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Padhiyar J, Mahajan R, Panda M. RASopathies: Evolving Concepts in Pathogenetics, Clinical Features, and Management. Indian Dermatol Online J 2024; 15:392-404. [PMID: 38845651 PMCID: PMC11152490 DOI: 10.4103/idoj.idoj_594_23] [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: 08/03/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 06/09/2024] Open
Abstract
RASopathies refers to the group of disorders which are caused by a mutation in various genes of the RAS/MAPK (RAT sarcoma virus/Mitogen activated protein kinase) pathway. It includes many genes with varied functions, which are responsible for cell cycle regulation. As the mutation in one gene affects the entire pathway, there are many overlapping features among the various syndromes which are included under an umbrella term "RASopathies." However, neuroectodermal involvement is a unifying feature among these syndromes, which are caused by germline mutations affecting genes along this pathway. Recently, many other RASopathies have been described to involve blood vessels, lymphatics, and immune system. Also, many cutaneous mosaic disorders have been found to have mutations in the concerned pathway. The purpose of this article is to briefly review the pathogenesis of RASopathies with cutaneous manifestations, and summarise the features that can be helpful as diagnostic clues to dermatologists. As we understand more about the pathogenesis of the pathway at the cellular level, the research on genotype-phenotype correlation and therapeutic options broadens. Targeted therapy is in the clinical and preclinical trial phase, which may brighten the future of many patients.
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Affiliation(s)
- Jigna Padhiyar
- Department of DVL, Gujarat Cancer Society Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, India
| | - Rahul Mahajan
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Maitreyee Panda
- Department of Dermatology, IMS and SUM Hospital, Bhubaneshwar, Odisha, India
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2
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Clabbers JMK, Roemen GMJM, Rajan N, Shah A, Woo P, Arefi M, Vreeburg M, Steijlen PM, Gostyński A, van Geel M. HRAS mosaicism in linear palmoplantar keratoderma. J Eur Acad Dermatol Venereol 2024; 38:e382-e384. [PMID: 37909292 DOI: 10.1111/jdv.19613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/24/2023] [Indexed: 11/03/2023]
Affiliation(s)
- J M K Clabbers
- Department of Dermatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Dermatology, Haga Hospital, The Hague, The Netherlands
| | - G M J M Roemen
- Department of Pathology, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - N Rajan
- Department of Dermatology, Newcastle University, Newcastle, UK
| | - A Shah
- Department of Dermatology, Northampton General Hospital, Northampton, UK
| | - P Woo
- Department of Dermatology, Northampton General Hospital, Northampton, UK
| | - M Arefi
- Department of Dermatology, Newcastle University, Newcastle, UK
| | - M Vreeburg
- Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - P M Steijlen
- Department of Dermatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - A Gostyński
- Department of Dermatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - M van Geel
- Department of Dermatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
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3
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Schoelinck J, Pissaloux D, Mouthon M, Vergara R, de la Fouchardière A. [Clinical, histological and genetic correlations in melanocytic tumours with chromosomal rearrangements]. Ann Pathol 2024:S0242-6498(24)00031-2. [PMID: 38320889 DOI: 10.1016/j.annpat.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/08/2024]
Abstract
In some tumoral subtypes chromosomal translocations lead to an oncogenic chimeric protein acting as a tumorigenesis driver event. The main fusion model combines the promoter swapping of an inactivated tumor suppressor gene and a functional kinase that evades its regulatory system. The range of described fusions keeps growing in the 2023 WHO classification of melanocytic tumours. It is not limited to the group of Spitz tumours as previously but now extends to blue tumours and dermal tumours with a melanocytic phenotype. Molecular pathology helps detect these anomalies using clinical and morphological features. This analysis is essential as this strongly conditions the adapted local treatment of such tumours who are often overtreated.
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Affiliation(s)
- Jeremy Schoelinck
- Service de biopathologie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, Lyon, France.
| | - Daniel Pissaloux
- Service de biopathologie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, Lyon, France
| | - Maxime Mouthon
- Service de biopathologie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, Lyon, France
| | - Rémi Vergara
- Service de biopathologie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, Lyon, France
| | - Arnaud de la Fouchardière
- Service de biopathologie, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, Lyon, France; Équipe labellisée Ligue contre le cancer, Inserm 1052, CNRS 5286, centre Léon-Bérard, Cancer Research Center of Lyon, université de Lyon, université Claude-Bernard Lyon 1, Lyon, France
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4
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Zhang J, Xu Q, Deng D. Genetic and phenotypic diversities of nevus spilus phenotypes: Case series and a proposed diagnostic algorithm. Clin Genet 2023; 104:593-597. [PMID: 37501405 DOI: 10.1111/cge.14402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023]
Abstract
Nevus spilus (NS) is composed of multiple types that characterized by a congenital hyperpigmented patch within variable even superimposed lesions originating from melanocytic lineage cells. The molecular mechanism and classification of diverse NS phenotypes remain unclear. Five children with a phenotype of NS were genotyped by the panel based on next-generation sequencing in this study. DNA from biopsies, blood samples and hair follicle were sequenced to confirm the presence of a somatic mutation. Sequencing results indicated somatic mutation in the gene of NRAS or HRAS in all biopsies from the nevi, and the pathogenic variants were not detected in the samples of blood and hair follicle. This study successfully identified the somatic mutation in five unrelated children with diverse NS phenotypes. Moreover, it provided typical images and differential diagnoses between variable NS phenotypes in clinical, pathological, and genetic features, and first proposed a clinical diagnostic algorithm that contributed to simplifying and optimizing the diagnoses and management of these overlapped diseases.
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Affiliation(s)
- Jia Zhang
- Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qianyue Xu
- Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dan Deng
- Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Dermatology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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5
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Fumero-Velázquez M, Hagstrom M, Dhillon S, Olivares S, Jennings LJ, Dittman D, Sukhanova M, Arva NC, Goldstein SD, Theos A, Pavlidakey P, Carr Z, Gerami P. Agminated presentation of fusion-driven melanocytic neoplasms. J Cutan Pathol 2023; 50:913-921. [PMID: 37407520 DOI: 10.1111/cup.14482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The conventionally understood pathogenesis of agminated Spitz nevi includes a mosaic HRAS mutation followed by copy number gains in 11p. However, we have recently observed agminated presentations of fusion-driven melanocytic neoplasms. METHODS We retrieved cases from our database of benign fusion-induced melanocytic neoplasms with an agminated presentation. Both the primary lesion and the secondary lesion were sequenced. TERT-promoter mutational testing and the melanoma fluorescence in situ hybridization assay were also performed. RESULTS Three cases were included. Two had a PRKCA fusion (partners ATP2B4 and MPZL1) and one had a ZCCHC8::ROS1 fusion. None of the cases met morphologic or molecular criteria for malignancy. There was no evidence of tumor progression in secondary lesions. The same fusion was identified in the primary and secondary lesions. None of the patients developed evidence of nodal or systemic metastasis. CONCLUSIONS We present accumulating evidence that fusion-driven melanocytic neoplasms can present with an agminated presentation. The differential diagnosis of an agminated presentation versus a locally recurrent or potentially locally metastatic tumor is critical, and accurate diagnosis has significant prognostic and therapeutic consequences for the patient. As with HRAS mutations, fusion-driven melanocytic tumors may have an agminated presentation.
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Affiliation(s)
- Mónica Fumero-Velázquez
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael Hagstrom
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Soneet Dhillon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lawrence J Jennings
- Division of Molecular Pathology, Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - David Dittman
- Division of Molecular Pathology, Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Madina Sukhanova
- Division of Molecular Pathology, Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nicoleta C Arva
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Seth D Goldstein
- Department of Surgery, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy Theos
- Department of Dermatology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter Pavlidakey
- Department of Dermatology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Zachary Carr
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Lipsker G, Lipsker D. Congenital spilo-melanocytic nevus: a speckled lentiginous naevus and a spilus-like congenital melanocytic nevus in close proximity. J Eur Acad Dermatol Venereol 2022; 36:e926-e927. [PMID: 35771121 DOI: 10.1111/jdv.18391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G Lipsker
- Faculté de Médecine, Université de Paris, Paris, France
| | - D Lipsker
- Faculté de Médecine, Université de Strasbourg, Strasbourg, France
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Davies OMT, Bruckner AL, McCalmont T, Mascarenhas L, Oza V, Williams ML, Wine-Lee L, Shern JF, Siegel DH. Cutaneous mosaic RASopathies associated with rhabdomyosarcoma. Pediatr Blood Cancer 2022; 69:e29639. [PMID: 35253347 DOI: 10.1002/pbc.29639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 12/28/2022]
Abstract
Variants in RAS are known drivers of certain pediatric blood and solid cancers, including brain tumors. Though most RAS-driven cancers are thought to occur sporadically, genetic syndromes caused by germline RAS variants portend a slightly higher risk of rhabdomyosarcoma (RMS) development. Three new cases and a review of the literature demonstrate that in rare cases, certain somatic RAS variants are associated with an increased risk of RMS and that RMS development may be heralded by the presence of concomitant RAS-driven birthmarks. Further prospective studies are needed to establish incidence and recommend appropriate monitoring guidelines for patients at risk.
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Affiliation(s)
- Olivia M T Davies
- Department of Dermatology, Medical College of Wisconsin (MCW), Milwaukee, Wisconsin, USA
| | - Anna L Bruckner
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Timothy McCalmont
- Department of Dermatology, Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Leo Mascarenhas
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, California, USA
| | - Vikash Oza
- Department of Dermatology, NYU School of Medicine, New York City, New York, USA
| | - Mary L Williams
- Department of Dermatology, Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Lara Wine-Lee
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jack F Shern
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Dawn H Siegel
- Department of Dermatology, Medical College of Wisconsin (MCW), Milwaukee, Wisconsin, USA
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8
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Abstract
Congenital pigmentary anomalies may be evident at birth or soon after, with some birthmarks becoming apparent later in infancy or early childhood. It is important to recognize various pigmentary anomalies in the neonate, most of which are benign but a subset of which are associated with cutaneous morbidity or systemic ramifications and require further evaluation. This review will focus on pigmentary mosaicism, congenital melanocytic nevi, nevus spilus, dermal melanocytosis, and pigmentary anomalies associated with neurofibromatosis type 1 (café au lait spots, freckling, plexiform neurofibromas, nevus anemicus), tuberous sclerosis (hypomelanotic macules), and incontinentia pigmenti.
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9
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Kervarrec T, Briand C, Pissaloux D, Tirode F, Abasq-Thomas C, Fraitag S, de la Fouchardière A. Agminated Spitz naevus with an activating HRAS Q61R mutation. Pathology 2021; 54:374-376. [PMID: 34412857 DOI: 10.1016/j.pathol.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/03/2021] [Accepted: 04/25/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Thibault Kervarrec
- Department of Pathology, Centre Hospitalier Universitaire de Tours, Tours, France; Department of Biopathology, Center Léon Bérard, Lyon, France.
| | - Clémence Briand
- Department of Dermatology, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Daniel Pissaloux
- Department of Pathology, Centre Hospitalier Universitaire de Tours, Tours, France; Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer, Lyon, France
| | - Franck Tirode
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer, Lyon, France
| | - Claire Abasq-Thomas
- Department of Dermatology, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Sylvie Fraitag
- Department of Pathology, Institut Imagine, APHP, Hôpital Universitaire Necker-Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Arnaud de la Fouchardière
- Department of Pathology, Centre Hospitalier Universitaire de Tours, Tours, France; Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer, Lyon, France
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10
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Lee AY. Skin Pigmentation Abnormalities and Their Possible Relationship with Skin Aging. Int J Mol Sci 2021; 22:ijms22073727. [PMID: 33918445 PMCID: PMC8038212 DOI: 10.3390/ijms22073727] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/24/2021] [Accepted: 04/01/2021] [Indexed: 12/13/2022] Open
Abstract
Skin disorders showing abnormal pigmentation are often difficult to manage because of their uncertain etiology or pathogenesis. Abnormal pigmentation is a common symptom accompanying aging skin. The association between skin aging and skin pigmentation abnormalities can be attributed to certain inherited disorders characterized by premature aging and abnormal pigmentation in the skin and some therapeutic modalities effective for both. Several molecular mechanisms, including oxidative stress, mitochondrial DNA mutations, DNA damage, telomere shortening, hormonal changes, and autophagy impairment, have been identified as involved in skin aging. Although each of these skin aging-related mechanisms are interconnected, this review examined the role of each mechanism in skin hyperpigmentation or hypopigmentation to propose the possible association between skin aging and pigmentation abnormalities.
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Affiliation(s)
- Ai-Young Lee
- Department of Dermatology, College of Medicine, Dongguk University Ilsan Hospital, 814 Siksa-dong, Ilsandong-gu, Goyang-si 410-773, Gyeonggi-do, Korea
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11
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Goto K, Pissaloux D, Kauer F, Huriet V, Tirode F, de la Fouchardière A. GOPC-ROS1 mosaicism in agminated Spitz naevi: report of two cases. Virchows Arch 2021; 479:559-564. [PMID: 33733342 DOI: 10.1007/s00428-020-02992-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
Spitz tumors are genetically associated with activating HRAS point mutations or fusions of either ALK, ROS1, NTRK1, NTRK3, RET, MET, MERTK, LCK, BRAF, MAP3K8, or MAP3K3. All these driver gene alterations are mutually exclusive. We report two cases of agminated Spitz naevi with a GOPC-ROS1 fusion. Both cases occurred on the lower limb of young adults. Since adolescence, pigmented or pink-colored papules have been periodically arising in a limited area of skin. In one case, an ill-defined hyperpigmented macule known since childhood was present in the background. Morphologically, at least five lesions were analyzed from each patient. In one case, all were predominantly junctional pigmented Spitz naevi, and in the other case, all were compound unpigmented Spitz naevi. No atypical features were present. RNA-sequencing revealed a GOPC-ROS1 gene translocation in both cases. Split signals of ROS1 gene in fluorescence in situ hybridization were observed not only in the nests of spitzoid melanocytes but also in the bland basal melanocytes surrounding the proliferations. These findings suggest the presence of a GOPC-ROS1 mosaicism in melanocytes with further emergence of agminated Spitz naevi potentially triggered by other genetic alterations. This expands the spectrum of genetic anomalies described in agminated Spitz naevi and our understanding of the mechanisms involved in their emergence.
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Affiliation(s)
- Keisuke Goto
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.,Department of Pathology, Itabashi Central Clinical Laboratory, Tokyo, Japan.,Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Nagaizumi, Japan.,Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan.,Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Daniel Pissaloux
- Department of Biopathology, Center Léon Bérard, 28, rue Laennec, 69008, Lyon, France.,Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer, Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Lyon, France
| | | | | | - Franck Tirode
- Department of Biopathology, Center Léon Bérard, 28, rue Laennec, 69008, Lyon, France.,Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer, Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Lyon, France
| | - Arnaud de la Fouchardière
- Department of Biopathology, Center Léon Bérard, 28, rue Laennec, 69008, Lyon, France. .,Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer, Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Lyon, France.
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12
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Chacon‐Camacho OF, Lopez‐Moreno D, Morales‐Sanchez MA, Hofmann E, Pacheco‐Quito M, Wieland I, Cortes‐Gonzalez V, Villanueva‐Mendoza C, Zenker M, Zenteno JC. Expansion of the phenotypic spectrum and description of molecular findings in a cohort of patients with oculocutaneous mosaic RASopathies. Mol Genet Genomic Med 2019; 7:e625. [PMID: 30891959 PMCID: PMC6503218 DOI: 10.1002/mgg3.625] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Postzygotic KRAS, HRAS, NRAS, and FGFR1 mutations result in a group of mosaic RASopathies characterized by related developmental anomalies in eye, skin, heart, and brain. These oculocutaneous disorders include oculoectodermal syndrome (OES) encephalo-cranio-cutaneous lipomatosis (ECCL), and Schimmelpenning-Feuerstein-Mims syndrome (SFMS). Here, we report the results of the clinical and molecular characterization of a novel cohort of patients with oculocutaneous mosaic RASopathies. METHODS Two OES, two ECCL, and two SFMS patients were ascertained in the study. In addition, two subjects with unilateral isolated epibulbar dermoids were also enrolled. Molecular analysis included PCR amplification and Sanger sequencing of KRAS, HRAS, NRAS, and FGFR1 genes in DNA obtained from biopsies (skin/epibulbar dermoids), buccal mucosa, and blood leukocytes. Massive parallel sequencing was employed in two cases with low-level mosaicism. RESULTS In DNA from biopsies, mosaicism for pathogenic variants, including KRAS p.Ala146Thr in two OES subjects, FGFR1 p.Asn546Lys and KRAS p.Ala146Val in ECCL patients, and KRAS p.Gly12Asp in both SFMS patients, was demonstrated. No mutations were shown in DNA from conjunctival lesions in two subjects with isolated epibubar dermoids. CONCLUSION Our study allowed the expansion of the clinical spectrum of mosaic RASopathies and supports that mosaicism for recurrent mutations in KRAS and FGFR1 is a commonly involved mechanism in these rare oculocutaneous anomalies.
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Affiliation(s)
| | - Daniel Lopez‐Moreno
- Department of GeneticsInstitute of Ophthalmology “Conde de Valenciana”Mexico CityMexico
| | | | - Enriqueta Hofmann
- Department of GlaucomaInstitute of Ophthalmology “Conde de Valenciana”Mexico CityMexico
| | | | - Ilse Wieland
- Institute of Human Genetics, University HospitalMagdeburgGermany
| | - Vianney Cortes‐Gonzalez
- Department of GeneticsHospital "Dr. Luis Sanchez Bulnes", Asociación para Evitar la Ceguera en MéxicoMexico CityMexico
| | - Cristina Villanueva‐Mendoza
- Department of GeneticsHospital "Dr. Luis Sanchez Bulnes", Asociación para Evitar la Ceguera en MéxicoMexico CityMexico
| | - Martin Zenker
- Institute of Human Genetics, University HospitalMagdeburgGermany
| | - Juan Carlos Zenteno
- Department of GeneticsInstitute of Ophthalmology “Conde de Valenciana”Mexico CityMexico
- Department of Biochemistry, Faculty of MedicineUNAMMexico CityMexico
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13
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Miraglia E, Fino P, Calvieri S, Giustini S. Nevus spilus in neurofibromatosis type 1: a single center experience. GIORN ITAL DERMAT V 2018; 155:691-692. [PMID: 30295445 DOI: 10.23736/s0392-0488.18.06088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Emanuele Miraglia
- Department of Dermatology and Venereology, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy -
| | - Pasquale Fino
- Unit of Plastic Surgery, P. Valdoni Department of Surgery, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Stefano Calvieri
- Department of Dermatology and Venereology, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Sandra Giustini
- Department of Dermatology and Venereology, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
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14
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Abstract
Genetic mosaicism arises when a zygote harbors two or more distinct genotypes, typically due to de novo, somatic mutation during embryogenesis. The clinical manifestations largely depend on the differentiation status of the mutated cell; earlier mutations target pluripotent cells and generate more widespread disease affecting multiple organ systems. If gonadal tissue is spared-as in somatic genomic mosaicism-the mutation and its effects are limited to the proband, whereas mosaicism also affecting the gametes, such as germline or gonosomal mosaicism, is transmissible. Mosaicism is easily appreciated in cutaneous disorders, as phenotypically distinct mutant cells often give rise to lesions in patterns determined by the affected cell type. Genetic investigation of cutaneous mosaic disorders has identified pathways central to disease pathogenesis, revealing novel therapeutic targets. In this review, we discuss examples of cutaneous mosaicism, approaches to gene discovery in these disorders, and insights into molecular pathobiology that have potential for clinical translation.
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Affiliation(s)
- Young H Lim
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 06520, USA; .,Departments of Pathology and Genetics, Yale University School of Medicine, New Haven, Connecticut 06520, USA
| | - Zoe Moscato
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 06520, USA;
| | - Keith A Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 06520, USA; .,Departments of Pathology and Genetics, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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15
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Porubsky C, Teer JK, Zhang Y, Deschaine M, Sondak VK, Messina JL. Genomic analysis of a case of agminated Spitz nevi and congenital-pattern nevi arising in extensive nevus spilus. J Cutan Pathol 2017; 45:180-183. [PMID: 29210482 DOI: 10.1111/cup.13082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/02/2017] [Accepted: 11/17/2017] [Indexed: 12/30/2022]
Abstract
Nevus spilus is a melanocytic neoplasm characterized by a tan macular background punctuated by multiple hyperpigmented macules or papules that represent various types of nevi. These include junctional and compound nevi, Spitz nevi, and rarely blue nevi. We report a unique case of widespread, multiple nevi spili giving rise to agminated Spitz nevi and congenital-pattern compound nevi. We performed genetic analysis to further characterize the mutational profile of this rare entity.
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Affiliation(s)
- Caitlin Porubsky
- Department of Dermatology, PCOM Mednet/North Fulton Hospital Medical Campus, Roswell, Georgia
| | - Jamie K Teer
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida.,Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida
| | - Yonghong Zhang
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Maria Deschaine
- Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Jane L Messina
- Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
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16
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Om A, Cathey SS, Gathings RM, Hudspeth M, Lee JA, Marzolf S, Wine Lee L. Phacomatosis Pigmentokeratotica: A Mosaic RASopathy with Malignant Potential. Pediatr Dermatol 2017; 34:352-355. [PMID: 28523882 DOI: 10.1111/pde.13119] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Phacomatosis pigmentokeratotica (PPK) is a rare epidermal nevus syndrome characterized by the co-occurrence of a nevus sebaceous arranged along the lines of Blaschko with a speckled lentiginous nevus (SLN). We report a novel KRAS mutation in a patient with a large nevus sebaceous and an SLN who subsequently developed a vaginal botryoid rhabdomyosarcoma, an association not previously reported in the literature. This case expands our knowledge of the genetic basis for phacomatosis, in which mutations in HRAS have been previously described, although this report provides evidence that activating mutations in KRAS or HRAS may cause PPK. This report confirms that PPK is a mosaic RASopathy with malignant potential and raises the question of whether screening for other RAS-associated malignancies should be performed for all children with PPK.
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Affiliation(s)
- Amit Om
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Sara S Cathey
- Greenwood Genetic Center, North Charleston, South Carolina
| | - Robert M Gathings
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Michelle Hudspeth
- Hematology-Oncology Division, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer A Lee
- Greenwood Genetic Center, North Charleston, South Carolina
| | - Sean Marzolf
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Lara Wine Lee
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
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17
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Risk of melanocytic nevi and nonmelanoma skin cancer in children after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2017; 52:989-997. [DOI: 10.1038/bmt.2017.57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/14/2017] [Accepted: 02/09/2017] [Indexed: 01/20/2023]
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18
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Abstract
PURPOSE OF REVIEW The article intends to review recent updates in the management of congenital melanocytic nevi (CMN) and the evolving genomic landscape that has begun to shed light on the nature of nevogenesis, malignant potential, and possible therapeutic targets for those with melanoma and neurologic involvement. RECENT FINDINGS CMN are the result of postzygotic somatic mutations involving key proteins in the mitogen-activated protein kinase pathway, primarily NRAS and BRAF. Complications include a spectrum of neurologic findings and development of melanoma. Patients with extracutaneous involvement may be better termed as having 'CMN syndrome'. MRI findings in high risk patients with multiple CMN may best predict clinical outcome. SUMMARY The management of patients with CMN is complex. Neurologic involvement and melanoma remain the two most devastating complications. New, genetically targeted therapies for patients with complications may be of value, and research for potential therapies is ongoing.
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19
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Boppudi S, Bögershausen N, Hove H, Percin E, Aslan D, Dvorsky R, Kayhan G, Li Y, Cursiefen C, Tantcheva-Poor I, Toft P, Bartsch O, Lissewski C, Wieland I, Jakubiczka S, Wollnik B, Ahmadian M, Heindl L, Zenker M. Specific mosaicKRASmutations affecting codon 146 cause oculoectodermal syndrome and encephalocraniocutaneous lipomatosis. Clin Genet 2016; 90:334-42. [DOI: 10.1111/cge.12775] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/29/2016] [Accepted: 03/06/2016] [Indexed: 01/08/2023]
Affiliation(s)
- S. Boppudi
- Institute of Human Genetics; University Hospital Magdeburg, Otto-von-Guericke University; Magdeburg Germany
| | - N. Bögershausen
- Institute of Human Genetics; University Medical Center Goettingen, Georg-August University; Goettingen Germany
- Institute of Human Genetics; University of Cologne; Cologne Germany
| | - H.B. Hove
- Department of Clinical Genetics; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - E.F. Percin
- Department of Medical Genetics, Faculty of Medicine; Gazi University; Ankara Turkey
| | - D. Aslan
- Section of Hematology, Department of Pediatrics, Faculty of Medicine; Gazi University; Ankara Turkey
| | - R. Dvorsky
- Institute of Biochemistry and Molecular Biology II, Medical Faculty; Heinrich-Heine-University; Düsseldorf Germany
| | - G. Kayhan
- Department of Medical Genetics, Faculty of Medicine; Gazi University; Ankara Turkey
| | - Y. Li
- Institute of Human Genetics; University Medical Center Goettingen, Georg-August University; Goettingen Germany
- Institute of Human Genetics; University of Cologne; Cologne Germany
| | - C. Cursiefen
- Department of Ophthalmology; University of Cologne; Cologne Germany
| | | | - P.B. Toft
- Department of Ophthalmology; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - O. Bartsch
- Institute of Human Genetics; University Medical Centre of the Johannes Gutenberg University Mainz; Mainz Germany
| | - C. Lissewski
- Institute of Human Genetics; University Hospital Magdeburg, Otto-von-Guericke University; Magdeburg Germany
| | - I. Wieland
- Institute of Human Genetics; University Hospital Magdeburg, Otto-von-Guericke University; Magdeburg Germany
| | - S. Jakubiczka
- Institute of Human Genetics; University Hospital Magdeburg, Otto-von-Guericke University; Magdeburg Germany
| | - B. Wollnik
- Institute of Human Genetics; University Medical Center Goettingen, Georg-August University; Goettingen Germany
- Institute of Human Genetics; University of Cologne; Cologne Germany
| | - M.R. Ahmadian
- Institute of Biochemistry and Molecular Biology II, Medical Faculty; Heinrich-Heine-University; Düsseldorf Germany
| | - L.M. Heindl
- Department of Ophthalmology; University of Cologne; Cologne Germany
| | - M. Zenker
- Institute of Human Genetics; University Hospital Magdeburg, Otto-von-Guericke University; Magdeburg Germany
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20
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Krengel S, Widmer D, Kerl K, Levesque M, Schiestl C, Weibel L. Naevus spilus-type congenital melanocytic naevus associated with a novelNRAScodon 61 mutation. Br J Dermatol 2015; 174:642-4. [DOI: 10.1111/bjd.14105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S. Krengel
- Department of Dermatology; University Hospital Schleswig-Holstein; Campus Lübeck, Ratzeburger Allee 160 D-23538 Lübeck Germany
| | - D.S. Widmer
- Department of Dermatology; University Hospital Zürich; University of Zürich; Zürich Switzerland
| | - K. Kerl
- Department of Dermatology; University Hospital Zürich; University of Zürich; Zürich Switzerland
| | - M.P. Levesque
- Department of Dermatology; University Hospital Zürich; University of Zürich; Zürich Switzerland
| | - C. Schiestl
- Department of Plastic and Reconstructive Surgery; University Children's Hospital Zürich; Zürich Switzerland
| | - L. Weibel
- Department of Dermatology; University Hospital Zürich; University of Zürich; Zürich Switzerland
- Department of Pediatric Dermatology; University Children's Hospital Zürich; Zürich Switzerland
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21
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Naevus spilus. Hautarzt 2015; 66:390-1. [DOI: 10.1007/s00105-015-3624-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Lee S, Hummel H, Krengel S, Enk A, Haenssle H. Mosaic
RAS
opathies: phenotypic and genotypic differentiation of naevus spilus‐type congenital melanocytic naevus and segmental naevus spilus. J Eur Acad Dermatol Venereol 2015; 30:1244-6. [DOI: 10.1111/jdv.13173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S.B. Lee
- Department of Dermatology, Venerology, and Allergology University Medical Center Ruprecht‐Karls‐University Heidelberg Germany
| | - H.‐M. Hummel
- Department of Pediatrics and Neuropediatrics University Medical Center Georg‐August‐University Göttingen Germany
| | - S. Krengel
- Department of Dermatology University Hospital of Lübeck Lübeck Germany
| | - A. Enk
- Department of Dermatology, Venerology, and Allergology University Medical Center Ruprecht‐Karls‐University Heidelberg Germany
| | - H.A. Haenssle
- Department of Dermatology, Venerology, and Allergology University Medical Center Ruprecht‐Karls‐University Heidelberg Germany
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23
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Luo S, Tsao H. Epidermal, sebaceous, and melanocytic nevoid proliferations are spectrums of mosaic RASopathies. J Invest Dermatol 2015; 134:2493-2496. [PMID: 25219651 DOI: 10.1038/jid.2014.244] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Growing evidence demonstrates that various nevoid proliferations such as keratinocytic epidermal nevi and nevus sebaceous result from somatic mosaicism. Many of the mutations identified have been within the RAF/RAS/MAPK pathway, hence supporting the previously introduced term "mosaic RASopathy" for these nevi. In this issue, Kinsler et al. were among the first to characterize certain pigmented melanocytic nevi that may also fit this paradigm. To better frame these findings, we provide a summary of the analogous genotypic profiles for epidermal and melanocytic nevi from recent studies.
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Affiliation(s)
- Su Luo
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hensin Tsao
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Wellman Center for Photomedicine and MGH Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
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24
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Abstract
A new or changing melanocytic nevus in a child or adolescent often leads to concern in parents and physicians. To avoid undue alarm and unnecessary procedures, dermatologists should be aware of the natural history and clinical spectrum of nevi in pediatric patients, as well as findings that are potentially worrisome in this age group. This review provides an update on melanocytic nevi in children, focusing on their dynamic evolution over time, molecular insights into nevogenesis, and phenotypic markers for increased risk of melanoma in adolescence and adulthood. Special considerations for Spitz nevi and nevi located in particular sites (eg, scalp, acral, genital) are highlighted. Current understanding of the risks associated with congenital melanocytic nevi of different sizes and strategies for the management of children with numerous acquired nevi, Spitz nevi, and congenital nevi are also discussed.
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25
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Shen AS, Peterhof E, Kind P, Rütten A, Zelger B, Landthaler M, Berneburg M, Hafner C, Groesser L. Activating mutations in the RAS/mitogen-activated protein kinase signaling pathway in sporadic trichoblastoma and syringocystadenoma papilliferum. Hum Pathol 2014; 46:272-6. [PMID: 25532942 DOI: 10.1016/j.humpath.2014.11.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 10/24/2014] [Accepted: 11/01/2014] [Indexed: 10/24/2022]
Abstract
Trichoblastoma (TB) and syringocystadenoma papilliferum (SCAP) are both rare adnexal skin lesions occurring either sporadically or as secondary neoplasms in sebaceous nevi. TB and SCAP associated with sebaceous nevi have been shown to carry the same HRAS mutation as the underlying nevus. However, the genetic background of sporadic TB and SCAP has remained unknown. Therefore, we screened 18 sporadic TBs and 23 sporadic syringocystadenoma papillifera from 41 patients for the presence of activating mutations in RAS genes and other oncogenes. Using a RAS SNaPshot assay, HRAS mutations were detected in 2 (11%) of 18 sporadic TB and 6 (26%) of 23 sporadic syringocystadenoma papillifera. A KRAS mutation was identified in 1 sporadic SCAP. High-throughput oncogene mutation profiling furthermore identified BRAF V600E mutations in sporadic syringocystadenoma papillifera, which could be validated in 12 (52%) of 23 lesions using a BRAF SNaPshot assay. BRAF and RAS mutations were mutually exclusive in sporadic syringocystadenoma papillifera. No BRAF mutation could be detected in 3 syringocystadenoma papillifera secondarily arisen from a sebaceous nevus as well as in sporadic TB. In 14 lesions carrying an oncogenic mutation, nonlesional control tissue from the epidermal margin revealed a wild-type sequence, thus proving the somatic character of the mutation. Our results indicate that activation of the RAS-mitogen-activated protein kinase pathway by BRAF and RAS mutations contributes significantly to the tumorigenesis of sporadic SCAP and, less frequently, of sporadic TB.
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Affiliation(s)
- Anne-Sophie Shen
- Department of Dermatology, University of Regensburg, 93053 Regensburg, Germany
| | - Eva Peterhof
- Department of Dermatology, University of Regensburg, 93053 Regensburg, Germany
| | - Peter Kind
- Dermatohistological Laboratory Prof. Kind, 63065 Offenbach, Germany
| | - Arno Rütten
- Dermatopathology Friedrichshafen, 88048 Friedrichshafen, Germany
| | - Bernhard Zelger
- Department of Dermatology and Venerology, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Michael Landthaler
- Department of Dermatology, University of Regensburg, 93053 Regensburg, Germany
| | - Mark Berneburg
- Department of Dermatology, University of Regensburg, 93053 Regensburg, Germany
| | - Christian Hafner
- Department of Dermatology, University of Regensburg, 93053 Regensburg, Germany; Dermatohistological Laboratory, Sonnenstr. 7, 80331 Munich, Germany
| | - Leopold Groesser
- Department of Dermatology, University of Regensburg, 93053 Regensburg, Germany.
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26
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Next-generation sequencing of nevus spilus-type congenital melanocytic nevus: exquisite genotype-phenotype correlation in mosaic RASopathies. J Invest Dermatol 2014; 134:2658-2660. [PMID: 24751729 PMCID: PMC4165863 DOI: 10.1038/jid.2014.195] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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