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Solomon DA, Ramani B, Eiger-Moscovich M, Milman T, Uludag G, Crawford JB, Phan I, Char DH, Shields CL, Eagle RC, Bastian BC, Bloomer MM, Pekmezci M. Iris and Ciliary Body Melanocytomas Are Defined by Solitary GNAQ Mutation Without Additional Oncogenic Alterations. Ophthalmology 2022; 129:1429-1439. [PMID: 35835335 DOI: 10.1016/j.ophtha.2022.07.002] [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: 03/15/2022] [Revised: 06/20/2022] [Accepted: 07/05/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To analyze the genetic features of melanocytomas and melanomas of the anterior uvea and assess the value of molecular testing for diagnosis and prognostication. DESIGN Retrospective case-control study. SUBJECTS Patients with melanocytoma (n = 16) and melanoma (n = 19) of the anterior uvea. METHODS Targeted next-generation sequencing was performed on formalin-fixed, paraffin-embedded tumor tissue from anterior uveal melanocytic tumors and correlated with clinicopathologic features. MAIN OUTCOME MEASURES Presence or absence of accompanying oncogenic alterations beyond GNAQ/GNA11 and their association with histologic features and local recurrence. RESULTS Hotspot missense mutations in GNAQ/GNA11 were identified in 91% (32/35) of all cases. None of the melanocytomas with or without atypia demonstrated chromosomal imbalances or additional oncogenic variants beyond GNAQ mutation, and none recurred over a median follow-up of 36 months. Additional alterations identified in a subset of melanomas include mutations in BAP1 (n = 3), EIF1AX (n = 4), SRSF2 (n = 1), PTEN (n = 1), and EP300 (n = 1); monosomy 3p (n = 6); trisomy 6p (n = 3); trisomy 8q (n = 2); and an ultraviolet mutational signature (n = 5). Local recurrences were limited to melanomas, all of which demonstrated oncogenic alterations in addition to GNAQ/GNA11 (n = 5). A single melanoma harboring GNAQ and BAP1 mutations and monosomy 3 was the only tumor that metastasized. CONCLUSIONS In this study, anterior segment uveal melanocytomas did not display oncogenic alterations beyond GNAQ/GNA11. Therefore, they are genetically similar to uveal nevi rather than uveal melanoma based on their molecular features known from the literature. Molecular testing can be performed on borderline cases to aid risk stratification and clinical management decisions.
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Affiliation(s)
- David A Solomon
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Biswarathan Ramani
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - Maya Eiger-Moscovich
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gunay Uludag
- Department of Pathology, University of California, San Francisco, San Francisco, California
| | - J Brooks Crawford
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Isabella Phan
- Department of Ophthalmology, Kaiser Permanente San Francisco, San Francisco, California
| | - Devron H Char
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ralph C Eagle
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Boris C Bastian
- Department of Pathology, University of California, San Francisco, San Francisco, California; Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Michele M Bloomer
- Department of Pathology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
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Van Trigt WK, Kelly KM, Hughes CCW. GNAQ mutations drive port wine birthmark-associated Sturge-Weber syndrome: A review of pathobiology, therapies, and current models. Front Hum Neurosci 2022; 16:1006027. [PMID: 36405075 PMCID: PMC9670321 DOI: 10.3389/fnhum.2022.1006027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Port-wine birthmarks (PWBs) are caused by somatic, mosaic mutations in the G protein guanine nucleotide binding protein alpha subunit q (GNAQ) and are characterized by the formation of dilated, dysfunctional blood vessels in the dermis, eyes, and/or brain. Cutaneous PWBs can be treated by current dermatologic therapy, like laser intervention, to lighten the lesions and diminish nodules that occur in the lesion. Involvement of the eyes and/or brain can result in serious complications and this variation is termed Sturge-Weber syndrome (SWS). Some of the biggest hurdles preventing development of new therapeutics are unanswered questions regarding disease biology and lack of models for drug screening. In this review, we discuss the current understanding of GNAQ signaling, the standard of care for patients, overlap with other GNAQ-associated or phenotypically similar diseases, as well as deficiencies in current in vivo and in vitro vascular malformation models.
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Affiliation(s)
- William K. Van Trigt
- Department of Molecular Biology and Biochemistry, School of Biological Sciences, University of California, Irvine, Irvine, CA, United States,*Correspondence: William K. Van Trigt,
| | - Kristen M. Kelly
- Department of Dermatology, School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Christopher C. W. Hughes
- Department of Molecular Biology and Biochemistry, School of Biological Sciences, University of California, Irvine, Irvine, CA, United States,Christopher C. W. Hughes,
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Genetic Alterations in Melanocytoma Associated with Oculodermal Melanocytosis. Ophthalmic Plast Reconstr Surg 2021; 38:e77-e80. [DOI: 10.1097/iop.0000000000002115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Francis JH, Milman T, Grossniklaus H, Albert D, Folberg R, Levitin G, Coupland S, Catalanotti F, Rabady D, Kandoth C, Busam K, Abramson D. GNAQ Mutations in Diffuse and Solitary Choroidal Hemangiomas. Ophthalmology 2018; 126:759-763. [PMID: 30537484 DOI: 10.1016/j.ophtha.2018.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 12/16/2022] Open
Abstract
PURPOSE GNAQ mutations have been identified in port wine stains (both syndromic and nonsyndromic) and melanocytic ocular neoplasms. This study investigates the presence of GNAQ mutations in diffuse (those associated with Sturge-Weber syndrome [SWS]) and solitary choroidal hemangiomas. PARTICIPANTS Tissue from 11 patients with the following diagnoses: port wine stain (n = 3), diffuse choroidal hemangioma (n = 1), solitary choroidal hemangioma (n = 6), and choroidal nevus (n = 1). METHODS Ten specimens were interrogated with Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets, a hybridization capture-based next-generation sequencing assay for targeted deep sequencing of all exons and selected introns of 468 key cancer genes in formalin-fixed, paraffin-embedded tumors. Digital polymerase chain reaction was used to detect GNAQ Q209 mutation in 1 specimen. MAIN OUTCOME MEASURES Detection of GNAQ codon-specific mutation. RESULTS Activating somatic GNAQ mutations (c.547C > T; p.Arg183Cys) were found in 100% (3 of 3) of the port wine stain and in the diffuse choroidal hemangioma. Somatic GNAQ mutations (c.626A > T; p.Gln209Leu) were found in 100% (6 of 6) of the solitary choroidal hemangiomas and (c.626A > C; p.Gln209Pro) in the choroidal nevus. CONCLUSIONS GNAQ mutations occur in both diffuse and solitary hemangiomas, although at distinct codons. An R183 codon is mutant in diffuse choroidal hemangiomas, consistent with other Sturge-Weber vascular malformations. By contrast, solitary choroidal hemangiomas have mutations in the Q209 codon, similar to other intraocular melanocytic neoplasms.
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Affiliation(s)
- Jasmine H Francis
- Memorial Sloan-Kettering Cancer Center, New York, New York; Weill Cornell Medical Center, New York, New York.
| | - Tatyana Milman
- Departments of Ophthalmology and Pathology, Wills Eye Hospital and Thomas Jefferson University Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Hans Grossniklaus
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Daniel Albert
- McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, Wisconsin
| | - Robert Folberg
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Gregory Levitin
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Sarah Coupland
- Department of Cellular and Molecular Medicine, University of Liverpool, Liverpool, United Kingdom
| | | | - David Rabady
- Ophthalmic Consultants of the Capital Region, Albany, New York
| | - Cyriac Kandoth
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Klaus Busam
- Memorial Sloan-Kettering Cancer Center, New York, New York; Weill Cornell Medical Center, New York, New York
| | - David Abramson
- Memorial Sloan-Kettering Cancer Center, New York, New York; Weill Cornell Medical Center, New York, New York
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Francis JH, Grossniklaus HE, Habib LA, Marr B, Abramson DH, Busam KJ. BRAF, NRAS, and GNAQ Mutations in Conjunctival Melanocytic Nevi. Invest Ophthalmol Vis Sci 2018; 59:117-121. [PMID: 29332123 PMCID: PMC6110167 DOI: 10.1167/iovs.17-22517] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate BRAF, NRAS, and GNAQ mutations in surgical specimens of common and blue conjunctival melanocytic nevi. Methods Surgical specimens from 25 conjunctival melanocytic nevi (23 common and 2 blue) of 25 patients were evaluated. All common nevi were analyzed immunohistochemically for the expression of BRAF V600E or NRAS Q61R. One lesion with negative immunoreactivity and for all blue nevi, a hybridization capture-based next-generation sequencing method was employed for mutation analysis. For common nevi, genetic features were compared with clinical and histopathologic findings. Continuous variables (age at excision and largest basal diameter) were compared with a Students's t-test and all categoric variables were compared with Fisher's Exact Test. Results Of common melanocytic nevi, 9 (39.1%) were immunoreactive for NRASQ61R and 13 (56.5%) were immunoreactive for BRAFV600E. One common nevus, which was immunonegative for both BRAFV600E and NRASQ61R was found to harbor an NRASQ61K mutation by sequence analysis. Patients with NRAS-mutated nevi were more likely to report occurrence of the lesion prior to 18-years old and more likely to have intrinsic cysts. The mean largest basal diameter was 6.0 and 3.5 mm for NRAS- and BRAF-immunoreactive lesions, respectively (P = 0.003). GNAQ mutations were identified in each of the two blue nevi of this study. Conclusions These findings document that common conjunctival melanocytic nevi have mutually exclusive mutations in BRAF and NRAS. The two conjunctival blue nevi harbored GNAQ mutations. This suggests the driver mutations of conjunctival nevi are similar to those of nevi of the skin. At the molecular level, conjunctival nevi appear more like cutaneous nevi than choroidal nevi.
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Affiliation(s)
- Jasmine H Francis
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States.,Department of Ophthalmology, Weill-Cornell Medical Center, New York, New York, United States
| | - Hans E Grossniklaus
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Larissa A Habib
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Brian Marr
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States.,Department of Ophthalmology, Weill-Cornell Medical Center, New York, New York, United States
| | - David H Abramson
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States.,Department of Ophthalmology, Weill-Cornell Medical Center, New York, New York, United States
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States.,Department of Pathology, Weill-Cornell Medical Center, New York, New York, United States
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Abstract
Cutaneous melanoma (CM) and uveal melanoma (UM) derive from cutaneous and uveal melanocytes that share the same embryonic origin and display the same cellular function. However, the etiopathogenesis and biological behaviors of these melanomas are very different. CM and UM display distinct landscapes of genetic alterations and show different metastatic routes and tropisms. Hence, therapeutic improvements achieved in the last few years for the treatment of CM have failed to ameliorate the clinical outcomes of patients with UM. The scope of this review is to discuss the differences in tumorigenic processes (etiologic factors and genetic alterations) and tumor biology (gene expression and signaling pathways) between CM and UM. We develop hypotheses to explain these differences, which might provide important clues for research avenues and the identification of actionable vulnerabilities suitable for the development of new therapeutic strategies for metastatic UM.
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Affiliation(s)
- Charlotte Pandiani
- U1065, Institut National de la Santé et de la Recherche Médicale Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, 06200 Nice, France
| | - Guillaume E Béranger
- U1065, Institut National de la Santé et de la Recherche Médicale Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, 06200 Nice, France
| | - Justine Leclerc
- U1065, Institut National de la Santé et de la Recherche Médicale Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, 06200 Nice, France
| | - Robert Ballotti
- U1065, Institut National de la Santé et de la Recherche Médicale Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, 06200 Nice, France
| | - Corine Bertolotto
- U1065, Institut National de la Santé et de la Recherche Médicale Centre Méditerranéen de Médecine Moléculaire, Université Côte d'Azur, 06200 Nice, France
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