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Mathiesen JS, Nielsen SG, Rasmussen ÅK, Kiss K, Wadt K, Hermann AP, Nielsen MF, Larsen SR, Brusgaard K, Frederiksen AL, Godballe C, Rossing M. Variability in Medullary Thyroid Carcinoma in RET L790F Carriers: A Case Comparison Study of Index Patients. Front Endocrinol (Lausanne) 2020; 11:251. [PMID: 32411094 PMCID: PMC7198720 DOI: 10.3389/fendo.2020.00251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/06/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Previous studies have suggested that the variability in age of onset and aggressiveness of medullary thyroid carcinoma (MTC) in patients with multiple endocrine neoplasia type 2A (MEN 2A) carrying the same REarranged during Transfection (RET) mutation may be caused by additional RET germline variants or somatic variants. Methods: This study was a retrospective case comparison study of all MEN 2A index patients (n = 2) with the RET L790F germline mutation in Denmark. Whole blood and MTC tissue were analyzed for RET germline variants and other somatic variants (>500), respectively. Results: Patient 1 presented with MTC (T1aN1bM0) at age 14 years, while patient 2 presented with MTC (T1bN0M0) at age 70 years. No germline RET germline variants nor other variants were found to explain this MTC variability. Conclusions: We could not confirm the previously reported finding of a somatic RET variant as likely responsible for the early onset and aggressiveness of MTC in a RET germline mutation carrier. Also, we found no RET germline variants that could explain the MTC variability among our index patients. We did, however, identify a somatic FLT3 R387Q variant with an unknown potential as genetic modifier. Further large-scale studies are needed to investigate genetic modifiers in RET L790F carriers.
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Affiliation(s)
- Jes Sloth Mathiesen
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- *Correspondence: Jes Sloth Mathiesen
| | - Søren Grønlund Nielsen
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Katalin Kiss
- Department of Pathology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Karin Wadt
- Department of Clinical Genetics, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | - Klaus Brusgaard
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | | | - Christian Godballe
- Department of ORL Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
| | - Maria Rossing
- Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark
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2
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Amooee A, Lookzadeh MH, Mirjalili SR, Miresmaeili SM, Aghili K, Zare-Shehneh M, Neamatzadeh H. ASSOCIATION OF RS2435357 AND RS1800858 POLYMORPHISMS IN RET PROTO-ONCOGENE WITH HIRSCHSPRUNG DISEASE: SYSTEMATIC REVIEW AND META-ANALYSIS. ACTA ACUST UNITED AC 2019; 32:e1448. [PMID: 31644668 PMCID: PMC6812143 DOI: 10.1590/0102-672020190001e1448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/16/2019] [Indexed: 01/22/2023]
Abstract
Introduction:
Many published studies have estimated the association of rs2435357 and
rs1800858 polymorphisms in the proto-oncogene rearranged during transfection
(RET) gene with Hirschsprung disease (HSCR) risk. However, the results
remain inconsistent and controversial.
Aim:
To perform a meta-analysis get a more accurate estimation of the association
of rs2435357 and rs1800858 polymorphisms in the RET proto-oncogene with HSCR
risk.
Methods:
The eligible literatures were searched by PubMed, Google Scholar, EMBASE, and
Chinese National Knowledge Infrastructure (CNKI) up to June 30, 2018.
Summary odds ratios (ORs) and 95% confidence intervals (CIs) were used to
evaluate the susceptibility to HSCR.
Results:
A total of 20 studies, including ten (1,136 cases 2,420 controls) for
rs2435357 and ten (917 cases 1,159 controls) for rs1800858 were included.
The overall results indicated that the rs2435357 (allele model: OR=0.230,
95% CI 0.178-0.298, p=0.001; homozygote model: OR=0.079, 95% CI 0.048-0.130,
p=0.001; heterozygote model: OR=0.149, 95% CI 0.048-0.130, p=0.001; dominant
model: OR=0.132, 95% CI 0.098-0.179, p=0.001; and recessive model: OR=0.239,
95% CI 0.161-0.353, p=0.001) and rs1800858 (allele model: OR=5.594, 95% CI
3.653-8.877, p=0.001; homozygote model: OR=8.453, 95% CI 3.783-18.890,
p=0.001; dominant model: OR=3.469, 95% CI 1.881-6.396, p=0.001; and
recessive model: OR=6.120, 95% CI 3.608-10.381, p=0.001) polymorphisms were
associated with the increased risk of HSCR in overall.
Conclusions:
The results suggest that the rs2435357 and rs1800858 polymorphisms in the RET
proto-oncogene might be associated with HSCR risk.
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Affiliation(s)
| | | | | | | | - Kazem Aghili
- Shahid Sadoughi University of Medical Sciences, Radiology
| | - Masoud Zare-Shehneh
- Shahid Sadoughi University of Medical Sciences, Medical Genetics, Yazd, Yazd, Iran
| | - Hossein Neamatzadeh
- Shahid Sadoughi University of Medical Sciences, Medical Genetics, Yazd, Yazd, Iran
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3
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Machens A, Dralle H. Long-term outcome after DNA-based prophylactic neck surgery in children at risk of hereditary medullary thyroid cancer. Best Pract Res Clin Endocrinol Metab 2019; 33:101274. [PMID: 31043326 DOI: 10.1016/j.beem.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Advances in sequencing technology, providing unprecedented insights into cancer progression, have shifted the treatment paradigm towards precision medicine for hereditary medullary thyroid cancer (MTC), away from the 'one-size-fits-all' approach predicated on genetic risk alone. The DNA-based/biochemical concept, factoring serum calcitonin into the benefit-risk equation, optimizes biochemical cure while minimizing extent of prophylactic surgery and operative morbidity in children at risk. The transformative effect that has taking effect on medical practice has been impressive: Increasingly earlier molecular diagnosis and more limited prophylactic neck operations yielded excellent clinical outcomes at expert facilities 7-16 years postoperatively: biochemical cure rates approximating 100%; absence of residual structural disease or recurrence; and rarely any permanent operative morbidity. These excellent results, contingent on proper health care funding and pediatric surgical specialization, make a case for early prophylactic thyroidectomy in experienced hands once calcitonin serum levels exceed the upper normal limit of the assay in young gene carriers.
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Affiliation(s)
- Andreas Machens
- Medical Faculty, Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle (Saale), Germany.
| | - Henning Dralle
- Medical Faculty, Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle (Saale), Germany; Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, D-45122 Essen, Germany
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4
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Martins-Costa MC, Lindsey SC, Cunha LL, Carreiro-Filho FP, Cortez AP, Holanda ME, Farias JWMD, Lima SB, Ferreira LAA, Maia Filho PC, Camacho CP, Furuzawa GK, Kunii IS, Dias-da-Silva MR, Martins JRM, Maciel RMB. A pioneering RET genetic screening study in the State of Ceará, Brazil, evaluating patients with medullary thyroid cancer and at-risk relatives: experience with 247 individuals. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 62:623-635. [PMID: 30624503 PMCID: PMC10118677 DOI: 10.20945/2359-3997000000088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/25/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Initial diagnosis of medullary thyroid carcinoma (MTC) is frequently associated with advanced stages and a poor prognosis. Thus, the need for earlier diagnoses and detection in relatives at risk for the disease has led to increased use of RET genetic screening. SUBJECTS AND METHODS We performed RET screening in 247 subjects who were referred to the Brazilian Research Consortium for Multiple Endocrine Neoplasia (BRASMEN) Center in the State of Ceará. Direct genetic sequencing was used to analyze exons 8, 10, 11, and 13-16 in MTC index cases and specific exons in at risk relatives. Afterward, clinical follow-up was offered to all the patients with MTC and their affected relatives. RESULTS RET screening was performed in 60 MTC index patients and 187 at-risk family members. At the initial clinical assessment of the index patients, 54 (90%) were diagnosed with apparently sporadic disease and 6 (10%) diagnosed with hereditary disease. After RET screening, we found that 31 (52%) index patients had sporadic disease, and 29 (48%) had hereditary disease. Regarding at-risk relatives, 73/187 were mutation carriers. Mutations in RET codon 804 and the rare p.M918V mutation were the most prevalent. CONCLUSIONS Performing RET screening in Ceará allowed us to identify a different mutation profile in this region compared with other areas. RET screening also enabled the diagnosis of a significant number of hereditary MTC patients who were initially classified as sporadic disease patients and benefited their relatives, who were unaware of the risks and the consequences of bearing a RET mutation.
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Affiliation(s)
- Maria Cecília Martins-Costa
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil.,Centro de Endocrinologia e Metabologia, Hospital Geral de Fortaleza (HGF), Fortaleza, CE, Brasil.,Departamento de Medicina, Universidade de Fortaleza (UNIFOR), Fortaleza, CE, Brasil
| | - Susan C Lindsey
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Lucas L Cunha
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | | | - André P Cortez
- Santa Casa de Misericórdia de Fortaleza, Fortaleza, CE, Brasil.,Hospital Geral Dr. César Cals, Fortaleza, CE, Brasil
| | | | - J Wilson M de Farias
- Departamento de Cirurgia de Cabeça e Pescoço, Hospital Geral de Fortaleza, Fortaleza, CE, Brasil.,Santa Casa de Misericórdia de Fortaleza, Fortaleza, CE, Brasil
| | - Sérgio B Lima
- Santa Casa de Misericórdia de Fortaleza, Fortaleza, CE, Brasil
| | - Luís A Albano Ferreira
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE, Brasil.,Hospital Infantil Albert Sabin, Fortaleza, CE, Brasil
| | | | - Cléber P Camacho
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Gilberto K Furuzawa
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Ilda S Kunii
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Magnus R Dias-da-Silva
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - João R M Martins
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil.,Divisão de Biologia Molecular, Departamento de Bioquímica, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Rui M B Maciel
- Centro de Doenças da Tiroide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil.,Fleury Medicina e Saúde, São Paulo, SP, Brasil
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5
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Al-Kurd A, Gross DJ, Zangen D, Atlan K, Mazeh H, Grozinsky-Glasberg S. Bilateral Medullary Thyroid Carcinoma in a 3-Year-Old Female Patient with Multiple Endocrine Neoplasia 2A Syndrome Undergoing Prophylactic Thyroidectomy: Should Current Guidelines Be Revised? Eur Thyroid J 2018; 7:267-271. [PMID: 30374431 PMCID: PMC6198771 DOI: 10.1159/000489170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/11/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Multiple endocrine neoplasia (MEN) 2A is an autosomal dominant disorder that results from a mutation in the RET proto-oncogene on chromosome 10. Almost all of the affected patients develop medullary thyroid carcinoma (MTC). The American Thyroid Association recommends prophylactic thyroidectomy in MEN 2A pediatric patients, with the age of the recommended thyroidectomy varying according to the codon mutation present. OBJECTIVES This report questions the reliability of the currently placed guidelines and whether the age threshold for prophylactic thyroidectomy in patients with known codon 634 mutations should be lowered, in parallel with an earlier evaluation of calcitonin levels in the serum. METHODS We report the preoperative diagnosis as well as operative and postoperative course of a 3-year-old female patient with MEN 2A (codon 634 mutation) who underwent prophylactic thyroidectomy. The postoperative histopathologic findings are presented and discussed. RESULTS Despite the prophylactic nature of the operation, in parallel with a borderline calcitonin increase in the serum, bilateral MTC was discovered on pathology. CONCLUSION It is likely that the current guidelines should be revised to recommend calcitonin screening and prophylactic thyroidectomy at an earlier age for MEN 2A patients with known codon 634 mutations.
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Affiliation(s)
- Abbas Al-Kurd
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- *Abbas Al-Kurd, MD, Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, PO Box 24035, Jerusalem (Israel), E-Mail
| | - David J. Gross
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Zangen
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Karine Atlan
- Department of Pathology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Haggi Mazeh
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Department of Endocrinology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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6
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Prete FP, Abdel-Aziz T, Morkane C, Brain C, Kurzawinski TR. Prophylactic thyroidectomy in children with multiple endocrine neoplasia type 2. Br J Surg 2018; 105:1319-1327. [PMID: 29663329 DOI: 10.1002/bjs.10856] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/16/2017] [Accepted: 02/12/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND In patients with multiple endocrine neoplasia type 2 (MEN2) syndrome, genetic testing offers early diagnosis, stratifies the risk of developing medullary thyroid cancer (MTC) and informs the timing of thyroidectomy. The efficacy of treatment, which depends on timely and safe surgery, is not well established. METHODS This was a retrospective review of diagnostic and clinicopathological outcomes of prophylactic thyroidectomy in children with MEN2 between 1995 and 2013 in the UK. American Thyroid Association (ATA) 2009 guidelines were used as a benchmark for adequate treatment. RESULTS Seventy-nine children from 16 centres underwent total thyroidectomy. Thirty-eight patients (48 per cent) underwent genetic testing and 36 (46 per cent) had an operation performed above the age recommended by the ATA 2009 guidelines; pathology showed MTC in 30 patients (38 per cent). Late surgery, above-normal preoperative calcitonin level and MTC on pathology correlated with late genetic testing. Twenty-five children had lymphadenectomy; these patients had more parathyroid glands excised (mean difference 0·61, 95 per cent c.i. 0·24 to 0·98; P = 0·001), and were more likely to have hypocalcaemia requiring medication (relative risk (RR) 3·12, 95 per cent c.i. 1·54 to 6·32; P = 0·002) and permanent hypoparathyroidism (RR 3·24, 1·29 to 8·11; P = 0·010) compared with those who underwent total thyroidectomy alone. Age did not influence the development of complications. CONCLUSION Late genetic testing may preclude age-appropriate surgery, increasing the risk of operating when MTC has already developed. Early genetic testing and age-appropriate surgery may help avoid unnecessary lymphadenectomy and improve outcomes.
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Affiliation(s)
- F P Prete
- Division of Endocrine Surgery, University College Hospital and Great Ormond Street Hospital, London, UK.,Division of Minimally Invasive and Endocrine Surgery, Policlinico di Bari University Hospital, Bari, Italy
| | - T Abdel-Aziz
- Division of Endocrine Surgery, University College Hospital and Great Ormond Street Hospital, London, UK.,Department of General Surgery, University of Alexandria, Alexandria, Egypt
| | - C Morkane
- Division of Endocrine Surgery, University College Hospital and Great Ormond Street Hospital, London, UK
| | - C Brain
- Division of Endocrine Surgery, University College Hospital and Great Ormond Street Hospital, London, UK
| | - T R Kurzawinski
- Division of Endocrine Surgery, University College Hospital and Great Ormond Street Hospital, London, UK
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7
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Kamboj A, Lause M, Kumar P. Ophthalmic manifestations of endocrine disorders-endocrinology and the eye. Transl Pediatr 2017; 6:286-299. [PMID: 29184810 PMCID: PMC5682375 DOI: 10.21037/tp.2017.09.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Disorders of the endocrine system usually manifest in a multi-organ fashion. More specifically, many endocrinopathies become apparent in the eye first through a variety of distinct pathophysiologic disturbances. The eye provides physicians with valuable clues for the recognition and management of numerous systemic diseases, including many disorders of the endocrine pathway. Recognizing ophthalmic manifestations of endocrine disorders is critical not only for rapid diagnosis and treatment, but also to prevent significant morbidity and mortality. In this review, we discuss relevant ophthalmic findings associated with key disorders of the pancreas, thyroid gland, and hypothalamic-pituitary axis, as well as with multiple hereditary endocrine syndromes. We have chosen to focus on diabetes mellitus (DM), Graves' ophthalmopathy, pituitary tumors, and some less common disorders that underscore the unique relationship between the eye and the endocrine system.
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Affiliation(s)
- Alisha Kamboj
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Michael Lause
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Priyanka Kumar
- Department of Ophthalmology, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
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9
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Toledo SPA, Lourenço DM, Toledo RA. A differential diagnosis of inherited endocrine tumors and their tumor counterparts. Clinics (Sao Paulo) 2013; 68:1039-56. [PMID: 23917672 PMCID: PMC3715026 DOI: 10.6061/clinics/2013(07)24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/26/2013] [Indexed: 12/15/2022] Open
Abstract
Inherited endocrine tumors have been increasingly recognized in clinical practice, although some difficulties still exist in differentiating these conditions from their sporadic endocrine tumor counterparts. Here, we list the 12 main topics that could add helpful information and clues for performing an early differential diagnosis to distinguish between these conditions. The early diagnosis of patients with inherited endocrine tumors may be performed either clinically or by mutation analysis in at-risk individuals. Early detection usually has a large impact in tumor management, allowing preventive clinical or surgical therapy in most cases. Advice for the clinical and surgical management of inherited endocrine tumors is also discussed. In addition, recent clinical and genetic advances for 17 different forms of inherited endocrine tumors are briefly reviewed.
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Affiliation(s)
- Sergio P A Toledo
- Division of Endocrinology, Endocrine Genetics Unit (LIM-25), Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil.
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10
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Jarzab B, Szpak-Ulczok S, Wloch J, Czarniecka A, Krajewska J. Timing and criteria for prophylactic thyroidectomy in asymptomatic RET carriers - the role of Ct serum level. Thyroid Res 2013; 6 Suppl 1:S9. [PMID: 23514096 PMCID: PMC3599705 DOI: 10.1186/1756-6614-6-s1-s9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Authors summarize in this brief review results of European discussion, held on ETA-CRN Meeting in Lisbon, 2009, on the American Thyroid Association Medullary Thyroid Cancer (MTC) Guidelines published in the same year and focus on the timing of prophylactic thyroidectomy. ATA 2009 guidelines classified RET protooncogene mutation carriers into 4 levels: A, B, C, D. ATA for prophylactic thyroidectomy were generally independent of the serum calcitonin (Ct) concentration but based on a priori risk levels. This was well accepted as the important novelty was to delineate risk level specially for RET 634 mutation (level C). In the ATA Guidelines total prophylactic thyroidectomy below age 5 years was recommended in RET 634 mutation carriers regardless of Ct status. However, some European experts favored to base the decision not only on the results of DNA testing but also on the going Ct level. The European discussion reflected divergent opinions and indicated the need of publication of European experience instead of arbitrary opinions. It was stressed that patients carrying the same RET mutation present heterogenic progression to the clinically overt medullary thyroid cancer, even in the same family. Thus, in summary, the ATA MTC guidelines constituted a positive stimulus to publish further evidence for Ct-guided pre-emptive thyroidectomy for RET gene mutation carriers and the conclusion is drawn on the basis of experience expressed in Lisbon and published later evidence that the integrated algorithm based on age - Ct - type of RET mutation should be considered in the decision of pre-emptive thyroidectomy.
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Affiliation(s)
- Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
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11
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Sim Y, Yap F, Soo KC, Low Y. Medullary thyroid carcinoma in ethnic Chinese with MEN2A: a case report and literature review. J Pediatr Surg 2013; 48:e43-6. [PMID: 23331839 DOI: 10.1016/j.jpedsurg.2012.10.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/29/2012] [Accepted: 10/31/2012] [Indexed: 11/18/2022]
Abstract
Medullary Thyroid Carcinoma (MTC) is the most common cause of death in MEN patients. It is curative by prophylactic total thyroidectomy, but controversies remain as to the optimal timing for prophylactic thyroidectomy. The current recommendation is for prophylactic total thyroidectomy before age 5, but a recent study suggested that in the ethnic Chinese, even "high risk" mutations did not result in early malignant change, and it was suggested that prophylactic thyroidectomy may be performed at a later age. We report a case of an ethnic Chinese girl with MEN2A codon 634 (C634R) mutation, whose operative specimen at prophylactic thyroidectomy at 4 years 8 months showed MTC. We advocate that management of MEN2A patients should be codon-directed, regardless of ethnicity.
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Affiliation(s)
- Yirong Sim
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore S229899, Singapore
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12
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Quedas EPS, Longuini VC, Sekiya T, Coutinho FL, Toledo SPA, Tannuri U, Toledo RA. RET haplotype, not linked to the C620R activating mutation, associated with Hirschsprung disease in a novel MEN2 family. Clinics (Sao Paulo) 2012; 67 Suppl 1:57-61. [PMID: 22584707 PMCID: PMC3328835 DOI: 10.6061/clinics/2012(sup01)11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Hirschsprung disease is a congenital form of aganglionic megacolon that results from cristopathy. Hirschsprung disease usually occurs as a sporadic disease, although it may be associated with several inherited conditions, such as multiple endocrine neoplasia type 2. The rearranged during transfection (RET) proto-oncogene is the major susceptibility gene for Hirschsprung disease, and germline mutations in RET have been reported in up to 50% of the inherited forms of Hirschsprung disease and in 15-20% of sporadic cases of Hirschsprung disease. The prevalence of Hirschsprung disease in multiple endocrine neoplasia type 2 cases was recently determined to be 7.5% and the cooccurrence of Hirschsprung disease and multiple endocrine neoplasia type 2 has been reported in at least 22 families so far. It was initially thought that Hirschsprung disease could be due to disturbances in apoptosis or due to a tendency of the mutated RET receptor to be retained in the Golgi apparatus. Presently, there is strong evidence favoring the hypothesis that specific inactivating haplotypes play a key role in the fetal development of congenital megacolon/Hirschsprung disease. In the present study, we report the genetic findings in a novel family with multiple endocrine neoplasia type 2: a specific RET haplotype was documented in patients with Hirschsprung disease associated with medullary thyroid carcinoma, but it was absent in patients with only medullary thyroid carcinoma. Despite the limited number of cases, the present data favor the hypothesis that specific haplotypes not linked to RET germline mutations are the genetic causes of Hirschsprung disease.
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Affiliation(s)
- Elisangela P S Quedas
- Division of Endocrinology, Endocrine Genetics Unit, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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13
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Tavares MR, Toledo SPA, Montenegro FLM, Moyses RA, Toledo RA, Sekyia T, Cernea CR, Brandão LG. Surgical approach to medullary thyroid carcinoma associated with multiple endocrine neoplasia type 2. Clinics (Sao Paulo) 2012; 67 Suppl 1:149-54. [PMID: 22584721 PMCID: PMC3328814 DOI: 10.6061/clinics/2012(sup01)25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
We briefly review the surgical approaches to medullary thyroid carcinoma associated with multiple endocrine neoplasia type 2 (medullary thyroid carcinoma/multiple endocrine neoplasia type 2). The recommended surgical approaches are usually based on the age of the affected carrier/patient, tumor staging and the specific rearranged during transfection codon mutation. We have focused mainly on young children with no apparent disease who are carrying a germline rearranged during transfection mutation. Successful management of medullary thyroid carcinoma in these cases depends on early diagnosis and treatment. Total thyroidectomy should be performed before 6 months of age in infants carrying the rearranged during transfection 918 codon mutation, by the age of 3 years in rearranged during transfection 634 mutation carriers, at 5 years of age in carriers with level 3 risk rearranged during transfection mutations, and by the age of 10 years in level 4 risk rearranged during transfection mutations. Patients with thyroid tumor >5 mm detected by ultrasound, and basal calcitonin levels >40 pg/ml, frequently have cervical and upper mediastinal lymph node metastasis. In the latter patients, total thyroidectomy should be complemented by extensive lymph node dissection. Also, we briefly review our data from a large familial medullary thyroid carcinoma genealogy harboring a germline rearranged during transfection Cys620Arg mutation. All 14 screened carriers of the rearranged during transfection Cys620Arg mutation who underwent total thyroidectomy before the age of 12 years presented persistently undetectable serum levels of calcitonin (<2 pg/ml) during the follow-up period of 2-6 years. Although it is recommended that preventive total thyroidectomy in rearranged during transfection codon 620 mutation carriers is performed before the age of 5 years, in this particular family the surgical intervention performed before the age of 12 years led to an apparent biochemical cure.
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Affiliation(s)
- Marcos R Tavares
- Head and Neck Surgery Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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