Rodrigues P, Henrique R, Chaves P, Pereira AD, Brandão C, Albuquerque C, Teixeira MR. The nonsense mutation MSH2 c.2152C>T shows a founder effect in Portuguese Lynch syndrome families. Genes Chromosomes Cancer 2019; 58:657-664. [PMID: 30968502 DOI: 10.1002/gcc.22759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 12/27/2022] Open
Abstract
The mutational spectrum of the MMR genes is highly heterogeneous, but specific mutations are observed at high frequencies in well-defined populations or ethnic groups, due to founder effects. The MSH2 mutation c.2152C>T, p.(Gln718*), has occasionally been described in Lynch families worldwide, including in Portuguese Lynch syndrome families. During genetic testing for Lynch syndrome at the Portuguese Oncology Institutes of Porto and Lisbon, this mutation was identified in 28 seemingly unrelated families. In order to evaluate if this alteration is a founder mutation, haplotype analysis using microsatellite and SNP markers flanking the MSH2 gene was performed in the 28 probands and 87 family members. Additionally, the geographic origin of these families was evaluated and the age of the mutation estimated. Twelve different haplotypes were phased for 13 out of the 28 families and shared a conserved region of ∼3.6 Mb. Based on the mutation and recombination events observed in the microsatellite haplotypes and assuming a generation time of 25 years, the age estimate for the MSH2 mutation was 273 ± 64 years. The geographic origins of these families were mostly from the Northern region of Portugal. Concluding, these results suggest that the MSH2 c.2152C>T alteration is a founder mutation in Portugal with a relatively recent origin. Furthermore, its high proportion indicates that screening for this mutation as a first step, together with the previously reported Portuguese founder mutations, may be cost-effective in genetic testing of Lynch syndrome suspects of Portuguese ancestry.
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Affiliation(s)
- Manuela Pinheiro
- Department of Genetics, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Inês Francisco
- Molecular Pathobiology Research Unit, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Carla Pinto
- Department of Genetics, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Ana Peixoto
- Department of Genetics, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Isabel Veiga
- Department of Genetics, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Bruno Filipe
- Molecular Pathobiology Research Unit, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Catarina Santos
- Department of Genetics, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Sofia Maia
- Department of Genetics, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - João Silva
- Department of Genetics, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Pedro Pinto
- Department of Genetics, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Rui Santos
- Department of Genetics, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Isabel Claro
- Department of Gastroenterology, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal.,Familial Risk Clinic, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Pedro Lage
- Department of Gastroenterology, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal.,Familial Risk Clinic, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Paula Lopes
- Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Sara Ferreira
- Department of Gastroenterology, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal.,Familial Risk Clinic, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Isadora Rosa
- Department of Gastroenterology, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal.,Familial Risk Clinic, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Ricardo Fonseca
- Department of Pathology, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Paula Rodrigues
- Familial Risk Clinic, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Rui Henrique
- Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal.,Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Paula Chaves
- Department of Pathology, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - António Dias Pereira
- Department of Gastroenterology, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Catarina Brandão
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Cristina Albuquerque
- Molecular Pathobiology Research Unit, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Manuel R Teixeira
- Department of Genetics, Portuguese Oncology Institute of Porto, Porto, Portugal.,Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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Abstract
Sebaceous neoplasms such as adenoma, sebaceoma, and carcinoma, although sporadic in their occurrence, are clinically significant because of their association with Muir-Torre syndrome (MTS). MTS is a rare autosomal dominant genodermatosis characterized by the occurrence of sebaceous neoplasms and/or keratoacanthomas and visceral malignancies. MTS is usually the result of germline mutations in the DNA mismatch repair genes MSH2 and, albeit less commonly, MLH1. Although less know, MSH6 is yet another key player. Evidence from Lynch syndrome indicates that pathogenic germline mutations in MSH6 are typically microsatellite stable and have a clinical presentation that differs from that associated with germline mutations in MSH2 and/or MLH1. Given this unique mutator phenotype of MSH6, the primary aim of this review was to underscore the clinical manifestations associated with pathogenic mutations in MSH6 in patients with MTS. As the current clinical and laboratory work-up of MTS is geared toward patients harboring a germline mutation in MSH2 and/or MLH1, an additional aim was to provide a scaffolding for the work-up of a patient presenting with an isolated germline mutation in MSH6.
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Pathologic Findings in Prophylactic and Nonprophylactic Hysterectomy Specimens of Patients With Lynch Syndrome. Am J Surg Pathol 2016; 40:1177-91. [DOI: 10.1097/pas.0000000000000684] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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