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Sinson H, Karayan-Tapon L, Godet J, Rivet P, Alleyrat C, Battistella M, Pierron H, Morel F, Lecron JC, Favot L, Frouin E. Immunohistochemistry, Molecular Biology, and Clinical Scoring for the Detection of Muir-Torre Syndrome in Cutaneous Sebaceous Tumors: Which Strategy? Dermatology 2023; 239:889-897. [PMID: 37717564 DOI: 10.1159/000534126] [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: 12/23/2022] [Accepted: 09/08/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Sebaceous neoplasms (SNs) always raise the possibility of an association with Muir-Torre syndrome (MTS) and permit to screen internal malignancies, colorectal and endometrial carcinomas, before they become symptomatic. Immunohistochemistry (IHC), molecular biology, and clinical examination are different approaches for detection of MTS. We conducted a retrospective analysis of non-selected SNs in order to determine the optimal tools to implement for MTS screening. METHODS Deficient MMR phenotype (dMMR) was determined by either IHC using antibodies directed to four mismatch repair (MMR) antigens on tissue microarray or molecular biology using pentaplex PCR. The Mayo Clinic risk score of MTS was calculated from medical records. Sensibility and specificity of each test for the detection of MTS were determined. RESULTS We included 107 patients, 8 with multiple SNs, for a total of 123 SNs (43 sebaceous adenomas, 19 sebaceomas, and 61 sebaceous carcinomas (SC)). Loss of at least one MMR protein was observed in 70.7% of tumors, while 48% had a microsatellite instable phenotype. Concordance between both techniques was 92.9%, with a 0.85 Cohen's kappa coefficient. Nineteen patients (20.2%) had a ≥2 points Mayo Clinic risk score, one having a pMMR SC. Among the 13 patients with confirmed MTS, 2 had a low Mayo Clinic risk score (1 point). IHC had the highest sensitivity for MTS screening (100%) with a specificity of 34.1%, while a >2-point Mayo Clinic risk score had a lower sensitivity (92%) but a higher specificity (89%). CONCLUSION To detect MTS in SN patients, the first-line Mayo Clinic risk score followed by IHC appears to be the most accurate strategy with lower cost for society. This strategy should be adapted to the medico-economic resources of each country.
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Affiliation(s)
- Hélinie Sinson
- Department of Pathology, University Hospital of Poitiers, Poitiers, France
| | - Lucie Karayan-Tapon
- ProDiCeT, University of Poitiers, Poitiers, France
- CHU De Poitiers, Department of Cancer Biology, Poitiers, France
| | - Julie Godet
- Department of Pathology, University Hospital of Poitiers, Poitiers, France
| | - Pierre Rivet
- ProDiCeT, University of Poitiers, Poitiers, France
- CHU De Poitiers, Department of Cancer Biology, Poitiers, France
| | - Camille Alleyrat
- Plateforme Méthodologie Biostatistiques, Data-Management, University Hospital of Poitiers, Poitiers, France
| | - Maxime Battistella
- Department of Pathology, Saint-Louis Hospital, AP-HP, Université Paris Cité, INSERM U976, Paris, France
| | - Hugo Pierron
- Department of Pathology, University Hospital of Poitiers, Poitiers, France
- CHU De Poitiers, Department of Cancer Biology, Poitiers, France
| | | | - Jean-Claude Lecron
- LITEC, University of Poitiers, Poitiers, France
- Department of Immunology and Inflammation, University Hospital of Poitiers, Poitiers, France
| | - Laure Favot
- LITEC, University of Poitiers, Poitiers, France
| | - Eric Frouin
- Department of Pathology, University Hospital of Poitiers, Poitiers, France
- LITEC, University of Poitiers, Poitiers, France
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Basnayake O, Jayarajah U, Subasinghe D, Rajapakse K, Beneragama T, Sivaganesh S. Two squamous cell carcinomas of the skin in a patient with Lynch syndrome. Int J Surg Case Rep 2022; 102:107822. [PMID: 36512881 PMCID: PMC9763668 DOI: 10.1016/j.ijscr.2022.107822] [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: 07/05/2022] [Revised: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Although synchronous and metachronous tumours of the bowel are well known associations of Lynch syndrome, the association of skin malignancies in such patients are extremely rare. CASE PRESENTATION A 40-year-old Sri Lankan man with a strong family history of colorectal cancer had an extended right hemicolectomy for a moderately differentiated adenocarcinoma. Two months after surgery, he developed two discrete ulcerative skin lesions in the chin and occipital region which excision biopsy confirmed to be squamous cell carcinoma. After more than two years of follow-up, patient remains disease free. CLINICAL DISCUSSION The Muir Torre variant of Lynch syndrome is characteristically associated with sebaceous adenomas and carcinomas, though occurence of squamous cell carcinomas are rare. In reported cases, defective mismatch repair genes associated with Lynch syndrome may suggest an increased predisposition for squamous cell carcinomas. CONCLUSION Patients with Lynch syndrome should be educated on the importance of seeking an early medical consult for new skin lesions and raising awareness of this rare phenomenon for physicians involved in follow up is important.
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Affiliation(s)
- Oshan Basnayake
- University Surgical Unit, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Umesh Jayarajah
- University Surgical Unit, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Duminda Subasinghe
- Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Kavinda Rajapakse
- Plastic and Reconstructive Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Thushan Beneragama
- Plastic and Reconstructive Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Sivasuriya Sivaganesh
- Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka,Corresponding author at: Department of Surgery, Faculty of Medicine, Kynsey Road, Colombo 8, Western Province, Sri Lanka.
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3
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A retrospective cohort study of genetic referral and diagnosis of lynch syndrome in patients with cutaneous sebaceous lesions. Fam Cancer 2022:10.1007/s10689-022-00322-z. [PMID: 36437392 DOI: 10.1007/s10689-022-00322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
Abstract
Immunohistochemistry (IHC) of cutaneous sebaceous lesions (SL) can be used to screen patients for Lynch syndrome (LS). There is little data on rates of genetic referral and outcomes of genetic testing for patients with SL. This single-center retrospective study characterizes 400 + patients with SL, including IHC results, genetics referrals, and outcomes of genetic testing. Retrospective chart reviews were performed for patients with a pathology-confirmed diagnosis of SL at the University of Michigan between January 2009 and December 2019. 447 patients with 473 SL were identified. Excluding 20 patients with known LS, IHC was conducted in 173 (41%) patients. 92/173 (53%) patients had abnormal results. 69 of these 92 (75%) patients were referred to genetics. 32 additional patients were referred with normal IHC (n = 22) or without IHC (n = 10). Of 101 patients referred, 65 (64%) were seen and 47 (47%) completed genetic testing. 7/47 (15%) had pathogenic variants associated with LS, six with concordant abnormal IHC and one without IHC. Cancer genetics referral of patients with SL, particularly for lesions with abnormal IHC, yields a significant rate of LS diagnosis. Providers should consider genetics referral for patients with SL.
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4
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Zhao W, Jin L, Chen P, Li D, Gao W, Dong G. Colorectal cancer immunotherapy-Recent progress and future directions. Cancer Lett 2022; 545:215816. [PMID: 35810989 DOI: 10.1016/j.canlet.2022.215816] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/12/2022] [Accepted: 07/01/2022] [Indexed: 12/09/2022]
Abstract
Compared with conventional chemotherapy and targeted therapy, immunotherapy has changed the treatment prospects of various solid tumors and has recently become the main treatment method for metastatic or recurrent solid tumors, including malignant melanoma, non-small-cell lung cancer, and renal cell carcinoma. The application of immune checkpoint inhibitor (ICI)-based immunotherapy in patients with colorectal cancer (CRC) has yielded satisfactory results in terms of safety and efficacy, and several immunotherapeutic agents, including pembrolizumab, nivolumab, and ipilimumab, have been approved for the treatment of advanced CRC. The advent of other immunotherapies, such as chimeric antigen receptor-modified T (CAR-T) cells or cancer vaccines, have also contributed to the development of immunotherapy for CRC. Here, we summarize the findings of recent clinical trials on the efficacy of immunotherapy in CRC and briefly describe the mechanisms associated with tumor-intrinsic resistance to ICIs. We then discuss potential biomarkers for predicting the efficacy of immunotherapy.
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Affiliation(s)
- Wen Zhao
- School of Medicine, Nankai University, Tianjin, 300071, China; Department of General Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lujia Jin
- Department of General Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Peng Chen
- Department of General Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Dingchang Li
- Department of General Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Wenxing Gao
- Department of General Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Guanglong Dong
- School of Medicine, Nankai University, Tianjin, 300071, China; Department of General Surgery, Chinese PLA General Hospital, Beijing, 100853, China.
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5
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Abstract
Muir-Torre syndrome (MTS) is an autosomal dominant condition characterized by dermatological tumors along with visceral malignancies. The dermatological manifestations include recurrent sebaceous adenomas and keratoacanthomas. The commonly seen visceral malignancies are colorectal, gynecological, and urological. It is a variant of hereditary non-polyposis colorectal carcinoma syndrome (HNPCC). The underlying genetic mechanism is germline mutations in the DNA mismatch repair (MMR) genes leading to microsatellite instability (MSI), conferring an increased risk of developing malignancies. This is a case of a 57-year-old male patient with a history of colon cancer diagnosed at age 32 and multiple sebaceous adenomas. The patient also has a strong family history of cancer. They were referred to oncology after the immunohistochemical staining of a sebaceous adenoma showed loss of expression for MSH2 and MSH6. Next-generation sequencing identified a mutation in the MSH2 gene. These patients require genetic testing, counseling, and close follow-up with regular screening for cancer.
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Affiliation(s)
- Radhika Sheth
- Internal Medicine, Henry Ford Health System, Jackson, USA
| | - Priya Menon
- Internal Medicine, Henry Ford Health System, Jackson, USA
| | - Devin Malik
- Hematology/Oncology, Henry Ford Health System, Jackson, USA
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6
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Geueke A, Niemann C. Stem and progenitor cells in sebaceous gland development, homeostasis and pathologies. Exp Dermatol 2021; 30:588-597. [PMID: 33599012 DOI: 10.1111/exd.14303] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/04/2021] [Accepted: 02/14/2021] [Indexed: 12/11/2022]
Abstract
Sebaceous glands (SGs), typically associated with hair follicles, are critical for the homeostasis and function of mammalian skin. The main physiological function of SGs is the production and holocrine secretion of sebum to lubricate and protect the skin. Defective SGs have been linked to a variety of skin disorders, including acne, seborrheic dermatitis and formation of sebaceous tumors. Thus, a better understanding how SGs are formed and maintained is important to unravel the underlying molecular and cellular mechanisms of SG pathologies and to find better and effective therapies. Over the last two decades, research has come a long way from the initial identification of skin epithelial stem cells to the isolation and functional characterization of multiple stem cell pools as well as a better understanding of their unique and complex activities that drive skin homeostasis and operate in skin pathologies. Here, we discuss recent progress in unravelling cellular mechanisms underlying SG development, homeostasis and sebaceous tumor formation and assess the role of stem and progenitor cells in controlling SG physiology and disease processes. The development of elegant in vivo imaging as well as various in vitro and ex vivo stem cell and SG tissue models will advance mechanistic studies on SG function and allow drug screening and testing for efficient and successful targeting SG pathologies.
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Affiliation(s)
- Anna Geueke
- Center for Molecular Medicine Cologne, CMMC Research Institute, University of Cologne, Cologne, Germany
| | - Catherin Niemann
- Center for Molecular Medicine Cologne, CMMC Research Institute, University of Cologne, Cologne, Germany.,Center for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany
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7
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Takayama E, Yoshioka A, Takai T, Goto K. A case of Muir-Torre syndrome with a keratoacanthoma and sebaceous neoplasms: Clinicopathological features and a speculation on the pathogenesis of cutaneous tumor type. J Dermatol 2021; 48:690-694. [PMID: 33523490 DOI: 10.1111/1346-8138.15772] [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: 10/03/2020] [Revised: 12/21/2020] [Accepted: 01/10/2021] [Indexed: 11/26/2022]
Abstract
Muir-Torre syndrome is a hereditary condition characterized by occurrence of sebaceous neoplasms or keratoacanthomas and visceral tumors. The most common mechanism for this syndrome is a constitutional defect in the mismatch repair genes. We report the case of a 67-year-old woman with a mutator L homologue 1 (MLH1) mutation. She had a history of endometrial and colorectal cancers. The patient presented with a typical keratoacanthoma on the right cheek and numerous sebaceous neoplasms on the face and trunk. Seven sebaceous adenomas and a low-grade sebaceous carcinoma were excised. Most sebaceous adenomas showed dermoscopic features such as some yellow comedo-like globules and curved vessels in creamy-white areas. Moreover, they revealed pathological features such as keratoacanthoma-like architecture and peritumoral or intratumoral lymphocytes. One of these sebaceous adenomas indicated histopathologically spontaneous regression and another was continuous with the hair follicle. Immunohistochemical staining for mismatch repair proteins revealed loss of expression for MLH1 and postmeiotic segregation increased 2 (PMS2) proteins in tumor cells nuclei in both keratoacanthoma and sebaceous adenoma. Nuclei in overhanging epithelial lips of the keratoacanthoma were also negative. These findings suggest that the type of Muir-Torre syndrome-related cutaneous tumor may have been affected by mismatch repair protein deficient sites in the pilosebaceous unit.
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Affiliation(s)
- Eriko Takayama
- Department of Dermatology, Konan Medical Center, Kobe, Japan
| | - Akiko Yoshioka
- Department of Dermatology, Konan Medical Center, Kobe, Japan
| | - Toshihiro Takai
- Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Keisuke Goto
- Department of Dermatology, Hyogo Cancer Center, Akashi, Japan.,Department of Pathology, Itabashi Central Clinical Laboratory, Tokyo, Japan.,Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Nagaizumi, Japan.,Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
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8
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Boecker W, Reusch M, Mielke V, Reusch U, Hallermann C, Loening T, Tiemann M, Buchwalow I. Twenty-Eight Cases of Extraocular Sebaceous Carcinoma: A Correlative Clinicopathological and Immunohistochemical Analysis of Extraocular Sebaceous Carcinomas and Benign Sebaceous Gland Tumors. Am J Dermatopathol 2021; 43:93-102. [PMID: 32568835 DOI: 10.1097/dad.0000000000001667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ABSTRACT Extraocular sebaceous carcinoma (ESC) is a rare appendiceal skin tumor. In contrast to ocular sebaceous carcinoma, information about the exact cellular architecture of these lesions is scarce and the histogenesis of ESC is unknown. Here, we extend our previous study and investigate 28 extraocular carcinomas in comparison to 54 benign sebaceous tumors and 8 cases of normal sebaceous glands using a broad spectrum of antibodies against p63, several keratins, adipophilin, EMA, Ki67, androgen receptor, and mismatch repair proteins. This observational study demonstrates that p63- and K5/14-positive basaloid cells are key cells in normal sebaceous gland and in all sebaceous tumors and that these basaloid cells give rise to EMA+, adipophilin+ sebocytes, and K5/14+, K7±, K10± ductal structures. Finally, about half of ESC is associated with superficial in situ neoplasia, which provides evidence that at least part of these carcinomas arises from flat superficial in situ carcinoma. In contrast to the normal sebaceous gland, about half of all sebaceous tumors lack keratin K7. MMR protein IHC-profiles role will be discussed.
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Affiliation(s)
- Werner Boecker
- Gerhard-Domagk-Institute of Pathology, University of Muenster, Münster, Germany
- Dermatopathology Laboratory, Hamburg, Germany
- Gerhard-Seifert Referenzzentrum, Hamburg, Germany; and
| | | | | | | | | | | | | | - Igor Buchwalow
- Gerhard-Domagk-Institute of Pathology, University of Muenster, Münster, Germany
- Institute for Hematopathology, Hamburg, Germany
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9
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Abstract
Immunohistochemistry (IHC) is routinely performed in most laboratories, and other than purchase of commercially available antibodies, requires no additional equipment or reagents. As such, IHC is an accessible and relatively inexpensive test and one that can be performed quite quickly. This is in sharp contrast to genomic or mutational testing methodologies that are routinely "send out" tests as they require specialized equipment and reagents as well as individuals with expertise in the performance of the tests and analysis of the results, resulting in a prolonged turn-round-time and enhanced associated costs. However, many open questions remain in a rapidly changing therapeutic and scientific landscape with most obvious one being what exactly is the utility of "good old fashioned" IHC in the age of targeted therapy? For molecular applications, is a negative immunohistochemical result enough as a stand-alone diagnostic or predictive product? Is a positive immunohistochemical result perhaps more suitable for a role in screening for molecular alterations rather than a definitive testing modality? This review is an attempt to answer those very questions. We elucidate the broad range of entities in which IHC is currently used as a molecular surrogate and underscore pearls and pitfalls associated with each. Special attention is given to entities for which targeted therapies are currently available and to entities in which molecular data is of clinical utility as a prognosticator.
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10
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Tetzlaff MT, North J, Esmaeli B. Update on sebaceous neoplasia: the morphologic spectrum and molecular genetic drivers of carcinoma. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.mpdhp.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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11
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Kuwabara K, Suzuki O, Chika N, Kumamoto K, Minabe T, Fukuda T, Arai E, Tamaru JI, Akagi K, Eguchi H, Okazaki Y, Ishida H. Prevalence and molecular characteristics of DNA mismatch repair protein-deficient sebaceous neoplasms and keratoacanthomas in a Japanese hospital-based population. Jpn J Clin Oncol 2018; 48:514-521. [PMID: 29718441 DOI: 10.1093/jjco/hyy055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/11/2018] [Indexed: 01/25/2023] Open
Abstract
Background Muir-Torre syndrome (MTS) is currently considered as a clinical variant of Lynch syndrome (LS). The clinical significance of the screening of patients with MTS-associated cutaneous tumors for the identification of LS has not yet been established. In addition, the prevalence and molecular characteristics of mismatch repair (MMR) protein deficiency in such tumors has scarcely been investigated in the Japanese population. Methods Immunohistochemistry (IHC) for MMR proteins (MLH1, MSH2, MSH6 and PMS2) was performed in formalin-fixed paraffin-embedded sections prepared from 16 sebaceous neoplasms (SNs) resected from 13 patients and 32 keratoacanthomas (KAs) resected from 31 patients at our institution between January 2005 and March 2014. Tumors showing MMR protein loss were further subjected to genetic analysis for detecting the presence of germline and/or somatic alterations of the MMR genes to identify the precise molecular mechanisms underlying the protein loss. Results Among the 16 SNs resected from 13 patients, eight SNs resected from five patients (38.5%) showed loss of expression of MMR proteins (MLH1/PMS2 loss, one patient; MSH2/MSH6 loss, four patients). Genetic analyses showed a pathogenic germline MSH2 mutation in one patient, somatic hypermethylation of the MLH1 promoter region in one patient, and somatic alterations of MSH2 without detectable germline mutations of MSH2 in three patients. None of the KAs examined in the study showed any loss of MMR protein expression. Conclusions The efficacy of routine screening of cutaneous neoplasms known to be associated with MTS by IHC for MMR proteins to identify LS may be fairly limited. MMR protein loss as determined by IHC in SNs is not always diagnostic of LS, and appears, in most cases, to be a result of somatic inactivation of the MMR genes.
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Affiliation(s)
- Kouki Kuwabara
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University
| | - Okihide Suzuki
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University
| | - Noriyasu Chika
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University
| | - Kensuke Kumamoto
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University
| | - Toshiharu Minabe
- Department of Plastic Surgery, Saitama Medical Center, Saitama Medical University
| | - Tomoo Fukuda
- Department of Dermatology, Saitama Medical School, Saitama Medical University
| | - Eiichi Arai
- Department of Pathology, International Center, Saitama Medical University
| | - Jun-Ichi Tamaru
- Department of Pathology, Saitama Medical Center, Saitama Medical University
| | - Kiwamu Akagi
- Department of Cancer Prevention and Molecular Genetics, Saitama Prefectural Cancer Center
| | - Hidetaka Eguchi
- Research Center for Genomic Medicine, Saitama Medical University.,Diagnosis and Therapeutics of Intractable Diseases and Intractable Disease Research Center, Juntendo University Graduate School of Medicine, Japan
| | - Yasushi Okazaki
- Research Center for Genomic Medicine, Saitama Medical University.,Diagnosis and Therapeutics of Intractable Diseases and Intractable Disease Research Center, Juntendo University Graduate School of Medicine, Japan
| | - Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University
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12
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Lee JB, Litzner BR, Vidal CI. Review of the current medical literature and assessment of current utilization patterns regarding mismatch repair protein immunohistochemistry in cutaneous Muir-Torre syndrome-associated neoplasms. J Cutan Pathol 2017; 44:931-937. [PMID: 28749576 DOI: 10.1111/cup.13010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/17/2017] [Accepted: 07/24/2017] [Indexed: 11/30/2022]
Abstract
Muir-Torre syndrome is a clinical variant of Lynch syndrome defined by the synchronous or metachronous occurrence of at least one sebaceous neoplasm and at least one Lynch syndrome-related internal cancer. Although screening guidelines for patients with colorectal carcinomas have been established, screening guidelines for cutaneous Muir-Torre associated neoplasms are not currently available. As such, we reviewed the current evidence for the use of MLH1, MSH2, MSH6 and PMS2 immunohistochemistry when cutaneous Muir-Torre associated neoplasms are encountered. We identified weak to moderate support overall for the global use of these assays, with some evidence suggesting a tailored approach using clinical parameters as an adjunct. We also assessed the current utilization patterns of attendees of the American Society of Dermatopathology Annual Meeting (Chicago, 2016). We found that 91% of respondents utilize mismatch repair immunohistochemistry, with the majority utilizing these tests only when requested by the submitting clinician.
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Affiliation(s)
- Jason B Lee
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Brandon R Litzner
- Departments of Dermatology and Pathology, Via Christi Clinic, Ascension Medical Group, Wausau, Wisconsin.,Department of Family Medicine, University of Kansas Medical Center-Wichita, Wichita, Kansas
| | - Claudia I Vidal
- Departments of Dermatology and Pathology, Saint Louis University School of Medicine, St. Louis, Missouri
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14
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Kientz C, Joly MO, Faivre L, Clemenson A, Dalac S, Lepage C, Chapusot C, Jacquot C, Schiappa R, Lebrun M. A case report of Muir-Torre syndrome in a woman with breast cancer and MSI-Low skin squamous cell carcinoma. Hered Cancer Clin Pract 2017; 15:6. [PMID: 28507641 PMCID: PMC5429559 DOI: 10.1186/s13053-017-0066-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/09/2017] [Indexed: 01/28/2023] Open
Abstract
Background The tumor spectrum in the Lynch syndrome is well defined, comprising an increased risk of developing colonic and extracolonic malignancies. Muir-Torre syndrome is a variant with a higher risk of skin disease. Patients have been described carrying mutations in the mismatch repair genes and presenting tumors with unusual histology or affected organ not part of the Lynch syndrome spectrum. Hence, the real link between Lynch syndrome, or Muir-Torre syndrome, and these tumors remains difficult to assess. Case presentation We present the case of a 45-year-old-woman, diagnosed with breast cancer at 39 years of age and skin squamous cell carcinoma (SCC) at 41 years of age, without personal history of colorectal cancer. The microsatellite instability analysis performed on the skin SCC showed a low-level of microsatellite instability (MSI-Low). The immunohistochemical expression analysis of the four DNA mismatch repair proteins MLH1, MSH2, MSH6 and PMS2 showed a partial loss of the expression of MSH2 and MSH6 proteins. Germline deletion was found in MSH2 gene (c.1277-? _1661 + ?del), exon 8 to 10. Then, at 45 years of age, she presented hyperplastic polyps of the colon and a sebaceous adenoma. Conclusion Squamous cell carcinomas have been described in Lynch syndrome and Muir-Torre syndrome in two studies and two case reports. This new case further supports a possible relationship between Lynch syndrome and squamous cell carcinoma.
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Affiliation(s)
- Caroline Kientz
- Department of Genetics, Hôpital Nord, CHU Saint Etienne, 42055 Saint-Etienne Cedex 2, France
| | - Marie-Odile Joly
- Department of Central Anatomy and Pathological Cytology, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437 Lyon Cedex 3, France.,Claude Bernard University Lyon 1, University of Lyon, 69622 Villeurbanne Cedex, France
| | - Laurence Faivre
- Center of Genetics, Children's Hospital, 14 rue Gaffarel, BP 77 908, 21079 Dijon Cedex, France
| | - Alix Clemenson
- Department of Pathology, Hôpital Nord, CHU Saint Etienne, 42055 Saint-Etienne Cedex 2, France
| | - Sophie Dalac
- Department of Dermatology, University hospital F. Mitterrand, 14 rue Gaffarel, BP 77 908, 21079 Dijon Cedex, France
| | - Côme Lepage
- Inserm U 866, Hepatogastroenterology and Digestive Oncology, University Hospital F. Mitterrand, 14 rue Gaffarel, BP 77 908, 21079 Dijon Cedex, France.,University of Burgundy, Esplanade Erasme, 21078 Dijon, France
| | - Caroline Chapusot
- Genetic Cancers Platform, Burgundy Area, Pathology Department, University Hospital F. Mitterrand, 2 Rue Ducoudray, BP 37013, 21070 Dijon, France
| | - Caroline Jacquot
- Center of Genetics, Children's Hospital, 14 rue Gaffarel, BP 77 908, 21079 Dijon Cedex, France
| | - Renaud Schiappa
- Research center, Epidemiology and Bioinformatics Unit, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06189 Nice cedex 2, France
| | - Marine Lebrun
- Department of Genetics, Hôpital Nord, CHU Saint Etienne, 42055 Saint-Etienne Cedex 2, France
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15
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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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Abstract
BACKGROUND Periocular sebaceous carcinoma (PSC) is a rare but aggressive neoplasm that tends to clinically and histopathologically mimic other conditions. PSC can be challenging to diagnose using histomorphology alone given its overlap with 2 more common tumors that occur in this area (basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]). Use of immunohistochemistry can help resolve this differential diagnosis. METHODS A review of the literature was performed, focusing on the epidemiology, morphology, and immunohistochemical features of PSC. RESULTS The most useful immunostains in the differential diagnosis of PSC are epithelial membrane antigen, Ber-Ep4, androgen receptor (AR), and adipophilin. To discern PSC from BCC, one should use EMA, Ber-Ep4, AR, and adipophilin, whereas discerning PSC from SCC can be achieved by evaluating AR and adipophilin. In addition, p53 and ERBB2 (formally known as HER2/neu) are other potentially useful immunohistochemical markers for the differential diagnosis of PSC. CONCLUSIONS Use of new immunohistochemical techniques, as well as the elucidation of molecular alterations, such as the presence of ERBB2 amplification, will advance our understanding of PSC.
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Affiliation(s)
- Carlos Prieto-Granada
- Department of Dermatology & Cutaneous Surgery, University of South Florida, Tampa, FL 33612, USA.
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Sia PI, Rajak S, James C, Huilgol S, Selva D. Sebaceous adenomas in the absence of Muir-Torre syndrome. Can J Ophthalmol 2016; 51:e152-e153. [PMID: 27769341 DOI: 10.1016/j.jcjo.2016.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/10/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Paul Ikgan Sia
- Royal Adelaide Hospital, Adelaide, Australia; University of Adelaide, Adelaide, Australia.
| | - Saul Rajak
- Royal Adelaide Hospital, Adelaide, Australia
| | - Craig James
- Adelaide Pathology Partners, Adelaide, Australia
| | | | - Dinesh Selva
- Royal Adelaide Hospital, Adelaide, Australia; University of Adelaide, Adelaide, Australia
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Gupta V, Mridha AR, Sharma VK. Sebaceous hyperplasia and sebaceous adenomas presenting as leonine facies and improving with oral isotretinoin. Clin Exp Dermatol 2016; 41:923-924. [PMID: 27859604 DOI: 10.1111/ced.12918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- V Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - A R Mridha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - V K Sharma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Neelakantan IV, Di Palma S, Smith CET, McCoombe A. Parotid Sebaceous Carcinoma in Patient with Muir Torre Syndrome, Caused by MSH2 Mutation. Head Neck Pathol 2016; 10:354-61. [PMID: 26577210 PMCID: PMC4972744 DOI: 10.1007/s12105-015-0670-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 11/06/2015] [Indexed: 02/04/2023]
Abstract
Sebaceous carcinoma of parotid gland are extremely rare with only 29 cases reported so far. The development of parotid sebaceous carcinoma in association with mutation in the mismatch repair gene that causes Muir Torre Syndrome (MTS), a subset of Lynch Syndrome, is still unclear. This study describes such a case and reviews the literature to see if an association between parotid sebaceous carcinoma and multiple visceral malignancies seen in Lynch Syndrome has ever been described. MTS represents a small subset of the Hereditary Non Polyposis Colorectal Carcinoma family, thought to be a subtype of Lynch Syndrome, where patients are prone to develop multiple visceral cancers involving gastrointestinal and genitourinary tract along with sebaceous and non-sebaceous tumours of the skin. MTS is a rare hereditary, autosomal dominant cancer syndrome caused by Microsatellite Instability and defect in DNA mismatch repair protein. The germline mutation involves mostly hMSH2 and hMLH1 genes. In MTS the skin of the head and neck area with the periocular region in particular, is affected but sebaceous carcinomas of the parotid associated with visceral malignancies has not yet been reported in literature. Here we report an index case of sebaceous carcinoma of parotid gland in a patient with MTS.
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Affiliation(s)
| | - Silvana Di Palma
- Department of Histopathology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 8DY UK
| | - C. E. T. Smith
- Department of Histopathology, Frimley Park Hospital, Camberley, Surrey UK
| | - A. McCoombe
- Department of ENT, Frimley Park Hospital, Camberley, Surrey UK
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20
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Jessup CJ, Redston M, Tilton E, Reimann JDR. Importance of universal mismatch repair protein immunohistochemistry in patients with sebaceous neoplasia as an initial screening tool for Muir-Torre syndrome. Hum Pathol 2015; 49:1-9. [PMID: 26826402 DOI: 10.1016/j.humpath.2015.10.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 11/17/2022]
Abstract
Muir-Torre syndrome, a Lynch syndrome variant, is characterized by sebaceous neoplasia plus one or more malignancies, typically colon cancer. The significance of DNA mismatch repair (MMR) deficiency detection by immunohistochemistry (IHC) in colorectal carcinomas is well established and is recommended as a screening tool for Lynch syndrome in newly diagnosed colorectal carcinomas. In comparison, literature on IHC application to detect MMR proteins (MLH1, MSH2, MSH6, and PMS2) in sebaceous neoplasia has been less studied and has been derived almost exclusively from tertiary care centers. Herein we describe the largest series to date characterizing MMR deficiency in sebaceous neoplasms, as well as the relative frequencies of each deficiency. Two hundred sixteen consecutive sebaceous neoplasms (216 patients) were analyzed from a community practice setting (133 sebaceous adenomas, 68 sebaceomas, 15 sebaceous carcinomas). One hundred forty-three were MMR deficient (66%), of which 90 were MSH2/MSH6 deficient (63%), 27 MLH1/PMS2 deficient (19%), 22 MSH6 deficient (15%), and 4 PMS2 deficient (3%). MMR deficiency was significantly associated with site, with tumors off of the head and neck more likely to be MMR deficient (specificity 96%). In contrast to prior reports, no significant trend in MMR-deficient versus -nondeficient tumors was seen in age at presentation (median age, 68 versus 66), tumor-infiltrating lymphocytes, or tumor type. Given the low sensitivity of age < 60 years (30%), location off of the head and neck (41%), or presence of tumor-infiltrating lymphocytes (29%) in MMR deficiency detection, IHC screening programs should test all sebaceous neoplasms for MMR deficiency, regardless of their clinicopathological features.
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Affiliation(s)
- Chad J Jessup
- Miraca Life Sciences Research Institute, Newton, MA 02464; Tufts Medical Center, Department of Dermatology, Boston, MA 02110
| | - Mark Redston
- Miraca Life Sciences Research Institute, Newton, MA 02464
| | - Erin Tilton
- Miraca Life Sciences Research Institute, Newton, MA 02464
| | - Julie D R Reimann
- Miraca Life Sciences Research Institute, Newton, MA 02464; Tufts Medical Center, Department of Dermatology, Boston, MA 02110.
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Hung CT, Wang WM. JAAD Grand Rounds quiz: A subcutaneous nodule on the right shoulder. J Am Acad Dermatol 2015; 73:889-91. [PMID: 26475550 DOI: 10.1016/j.jaad.2013.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 01/15/2013] [Accepted: 01/25/2013] [Indexed: 10/22/2022]
Abstract
LEARNING OBJECTIVES At the conclusion of this learning activity, physician participants should be able to assess their own diagnostic and patient management skills and use the results of this exercise to help determine personal learning needs. Instructions: In answering each question, refer to the specific directions provided. Because it is often necessary to provide information occurring later in a series that give away answers to earlier questions, please answer the questions in each series in sequence.
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Demolin G, Romain M, Münschke A, Vandingenen T, Blaude MA, Van Craynest MP. [Case report: Muir-Torre syndrome diagnosed from a sebaceoma mimicking an ulcerated breast cancer]. ACTA ACUST UNITED AC 2015; 45:767-74. [PMID: 26321614 DOI: 10.1016/j.jgyn.2015.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 06/10/2015] [Accepted: 06/18/2015] [Indexed: 12/21/2022]
Abstract
On the basis of a case report, we conducted a search through the literature concerning Muir-Torre syndrome. This syndrome is considered to be a phenotypic variant of Lynch syndrome (or Human Non Polyposis Colorectal Cancer). Muir-Torre syndrome is a familial cancer syndrome defined as the association of an internal malignancy with cutaneous sebaceous tumors. It is a rare disease. In our knowledge, this case is the first reported skin lesion related to Muir-Torre syndrome, located on the breast and mimicking ulcerated breast cancer. Genetic counselling obviously has an important place in the management of this pathology.
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Affiliation(s)
- G Demolin
- Service de gynécologie-obstétrique, CH Epicura, route de Mons, 63, 7301 Hornu, Belgique.
| | - M Romain
- Service de gynécologie-obstétrique, CH Epicura, route de Mons, 63, 7301 Hornu, Belgique
| | - A Münschke
- Service de gynécologie-obstétrique, CH Epicura, route de Mons, 63, 7301 Hornu, Belgique
| | - T Vandingenen
- Service d'oncologie, CH Epicura, route de Mons, 63, 7301 Hornu, Belgique
| | - M-A Blaude
- Service de radiologie, CH Epicura, route de Mons, 63, 7301 Hornu, Belgique
| | - M-P Van Craynest
- Anatomie pathologique, New Labpatho, place Saint-Sébastien, 56, 1420 Braine-l'Alleud, Belgique
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23
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Oliveira CMPB, Campos JGD, Maia MR, Lobo LEDS, Valle FFD. The role of immunohistochemistry in the Muir-Torre Syndrome. An Bras Dermatol 2015; 90:168-70. [PMID: 26312706 PMCID: PMC4540540 DOI: 10.1590/abd1806-4841.20153406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/06/2014] [Indexed: 11/21/2022] Open
Abstract
Muir-Torre Syndrome is defined by the coexistence of sebaceous skin tumors and
internal malignancies. Mutations in the DNA mismatch repair genes are found in the
inherited form of the disease, resulting in the absence of crucial enzymes involved
with DNA replication process. This case describes a patient with sebaceous adenoma
and colorectal carcinoma, meeting the criteria for Muir-Torre Syndrome. The
immunohistochemical analysis of the skin lesion was an important tool to confirm the
diagnosis, as it revealed nuclear negativity for MSH2 and MSH6.
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Hatta N, Takata A, Ishizawa S, Niida Y. Family with MSH2 mutation presenting with keratoacanthoma and precancerous skin lesions. J Dermatol 2015; 42:1087-90. [PMID: 26077460 DOI: 10.1111/1346-8138.12949] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 04/10/2015] [Indexed: 11/27/2022]
Abstract
Muir-Torre syndrome (MTS) is a familial cancer syndrome characterized by a predisposition to keratoacanthoma (KA) and sebaceous tumors. Although MTS and hereditary non-polyposis colorectal cancer (HNPCC) share the same genetic alterations in mismatch repair (MMR) genes, the other skin lesions in MTS or HNPCC have been only rarely reported. We report a family with an MSH2 mutation c.1126_1127delTT (p.Leu376Thrfs*12). A 46-year-old male proband developed KA with sebaceous differentiation, colon cancer and gastric cancer, and fulfilled the diagnostic criteria for MTS. His 80-year-old mother, diagnosed with HNPCC, presented with multiple gastrointestinal tract cancers, Bowen's disease and actinic keratosis. Immunostaining revealed attenuated MSH2 protein expression in KA, as well as in Bowen's disease and actinic keratosis lesions. These findings suggest that MMR gene abnormality is also critical in the development of benign or malignant cutaneous tumors such as actinic keratosis and Bowen's disease in MTS/HNPCC patients.
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Affiliation(s)
- Naohito Hatta
- Department of Dermatology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Akiko Takata
- Department of Dermatology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Shin Ishizawa
- Department of Pathology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Yo Niida
- Division of Genomic Medicine, Medical Research Institute, Kanazawa Medical University, Kanazawa, Japan
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25
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Sorscher S. A case of squamous cell carcinoma of the skin due to the molecularly confirmed Lynch Syndrome. Hered Cancer Clin Pract 2015; 13:12. [PMID: 25995776 PMCID: PMC4438563 DOI: 10.1186/s13053-015-0033-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 05/11/2015] [Indexed: 11/10/2022] Open
Abstract
Patients with Lynch Syndrome are at high risk for developing a variety of cancers including cancers of the colon or rectum, small bowel, stomach, uterus, renal pelvis, ureter, biliary tract, ovaries, brain and pancreas (N Engl J Med 348: 919-32, 2003; Gut 57:1097-101, 2008; NCCN, Inc Guideline. Ft. Washington, PA. Online Version 2.2014). Lack of MLH-1 and MSH-2 expression commonly result from germline mutations in this inherited cancer syndrome. Here, we report the case of a patient with a molecularly confirmed germline mutation in MLH-1 along with a colon cancer showing lack of expression of MLH-1 as well as a squamous cell cancer of the skin from the abdominal wall also demonstrating lack of expression of MLH-1. This case appears to represent the second case report of a squamous cell skin cancer apparently due to the Lynch Syndrome and further supports a proposed relationship between Lynch Syndrome and these tumors.
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Affiliation(s)
- Steven Sorscher
- Division of Oncology, Washington University in St. Louis, 660 S. Euclid Avenue CB 8056, 63110, St. Louis, MO USA
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26
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Abstract
CONTEXT Immunohistochemistry is not a diagnostic test but a highly valuable tool that requires interpretation within a context. OBJECTIVE To review the current status and limitations of immunohistochemistry in dermatopathology. DATA SOURCES English-language literature published between 1980 and 2014. CONCLUSIONS Although immunohistochemistry is rarely completely specific or sensitive, it is an important adjunctive technique in dermatopathology and can be helpful in a series of diagnostic dilemmas.
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Affiliation(s)
- Tammie Ferringer
- From the Departments of Dermatology and Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania
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27
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Woo JY, Suhng EA, Choi YW, Choi HY, Byun JY. Cystic sebaceous tumour with no evidence of Muir-Torre syndrome. J Eur Acad Dermatol Venereol 2015; 30:1038-9. [PMID: 25753622 DOI: 10.1111/jdv.13093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J Y Woo
- Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, Korea
| | - E A Suhng
- Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Y W Choi
- Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, Korea
| | - H Y Choi
- Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, Korea
| | - J Y Byun
- Department of Dermatology, School of Medicine, Ewha Womans University, Seoul, Korea
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Everett JN, Raymond VM, Dandapani M, Marvin M, Kohlmann W, Chittenden A, Koeppe E, Gustafson SL, Else T, Fullen DR, Johnson TM, Syngal S, Gruber SB, Stoffel EM. Screening for germline mismatch repair mutations following diagnosis of sebaceous neoplasm. JAMA Dermatol 2015; 150:1315-21. [PMID: 25006859 DOI: 10.1001/jamadermatol.2014.1217] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Sebaceous neoplasms (SNs) define the Muir-Torre syndrome variant of Lynch syndrome (LS), which is associated with increased risk for colon and other cancers necessitating earlier and more frequent screening to reduce morbidity and mortality.Immunohistochemical (IHC) staining for mismatch repair (MMR) proteins in SNs can be used to screen for LS, but data on subsequent germline genetic testing to confirm LS diagnosis are limited.OBJECTIVE To characterize the utility of IHC screening of SNs in identification of germline MMR mutations confirming LS.DESIGN, SETTING, AND PARTICIPANTS Retrospective study at 2 academic cancer centers of 86 adult patients referred for clinical genetics evaluation after diagnosis of SN.MAIN OUTCOMES AND MEASURES Results of tumor IHC testing and germline genetic testing were reviewed to determine positive predictive value and sensitivity of IHC testing in diagnosis of LS. Clinical variables, including age at diagnosis of SN, clinical diagnostic criteria for LS and Muir-Torre syndrome, and family history characteristics were compared between mutation carriers and noncarriers.RESULTS Of 86 patients with SNs, 25 (29%) had germline MMR mutations confirming LS.Among 77 patients with IHC testing on SNs, 38 (49%) had loss of staining of 1 or more MMR proteins and 14 had germline MMR mutations. Immunohistochemical analysis correctly identified 13 of 16 MMR mutation carriers, corresponding to 81% sensitivity. Ten of 12 patients(83%) with more than 1 SN had MMR mutations. Fifty-two percent of MMR mutation carriers did not meet clinical diagnostic criteria for LS, and 11 of 25 (44%) did not meet the clinical definition of Muir-Torre syndrome. CONCLUSIONS AND RELEVANCE Immunohistochemical screening of SNs is effective in identifying patients with germline MMR mutations and can be used as a first-line test when LSis suspected. Abnormal IHC results, including absence of MSH2, are not diagnostic of LS and should be interpreted cautiously in conjunction with family history and germline genetic testing. Use of family history to select patients for IHC screening has substantial limitations,suggesting that universal IHC screening of SNs merits further study. Clinical genetics evaluation is warranted for patients with abnormal IHC test results, normal IHC test results with personal or family history of other LS-associated neoplasms, and/or multiple SNs.
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Jagan L, Zoroquiain P, Bravo-Filho V, Logan P, Qutub M, Burnier MN. Sebaceous adenomas of the eyelid and Muir-Torre Syndrome. Br J Ophthalmol 2015; 99:909-13. [PMID: 25595178 DOI: 10.1136/bjophthalmol-2014-305873] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/21/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Sebaceous adenomas (SAs) are rare, benign sebaceous gland tumours of the eyelid. SAs may be associated with primary internal malignancies. This association is known as Muir-Torre Syndrome (MTS). The purpose of this study was to approximate the prevalence of SAs, to determine the reliability of the clinical diagnosis of SAs and to demonstrate immunohistochemical staining of DNA mismatch repair proteins mutL homologue 1 (MLH1) and mutS homologue 2 (MSH2) for a case of MTS. METHODS We reviewed the histopathology reports from all eyelid specimens collected between 1993 and 2013 at the Henry C Witelson Ocular Pathology Laboratory to determine the proportion of SAs. For the SAs identified on histopathology, we looked at patient charts to see what diagnosis was originally suspected on clinical examination. Immunohistochemical staining for MLH1 and MSH2 was performed on all SAs to screen for MTS. RESULTS Of the 5884 eyelid specimens collected, 9 were SAs (6 women, 3 men; 42-72 years old). The diagnosis of SA was suspected clinically in only one of the nine cases based on the gross appearance of the eyelid lesion. Immunohistochemistry revealed one SA case with positive MLH1 expression and negative MSH2 expression. These findings prompted systemic work-up and this patient was diagnosed with MTS after discovery of a colon adenocarcinoma T2M0N0. CONCLUSIONS The diagnosis of eyelid SA is rare. The importance of this benign eyelid tumour stems from its association with internal malignancies in MTS. Immunohistochemical staining of mismatch repair proteins MLH1 and MSH2 is a valid and accessible strategy for investigating MTS in patients with SAs.
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Affiliation(s)
- Lisa Jagan
- Henry C Witelson Ocular Pathology Laboratory, Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
| | - Pablo Zoroquiain
- Henry C Witelson Ocular Pathology Laboratory, Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
| | - Vasco Bravo-Filho
- Henry C Witelson Ocular Pathology Laboratory, Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
| | - Patrick Logan
- Henry C Witelson Ocular Pathology Laboratory, Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
| | - Mohammed Qutub
- Henry C Witelson Ocular Pathology Laboratory, Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
| | - Miguel N Burnier
- Henry C Witelson Ocular Pathology Laboratory, Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
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Boennelycke M, Thomsen BM, Holck S. Sebaceous neoplasms and the immunoprofile of mismatch-repair proteins as a screening target for syndromic cases. Pathol Res Pract 2014; 211:78-82. [PMID: 25457183 DOI: 10.1016/j.prp.2014.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 09/07/2014] [Accepted: 10/15/2014] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Muir-Torre syndrome (MTS), a subset of Lynch syndrome, is characterized by concurrent or sequential development of sebaceous neoplasms, and internal malignancies, specifically colorectal carcinoma (CRC), and can be related to mismatch-repair (MMR)-protein deficiency. In CRC context, p16-negativity in MLH1-deficient cases may denote methylation rather than mutation. The prime aim of this study was to evaluate the mismatch-repair (MMR)-protein deficiency and the p16 status among sebaceous neoplasms. MATERIAL AND METHOD From January 1990 through October 2012, 26 sebaceous adenomas (SAs) and 6 sebaceous carcinomas (SCs) were accrued. The expression of MLH1, MSH2, MSH6, and PMS2 was recorded. MLH1-deficient cases were tested for p16 status. RESULTS Eighteen (56%) of the 32 specimens with SA or SC displayed MMR-protein deficiency, comprising 17 (65.4%) SAs (MSH2/MSH6 loss in 12, MLH1/PMS2 loss in 3, MSH6 loss only in 2 cases) and 1 (16.7%) SC (MLH1/PMS2 loss). All 4 MLH1 deficient cases were p16-positive. CONCLUSION A substantial proportion of sebaceous neoplasms were MMR-protein deficient and thus likely MTS candidates. Given the low prevalence of sebaceous neoplasms in Denmark, immunohistochemistry for the four MMR-proteins is recommended in the initial diagnostic approach. The addition of p16 was none-informative, but evaluation of its utility in larger series is warranted.
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Affiliation(s)
- Marie Boennelycke
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Birthe M Thomsen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Holck
- Department of Pathology, Copenhagen University Hospital Hvidovre, Denmark
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31
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Kraft S, Granter SR. Molecular pathology of skin neoplasms of the head and neck. Arch Pathol Lab Med 2014; 138:759-87. [PMID: 24878016 DOI: 10.5858/arpa.2013-0157-ra] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Skin neoplasms include the most common malignancies affecting humans. Many show an ultraviolet (UV)-induced pathogenesis and often affect the head and neck region. OBJECTIVE To review literature on cutaneous neoplasms that show a predilection for the head and neck region and that are associated with molecular alterations. DATA SOURCES Literature review. CONCLUSIONS Common nonmelanoma skin cancers, such as basal and squamous cell carcinomas, show a UV-induced pathogenesis. Basal cell carcinomas are characterized by molecular alterations of the Hedgehog pathway, affecting patched and smoothened genes. While squamous cell carcinomas show UV-induced mutations in several genes, driver mutations are only beginning to be identified. In addition, certain adnexal neoplasms also predominantly affect the head and neck region and show interesting, recently discovered molecular abnormalities, or are associated with hereditary conditions whose molecular genetic pathogenesis is well understood. Furthermore, recent advances have led to an increased understanding of the molecular pathogenesis of melanoma. Certain melanoma subtypes, such as lentigo maligna melanoma and desmoplastic melanoma, which are more often seen on the chronically sun-damaged skin of the head and neck, show differences in their molecular signature when compared to the other more common subtypes, such as superficial spreading melanoma, which are more prone to occur at sites with acute intermittent sun damage. In summary, molecular alterations in cutaneous neoplasms of the head and neck are often related to UV exposure. Their molecular footprint often reflects the histologic tumor type, and familiarity with these changes will be increasingly necessary for diagnostic and therapeutic considerations.
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Affiliation(s)
- Stefan Kraft
- From the Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (Dr Kraft); and the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Dr Granter)
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32
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Ponti G, Pellacani G, Ruini C, Percesepe A, Longo C, Mandel VD, Crucianelli F, Gorelli G, Tomasi A. Muir–Torre syndrome or phenocopy? The value of the immunohistochemical expression of mismatch repair proteins in sebaceous tumors of immunocompromised patients. Fam Cancer 2014; 13:553-61. [DOI: 10.1007/s10689-014-9733-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rajan KD A, Burris C, Iliff N, Grant M, Eshleman JR, Eberhart CG. DNA mismatch repair defects and microsatellite instability status in periocular sebaceous carcinoma. Am J Ophthalmol 2014; 157:640-7.e1-2. [PMID: 24321472 DOI: 10.1016/j.ajo.2013.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 11/26/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE To characterize mismatch repair protein expression and the role of DNA repair abnormalities in sebaceous carcinomas of the ocular adnexa. DESIGN Retrospective case-series study. METHODS We reviewed 10 cases of sporadic sebaceous carcinoma and 1 case involving a patient with a family history consistent with Muir-Torre syndrome. Immunohistochemistry was used to analyze the presence of 4 mismatch repair proteins (MLH1, MSH2, MSH6, and PMS2) in these tumors. DNA was extracted from 7 of the larger tumors as well as from adjacent normal control tissue and microsatellite instability (MSI) analysis using 5 highly sensitive mononucleotides and 2 pentanucleotides was performed. RESULTS All 10 sporadic periocular sebaceous carcinomas maintained strong staining of the 4 mismatch repair genes, while tumor from the patient with Muir-Torre syndrome showed loss of staining for the mismatch repair genes MSH2 and MSH6. MSI testing of 7 tumors identified no changes in sporadic cases and yielded results supporting presence of repeat sequence instability in the Muir-Torre-associated case. CONCLUSIONS Sporadic sebaceous carcinoma of the ocular adnexa is not commonly associated with a loss of mismatch repair genes or microsatellite instability.
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Wachter DL, Rauh C, Wenkel E, Fasching PA, Beckmann MW, Hartmann A. [Sebaceous breast carcinoma: report of a rare histological special subtype]. DER PATHOLOGE 2014; 35:72-6. [PMID: 24414613 DOI: 10.1007/s00292-013-1844-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report on a case of sebaceous carcinoma of the breast as a rare histological special subtype of breast cancer. Because these tumors are uncommon, differential diagnostic considerations and the exclusion of Muir-Torre syndrome are emphasized. Finally possible mechanisms of development and therapeutic strategies for this carcinoma are discussed.
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MESH Headings
- Adenocarcinoma, Sebaceous/diagnosis
- Adenocarcinoma, Sebaceous/pathology
- Biomarkers, Tumor/analysis
- Biopsy, Needle
- Breast/pathology
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Diagnosis, Differential
- Female
- Humans
- Mammography
- Middle Aged
- Muir-Torre Syndrome/diagnosis
- Muir-Torre Syndrome/pathology
- Neoplasms, Hormone-Dependent/diagnosis
- Neoplasms, Hormone-Dependent/pathology
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/pathology
- Prognosis
- Receptor, ErbB-2/analysis
- Receptors, Estrogen/analysis
- Receptors, Progesterone/analysis
- Ultrasonography, Mammary
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Affiliation(s)
- D L Wachter
- Pathologisches Institut, Universitätsklinikum Erlangen, Krankenhausstr. 8-10, 91054, Erlangen, Deutschland
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Cockerell C, Mihm MC, Hall BJ, Chisholm C, Jessup C, Merola M. Adnexal Neoplasms. Dermatopathology (Basel) 2014. [DOI: 10.1007/978-1-4471-5448-8_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Guillemette S, Branagan A, Peng M, Dhruva A, Schärer OD, Cantor SB. FANCJ localization by mismatch repair is vital to maintain genomic integrity after UV irradiation. Cancer Res 2013; 74:932-44. [PMID: 24351291 DOI: 10.1158/0008-5472.can-13-2474] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Nucleotide excision repair (NER) is critical for the repair of DNA lesions induced by UV radiation, but its contribution in replicating cells is less clear. Here, we show that dual incision by NER endonucleases, including XPF and XPG, promotes the S-phase accumulation of the BRCA1 and Fanconi anemia-associated DNA helicase FANCJ to sites of UV-induced damage. FANCJ promotes replication protein A phosphorylation and the arrest of DNA synthesis following UV irradiation. Interaction defective mutants of FANCJ reveal that BRCA1 binding is not required for FANCJ localization, whereas interaction with the mismatch repair (MMR) protein MLH1 is essential. Correspondingly, we find that FANCJ, its direct interaction with MLH1, and the MMR protein MSH2 function in a common pathway in response to UV irradiation. FANCJ-deficient cells are not sensitive to killing by UV irradiation, yet we find that DNA mutations are significantly enhanced. Thus, we considered that FANCJ deficiency could be associated with skin cancer. Along these lines, in melanoma we found several somatic mutations in FANCJ, some of which were previously identified in hereditary breast cancer and Fanconi anemia. Given that, mutations in XPF can also lead to Fanconi anemia, we propose collaborations between Fanconi anemia, NER, and MMR are necessary to initiate checkpoint activation in replicating human cells to limit genomic instability.
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Affiliation(s)
- Shawna Guillemette
- Authors' Affiliations: Department of Cancer Biology, University of Massachusetts Medical School, Women's Cancers Program, UMASS Memorial Cancer Center, Worcester, Massachusetts; and Department of Pharmacological Sciences & Department of Chemistry, Stony Brook University, Stony Brook, New York
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Wong CY, Tang RKT, Lam RF, Io IYF, Yuen CYF, Ho JWC, Tse RKK. Muir-Torre Syndrome in a Middle-Aged Chinese Patient with Sebaceous Carcinoma of the Eyelid. Semin Ophthalmol 2013; 30:420-2. [PMID: 24117411 DOI: 10.3109/08820538.2013.833267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Muir-Torre syndrome is a rare, autosomal dominant condition characterized by the presence of a skin tumor of sebaceous differentiation and visceral malignancies. We reviewed the case of a 46-year-old Chinese man who had a bleeding mass over the right upper eyelid. He had a history of colon cancer and a family history satisfying the Amsterdam criteria for hereditary non-polyposis colorectal cancer syndrome with germline mutation in the MutS homolog-2 gene. The eyelid lesion was excised completely and submitted for histopathologic examination which showed sebaceous carcinoma. Frozen section and conjunctival map biopsy showed no residual malignancy or local metastasis. Post-operative positron-emission tomography with combined computed tomography did not reveal any residual or visceral malignancy. He had no recurrence in the 32-month follow-up period. We should consider Muir-Torre syndrome in patients with sebaceous carcinoma, especially in the presence of personal and/or family history of visceral malignancies.
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Affiliation(s)
- Ching-Yuen Wong
- a Department of Ophthalmology , Caritas Medical Centre , Hong Kong
| | | | - Robert Fung Lam
- a Department of Ophthalmology , Caritas Medical Centre , Hong Kong
| | - Ida Yu-Fong Io
- a Department of Ophthalmology , Caritas Medical Centre , Hong Kong
| | - Can Yin-Fun Yuen
- a Department of Ophthalmology , Caritas Medical Centre , Hong Kong
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Mismatch repair protein deficiency is common in sebaceous neoplasms and suggests the importance of screening for Lynch syndrome. Am J Dermatopathol 2013; 35:191-5. [PMID: 22722469 DOI: 10.1097/dad.0b013e31825f7efe] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The association between Lynch syndrome and sebaceous neoplasms is well characterized. The absence of expression of mismatch repair proteins (MMRPs) by immunohistochemistry (IHC) is often used in other Lynch-associated tumors to guide testing. IHC for MLH1, PMS2, MSH2, and MSH6 was performed on 36 benign and malignant sebaceous neoplasms with the absence of one or more MMRP in 38.9% of cases. Among lesions with abnormal IHC, 71.4% were missing both MSH2 and MSH6, 21.4% lacked MLH1 and PMS2, and 7.1% lacked only MSH6. Of the 10 patients with absent MMRP, 5 had gene-test confirmed Lynch syndrome, 3 had no suggestive personal or family medical history and 2 had no recorded data. Tumor-infiltrating lymphocytes in neoplasms with absent MMRP were statistically significantly greater than in those with intact MMRP (16.5 vs. 9.7, P = 0.027). MMRP deficiency is common in sebaceous neoplasms, suggesting the importance of screening for Lynch syndrome in these patients.
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Baker GM, Selim MA, Hoang MP. Vulvar Adnexal Lesions: A 32-Year, Single-Institution Review From Massachusetts General Hospital. Arch Pathol Lab Med 2013; 137:1237-46. [DOI: 10.5858/arpa.2012-0434-oa] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Because the skin and modified mucosal surfaces of the vulvar region contain dense apocrine glands and anogenital mammary-like glands, in addition to eccrine glands and folliculosebaceous units, benign as well as malignant lesions derived from these adnexal structures are, not surprisingly, found in the vulva. However, their incidence occurring in the vulva has not been reported, to our knowledge.
Objective.—To determine the incidence of various vulvar adnexal lesions.
Design.—We performed a retrospective review (1978–2010) of the cases at our institution.
Results.—A total of 189 vulvar adnexal lesions were identified. Most of these lesions were benign (133 of 189; 70%), with hidradenoma papilliferum being the most common, followed by syringoma and various types of cysts. Rare cases of tubular adenoma, poroma, spiradenoma, hidradenoma, cylindroma, sebaceoma, and trichoepithelioma were identified. Malignant adnexal neoplasms comprised the remaining 30% (56 of 189) of the cases. Extramammary Paget disease was the most common (49 of 56), and 29% (14 of 49) demonstrated an invasive component. Rare cases of basal cell carcinoma, sebaceous carcinoma, apocrine carcinoma, adenoid cystic carcinoma, and spiradenocarcinoma were identified.
Conclusions.—In this retrospective review, we identified several benign entities that have not been previously reported on the vulva, namely pilomatricoma, poroma, spiradenoma, and sebaceoma. Hidradenoma papilliferum and extramammary Paget disease were the most common benign and malignant adnexal neoplasms, respectively. The spectrum of various vulvar adnexal lesions appears to reflect the frequency of the underlying glandular elements.
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Affiliation(s)
- Gabrielle M. Baker
- From the Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston (Drs Baker and Hoang); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Selim)
| | - M. Angelica Selim
- From the Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston (Drs Baker and Hoang); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Selim)
| | - Mai P. Hoang
- From the Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston (Drs Baker and Hoang); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Selim)
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40
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Walsh MD, Cummings MC, Pearson SA, Clendenning M, Walters RJ, Nagler B, Hopper JL, Jenkins MA, Suthers GK, Goldblatt J, Tucker K, Gattas MR, Arnold J, Parry S, Macrae FA, McGuckin MA, Young JP, Buchanan DD. Lynch syndrome-associated breast cancers do not overexpress chromosome 11-encoded mucins. Mod Pathol 2013; 26:944-54. [PMID: 23370770 PMCID: PMC4204018 DOI: 10.1038/modpathol.2012.232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 11/30/2012] [Accepted: 12/03/2012] [Indexed: 11/09/2022]
Abstract
Mismatch repair-deficient breast cancers may be identified in Lynch syndrome mutation carriers, and have clinicopathological features in common with mismatch repair-deficient colorectal and endometrial cancers such as tumour-infiltrating lymphocytes and poor differentiation. Mismatch repair-deficient colorectal cancers frequently show mucinous differentiation associated with upregulation of chromosome 11 mucins. The aim of this study was to compare the protein expression of these mucins in mismatch repair-deficient and -proficient breast cancers. Cases of breast cancer (n=100) were identified from families where (1) both breast and colon cancer co-occurred and (2) families met either modified Amsterdam criteria or had at least one early-onset (<50 years) colorectal cancer. Tumour sections were stained for the epithelial mucins, MUC2, MUC5AC, MUC5B and MUC6, and the homeobox protein CDX2, a regulator of MUC2 expression. In all, 16 mismatch repair-deficient Lynch syndrome breast cancers and 84 non-Lynch breast cancers were assessed for altered mucin expression. No significant difference in the expression of MUC2, MUC5AC or MUC6 was observed between the mismatch repair-deficient and mismatch repair-proficient breast cancers; however, there was a trend for mismatch repair-deficient tumours to express high levels of MUC5B less frequently (P=0.07, OR=0.2 (0.0-1.0)). Co-expression of two or more gel-forming mucins was common. Ectopic expression of CDX2 was associated with expression of MUC2 (P=0.035, OR=8.7 (1.3-58.4)). Mismatch repair-deficient breast cancers do not show differential expression of the mucins genes on chromosome 11 when compared with mismatch repair-proficient breast cancers, in contrast with mismatch repair-deficient colorectal and endometrial cancers, which frequently have increased mucin protein expression when compared with their mismatch repair-proficient counterparts. In addition, ectopic CDX2 expression is positively associated with de novo MUC2 expression.
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Affiliation(s)
- Michael D Walsh
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Herston, QLD 4006, Australia.
| | - Margaret C Cummings
- University of Queensland Centre for Clinical Research, Herston, QLD, Australia
| | - Sally-Ann Pearson
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Herston QLD, Australia
| | - Mark Clendenning
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Herston QLD, Australia
| | - Rhiannon J Walters
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Herston QLD, Australia
| | - Belinda Nagler
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Herston QLD, Australia
| | - John L Hopper
- University of Melbourne, Centre for MEGA Epidemiology, School of Population Health, Melbourne, VIC, Australia
| | - Mark A Jenkins
- University of Melbourne, Centre for MEGA Epidemiology, School of Population Health, Melbourne, VIC, Australia
| | - Graeme K Suthers
- South Australian Clinical Genetics Service, North Adelaide, SA, Australia,Department of Paediatrics, University of Adelaide, SA, Australia
| | - Jack Goldblatt
- Genetic Services of Western Australia, King Edward Memorial Hospital, Subiaco, WA, Australia,School of Paediatrics and Child Health University of Western Australia, Nedlands, WA, Australia
| | - Kathy Tucker
- Clinical Genetics Service, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Michael R Gattas
- Genetic Health Queensland, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | - Julie Arnold
- Northern Regional Genetics, Auckland Hospital, Auckland, New Zealand
| | - Susan Parry
- Northern Regional Genetics, Auckland Hospital, Auckland, New Zealand,University of Auckland, Auckland, New Zealand
| | - Finlay A Macrae
- Department of Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Joanne P Young
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Herston QLD, Australia
| | - Daniel D Buchanan
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Herston QLD, Australia
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Grandhi R, Deibert CP, Pirris SM, Lembersky B, Mintz AH. Simultaneous Muir-Torre and Turcot's syndrome: A case report and review of the literature. Surg Neurol Int 2013; 4:52. [PMID: 23646262 PMCID: PMC3640225 DOI: 10.4103/2152-7806.110512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/08/2013] [Indexed: 11/29/2022] Open
Abstract
Background: Muir-Torre syndrome (MTS) is an autosomal dominant syndrome characterized by neoplasms of the sebaceous gland or keratoacanthomas, in addition to visceral malignancies. Cerebral neoplasms in patients with hereditary nonpolyposis colorectal cancer (HNPCC) or familial adenomatous polyposis suffer from Turcot's syndrome. Genetic mutations in MutS homolog (MSH)-2, MutL homolog (MLH)-1, and MutS homolog (MSH)-6 DNA mismatch repair genes are the most common in MTS with MSH-2 being the most predominant. In HNPCC MLH-1 and MSH-2 mutations are approximately equal in prevalence. Case Description: We present the case of a 58-year-old male with a prior history of being treated for colonic adenocarcinoma and skin lesions leading to a diagnosis of MTS. The patient later developed a World Health Organization (WHO) grade 4 glioma requiring surgical resection. Pathology revealed mutations in MSH-2 and MSH-6 mismatch repair genes. Conclusions: This case represents the first report of Turcot's and MTS with extensive molecular testing on the cerebral neoplasm demonstrating a molecular relationship between Turcot's and MTS and only the second published report of simultaneous Turcot's and MTS.
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Affiliation(s)
- Ramesh Grandhi
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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42
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Screening for Muir-Torre syndrome using mismatch repair protein immunohistochemistry of sebaceous neoplasms. J Genet Couns 2012; 22:393-405. [PMID: 23212176 DOI: 10.1007/s10897-012-9552-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 10/31/2012] [Indexed: 01/13/2023]
Abstract
Screening for the Muir-Torre variant of Lynch Syndrome (LS) using Mismatch Repair (MMR) gene immunohistochemistry (IHC) on sebaceous neoplasms (SNs) is technically feasible. To date, research into the clinical utility of MMR IHC for this indication is limited. We conducted a retrospective chart review of 90 patients with MMR IHC completed on at least one SN from January 2005 to May 2010. SNs included were adenomas, epitheliomas, carcinomas and basal and squamous cell carcinomas with sebaceous differentiation. Of the 90 patients, 13 (14 %) had genetically confirmed or fulfilled clinical criteria for a diagnosis of MTS and 51 patients (57 %) presented with an abnormal MMR IHC result (loss of one or more MMR proteins) on at least one SN. Abnormal IHC had a sensitivity of 85 %, specificity of 48 %, positive predictive value (PPV) of 22 % and negative predictive value (NPV) of 95 % when evaluating for MTS. When personal or family history of colorectal cancer (≥2 family members with a history of colorectal cancer) was taken into consideration, ignoring IHC results, sensitivity was 92 %, specificity was 99 %, PPV was 92 % and NPV was 99 %. MMR IHC on SNs when used to screen for MTS has poor diagnostic utility. We recommend that MMR IHC not be performed routinely on SNs when the patient does not have either personal or family history of colorectal cancer.
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Lee BA, Yu L, Ma L, Lind AC, Lu D. Sebaceous neoplasms with mismatch repair protein expressions and the frequency of co-existing visceral tumors. J Am Acad Dermatol 2012; 67:1228-34. [DOI: 10.1016/j.jaad.2012.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 03/10/2012] [Accepted: 03/23/2012] [Indexed: 02/08/2023]
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Niemann C, Horsley V. Development and homeostasis of the sebaceous gland. Semin Cell Dev Biol 2012; 23:928-36. [PMID: 22960253 DOI: 10.1016/j.semcdb.2012.08.010] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 08/15/2012] [Accepted: 08/24/2012] [Indexed: 12/16/2022]
Abstract
The important role of epidermal appendages especially the sebaceous gland has only recently been recognized. In particular, it has been convincingly shown that normal development and maintenance of the sebaceous gland are required for skin homeostasis since atrophic sebaceous glands and disturbances in sebaceous lipid composition result in major defects of the physiological barrier and maintenance of the skin. Consequently, it is important to unravel the signaling network controlling proper sebaceous lineage differentiation in mammalian skin and to understand the underlying mechanisms leading to severe skin diseases, including abnormal proliferation and differentiation of the gland, defects of the lipid metabolism and barrier, as well as sebaceous tumor formation. Over the last years, results from transgenic and knock out mouse models manipulating distinct signaling pathways in the skin as well as the detailed analysis of human sebaceous gland-derived cell lines provided new insights into crucial mediators balancing proliferation and differentiation of the sebaceous gland. Here, we discuss our current knowledge of in vivo mechanisms of sebaceous gland development, maintenance and disorders and highlight recent contributions to the field of sebaceous gland biology.
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Affiliation(s)
- Catherin Niemann
- Center for Molecular Medicine Cologne, University of Cologne, Germany.
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45
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Sidhu HK, Patel RV, Goldenberg G. Dermatology clinics: what's new in dermatopathology: news in nonmelanocytic neoplasia. Dermatol Clin 2012; 30:623-41, vi. [PMID: 23021050 DOI: 10.1016/j.det.2012.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article reviews the recent dermatopathology literature involving nonmelanocytic neoplasia, with a focus on important work done over the last 5 years. The discussion includes advances in the understanding of Merkel cell carcinoma pathogenesis and prognosis; changes in the seventh edition of the American Joint Committee of Cancer staging manual in reference to staging of squamous cell carcinoma and Merkel cell carcinoma; newly described or rare histopathologic patterns and entities including squamoid eccrine ductal carcinoma, rippled-pattern adnexal neoplasms, onychomatricoma, spindle cell predominant trichodiscoma/neurofollicular hamartoma, and myoepithelioma; and microsatellite instability in sebaceous neoplasms of Muir-Torre syndrome and other tumors.
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Affiliation(s)
- Harleen K Sidhu
- Department of Pathology, Mount Sinai School of Medicine, One Gustave L Levy Place, New York, NY 10029, USA
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46
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Hoang MT, Mock JR, Hoang MP, Cohen JB, Le LQ. An exophytic, bleeding nodule on the left malar region. Clin Exp Dermatol 2012; 38:217-8. [PMID: 22681240 DOI: 10.1111/j.1365-2230.2012.04400.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M T Hoang
- Department of Dermatology, University of Texas South-Western Medical Center, Dallas, TX, USA
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Considerations on the Performance of Immunohistochemistry for Mismatch Repair Gene Proteins in Cases of Sebaceous Neoplasms and Keratoacanthomas With Reference to Muir–Torre Syndrome. Am J Dermatopathol 2012; 34:416-22. [DOI: 10.1097/dad.0b013e3182226a28] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Rahner N, Brockschmidt FF, Steinke V, Kahl P, Becker T, Vasen HFA, Wijnen JT, Tops CJM, Holinski-Feder E, Ligtenberg MJL, Spruijt L, Görgens H, Stemmler S, Kloor M, Dietmaier W, Schumacher J, Nöthen MM, Propping P. Mutation and association analyses of the candidate genes ESR1, ESR2, MAX, PCNA, and KAT2A in patients with unexplained MSH2-deficient tumors. Fam Cancer 2011; 11:19-26. [PMID: 22086303 DOI: 10.1007/s10689-011-9489-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lynch syndrome (Hereditary non-polyposis colorectal cancer/HNPCC) is a cancer susceptibility syndrome which is caused by germline mutations in DNA mismatch repair (MMR) genes, in particular MLH1 and MSH2. A pathogenic germline mutation in the respective MMR gene is suggested by the finding of a loss of a mismatch repair protein in tumor tissue on immunohistochemical staining combined with an early age of onset and/or the familial occurrence of colorectal cancer. Pathogenic germline mutations are identifiable in around 60% of patients suspected of Lynch syndrome, depending on the familial occurrence. The aim of the present study was to identify novel susceptibility genes for Lynch syndrome. 64 Healthy controls and 64 Lynch syndrome patients with no pathogenic MSH2 mutation but a loss of MSH2 expression in their tumor tissue were screened for rare and disease causing germline mutations in the functional candidate genes ESR1, ESR2, MAX, PCNA, and KAT2A. Thirty variants were identified, and these were then genotyped in an independent sample of 36 mutation negative Lynch syndrome patients and 234 controls. Since a trend towards association was observed for KAT2A, an additional set of 21 tagging SNPs was analyzed at this locus in a final case-control sample of 142 mutation negative Lynch syndrome patients and 298 controls. The mutation analysis failed to reveal any rare disease-causing mutations. No association was found at the single-marker or haplotypic level for any common disease-modifying variant. The present results suggest that neither rare nor common genetic variants in ESR1, ESR2, MAX, PCNA, or KAT2A contribute to the development of Lynch syndrome.
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Affiliation(s)
- Nils Rahner
- Institute of Human Genetics, BMZ, University of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
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Mojtahed A, Schrijver I, Ford JM, Longacre TA, Pai RK. A two-antibody mismatch repair protein immunohistochemistry screening approach for colorectal carcinomas, skin sebaceous tumors, and gynecologic tract carcinomas. Mod Pathol 2011; 24:1004-14. [PMID: 21499234 DOI: 10.1038/modpathol.2011.55] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mismatch repair protein immunohistochemistry is a widely used method for detecting patients at risk for Lynch syndrome. Recent data suggest that a two-antibody panel approach using PMS2 and MSH6 is an effective screening protocol for colorectal carcinoma, but there are limited data concerning this approach for extraintestinal tumors. The purpose of this study was to review the utility of a two-antibody panel approach in colorectal carcinoma and extraintestinal tumors. We evaluated mismatch repair protein expression in two cohorts: (1) a retrospective analysis of intestinal and extraintestinal tumors (n=334) tested for mismatch repair protein immunohistochemistry and (2) a prospectively accrued series of intestinal, gynecologic tract, and skin sebaceous neoplasms (n=98). A total of 432 cases were analyzed, including 323 colorectal, 50 gynecologic tract, 49 skin sebaceous, and 10 other neoplasms. Overall, 102/432 tumors (24%) demonstrated loss of at least one mismatch repair protein. Concurrent loss of MLH1 and PMS2 was the most common pattern of abnormal expression (50/432, 12%) followed by concurrent loss of MSH2 and MSH6 (33/432, 8%). Of 55 cases with abnormal PMS2 expression, 5 (9%) demonstrated isolated loss of PMS2 expression. Of 47 cases with abnormal MSH6 expression, 14 (30%) demonstrated isolated loss of MSH6 expression. Isolated loss of MLH1 or MSH2 was not observed. Colorectal carcinomas more frequently demonstrated abnormal expression of PMS2 (39/59, 66%). Skin sebaceous neoplasms more frequently demonstrated abnormal expression of MSH6 (18/24, 75%, respectively). A total of 65 tumors with abnormal mismatch repair protein expression were tested for microsatellite instability (MSI): 47 (72%) MSI high, 9 (14%) MSI low, and 9 (14%) microsatellite stable (MSS). Abnormal MSH6 expression accounted for 14/18 (78%) cases that were MSS or MSI low. Our findings confirm the utility of a two-antibody approach using PMS2 and MSH6 in colorectal carcinoma and indicate that this approach is effective in extraintestinal neoplasms associated with Lynch syndrome.
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Landis MN, Davis CL, Bellus GA, Wolverton SE. Immunosuppression and sebaceous tumors: a confirmed diagnosis of Muir-Torre syndrome unmasked by immunosuppressive therapy. J Am Acad Dermatol 2011; 65:1054-1058.e1. [PMID: 21550136 DOI: 10.1016/j.jaad.2010.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 07/30/2010] [Accepted: 08/08/2010] [Indexed: 10/18/2022]
Abstract
Muir-Torre syndrome (MTS) is an autosomal dominant genodermatosis caused by mutations in the DNA mismatch repair genes MLH1 and MSH2. This case describes a patient with an extensive family history of colon cancer who experienced the onset of multiple sebaceous adenomas and carcinomas after undergoing kidney transplantation and receiving immunosuppressive therapy. The finding of deficient MSH2 expression in the immunohistochemical analysis of a sebaceous carcinoma prompted genetic testing for a systemic mutation in the mismatch repair gene. A systemic mutation of the MSH2 gene was detected and, despite the absence of a visceral malignancy, the diagnosis of MTS was made. Immunosuppression has previously been thought to play a possible role in unmasking a latent MTS phenotype in transplant recipients, but systemic mutations have not previously been analyzed. The relationship between immunosuppression and sebaceous tumors with the possibility of unmasking a MTS phenotype in transplant recipients is discussed.
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Affiliation(s)
- Megan N Landis
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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