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Abdelmaksoud-Dammak R, Ammous-Boukhris N, BenAyed-Guerfali D, Gdoura Y, Boujelben I, Guidara S, Charfi S, Boudabbous W, Ammar S, Rhaiem W, Boudawara MZ, Kamoun H, Sallemi-Boudawara T, Mhiri R, Mokdad-Gargouri R. Strategies for diagnosis and management of CMMRD in low-resource countries: report of a Tunisian family. Fam Cancer 2024:10.1007/s10689-024-00386-z. [PMID: 38687438 DOI: 10.1007/s10689-024-00386-z] [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: 11/17/2023] [Accepted: 03/30/2024] [Indexed: 05/02/2024]
Abstract
Constitutional Mismatch Repair Deficiency (CMMRD) is a rare childhood cancer predisposition syndrome, caused by biallelic pathogenic germline variants in the mismatch repair genes. Diagnosis and management of this syndrome is challenging, especially in low-resource settings. This study describes a patient diagnosed with colorectal cancer and grade 3 astrocytoma at the age of 11 and 12 respectively. Immunohistochemistry analysis showed a loss of MSH2 and MSH6 protein expression in CRC tissues of the patient. We identified by Targeted Exome Sequencing a homozygous pathogenic germline variant in exon 9 of the MSH6 gene (c.3991 C > T; p.Ala1268Glyfs*6). Genetic investigation of the family showed that the father was heterozygous for the identified pathogenic variant while the brother was wild type for this variant. Our study highlights the importance of a correct and timely diagnosis of CMMRD which can have implications for treatment. It also underlines the imperative need to enhance awareness, diagnostic standards, and surveillance that are crucial for patients and their families.
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Affiliation(s)
- Rania Abdelmaksoud-Dammak
- Department of Cancer Genetics, Laboratory of Molecular Biotechnology of Eukaryotes, Center of Biotechnology of Sfax, University of Sfax BPK 1177, Sfax, 3018, Tunisia
| | - Nihel Ammous-Boukhris
- Department of Cancer Genetics, Laboratory of Molecular Biotechnology of Eukaryotes, Center of Biotechnology of Sfax, University of Sfax BPK 1177, Sfax, 3018, Tunisia
| | - Dorra BenAyed-Guerfali
- Department of Cancer Genetics, Laboratory of Molecular Biotechnology of Eukaryotes, Center of Biotechnology of Sfax, University of Sfax BPK 1177, Sfax, 3018, Tunisia
| | - Yassine Gdoura
- Department of Neurosurgery, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Imen Boujelben
- Department of Human Genetics, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Souhir Guidara
- Department of Human Genetics, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Slim Charfi
- Department of Anatomopathology, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Wiem Boudabbous
- Department of Neurosurgery, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Saloua Ammar
- Department of Pediatric Surgery, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Wiem Rhaiem
- Department of Pediatric Surgery, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | | | - Hassen Kamoun
- Department of Human Genetics, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | | | - Riadh Mhiri
- Department of Pediatric Surgery, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Raja Mokdad-Gargouri
- Department of Cancer Genetics, Laboratory of Molecular Biotechnology of Eukaryotes, Center of Biotechnology of Sfax, University of Sfax BPK 1177, Sfax, 3018, Tunisia.
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Akrout F, Achour A, Tops CMJ, Gallon R, Meddeb R, Achoura S, Ben Rekaya M, Hamdeni E, Rammeh S, Chkili R, Mansouri N, Belguith N, Mrad R. Constitutional mismatch repair deficiency syndrome with atypical features caused by a homozygous MLH1 missense variant (c.1918C>A, p.(Pro640Thr)): a case report. Front Oncol 2023; 13:1195814. [PMID: 37664053 PMCID: PMC10471184 DOI: 10.3389/fonc.2023.1195814] [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: 03/29/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
Constitutional mismatch repair deficiency (CMMRD) syndrome is a rare autosomal recessive genetic disorder caused by biallelic germline mutations in one of the mismatch repair genes. Carriers are at exceptionally high risk for developing, typically in early life, hematological and brain malignancies, as well as cancers observed in Lynch syndrome. We report a homozygous MLH1 missense variant (c.1918C>A p.(Pro640Thr)) in a Tunisian patient with CMMRD syndrome and a family history of early-age colorectal cancer. The proband presented initially with colonic oligopolyposis and adenosquamous carcinoma of the caecum. He later developed several malignancies, including undifferentiated carcinoma of the parotid, grade 4 IDH-mutant astrocytoma, and ampulla of Vater adenocarcinoma. The patient was older than typical for this disease and had a remarkably prolonged survival despite developing four distinct aggressive malignancies. The current report highlights the challenges in assessing the pathogenicity of the identified variant and the remarkable phenotypic diversity in CMMRD.
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Affiliation(s)
- Firas Akrout
- Department of Neurosurgery, Military Hospital of Tunis, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ahlem Achour
- Department of Congenital and Hereditary Diseases, Charles Nicolle Hospital, Tunis, Tunisia
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
- Laboratory of Human Genetics, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Carli M. J. Tops
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | - Richard Gallon
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rym Meddeb
- Department of Congenital and Hereditary Diseases, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory of Human Genetics, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Sameh Achoura
- Department of Neurosurgery, Military Hospital of Tunis, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mariem Ben Rekaya
- Research Unit of Onco-theranostic Biomarkers UR17ES15, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Emna Hamdeni
- Research Unit of Onco-theranostic Biomarkers UR17ES15, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Soumaya Rammeh
- Research Unit of Onco-theranostic Biomarkers UR17ES15, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ridha Chkili
- Department of Neurosurgery, Military Hospital of Tunis, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nada Mansouri
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Pathology, Military Hospital of Tunis, Tunis, Tunisia
| | - Neila Belguith
- Department of Congenital and Hereditary Diseases, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory of Human Molecular Genetics, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Ridha Mrad
- Department of Congenital and Hereditary Diseases, Charles Nicolle Hospital, Tunis, Tunisia
- Laboratory of Human Genetics, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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He L, Wang X, Jin Y, Xu W, Lyu J, Guan Y, Wu J, Han S, Liu G. A Prognostic Nomogram for Predicting Overall Survival in Pediatric Wilms Tumor Based on an Autophagy-related Gene Signature. Comb Chem High Throughput Screen 2021; 25:1385-1397. [PMID: 34525929 DOI: 10.2174/1386207324666210826143727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 04/15/2021] [Accepted: 05/05/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Wilms tumor (WT) is the most common primary renal malignancy in children. Autophagy plays dual roles in the promotion and suppression of various cancers. OBJECTIVE The goal of our study was to develop a novel autophagy-related gene (ARG) prognostic nomogram for WT. METHODS The Cancer Genome Atlas (TCGA) database was used. We screened the expression profiles of ARGs in 136 WT patients. The differentially expressed prognostic ARGs were evaluated by multivariate Cox regression analysis and survival analysis. A novel prognostic nomogram based on the ARGs and clinical characteristics was established using multivariate Cox regression analysis. RESULTS First, 69 differentially expressed ARGs were identified in WT patients. Then, multivariate Cox regression analysis was used to determine 4 key prognostic ARGs (CC3CL1, ERBB2, HIF-α and CXCR4) in WT. According to their ARG expression levels, the patients were clustered into high- and low-risk groups. Next, survival analysis indicated that high-risk patients had significantly poorer overall survival than low-risk patients. The results of functional enrichment analysis suggested that autophagy may play a tumor-suppressive role in the initiation of WT. Finally, a prognostic nomogram with a Harrell's concordance index (C-index) of 0.841 was used to predict the survival probability of WT patients by integrating clinical characteristics and the 4-ARG signature. The calibration curve indicated its excellent predictive performance. CONCLUSION In summary, the ARG signature could be a promising biomarker for monitoring the outcomes of WT. We established a novel nomogram based on the ARG signature, which accurately predicts the overall survival of WT patients.
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Affiliation(s)
- Longkai He
- Department of Pediatrics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong. China
| | - Xiaotong Wang
- Department of Pediatrics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong. China
| | - Ya Jin
- Department of Pediatrics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong. China
| | - Weipeng Xu
- Department of Pediatrics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong. China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong. China
| | - Yi Guan
- Department of Pediatrics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong. China
| | - Jingchao Wu
- Department of Pediatrics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong. China
| | - Shasha Han
- Department of Pediatrics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong. China
| | - Guosheng Liu
- Department of Pediatrics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong. China
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