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Kumar V, Doros L, Thompson M, Mushti SL, Charlab R, Spehalski EI, Zhao H, Thompson MD, Tang S, Pazdur R, Lemery SJ, Theoret MR, Fashoyin-Aje LA. FDA Approval Summary: Ripretinib for Advanced Gastrointestinal Stromal Tumor. Clin Cancer Res 2023; 29:2020-2024. [PMID: 36485007 PMCID: PMC10238554 DOI: 10.1158/1078-0432.ccr-22-2400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/21/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
On May 15, 2020, the FDA approved ripretinib for adult patients with advanced gastrointestinal stromal tumor who have received prior treatment with three or more kinase inhibitors, including imatinib. The approval was based on results from INVICTUS (NCT03353753), an international, multi-center, double-blind, placebo-controlled trial. Patients were randomly allocated (2:1) to receive either ripretinib 150 mg once daily (n = 85) or matching placebo (n = 44). The trial demonstrated a statistically significant improvement in progression-free survival (PFS) as assessed by modified RECIST v1.1 by blinded independent central review for patients randomized to ripretinib, with a median PFS of 6.3 months [95% confidence interval (CI): 4.6-6.9] compared with 1.0 month (95% CI: 0.9-1.7) for placebo [HR: 0.15 (95% CI: 0.09-0.25); P < 0.0001, stratified log-rank test]. There was no statistically significant difference in objective response rate in the ripretinib arm, 9% (95% CI: 4.2-18) compared with placebo 0% [(95% CI: 0-8); P = 0.0504, Fisher exact test]. The median overall survival (OS) in the ripretinib arm was 15.1 months (95% CI: 12.3-15.1) compared with 6.6 months (95% CI: 4.1-11.6) in the placebo arm. A formal statistical comparison of OS was not made due to the prespecified hierarchical analysis plan. The most common (≥20%) adverse events with ripretinib, in order of decreasing frequency, were alopecia, fatigue, nausea, abdominal pain, constipation, myalgia, diarrhea, decreased appetite, palmar-plantar erythrodysesthesia, and vomiting. Other important risks of ripretinib include new primary cutaneous malignancies, hypertension, and cardiac dysfunction.
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Affiliation(s)
- Vaibhav Kumar
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration
| | - Leslie Doros
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration
| | - Margaret Thompson
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration
| | - Sirisha L. Mushti
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration
| | - Rosane Charlab
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration
| | | | - Hong Zhao
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration
| | | | - Shenghui Tang
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration
| | - Richard Pazdur
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration
- Oncology Center of Excellence, U.S. Food and Drug Administration
| | - Steven J. Lemery
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration
| | - Marc R. Theoret
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration
- Oncology Center of Excellence, U.S. Food and Drug Administration
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2
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Achatz MI, Porter CC, Brugières L, Druker H, Frebourg T, Foulkes WD, Kratz CP, Kuiper RP, Hansford JR, Hernandez HS, Nathanson KL, Kohlmann WK, Doros L, Onel K, Schneider KW, Scollon SR, Tabori U, Tomlinson GE, Evans DGR, Plon SE. Cancer Screening Recommendations and Clinical Management of Inherited Gastrointestinal Cancer Syndromes in Childhood. Clin Cancer Res 2018; 23:e107-e114. [PMID: 28674119 DOI: 10.1158/1078-0432.ccr-17-0790] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/08/2017] [Accepted: 05/12/2017] [Indexed: 11/16/2022]
Abstract
Hereditary gastrointestinal cancer predisposition syndromes have been well characterized, but management strategies and surveillance remain a major challenge, especially in childhood. In October 2016, the American Association for Cancer Research organized the AACR Childhood Cancer Predisposition Workshop in which international experts in care of children with a hereditary risk of cancer met to define surveillance strategies and management of children with cancer predisposition syndromes. In this article, we review the current literature in polyposis syndromes that can be diagnosed in childhood and may be associated with an increased incidence of gastrointestinal neoplasms and other cancer types. These disorders include adenomatous polyposis syndromes (APC and MUTYH), juvenile polyposis coli (BMPR1A and SMAD4), Peutz-Jeghers Syndrome (STK11/LKB1), and PTEN hamartoma tumor syndrome (PHTS; PTEN), which can present with a more limited juvenile polyposis phenotype. Herein, the panel of experts provides recommendations for clinical diagnosis, approach to genetic testing, and focus on cancer surveillance recommendations when appropriate during the pediatric period. We also review current controversies on genetic evaluation of patients with hepatoblastoma and indications for surveillance for this tumor. Childhood cancer risks and surveillance associated with disorders involving the mismatch repair genes, including Lynch syndrome and constitutional mismatch repair deficiency (CMMRD), are discussed elsewhere in this series. Clin Cancer Res; 23(13); e107-e14. ©2017 AACRSee all articles in the online-only CCR Pediatric Oncology Series.
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Affiliation(s)
- Maria Isabel Achatz
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland.
| | | | - Laurence Brugières
- Child and Adolescent Cancer Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Harriet Druker
- Division of Hematology/Oncology, Department of Genetic Counselling, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Thierry Frebourg
- Department of Genetics, Rouen University Hospital, Rouen, France
| | - William D Foulkes
- Department of Medicine, Oncology and Human Genetics, McGill University, Montreal, Canada
| | - Christian P Kratz
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Roland P Kuiper
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jordan R Hansford
- Children's Cancer Centre, Royal Children's Hospital; Murdoch Children's Research Institute; University of Melbourne, Melbourne, Australia
| | | | | | - Wendy K Kohlmann
- Population Health Sciences Department, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Leslie Doros
- Cancer Genetics Clinic, Children's National Medical Center, Washington, DC
| | - Kenan Onel
- Department of Pediatrics, Hofstra-Northwell School of Medicine and Cohen Children's Medical Center, Manhasset, New York
| | - Kami Wolfe Schneider
- Division of Hematology, Oncology, Bone Marrow Transplant, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sarah R Scollon
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
| | - Uri Tabori
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Gail E Tomlinson
- Department of Pediatric Hematology-Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - D Gareth R Evans
- Department of Genomic Medicine, University of Manchester, St. Mary's Hospital, Manchester, United Kingdom
| | - Sharon E Plon
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, Texas
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3
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Kalish JM, Doros L, Helman LJ, Hennekam RC, Kuiper RP, Maas SM, Maher ER, Nichols KE, Plon SE, Porter CC, Rednam S, Schultz KAP, States LJ, Tomlinson GE, Zelley K, Druley TE. Surveillance Recommendations for Children with Overgrowth Syndromes and Predisposition to Wilms Tumors and Hepatoblastoma. Clin Cancer Res 2018; 23:e115-e122. [PMID: 28674120 DOI: 10.1158/1078-0432.ccr-17-0710] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 04/23/2017] [Accepted: 05/09/2017] [Indexed: 12/13/2022]
Abstract
A number of genetic syndromes have been linked to increased risk for Wilms tumor (WT), hepatoblastoma (HB), and other embryonal tumors. Here, we outline these rare syndromes with at least a 1% risk to develop these tumors and recommend uniform tumor screening recommendations for North America. Specifically, for syndromes with increased risk for WT, we recommend renal ultrasounds every 3 months from birth (or the time of diagnosis) through the seventh birthday. For HB, we recommend screening with full abdominal ultrasound and alpha-fetoprotein serum measurements every 3 months from birth (or the time of diagnosis) through the fourth birthday. We recommend that when possible, these patients be evaluated and monitored by cancer predisposition specialists. At this time, these recommendations are not based on the differential risk between different genetic or epigenetic causes for each syndrome, which some European centers have implemented. This differentiated approach largely represents distinct practice environments between the United States and Europe, and these guidelines are designed to be a broad framework within which physicians and families can work together to implement specific screening. Further study is expected to lead to modifications of these recommendations. Clin Cancer Res; 23(13); e115-e22. ©2017 AACRSee all articles in the online-only CCR Pediatric Oncology Series.
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Affiliation(s)
- Jennifer M Kalish
- Division of Human Genetics, Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Leslie Doros
- Cancer Genetics Clinic, Children's National Medical Center, Washington, DC
| | - Lee J Helman
- Center for Cancer Research and Pediatric Oncology Branch, National Cancer Institute, Rockville, Maryland
| | - Raoul C Hennekam
- Department of Pediatrics, University of Amsterdam, Amsterdam, the Netherlands
| | - Roland P Kuiper
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Saskia M Maas
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands
| | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge, and Cambridge NIHR Biomedical Research Centre, Cambridge, United Kingdom
| | - Kim E Nichols
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sharon E Plon
- Department of Pediatrics/Hematology-Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | | | - Surya Rednam
- Department of Pediatrics/Hematology-Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Kris Ann P Schultz
- Division of Cancer and Blood Disorders, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Lisa J States
- Division of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gail E Tomlinson
- Division of Pediatric Hematology-Oncology and Greehey Children's Cancer Research Institute, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kristin Zelley
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Todd E Druley
- Division of Pediatric Hematology and Oncology, Washington University, St. Louis, Missouri
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4
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Schultz KAP, Rednam SP, Kamihara J, Doros L, Achatz MI, Wasserman JD, Diller LR, Brugières L, Druker H, Schneider KA, McGee RB, Foulkes WD. PTEN, DICER1, FH, and Their Associated Tumor Susceptibility Syndromes: Clinical Features, Genetics, and Surveillance Recommendations in Childhood. Clin Cancer Res 2018; 23:e76-e82. [PMID: 28620008 DOI: 10.1158/1078-0432.ccr-17-0629] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 11/16/2022]
Abstract
PTEN hamartoma tumor syndrome (PHTS), DICER1 syndrome, and hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome are pleiotropic tumor predisposition syndromes that include benign and malignant neoplasms affecting adults and children. PHTS includes several disorders with shared and distinct clinical features. These are associated with elevated lifetime risk of breast, thyroid, endometrial, colorectal, and renal cancers as well as melanoma. Thyroid cancer represents the predominant cancer risk under age 20 years. DICER1 syndrome includes risk for pleuropulmonary blastoma, cystic nephroma, ovarian sex cord-stromal tumors, and multinodular goiter and thyroid carcinoma as well as brain tumors including pineoblastoma and pituitary blastoma. Individuals with HLRCC may develop multiple cutaneous and uterine leiomyomas, and they have an elevated risk of renal cell carcinoma. For each of these syndromes, a summary of the key syndromic features is provided, the underlying genetic events are discussed, and specific screening is recommended. Clin Cancer Res; 23(12); e76-e82. ©2017 AACRSee all articles in the online-only CCR Pediatric Oncology Series.
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Affiliation(s)
- Kris Ann P Schultz
- International Pleuropulmonary Blastoma Registry, Cancer and Blood Disorders, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Surya P Rednam
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas
| | - Junne Kamihara
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Leslie Doros
- Cancer Genetics Clinic, Children's National Medical Center, Washington, DC
| | | | - Jonathan D Wasserman
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisa R Diller
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Laurence Brugières
- Child and Adolescent Cancer Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Harriet Druker
- Division of Hematology/Oncology and Department of Genetic Counselling, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Katherine A Schneider
- Pediatric Cancer Genetic Risk Program, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rose B McGee
- Department of Oncology, Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - William D Foulkes
- Department of Human Genetics and Research Institute, McGill University Health Centre, McGill University, Montreal, Québec, Canada.
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5
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Khan NE, Bauer AJ, Schultz KAP, Doros L, Decastro RM, Ling A, Lodish MB, Harney LA, Kase RG, Carr AG, Rossi CT, Field A, Harris AK, Williams GM, Dehner LP, Messinger YH, Hill DA, Stewart DR. Quantification of Thyroid Cancer and Multinodular Goiter Risk in the DICER1 Syndrome: A Family-Based Cohort Study. J Clin Endocrinol Metab 2017; 102:1614-1622. [PMID: 28323992 PMCID: PMC5443331 DOI: 10.1210/jc.2016-2954] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/27/2017] [Indexed: 01/08/2023]
Abstract
CONTEXT The risk of thyroid cancer and multinodular goiter (MNG) in DICER1 syndrome, a rare tumor-predisposition disorder, is unknown. OBJECTIVE To quantify the risk of thyroid cancer and MNG in individuals with DICER1 syndrome. DESIGN Family-based cohort study. SETTING National Institutes of Health (NIH) Clinical Center (CC). PARTICIPANTS The National Cancer Institute DICER1 syndrome cohort included 145 individuals with a DICER1 germline mutation and 135 family controls from 48 families. INTERVENTIONS Each individual completed a detailed medical history questionnaire. A subset underwent a 3-day evaluation at the NIH CC. MAIN OUTCOME MEASURES The cumulative incidence of MNG (or thyroidectomy) was quantified using the complement of the Kaplan-Meier product limit estimator. We compared the observed number of thyroid cancers in the NCI DICER1 cohort with matched data from the Surveillance, Epidemiology, and End Results (SEER) Program. We performed germline and somatic (thyroid cancer, MNG) DICER1 sequencing. RESULTS By the age of 40 years, the cumulative incidence of MNG or thyroidectomy was 75% in women and 17% in men with DICER1 syndrome compared with 8% of control women (P < 0.001) and 0% of control men (P = 0.0096). During 3937 person-years of observation, individuals with DICER1 syndrome had a 16-fold increased risk of thyroid cancer (95% confidence interval, 4.3 to 41; P < 0.05) compared with the SEER rates. Of 19 MNG nodules and 3 thyroid cancers, 16 (84%) and 3 (100%), respectively, harbored germline and somatic pathogenic DICER1 mutations. CONCLUSIONS We propose a model of thyroid carcinogenesis in DICER1 syndrome. Early-onset, familial, or male MNG should prompt consideration of the presence of DICER1 syndrome.
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MESH Headings
- Adenocarcinoma, Follicular/epidemiology
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/surgery
- Adolescent
- Adult
- Carcinoma/epidemiology
- Carcinoma/genetics
- Carcinoma/surgery
- Carcinoma, Papillary
- Case-Control Studies
- Cohort Studies
- DEAD-box RNA Helicases/genetics
- Family
- Female
- Germ-Line Mutation
- Goiter, Nodular/diagnostic imaging
- Goiter, Nodular/epidemiology
- Goiter, Nodular/genetics
- Goiter, Nodular/surgery
- Humans
- Incidence
- Male
- Neoplastic Syndromes, Hereditary/genetics
- Prevalence
- Ribonuclease III/genetics
- Risk
- Sequence Analysis, DNA
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/surgery
- Thyroidectomy/statistics & numerical data
- Ultrasonography
- Young Adult
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Affiliation(s)
- Nicholas E. Khan
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland 20850
| | - Andrew J. Bauer
- The Thyroid Center, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104
| | - Kris Ann P. Schultz
- Cancer and Blood Disorders, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55404
- International Pleuropulmonary Blastoma Registry, Minneapolis, Minnesota 55404
- International Ovarian and Testicular Stromal Tumor Registry, Minneapolis, Minnesota 55404
| | - Leslie Doros
- Food and Drug Administration, Silver Spring, Maryland 20993
| | - Rosamma M. Decastro
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland 20850
| | - Alexander Ling
- Radiology & Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892
| | - Maya B. Lodish
- Section of Endocrinology and Genetics, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892
| | | | | | | | - Christopher T. Rossi
- Division of Pathology and Center for Genetic Medicine Research, Children's National Health System, Washington, DC 20010
- Department of Integrative Systems Biology, George Washington University School of Medicine and Health Sciences, Washington, DC 20037
| | - Amanda Field
- Division of Pathology and Center for Genetic Medicine Research, Children's National Health System, Washington, DC 20010
- Department of Integrative Systems Biology, George Washington University School of Medicine and Health Sciences, Washington, DC 20037
| | - Anne K. Harris
- Cancer and Blood Disorders, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55404
- International Pleuropulmonary Blastoma Registry, Minneapolis, Minnesota 55404
- International Ovarian and Testicular Stromal Tumor Registry, Minneapolis, Minnesota 55404
| | - Gretchen M. Williams
- Cancer and Blood Disorders, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55404
- International Pleuropulmonary Blastoma Registry, Minneapolis, Minnesota 55404
| | - Louis P. Dehner
- Washington University in St. Louis, St. Louis, Missouri 63130
| | - Yoav H. Messinger
- Cancer and Blood Disorders, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota 55404
- International Pleuropulmonary Blastoma Registry, Minneapolis, Minnesota 55404
| | - D. Ashley Hill
- Division of Pathology and Center for Genetic Medicine Research, Children's National Health System, Washington, DC 20010
- Department of Integrative Systems Biology, George Washington University School of Medicine and Health Sciences, Washington, DC 20037
| | - Douglas R. Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland 20850
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6
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Brenneman M, Field A, Yang J, Williams G, Doros L, Rossi C, Schultz KA, Rosenberg A, Ivanovich J, Turner J, Gordish-Dressman H, Stewart D, Yu W, Harris A, Schoettler P, Goodfellow P, Dehner L, Messinger Y, Hill DA. Temporal order of RNase IIIb and loss-of-function mutations during development determines phenotype in pleuropulmonary blastoma / DICER1 syndrome: a unique variant of the two-hit tumor suppression model. F1000Res 2015; 4:214. [PMID: 26925222 PMCID: PMC4712775 DOI: 10.12688/f1000research.6746.2] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 01/27/2023] Open
Abstract
Pleuropulmonary blastoma (PPB) is the most frequent pediatric lung tumor and often the first indication of a pleiotropic cancer predisposition,
DICER1 syndrome, comprising a range of other individually rare, benign and malignant tumors of childhood and early adulthood. The genetics of
DICER1-associated tumorigenesis are unusual in that tumors typically bear neomorphic missense mutations at one of five specific “hotspot” codons within the RNase IIIb domain of
DICER 1, combined with complete loss of function (LOF) in the other allele. We analyzed a cohort of 124 PPB children for predisposing
DICER1 mutations and sought correlations with clinical phenotypes. Over 70% have inherited or
de novo germline LOF mutations, most of which truncate the
DICER1 open reading frame. We identified a minority of patients who have no germline mutation, but are instead mosaic for predisposing
DICER1 mutations. Mosaicism for RNase IIIb domain hotspot mutations defines a special category of
DICER1 syndrome patients, clinically distinguished from those with germline or mosaic LOF mutations by earlier onsets and numerous discrete foci of neoplastic disease involving multiple syndromic organ sites. A final category of PBB patients lack predisposing germline or mosaic mutations and have sporadic (rather than syndromic) disease limited to a single PPB tumor bearing tumor-specific RNase IIIb and LOF mutations. We propose that acquisition of a neomorphic RNase IIIb domain mutation is the rate limiting event in
DICER1-associated
tumorigenesis, and that distinct clinical phenotypes associated with mutational categories reflect the temporal order in which LOF and RNase IIIb domain mutations are acquired during development.
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Affiliation(s)
- Mark Brenneman
- Division of Pathology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Amanda Field
- Division of Pathology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA.,Center for Genetic Medicine Research, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Jiandong Yang
- Division of Pathology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA.,Center for Genetic Medicine Research, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Gretchen Williams
- International Pleuropulmonary Blastoma Registry, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA.,Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA
| | - Leslie Doros
- Division of Oncology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Christopher Rossi
- Division of Pathology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Kris Ann Schultz
- International Pleuropulmonary Blastoma Registry, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA.,Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Jennifer Ivanovich
- Department of Surgery, Washington University Medical Center, St. Louis, MO, 63110, USA
| | - Joyce Turner
- Division of Pathology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA.,Division of Genetics, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Heather Gordish-Dressman
- Center for Genetic Medicine Research, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA.,Department of Integrative Systems Biology, George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Douglas Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, 20892, USA
| | - Weiying Yu
- Center for Genetic Medicine Research, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA.,Division of Oncology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Anne Harris
- International Pleuropulmonary Blastoma Registry, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA.,Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA
| | - Peter Schoettler
- Center for Genetic Medicine Research, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Paul Goodfellow
- College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Louis Dehner
- Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA.,Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO, 63110, USA
| | - Yoav Messinger
- International Pleuropulmonary Blastoma Registry, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA.,Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA
| | - D Ashley Hill
- Division of Pathology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA.,Center for Genetic Medicine Research, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA.,Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA.,Department of Integrative Systems Biology, George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
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7
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Brenneman M, Field A, Yang J, Williams G, Doros L, Rossi C, Schultz KA, Rosenberg A, Ivanovich J, Turner J, Gordish-Dressman H, Stewart D, Yu W, Harris A, Schoettler P, Goodfellow P, Dehner L, Messinger Y, Hill DA. Temporal order of RNase IIIb and loss-of-function mutations during development determines phenotype in pleuropulmonary blastoma / DICER1 syndrome: a unique variant of the two-hit tumor suppression model. F1000Res 2015; 4:214. [PMID: 26925222 DOI: 10.12688/f1000research.6746.1] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 01/05/2023] Open
Abstract
Pleuropulmonary blastoma (PPB) is the most frequent pediatric lung tumor and often the first indication of a pleiotropic cancer predisposition, DICER1 syndrome, comprising a range of other individually rare, benign and malignant tumors of childhood and early adulthood. The genetics of DICER1-associated tumorigenesis are unusual in that tumors typically bear neomorphic missense mutations at one of five specific "hotspot" codons within the RNase IIIb domain of DICER 1, combined with complete loss of function (LOF) in the other allele. We analyzed a cohort of 124 PPB children for predisposing DICER1 mutations and sought correlations with clinical phenotypes. Over 70% have inherited or de novo germline LOF mutations, most of which truncate the DICER1 open reading frame. We identified a minority of patients who have no germline mutation, but are instead mosaic for predisposing DICER1 mutations. Mosaicism for RNase IIIb domain hotspot mutations defines a special category of DICER1 syndrome patients, clinically distinguished from those with germline or mosaic LOF mutations by earlier onsets and numerous discrete foci of neoplastic disease involving multiple syndromic organ sites. A final category of PBB patients lack predisposing germline or mosaic mutations and have sporadic (rather than syndromic) disease limited to a single PPB tumor bearing tumor-specific RNase IIIb and LOF mutations. We propose that acquisition of a neomorphic RNase IIIb domain mutation is the rate limiting event in DICER1-associated tumorigenesis, and that distinct clinical phenotypes associated with mutational categories reflect the temporal order in which LOF and RNase IIIb domain mutations are acquired during development.
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Affiliation(s)
- Mark Brenneman
- Division of Pathology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Amanda Field
- Division of Pathology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA.,Center for Genetic Medicine Research, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Jiandong Yang
- Division of Pathology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA.,Center for Genetic Medicine Research, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Gretchen Williams
- International Pleuropulmonary Blastoma Registry, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA.,Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA
| | - Leslie Doros
- Division of Oncology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Christopher Rossi
- Division of Pathology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Kris Ann Schultz
- International Pleuropulmonary Blastoma Registry, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA.,Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Jennifer Ivanovich
- Department of Surgery, Washington University Medical Center, St. Louis, MO, 63110, USA
| | - Joyce Turner
- Division of Pathology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA.,Division of Genetics, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Heather Gordish-Dressman
- Center for Genetic Medicine Research, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA.,Department of Integrative Systems Biology, George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Douglas Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, 20892, USA
| | - Weiying Yu
- Center for Genetic Medicine Research, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA.,Division of Oncology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Anne Harris
- International Pleuropulmonary Blastoma Registry, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA.,Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA
| | - Peter Schoettler
- Center for Genetic Medicine Research, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
| | - Paul Goodfellow
- College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Louis Dehner
- Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA.,Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO, 63110, USA
| | - Yoav Messinger
- International Pleuropulmonary Blastoma Registry, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA.,Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA
| | - D Ashley Hill
- Division of Pathology, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA.,Center for Genetic Medicine Research, Children's Research Institute, Children's National Medical Center and the George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA.,Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, 55404, USA.,Department of Integrative Systems Biology, George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA
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Messinger YH, Stewart DR, Priest JR, Williams GM, Harris AK, Schultz KAP, Yang J, Doros L, Rosenberg PS, Hill DA, Dehner LP. Pleuropulmonary blastoma: a report on 350 central pathology-confirmed pleuropulmonary blastoma cases by the International Pleuropulmonary Blastoma Registry. Cancer 2015; 121:276-85. [PMID: 25209242 PMCID: PMC4293209 DOI: 10.1002/cncr.29032] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/05/2014] [Accepted: 08/14/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pleuropulmonary blastoma (PPB) has 3 subtypes on a tumor progression pathway ranging from type I (cystic) to type II (cystic/solid) and type III (completely solid). A germline mutation in DICER1 is the genetic cause in the majority of PPB cases. METHODS Patients confirmed to have PPB by central pathology review were included, and their clinical characteristics and outcomes were reported. Germline DICER1 mutations were sought with Sanger sequencing. RESULTS There were 435 cases, and a central review confirmed 350 cases to be PPB; 85 cases (20%) were another entity. Thirty-three percent of the 350 PPB cases were type I or type I regressed (type Ir), 35% were type II, and 32% were type III or type II/III. The median ages at diagnosis for type I, type II, and type III patients were 8, 35, and 41 months, respectively. The 5-year overall survival (OS) rate for type I/Ir patients was 91%; all deaths in this group were due to progression to type II or III. OS was significantly better for type II versus type III (P = .0061); the 5-year OS rates were 71% and 53%, respectively. Disease-free survival (DFS) was also significantly better for type II versus type III (P = .0002); the 5-year DFS rates were 59% and 37%, respectively. The PPB type was the strongest predictor of outcome. Metastatic disease at the diagnosis of types II and III was also an independent unfavorable prognostic factor. Sixty-six percent of the 97 patients tested had a heterozygous germline DICER1 mutation. In this subset, the DICER1 germline mutation status was not related to the outcome. CONCLUSIONS Cystic type I/Ir PPB has a better prognosis than type II, and type II has a better outcome than type III. Surveillance of DICER1 carriers may allow the earlier detection of cystic PPB before its progression to type II or III PPB and thereby improve outcomes.
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Affiliation(s)
- Yoav H. Messinger
- International Pleuropulmonary Blastoma Registry, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Douglas R. Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD
| | - John R. Priest
- International Pleuropulmonary Blastoma Registry, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Gretchen M. Williams
- International Pleuropulmonary Blastoma Registry, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Anne K. Harris
- International Pleuropulmonary Blastoma Registry, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Kris Ann P. Schultz
- International Pleuropulmonary Blastoma Registry, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Jiandong Yang
- Division of Pathology, Children’s National Medical Center, Washington, DC
- Center for Genetic Medicine Research, Department of Integrative Systems Biology, George Washington University School of Medicine, Washington, DC
| | - Leslie Doros
- Division of Oncology, Children’s National Medical Center, Washington, DC
| | - Philip S. Rosenberg
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD
| | - D. Ashley Hill
- Division of Pathology, Children’s National Medical Center, Washington, DC
- Center for Genetic Medicine Research, Department of Integrative Systems Biology, George Washington University School of Medicine, Washington, DC
| | - Louis P. Dehner
- Department of Pathology and Immunology, Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish and St. Louis Children’s Hospitals, Washington University Medical Center, St. Louis, MO
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Schultz KAP, Harris A, Williams GM, Baldinger S, Doros L, Valusek P, Frazier AL, Dehner LP, Messinger Y, Hill DA. Reply: Serum microRNA screening for DICER1-associated pleuropulmonary blastoma. Pediatr Blood Cancer 2014; 61:2331-2. [PMID: 25251372 PMCID: PMC4205196 DOI: 10.1002/pbc.25233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 07/30/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Kris Ann P Schultz
- International Ovarian and Testicular Stromal Tumor Registry, Children's Hospital and Clinics of Minnesota, Minneapolis, MN; International Pleuropulmonary Blastoma Registry, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN; Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
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10
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Schultz KAP, Harris A, Williams GM, Baldinger S, Doros L, Valusek P, Frazier AL, Dehner LP, Messinger Y, Hill DA. Judicious DICER1 testing and surveillance imaging facilitates early diagnosis and cure of pleuropulmonary blastoma. Pediatr Blood Cancer 2014; 61:1695-7. [PMID: 24821309 PMCID: PMC4139105 DOI: 10.1002/pbc.25092] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 04/16/2014] [Indexed: 12/15/2022]
Abstract
Pleuropulmonary blastoma (PPB) and Sertoli-Leydig cell tumor (SLCT) are both associated with germline mutations in DICER1. In this brief report, a maternal history of SLCT led to identification of a deleterious DICER1 mutation in the patient and her asymptomatic infant. Radiographic screening revealed a large Type I PPB, which was completely resected. Identification of DICER1 mutation carriers and imaging of children at risk for PPB may allow detection of PPB in its earliest and most curable form, leading to increased likelihood of surgical cure and decreased risks of treatment-related late effects.
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Affiliation(s)
- Kris Ann P Schultz
- International Ovarian and Testicular Stromal Tumor Registry, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota; International Pleuropulmonary Blastoma Registry, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
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11
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Doros L, Yang J, Dehner L, Rossi CT, Skiver K, Jarzembowski J, Messinger Y, Schultz KA, Williams G, Hill DA. DICER1 mutations in embryonal rhabdomyosarcomas from children with and without familial PPB-tumor predisposition syndrome. Pediatr Blood Cancer 2012; 59:558-60. [PMID: 22180160 PMCID: PMC3708486 DOI: 10.1002/pbc.24020] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 11/02/2011] [Indexed: 01/19/2023]
Abstract
Embryonal rhabdomyosarcoma (ERMS) is the most common childhood sarcoma and is a component of the familial pleuropulmonary blastoma (PPB)-predisposition syndrome. Using the PPB model, we hypothesized that DICER1 mutations would be found in familial and sporadic forms of ERMS. Blood samples from four children with familial PPB and ERMS, and 52 sporadic ERMS tumors were tested for DICER1 mutations. Germline DICER1 mutations were found in all four patients with familial PPB and 2 of 52 (3.8%) sporadic ERMS had somatic mutations. Our findings confirm the pathogenetic relationship between ERMS and PPB suggesting that ERMS may result from abnormal miRNA regulation.
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Affiliation(s)
- Leslie Doros
- Department of Pathology, Children's National Medical Center, Washington, D.C., United States
| | - Jiandong Yang
- Department of Pathology, Children's National Medical Center, Washington, D.C., United States
| | - Louis Dehner
- Department of Pathology& Immunology, Washington University Medical Center, St. Louis, MO, United States
| | - Christopher T. Rossi
- Department of Pathology, Children's National Medical Center, Washington, D.C., United States
| | - Kerry Skiver
- Department of Pathology, Children's National Medical Center, Washington, D.C., United States
| | - Jason Jarzembowski
- Department of Pathology, Children's Hospitals of Wisconsin, Milwaukee, WI, United States
| | - Yoav Messinger
- International Pleuropulmonary Blastoma Registry, Minneapolis, MN, United States
- Division of Oncology, Children's Hospital and Clinics of Minnesota, Minneapolis, MN, United States
| | - Kris Ann Schultz
- International Pleuropulmonary Blastoma Registry, Minneapolis, MN, United States
- Division of Oncology, Children's Hospital and Clinics of Minnesota, Minneapolis, MN, United States
| | - Gretchen Williams
- International Pleuropulmonary Blastoma Registry, Minneapolis, MN, United States
- Division of Oncology, Children's Hospital and Clinics of Minnesota, Minneapolis, MN, United States
| | - D. Ashley Hill
- Department of Pathology, Children's National Medical Center, Washington, D.C., United States
- International Pleuropulmonary Blastoma Registry, Minneapolis, MN, United States
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Abstract
Umbilical metastases, also named Sister Mary Joseph's nodules, are well documented in the adult population and most often represent an underlying intra-abdominal malignancy, usually a carcinoma of gastrointestinal or gynecologic origin. They are indicative of widespread abdominal disease and are associated with a poor prognosis. An extensive review of the literature reveals only two such presentations in the pediatric population. A 14-year-old male presented with an umbilical mass, which was found to be a metastatic lesion of a desmoplastic small round cell tumor (DSRCT) of the abdomen. The diagnosis of an intra-abdominal malignancy, most commonly a DSRCT, should be considered in the presence of an umbilical mass in a child.
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Affiliation(s)
- Leslie Doros
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
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Abstract
The gene for the human CD4 glycoprotein, which serves as the receptor for human immunodeficiency virus type 1, along with approximately 23 kb of sequence upstream of the translational start site, was cloned. The ability of 5' flanking sequences to direct tissue-specific expression was tested in cell culture and in transgenic mice. A 5' flanking region of 6 kb was able to direct transcription of the CD4 gene in NIH 3T3 cells but did not result in detectable expression in the murine T-cell line EL4 or in four lines of transgenic mice. A larger 5' flanking region of approximately 23 kb directed high-level CD4 transcription in the murine T-cell line EL4 and in three independent lines of transgenic mice. Human CD4 expression in all tissues analyzed was tightly correlated with murine CD4 expression; the highest levels of human CD4 RNA expression were found in the thymus and spleen, with relatively low levels detected in other tissues. Expression of human CD4 protein in peripheral blood mononuclear cells was examined by flow cytometry in these transgenic animals and found to be restricted to the murine CD4+ subset of lymphocytes. Human CD4 protein, detected with an anti-human CD4 monoclonal antibody, was present on the surface of 45 to 50% of the peripheral blood mononuclear cells from all transgenic lines.
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Vitale J, Hagopian S, Blackwell C, Donaldson T, Gosselin J, Gillespie F, Montoya-Zavala M, Doros L, Xu X, Penniman W, Wadsworth S, Snyder B. Generation of alzheimers precursor protein transgenic rats. Theriogenology 1993. [DOI: 10.1016/0093-691x(93)90189-c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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