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Frank A, Bernstedt SW, Jamizadeh N, Forsberg A, Hedin C, Blom J, Backman AS. Complications of colonoscopy surveillance of patients with Lynch syndrome - 33 years of follow up. Fam Cancer 2024:10.1007/s10689-024-00416-w. [PMID: 39102097 DOI: 10.1007/s10689-024-00416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
BACKGROUND AND STUDY AIMS Lynch syndrome (LS) is a hereditary autosomal dominant condition, with an increased lifetime risk of developing malignancies including colorectal cancer (CRC). Current guidelines differ in recommended colonoscopy-surveillance intervals from 1 to 2 years. Although colonoscopy is considered a safe procedure, there are risks of severe adverse events (SAEs), such as perforation and bleeding, as well as adverse events (AEs), such as abdominal discomfort and post-colonoscopy gastrointestinal infections. Colonoscopy-related bleeding and perforation rates have been reported 0.17% and 0.11%, respectively. However, there are insufficient data regarding complications of colonoscopy-surveillance for LS patients. This study aims to investigate the risk of AEs among LS patients during colonoscopy in the Stockholm region. PATIENTS AND METHODS This retrospective cohort study includes 351 LS patients undergoing endoscopic surveillance at the Karolinska University Hospital, August 1989 - April 2021. Data from endoscopic surveillance colonoscopies were extracted from patients' medical records. RESULTS Of 1873 endoscopies in 351 LS patients, 12 complications (AEs) were documented within 30 days (0.64%) and with a total of 3 bleedings (SAEs, 0.16%). No perforations were identified. CONCLUSION Colonoscopy surveillance for LS patients shows a comparatively low risk of AEs per-examination. Colonoscopy complications per-patient, including both SAEs and AEs, show a significantly higher risk. Colonoscopy complications only including SAEs, show a comparatively low risk. Understanding the lifetime risk of surveillance-related colonoscopy complications is important when designing targeted surveillance programmes.
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Affiliation(s)
- Alexander Frank
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
- Gastroenterology unit, Dept. of Medicine, Capio S:t Görans Hospital, Stockholm, Sweden.
| | - Sophie Walton Bernstedt
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Gastroenterology unit, Dept. of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Div. of Upper Gastrointestinal diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Nigin Jamizadeh
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Anna Forsberg
- Gastroenterology unit, Dept. of Medicine, Capio S:t Görans Hospital, Stockholm, Sweden
- Dept. of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Hedin
- Gastroenterology unit, Dept. of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Dept. of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Johannes Blom
- Dept. of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Dept. of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Ann-Sofie Backman
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Gastroenterology unit, Dept. of Medicine, Ersta Hospital, Stockholm, Sweden
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Miyakura Y, Chino A, Tanakaya K, Lefor AK, Akagi K, Takao A, Yamada M, Ishida H, Komori K, Sasaki K, Miguchi M, Hirata K, Sudo T, Ishikawa T, Yamaguchi T, Tomita N, Ajioka Y. Current practice of colonoscopy surveillance in patients with lynch syndrome: A multicenter retrospective cohort study in Japan. DEN OPEN 2022; 3:e179. [PMID: 36330234 PMCID: PMC9624071 DOI: 10.1002/deo2.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/21/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
Objectives Colonoscopy surveillance reduces the incidence of colorectal cancer through the detection and endoscopic removal of adenomas. Current guidelines recommend that patients with Lynch syndrome should have colonoscopy surveillance every 1–2 years starting at the age of 20–25. However, insufficient data are available to evaluate the quality and safety of colonoscopy surveillance for patients with Lynch syndrome nationwide in Japan. Methods Patients with Lynch syndrome (n = 309) from 13 institutions who underwent one or more colonoscopy procedures were enrolled in this retrospective analysis. Colonoscopy completion rate, colonoscopy‐related complication rate, proportion with an adequate colonoscopy interval, and adenoma detection rate were reviewed. Results The colonoscopy completion rate was 98.8% and a history of previous colorectal cancer surgery was significantly associated with a higher completion rate. All complications were associated with endoscopic treatment and the rate of bleeding needing hemostasis and perforation needing surgical repair were both 0.16% after colonoscopy with polypectomy. The adenoma detection rate at the first colonoscopy was 25%. Although there was no difference in the completion and complication rates based on differences in the colonoscopy experience of the endoscopist, the detection rate of adenomas and intramucosal cancers was significantly higher with more experienced endoscopists. The proportion of patients developing cancer was significantly higher with a >24 months than a ≤24 months interval. Conclusion High‐volume experienced endoscopists and appropriate surveillance intervals may minimize the risk of developing colorectal cancers in patients with Lynch syndrome.
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Affiliation(s)
- Yasuyuki Miyakura
- Department of SurgerySaitama Medical Center Jichi Medical UniversitySaitamaJapan,Department of SurgeryJichi Medical UniversityTochigiJapan,The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan
| | - Akiko Chino
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Gastroenterology, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Kohji Tanakaya
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of SurgeryIwakuni Clinical CenterYamaguchiJapan
| | | | - Kiwamu Akagi
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Molecular Diagnosis and Cancer PreventionSaitama Cancer CenterSaitamaJapan
| | - Akinari Takao
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of GastroenterologyTokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Masayoshi Yamada
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Hideyuki Ishida
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Digestive Tract and General SurgerySaitama Medical Center, Saitama Medical UniversitySaitamaJapan
| | - Koji Komori
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Gastroenterological SurgeryAichi Cancer Center HospitalAichiJapan
| | - Kazuhito Sasaki
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Surgical Oncology, Faculty of MedicineThe University of TokyoTokyoJapan
| | - Masashi Miguchi
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of SurgeryHiroshima Prefectural HospitalHiroshimaJapan
| | - Keiji Hirata
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Surgery I, School of MedicineUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Tomoya Sudo
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of SurgeryKurume UniversityFukuokaJapan
| | - Toshiaki Ishikawa
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Medical Oncology, Faculty of MedicineJuntendo UniversityTokyoJapan
| | - Tatsuro Yamaguchi
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Department of Clinical Genetics, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Naohiro Tomita
- The Committee of Hereditary Colorectal Cancer, Japanese Society for Cancer of the Colon and RectumTokyoJapan,Cancer Treatment CenterToyonaka Municipal HospitalOsakaJapan
| | - Yoichi Ajioka
- Japanese Society for Cancer of Colon and RectumTokyoJapan,Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
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Lipton JM, Molmenti CLS, Desai P, Lipton A, Ellis SR, Vlachos A. Early Onset Colorectal Cancer: An Emerging Cancer Risk in Patients with Diamond Blackfan Anemia. Genes (Basel) 2021; 13:56. [PMID: 35052397 PMCID: PMC8774389 DOI: 10.3390/genes13010056] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022] Open
Abstract
Diamond Blackfan anemia (DBA) is a rare inherited bone marrow failure syndrome, the founding member of a class of disorders known as ribosomopathies. Most cases result from loss of function mutations or deletions in 1 of 23 genes encoding either a small or large subunit-associated ribosomal protein (RP), resulting in RP haploinsufficiency. DBA is characterized by red cell hypoplasia or aplasia, poor linear growth and congenital anomalies. Small case series and case reports demonstrate DBA to be a cancer predisposition syndrome. Recent analyses from the Diamond Blackfan Anemia Registry of North America (DBAR) have quantified the cancer risk in DBA. These studies reveal the most prevalent solid tumor, presenting in young adults and in children and adolescents, to be colorectal cancer (CRC) and osteogenic sarcoma, respectively. Of concern is that these cancers are typically detected at an advanced stage in patients who, because of their constitutional bone marrow failure, may not tolerate full-dose chemotherapy. Thus, the inability to provide optimal therapy contributes to poor outcomes. CRC screening in individuals over the age of 50 years, and now 45 years, has led to early detection and significant improvements in outcomes for non-DBA patients with CRC. These screening and surveillance strategies have been adapted to detect familial early onset CRC. With the recognition of DBA as a moderately penetrant cancer risk syndrome a rational screening and surveillance strategy will be implemented. The downstream molecular events, resulting from RP haploinsufficiency and leading to cancer, are the subject of significant scientific inquiry.
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Affiliation(s)
- Jeffrey M. Lipton
- Division of Hematology/Oncology and Cellular Therapy, Cohen Children’s Medical Center, New Hyde Park, NY 11040, USA; (P.D.); (A.V.)
- Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA; (C.L.S.M.); (A.L.)
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Christine L. S. Molmenti
- Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA; (C.L.S.M.); (A.L.)
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Division of Epidemiology, Department of Occupational Medicine, Epidemiology and Prevention, Great Neck, NY 11021, USA
| | - Pooja Desai
- Division of Hematology/Oncology and Cellular Therapy, Cohen Children’s Medical Center, New Hyde Park, NY 11040, USA; (P.D.); (A.V.)
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Alexander Lipton
- Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA; (C.L.S.M.); (A.L.)
| | - Steven R. Ellis
- Department of Biochemistry and Molecular Biology, University of Louisville, Louisville, KY 40202, USA;
| | - Adrianna Vlachos
- Division of Hematology/Oncology and Cellular Therapy, Cohen Children’s Medical Center, New Hyde Park, NY 11040, USA; (P.D.); (A.V.)
- Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA; (C.L.S.M.); (A.L.)
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
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Duarte M, Milikowski C. Gastrointestinal polyposis with associated cutaneous manifestations. Pathology 2021; 54:157-166. [PMID: 34763900 DOI: 10.1016/j.pathol.2021.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023]
Abstract
Cutaneous findings are commonly associated with underlying gastrointestinal disorders and, in many instances, may be the first manifestation. Many such syndromes have incomplete penetrance and variable expressivity, making them difficult to recognise. Skin manifestations may be an easily recognised feature of the underlying disorder. Most of these syndromes are hereditary but not all are associated with malignancies; either benign or premalignant extraintestinal lesions can be the initial manifestation. Some involve a single organ system, while others involve multiple organs of the gastrointestinal tract. In this review, we have focused on Lynch syndrome (hereditary nonpolyposis colon cancer and Muir-Torre syndrome), familial adenomatous polyposis, the hamartomatous polyposis syndromes that include Peutz-Jeghers syndrome and the PTEN hamartoma syndromes, which include Cowden syndrome and Bannayan-Riley-Ruvalcaba syndrome and, lastly, Cronkhite-Canada syndrome, which is not heritable. Some of these are associated with colorectal cancer, of which 15% are heritable. The majority are inherited in an autosomal dominant fashion. These syndromes are uncommon. However, because of the strong association with the cutaneous findings, early detection and screening may be possible and are key to decreasing the morbidity and mortality associated with them, for both the patient and family members. The clinical findings, epidemiological findings, underlying genetic alterations and pathological findings are reviewed.
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Affiliation(s)
- Melissa Duarte
- Department of Pathology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
| | - Clara Milikowski
- Department of Pathology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA.
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5
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Menahem B, Alves A, Regimbeau J, Sabbagh C. Lynch Syndrome: Current management In 2019. J Visc Surg 2019; 156:507-514. [DOI: 10.1016/j.jviscsurg.2019.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Hitchins MP, Vogelaar IP, Brennan K, Haraldsdottir S, Zhou N, Martin B, Alvarez R, Yuan X, Kim S, Guindi M, Hendifar AE, Kalady MF, DeVecchio J, Church JM, de la Chapelle A, Hampel H, Pearlman R, Christensen M, Snyder C, Lanspa SJ, Haile RW, Lynch HT. Methylated SEPTIN9 plasma test for colorectal cancer detection may be applicable to Lynch syndrome. BMJ Open Gastroenterol 2019; 6:e000299. [PMID: 31275589 PMCID: PMC6577308 DOI: 10.1136/bmjgast-2019-000299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/09/2019] [Accepted: 04/25/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The plasma-based methylated SEPTIN9 (mSEPT9) is a colorectal cancer (CRC) screening test for adults aged 50-75 years who are at average risk for CRC and have refused colonoscopy or faecal-based screening tests. The applicability of mSEPT9 for high-risk persons with Lynch syndrome (LS), the most common hereditary CRC condition, has not been assessed. This study sought preliminary evidence for the utility of mSEPT9 for CRC detection in LS. DESIGN Firstly, SEPT9 methylation was measured in LS-associated CRC, advanced adenoma, and subject-matched normal colorectal mucosa tissues by pyrosequencing. Secondly, to detect mSEPT9 as circulating tumor DNA, the plasma-based mSEPT9 test was retrospectively evaluated in LS subjects using the Epi proColon 2.0 CE assay adapted for 1mL plasma using the "1/1 algorithm". LS case groups included 20 peri-surgical cases with acolonoscopy-based diagnosis of CRC (stages I-IV), 13 post-surgical metastatic CRC, and 17 pre-diagnosis cases. The control group comprised 31 cancer-free LS subjects. RESULTS Differential hypermethylation was found in 97.3% (36/37) of primary CRC and 90.0% (18/20) of advanced adenomas, showing LS-associated neoplasia frequently produce the mSEPT9 biomarker. Sensitivity of plasma mSEPT9 to detect CRC was 70.0% (95% CI, 48%-88%)in cases with a colonoscopy-based CRC diagnosis and 92.3% (95% CI, 64%-100%) inpost-surgical metastatic cases. In pre-diagnosis cases, plasma mSEPT9 was detected within two months prior to colonoscopy-based CRC diagnosis in 3/5 cases. Specificity in controls was 100% (95% CI 89%-100%). CONCLUSION These preliminary findings suggest mSEPT9 may demonstrate similar diagnostic performance characteristics in LS as in the average-risk population, warranting a well-powered prospective case-control study.
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Affiliation(s)
- Megan P Hitchins
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Kevin Brennan
- Medicine, Stanford University, Stanford, California, USA
| | | | - Nianmin Zhou
- Medicine, Stanford University, Stanford, California, USA
| | - Brock Martin
- Medicine, Stanford University, Stanford, California, USA
| | - Rocio Alvarez
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Xiaopu Yuan
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sungjin Kim
- Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Maha Guindi
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew E Hendifar
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Comprehensive Cancer Center, Los Angeles, California, USA
| | - Matthew F Kalady
- Departments of Stem Cell and Regenerative Medicine and Colorectal Surgery, Sanford R Weiss MD Center for Hereditary Colorectal Neoplasia, Digestive Disease and Surgery Institute, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Jennifer DeVecchio
- Department of Stem Cell and Regenerative Medicine, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - James M Church
- Departments of Stem Cell and Regenerative Medicine and Colorectal Surgery, Sanford R Weiss MD Center for Hereditary Colorectal Neoplasia, Digestive Disease and Surgery Institute, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Albert de la Chapelle
- Department of Internal Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
| | - Heather Hampel
- Department of Internal Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
| | - Rachel Pearlman
- Department of Internal Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
| | - Maria Christensen
- Hereditary Cancer Center, Creighton University, Omaha, Nebraska, USA
| | - Carrie Snyder
- Hereditary Cancer Center, Creighton University, Omaha, Nebraska, USA
| | - Stephen J Lanspa
- Hereditary Cancer Center, Creighton University, Omaha, Nebraska, USA
| | - Robert W Haile
- Department of Medicine, Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Henry T Lynch
- Hereditary Cancer Center, Creighton University, Omaha, Nebraska, USA
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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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Campos S, Amaro P, Cunha I, Fraga J, Cipriano MA, Tomé L. Uncertainties in the Management of a Lynch Syndrome Patient: A Case Report. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2017; 24:241-246. [PMID: 29255760 DOI: 10.1159/000461590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/24/2017] [Indexed: 12/22/2022]
Abstract
Introduction Lynch syndrome (LS), the most common hereditary colorectal cancer syndrome, is characterized by mutations in mismatch repair (MMR) genes leading to an increased cancer risk, namely colorectal cancer. Case In the context of surveillance colonoscopy, a 40-mm flat lesion (0-IIa+b, Paris classification) was identified and submitted to piecemeal mucosal endoscopic resection in a 64-year-old LS patient with an MLH1 germline mutation (262delATC) and two previous segmental resections due to metachronous colorectal cancer. Pathology raised the suspicion of superficial submucosal invasive carcinoma with poor differentiation. Immunochemistry showed heterogeneous MLH1 expression and PMS2 loss. In a short-term follow-up colonoscopy, another 30-mm advanced carcinoma was identified. The patient was referred to surgery. Conclusion This case raises several issues: (1) the potentially fast tumorigenesis and progression to carcinoma in LS and implications for endoscopic screening and surveillance; (2) pitfalls in the interpretation of MMR proteins immunochemistry; (3) the role of endoscopic resection in LS.
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Affiliation(s)
- Sara Campos
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Pedro Amaro
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Inês Cunha
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Fraga
- Pathology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Luís Tomé
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Razvi MA, Giardiello FM, Law JK. DNA Mismatch Repair and Lynch Syndrome. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0366-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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10
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Homozygous germ-line mutation of the PMS2 mismatch repair gene: a unique case report of constitutional mismatch repair deficiency (CMMRD). BMC MEDICAL GENETICS 2017; 18:40. [PMID: 28381238 PMCID: PMC5381022 DOI: 10.1186/s12881-017-0391-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/06/2017] [Indexed: 12/11/2022]
Abstract
Background Constitutional mismatch repair deficiency syndrome results from bi-allelic inheritance of mutations affecting the key DNA mismatch repair genes: MLH1, MSH2, MSH6 or PMS2. Individuals with bi-allelic mutations have a dysfunctional mismatch repair system from birth; as a result, constitutional mismatch repair deficiency syndrome is characterised by early onset malignancies. Fewer than 150 cases have been reported in the literature over the past 20 years. This is the first report of the founder PMS2 mutation - NM_000535.5:c.1500del (p.Val501TrpfsTer94) in exon 11 and its associated cancers in this family. Case presentation The proband is 30 years old and is alive today. She is of Pakistani ethnic origin and a product of consanguinity. She initially presented aged 24 with painless bleeding per-rectum from colorectal polyps and was referred to clinical genetics. Clinical examination revealed two café-au-lait lesions, lichen planus, and a dermoid cyst. Her sister had been diagnosed in childhood with an aggressive brain tumour followed by colorectal cancer. During follow up, the proband developed 37 colorectal adenomatous polyps, synchronous ovarian and endometrial adenocarcinomas, and ultimately a metachronous gastric adenocarcinoma. DNA sequencing of peripheral lymphocytes revealed a bi-allelic inheritance of the PMS2 mutation NM_000535.5:c.1500del (p.Val501TrpfsTer94) in exon 11. Ovarian tumour tissue demonstrated low microsatellite instability. To date, she has had a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and a total gastrectomy. Aspirin and oestrogen-only hormone replacement therapy provide some chemoprophylaxis and manage postmenopausal symptoms, respectively. An 18-monthly colonoscopy surveillance programme has led to the excision of three high-grade dysplastic colorectal tubular adenomatous polyps. The proband’s family pedigree displays multiple relatives with cancers including a likely case of ‘true’ Turcot syndrome. Conclusions Constitutional mismatch repair deficiency syndrome should be considered in patients who present with early onset cancer, a strong family history of cancer, and cutaneous features resembling neurofibromatosis type I. Immunohistochemistry analysis of tumour and normal tissue is sensitive and specific for identifying patients with mismatch repair deficiency and should direct DNA sequencing of lymphocytic tissue to establish a diagnosis. Microsatellite instability status appears to be of little value in identifying patients who may have constitutional mismatch repair deficiency syndrome.
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