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Niedziela M, Muchantef K, Foulkes WD. Ultrasound features of multinodular goiter in DICER1 syndrome. Sci Rep 2022; 12:15888. [PMID: 36151231 PMCID: PMC9508228 DOI: 10.1038/s41598-022-19709-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 09/02/2022] [Indexed: 11/11/2022] Open
Abstract
DICER1 syndrome is caused by germline pathogenic mutations in the DICER1 gene. Multinodular goiter (MNG) is a common clinical feature of DICER1 syndrome in children and adults. The aim of this study was to determine the ultrasound (US) characteristics of MNG in patients with DICER1 syndrome. This retrospective study evaluated thyroid US in patients with DICER1 germline mutations (DICER1mut+) performed between 2011 and 2018 at a single center by the same pediatric endocrinologist, and the images were re-examined by an independent pediatric radiologist from another academic center. Patients < 18 years with DICER1mut+ and DICER1mut+ parents without previous thyroidectomy were included. Ultrasound phenotypes of MNG in the setting of DICER1 mutations were compared with known US features of thyroid malignancy. Thirteen DICER1mut+ patients were identified (10 children, 3 adults). Three children had a normal thyroid US; therefore, thyroid abnormalities were assessed in seven children and three adults. In both children and adults, multiple (≥ 3) mixed (cystic/solid) nodules predominated with single cystic, single cystic septated and single solid nodules, occasionally with a “spoke-like” presentation. All solid lesions were isoechogenic, and in only one with multiple solid nodules, intranodular blood flow on power/color Doppler was observed. Remarkably, macrocalcifications were present in all three adults. The spectrum of ultrasonographic findings of MNG in DICER1mut+ patients is characteristic and largely distinct from typical features of thyroid malignancy and therefore should inform physicians performing thyroid US of the possible presence of underlying DICER1 syndrome.
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Affiliation(s)
- Marek Niedziela
- Institute of Pediatrics, Department of Pediatric Endocrinology and Rheumatology, Karol Jonscher's Clinical Hospital, Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572, Poznan, Poland.
| | - Karl Muchantef
- Department of Radiology, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - William D Foulkes
- Department of Human Genetics, McGill University, Montreal, Canada.,Department of Medical Genetics, McGill University Health Centre, Montreal, QC, Canada.,Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
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2
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Bakhuizen JJ, Hanson H, van der Tuin K, Lalloo F, Tischkowitz M, Wadt K, Jongmans MCJ. Surveillance recommendations for DICER1 pathogenic variant carriers: a report from the SIOPE Host Genome Working Group and CanGene-CanVar Clinical Guideline Working Group. Fam Cancer 2021; 20:337-348. [PMID: 34170462 PMCID: PMC8484187 DOI: 10.1007/s10689-021-00264-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/19/2021] [Indexed: 12/15/2022]
Abstract
DICER1 syndrome is a rare genetic disorder that predisposes to a wide spectrum of tumors. Developing surveillance protocols for this syndrome is challenging because uncertainty exists about the clinical efficacy of surveillance, and appraisal of potential benefits and harms vary. In addition, there is increasing evidence that germline DICER1 pathogenic variants are associated with lower penetrance for cancer than previously assumed. To address these issues and to harmonize DICER1 syndrome surveillance programs within Europe, the Host Genome Working Group of the European branch of the International Society of Pediatric Oncology (SIOPE HGWG) and Clinical Guideline Working Group of the CanGene-CanVar project in the United Kingdom reviewed current surveillance strategies and evaluated additional relevant literature. Consensus was achieved for a new surveillance protocol and information leaflet that informs patients about potential symptoms of DICER1-associated tumors. The surveillance protocol comprises a minimum program and an extended version for consideration. The key recommendations of the minimum program are: annual clinical examination from birth to age 20 years, six-monthly chest X-ray and renal ultrasound from birth to age 6 years, and thyroid ultrasound every 3 years from age 8 to age 40 years. The surveillance program for consideration comprises additional surveillance procedures, and recommendations for DICER1 pathogenic variant carriers outside the ages of the surveillance interval. Patients have to be supported in choosing the surveillance program that best meets their needs. Prospective evaluation of the efficacy and patient perspectives of proposed surveillance recommendations is required to expand the evidence base for DICER1 surveillance protocols.
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Affiliation(s)
- Jette J Bakhuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Genetics, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Helen Hanson
- Department of Clinical Genetics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Karin van der Tuin
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Fiona Lalloo
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Karin Wadt
- Department of Clinical Genetics, Copenhagen University Hospital Righospitalet, Copenhagen, Denmark
| | - Marjolijn C J Jongmans
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands. .,Department of Genetics, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
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3
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Bisogno G, Sarnacki S, Stachowicz-Stencel T, Minard-Colin V, Ferrari A, Godzinski J, Gauthier-Villars M, Bien E, Hameury F, Helfre S, Schneider DT, Reguerre Y, Almaraz RL, Janic D, Cesen M, Kolenova A, Rascon J, Martinova K, Cosnarovici R, Pourtsidis A, Ben-Ami T, Roganovic J, Koscielniak E, Schultz KAP, Brecht IB, Orbach D. Pleuropulmonary blastoma in children and adolescents: The EXPeRT/PARTNER diagnostic and therapeutic recommendations. Pediatr Blood Cancer 2021; 68 Suppl 4:e29045. [PMID: 33826235 PMCID: PMC9813943 DOI: 10.1002/pbc.29045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 01/11/2023]
Abstract
Pleuropulmonary blastoma (PPB) is a rare cancer occurring mainly during early childhood and often associated with germline DICER1 mutations. It is classified by the macroscopic appearance into three interrelated clinico-pathologic entities on a developmental continuum. Complete tumor resection is a main prognostic factor and can be performed at diagnosis or after neoadjuvant treatment that includes chemotherapy and in some cases radiotherapy. Optimal modalities of neo- or adjuvant treatments can be challenging taking into account potential long-term toxicities in this young population. This paper presents the recommendations for diagnosis and treatment of children and adolescents with PPB elaborated by the European Cooperative Study Group for Pediatric Rare Tumors (EXPeRT) within the European Union-funded project PARTNER (Paediatric Rare Tumours Network - European Registry).
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Affiliation(s)
- Gianni Bisogno
- Hematology-Oncology Division, Department of Women’s and Children’s Health, Padova University Hospital, Italy
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
| | | | - V Minard-Colin
- Department of Paediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Jan Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Wroclaw, Poland
| | - Marion Gauthier-Villars
- Department of Genetics, Institut Curie, Paris, France; Paris Sciences Lettres Research University, Paris, France
| | - Ewa Bien
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Poland
| | - Frederic Hameury
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant, Lyon, France
| | | | | | - Yves Reguerre
- Pediatric Hematology-Oncology Department, Centre Hospitalier Universitaire, Saint Denis de La Réunion, France
| | - Ricardo Lopez Almaraz
- Pediatric Oncology- Hematology Unit, University Hospital of Cruces, Barakaldo-Bizkaia, Spain
| | - Dragana Janic
- Department of Hematology and Oncology, University Children's Hospital, University of Belgrade, Belgrade, Serbia
| | - Maja Cesen
- University Medical Centre, Ljubljana, Slovenia
| | - Alexandra Kolenova
- Department of Pediatric Hematology and Oncology, National Institute of Children's Diseases and Comenius University Bratislava, 833 40 Bratislava, Slovakia
| | - Jelena Rascon
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Kata Martinova
- Department of Hematology and Oncology, University Clinic for Children`s Diseases, Medical Faculty, Ss Cyril and Methodius University of Skopje, Republic of North Macedonia
| | - Rodica Cosnarovici
- Oncology Institute ”Prof. dr. Ion Chiricuta”, Oncopediatric Department, Cluj-Napoca, Romania
| | - Apostolos Pourtsidis
- Oncology Department, P. and A. Kyriakou Children's Hospital, 115 27 Athens, Greece
| | - Tal Ben-Ami
- Pediatric Hematology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Jelena Roganovic
- Department of Pediatrics, Clinical Hospital Center Rijeka, University of Rijeka, Croatia
| | - Ewa Koscielniak
- Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart - Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart, Germany
| | - Kris Ann P. Schultz
- International PPB/DICER1 Registry, Cancer and Blood Disorders, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Ines B. Brecht
- Pediatric Hematology and Oncology, Children’s Hospital, Eberhard-Karls-Universitaet Tuebingen, Germany
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with cancer), Institut Curie, PSL University, Paris, France
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4
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Guillerman RP, Foulkes WD, Priest JR. Imaging of DICER1 syndrome. Pediatr Radiol 2019; 49:1488-1505. [PMID: 31620849 DOI: 10.1007/s00247-019-04429-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/28/2019] [Accepted: 05/14/2019] [Indexed: 02/06/2023]
Abstract
DICER1 syndrome is a highly pleiotropic tumor predisposition syndrome that has been increasingly recognized in the last 10 years. Diseases in the syndrome result from mutations in both copies of the gene DICER1, a highly conserved gene that is critically implicated in micro-ribonucleic acid (miRNA) biogenesis and hence modulation of messenger RNAs. In general, susceptible individuals carry an inherited germline mutation that disables one copy of DICER1; within tumors, a very characteristic second mutation alters function of the other gene copy. About 20 hamartomatous, hyperplastic or neoplastic conditions comprise DICER1 syndrome. Most are not life-threatening, but some are aggressive malignancies. There are many unaffected carriers because penetrance is generally low; however, clinically occult thyroid nodules and lung cysts are frequent. Rare diseases of early childhood were the first recognized conditions in DICER1 syndrome, while other conditions affect adolescents and adults. The hallmarks of DICER1 syndrome are certain rare tumors including pleuropulmonary blastoma; cystic nephroma; ovarian Sertoli-Leydig cell tumor; sarcomas of the cervix, kidneys and cerebrum; pituitary blastoma; ciliary body medulloepithelioma; and nasal chondromesenchymal hamartoma. Radiologists are often the first practitioners to observe these diverse manifestations and play a primary role in recognizing DICER1 syndrome.
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Affiliation(s)
- R Paul Guillerman
- Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA.
| | - William D Foulkes
- Department of Human Genetics, McGill University, Lady Davis Institute, Segal Cancer Centre,, Jewish General Hospital,, Montreal, QC, Canada
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5
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Lichtenberger JP, Biko DM, Carter BW, Pavio MA, Huppmann AR, Chung EM. Primary Lung Tumors in Children: Radiologic-Pathologic Correlation From the Radiologic Pathology Archives. Radiographics 2019; 38:2151-2172. [PMID: 30422774 DOI: 10.1148/rg.2018180192] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Primary lung tumors in children are rare, with a narrow range of diagnostic considerations. However, the overlapping imaging appearances of these tumors necessitate attention to key discriminating imaging and pathologic features. In the neonate and infant, the important considerations include pleuropulmonary blastoma (PPB), infantile fibrosarcoma, and fetal lung interstitial tumor. Among these tumors, imaging findings such as air-filled cysts in type 1 PPB and homogeneously low attenuation of fetal lung interstitial tumors are relatively specific. Key pathologic and genetic discriminators among this group of tumors include the DICER1 germline mutation found in PPB and the t(12,15)(p13;q25) translocation and ETV6-NTRK3 fusion gene seen in infantile fibrosarcoma. Primary lung tumors in older children include inflammatory myofibroblastic tumors (IMTs), carcinoid salivary gland-type tumors of the lung, recurrent respiratory papillomatosis, and other rare entities. IMT, a spindle-cell proliferation with inflammatory elements, is the most common lung tumor in children. Anaplastic lymphoma kinase, a receptor-type protein tyrosine kinase, is present in 50% of these tumors, and this finding may support an imaging diagnosis of IMT. Carcinoid tumors account for a substantial portion of childhood lung tumors, and their characteristic avid enhancement on images corresponds to the compressed fibrovascular stroma histologically. Furthermore, novel imaging agents used with somatostatin receptor analogs have an emerging role in the evaluation of carcinoid tumors. Although less common than mucoepidermoid carcinoma, adenoid cystic carcinoma tends to recur given the perineural spread seen histologically. Integrating radiologic and pathologic knowledge is critical to accurate diagnosis, treatment planning, and surveillance of primary lung tumors in children.
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Affiliation(s)
- John P Lichtenberger
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
| | - David M Biko
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
| | - Brett W Carter
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
| | - Michael A Pavio
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
| | - Alison R Huppmann
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
| | - Ellen M Chung
- From the Department of Radiology and Radiological Sciences (J.P.L., E.M.C.) and Department of Pathology (J.P.L., A.R.H., E.M.C.), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814; Thoracic Radiology Section (J.P.L., D.M.B.) and Pediatric Radiology Section (D.M.B., E.M.C.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa (D.M.B.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.W.C.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (M.A.P.)
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6
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Knight S, Knight T, Khan A, Murphy AJ. Current Management of Pleuropulmonary Blastoma: A Surgical Perspective. CHILDREN-BASEL 2019; 6:children6080086. [PMID: 31349569 PMCID: PMC6721434 DOI: 10.3390/children6080086] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/09/2019] [Accepted: 07/20/2019] [Indexed: 12/25/2022]
Abstract
Pleuropulmonary blastomas (PPB) are pediatric, embryonal cancers of the lung parenchyma and pleural surfaces and are among the most common DICER1-related disorders. These tumors undergo evolution through several forms, allowing division into types I, Ir, II, and III, with correlates to the age of diagnosis and prognosis. We sought to provide a comprehensive review of the relevant literature describing the characteristics of these tumors and their multidisciplinary treatment, with an emphasis on surgical management. We describe the complementary roles of chemotherapy and surgery in the successful management of this disease. We discuss the timing of surgery and options for surgical approaches. We address the differentiation of PPB from congenital pulmonary airway malformation and the role of DICER1 testing for children with pulmonary cysts.
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Affiliation(s)
- Samantha Knight
- Southern Illinois University School of Medicine, Division of Surgery, Department of General Surgery, Springfield, IL 62702, USA.
| | - Tristan Knight
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI 48201, USA
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Amir Khan
- Southern Illinois University School of Medicine, Division of Surgery, Department of General Surgery, Springfield, IL 62702, USA
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA.
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Sertoli-Leydig Cell Tumour and DICER1 Mutation: A Case Report and Review of the Literature. Case Rep Obstet Gynecol 2018; 2018:7927362. [PMID: 30356399 PMCID: PMC6176314 DOI: 10.1155/2018/7927362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/06/2018] [Indexed: 12/13/2022] Open
Abstract
Sertoli-Leydig cell tumours of the ovary (SLCT) are rare tumours predominantly caused by mutations in the DICER1 gene. We present a patient with a unilateral SLCT who had an underlying germline DICER1 gene mutation. We discuss the underlying pathology, risks, and screening opportunities available to those with a mutation in this gene as SLCT is only one of a multitude of other tumours encompassing DICER1 syndrome. The condition is inherited in an autosomal dominant fashion. As such, genetic counselling is a key component of the management of women with SLCT.
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8
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Moke DJ, Thomas SM, Hiemenz MC, Nael A, Wang K, Shillingford N, Biegel JA, Mascarenhas L. Three synchronous malignancies in a patient with DICER1 syndrome. Eur J Cancer 2018; 93:140-143. [PMID: 29395683 DOI: 10.1016/j.ejca.2017.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 12/21/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Diana J Moke
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Stefanie M Thomas
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Matthew C Hiemenz
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ali Nael
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kasper Wang
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Nick Shillingford
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jaclyn A Biegel
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Leo Mascarenhas
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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9
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van Engelen K, Villani A, Wasserman JD, Aronoff L, Greer MLC, Tijerin Bueno M, Gallinger B, Kim RH, Grant R, Meyn MS, Malkin D, Druker H. DICER1 syndrome: Approach to testing and management at a large pediatric tertiary care center. Pediatr Blood Cancer 2018; 65. [PMID: 28960912 DOI: 10.1002/pbc.26720] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/08/2017] [Accepted: 06/11/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND To expand the current knowledge of DICER1 syndrome and to propose criteria for genetic testing based on experience at a pediatric tertiary care center. PROCEDURE This study involved a retrospective chart review of the 78 patients (47 probands and 31 family members) seen in the Cancer Genetics Program at The Hospital for Sick Children (SickKids) who were offered genetic testing for DICER1. RESULTS Of 47 probands offered genetic testing for DICER1, 46 pursued testing: 11 (23.9%) carried a pathogenic variant and one proband (2.1%) carried a missense variant of uncertain significance with evidence for pathogenicity. Thirty-one family members of variant-positive probands were offered testing: eight of the 25 who agreed to testing carried their familial variant (32.0%). Overall, 20 patients were identified to have a variant in DICER1 (eight males, 12 females). Of these, 13 (65.0%) presented with clinical manifestations associated with the syndrome. The most common lesions were pleuropulmonary blastoma (PPB) (five of 20 patients, 25.0%) and pineoblastoma (three of 20 patients, 15.0%). The average age at which individuals were diagnosed with a primary neoplasm was 5.2 years (range 0.8-20 years, median 3.0). Surveillance at our institution, with a median follow-up time of 23 months, has identified PPB in two asymptomatic individuals. These lesions were identified at early stages, thus potentially reducing treatment-related morbidity and mortality. CONCLUSION This study further delineates the DICER1 syndrome phenotype and demonstrates the feasibility of a DICER1 syndrome surveillance protocol for the early detection of tumors.
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Affiliation(s)
- Kalene van Engelen
- Genetics and Genome Biology Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Anita Villani
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan D Wasserman
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura Aronoff
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Marta Tijerin Bueno
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Bailey Gallinger
- Genetics and Genome Biology Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Genetic Counselling, University of Toronto, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Raymond H Kim
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ronald Grant
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - M Stephen Meyn
- Genetics and Genome Biology Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - David Malkin
- Genetics and Genome Biology Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Harriet Druker
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Genetic Counselling, University of Toronto, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
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Schultz KAP, Harris AK, Finch M, Dehner LP, Brown JB, Gershenson DM, Young RH, Field A, Yu W, Turner J, Cost NG, Schneider DT, Stewart DR, Frazier AL, Messinger Y, Hill DA. DICER1-related Sertoli-Leydig cell tumor and gynandroblastoma: Clinical and genetic findings from the International Ovarian and Testicular Stromal Tumor Registry. Gynecol Oncol 2017; 147:521-527. [PMID: 29037807 DOI: 10.1016/j.ygyno.2017.09.034] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/25/2017] [Accepted: 09/28/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ovarian sex cord-stromal tumors (OSCST) include juvenile granulosa cell tumors (JGCT), Sertoli-Leydig cell tumor (SLCT) and gynandroblastoma (GAB) among others. These ovarian sex cord-stromal tumors as well as other tumors including pleuropulmonary blastoma (PPB) may be associated with DICER1 mutations. We sought to describe the clinical and genetic findings from the first 107 individuals enrolled in the International Ovarian and Testicular Stromal Tumor Registry. METHODS Medical and family history were obtained for individuals consecutively enrolled in the International Ovarian and Testicular Stromal Tumor Registry. Pathology was centrally reviewed. DICER1 sequencing was performed on blood and tumor tissue. RESULTS Of the 107 participants, 49 had SLCT, 25 had JGCT and 5 had GAB. Nearly all (36/37) SLCTs and 4/4 GAB tested had a DICER1 mutation in an RNase IIIb domain hotspot; approximately half of these individuals had a predisposing germline DICER1 mutation. Metachronous SLCTs were seen in 3 individuals with germline DICER1 mutations. Other DICER1-associated conditions were seen in 19% of patients with SLCT or GAB. Three children of women with SLCT were diagnosed with PPB based on genetic testing and clinical screening during the course of this study. All were diagnosed with PPB in its earliest and most curable form (Type I), were treated with surgery alone, and are alive without evidence of disease. CONCLUSIONS Recognition of the distinct genetic basis for a group of these tumors improves precise classification in difficult cases and promotes mutation-based screening and early detection.
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Affiliation(s)
- Kris Ann P Schultz
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN, United States; Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN, United States.
| | - Anne K Harris
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN, United States; Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN, United States
| | - Michael Finch
- Children's Minnesota Research Institute, Children's Minnesota, Minneapolis, MN, United States
| | - Louis P Dehner
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN, United States; Lauren V. Ackerman Division of Surgical Pathology, Washington University Medical Center, St. Louis, MO, United States
| | - Jubilee B Brown
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, United States
| | - David M Gershenson
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Robert H Young
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Amanda Field
- Department of Pathology and Center for Cancer & Immunology Research, Children's National Medical Center, Washington, DC, 20010, United States; Center for Genetic Medicine Research, Children's Research Institute, United States
| | - Weiying Yu
- Department of Pathology and Center for Cancer & Immunology Research, Children's National Medical Center, Washington, DC, 20010, United States
| | - Joyce Turner
- Division of Genetics, Children's National Medical Center, George Washington University School of Medicine & Health Sciences, Washington, DC, United States
| | - Nicholas G Cost
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN, United States; Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO, United States
| | | | - Douglas R Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD
| | - A Lindsay Frazier
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN, United States; Dana-Farber Cancer Institute/Children's Cancer and Blood Disorders Center, Boston, MA, United States
| | - Yoav Messinger
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN, United States; Cancer and Blood Disorders, Children's Minnesota, Minneapolis, MN, United States
| | - D Ashley Hill
- International Ovarian and Testicular Stromal Tumor Registry, Children's Minnesota, Minneapolis, MN, United States; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Bardón-Cancho EJ, Haro-Díaz A, Alonso-García-de la Rosa FJ, Huerta-Aragonés J, García-Morín M, González-Martínez F, Garrido-Colino C. DICER1 mutation and tumors associated with a familial tumor predisposition syndrome: practical considerations. Fam Cancer 2017; 16:291-294. [PMID: 27830405 DOI: 10.1007/s10689-016-9949-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The familial tumor predisposition syndrome known as DICER1-pleuropulmonary blastoma (PPB) or DICER1 tumor predisposition syndrome was first described in 2009, and it involves an increased risk in the occurrence of various tumors, like cystic nephroma and PPB. Here is presented a girl with a cystic nephroma and two cystic lung lesions who was diagnosed years later with the DICER1 gene mutation. This mutation was also found in one of her parents. Thus, the screening for the DICER1 gene mutation may be important in children with certain/multiple tumors and their families.
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Affiliation(s)
- Eduardo J Bardón-Cancho
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Ana Haro-Díaz
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Jorge Huerta-Aragonés
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marina García-Morín
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Carmen Garrido-Colino
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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13
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Liu DJ, Perrier R, Wei XC, Joseph JT, Strother D. Metachronous Type I pleuropulmonary blastoma and atypical choroid plexus papilloma in a young child. Pediatr Blood Cancer 2016; 63:2240-2242. [PMID: 27442759 DOI: 10.1002/pbc.26160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 06/21/2016] [Accepted: 06/26/2016] [Indexed: 11/11/2022]
Abstract
Pleuropulmonary blastoma (PPB) is a rare childhood tumor, often associated with germline DICER1 mutations and a risk for development of other benign and malignant tumors, a constellation termed DICER1 syndrome. A 1-year-old male was diagnosed with Type I PPB and screened regularly thereafter for detection of intrathoracic and intraabdominal disease. Ten months after diagnosis of PPB, he presented with headaches and vomiting. He was diagnosed with atypical choroid plexus papilloma, a lesion not previously reported with PPB. The presence of central nervous system symptoms in patients with PPB or a phenotype suggestive of DICER1 syndrome should prompt early intracranial imaging.
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Affiliation(s)
- David J Liu
- MD Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Renee Perrier
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Xing-Chang Wei
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey T Joseph
- Department of Pathology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Douglas Strother
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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14
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DICER1 deletion and 14q32 microdeletion syndrome: an additional case and a review of the literature. Clin Dysmorphol 2016; 25:37-40. [PMID: 26513514 DOI: 10.1097/mcd.0000000000000105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Abstract
Dicer is central to microRNA-mediated silencing and several other RNA interference phenomena that are profoundly embedded in cancer gene networks. Most recently, both germline and somatic mutations in DICER1 have been identified in diverse types of cancer. Although some of the mutations clearly reduce the dosage of this key enzyme, others dictate surprisingly specific changes in select classes of small RNAs. This Review reflects on the molecular properties of the Dicer enzymes in small RNA silencing pathways, and rationalizes the newly discovered mutations on the basis of the activities and functions of its determinants.
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Affiliation(s)
- William D Foulkes
- 1] Departments of Human Genetics, Medicine and Oncology, McGill University; Lady Davis Institute, Jewish General Hospital and Research Institute, McGill University Health Centre, Montreal, Quebec, Canada. [2]
| | | | - Thomas F Duchaine
- 1] Department of Biochemistry and Goodman Cancer Research Centre, McGill University, Montreal, Quebec, Canada, H3A 1A3. [2]
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