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Utikal J, Nagel P, Müller V, Becker JC, Dippel E, Frisman A, Gschnell M, Griewank K, Hadaschik E, Helbig D, Hillen U, Leiter U, Pföhler C, Krönig L, Ziemer M, Ugurel S. S1-Guideline Sebaceous Carcinoma. J Dtsch Dermatol Ges 2024; 22:730-747. [PMID: 38679790 DOI: 10.1111/ddg.15405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/19/2024] [Indexed: 05/01/2024]
Abstract
Sebaceous gland carcinomas are rare malignant cutaneous adnexal tumors with sebocytic differentiation. The typical predilection area is the head and neck region, where sebaceous gland carcinomas are the most common malignant adnexal tumors of the skin. According to their localization a distinction is made between periocular and extraocular sebaceous gland carcinomas. Muir-Torre syndrome (MTS) should always be ruled out if it is suspected. In terms of prognosis, sebaceous gland carcinomas are potentially aggressive tumors with a clear tendency to recur and metastasize. Only small extraocular sebaceous gland carcinomas that have been completely resected have a very good prognosis. Sebaceous gland carcinomas most frequently metastasize lymphogenously to regional or distant lymph nodes; organ metastasis occurs less frequently. Periocular sebaceous gland carcinomas have a higher metastasis rate (up to 15%) than extraocular sebaceous gland carcinomas (up to 2%). Complete micrographically controlled surgery (MCS) of the primary tumor is the therapy of first choice, regardless of periocular or extraocular localization. Adjuvant or therapeutic radiotherapy may be considered. There is currently no established standard therapy for advanced, inoperable, or metastatic sebaceous gland carcinomas. Local procedures and systemic therapies such as chemotherapy or immunotherapy can be considered. The procedure should be determined individually by an interdisciplinary tumor board. Close follow-up care is recommended for these potentially aggressive carcinomas.
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Affiliation(s)
- Jochen Utikal
- Clinical Cooperation Unit Dermato-Oncology of the German Cancer Research Center (DKFZ) Heidelberg and the Department of Dermatology, Venereology and Allergology, Medical Faculty Mannheim, Ruprecht Karl University Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
| | - Pia Nagel
- Clinical Cooperation Unit Dermato-Oncology of the German Cancer Research Center (DKFZ) Heidelberg and the Department of Dermatology, Venereology and Allergology, Medical Faculty Mannheim, Ruprecht Karl University Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
| | - Verena Müller
- Clinical Cooperation Unit Dermato-Oncology of the German Cancer Research Center (DKFZ) Heidelberg and the Department of Dermatology, Venereology and Allergology, Medical Faculty Mannheim, Ruprecht Karl University Heidelberg, Mannheim, Germany
- DKFZ Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
| | - Jürgen C Becker
- Translational Skin Cancer Research, Department of Dermatology, University Medical Center Essen, and German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Edgar Dippel
- Department of Dermatology and Venereology, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | - Alexander Frisman
- Department of Radiation Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Martin Gschnell
- Department of Dermatology and Allergology, University Hospital Marburg, Marburg, Germany
| | - Klaus Griewank
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
| | - Eva Hadaschik
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
| | - Doris Helbig
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Uwe Hillen
- Department of Dermatology and Venereology, Vivantes Hospital Neukölln, Berlin, Germany
| | - Ulrike Leiter
- Center for Dermato-Oncology, Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - Claudia Pföhler
- Department of Dermatology, Venereology and Allergology and Skin Tumor Center, Saarland University Medical School, Homburg, Homburg/Saar, Germany
| | - Lisa Krönig
- Department of Dermatology and Allergology, University Hospital Marburg, Marburg, Germany
| | - Mirjana Ziemer
- Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Leipzig, Germany
| | - Selma Ugurel
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
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O'Brien A, Macfarlane S, Sommerlad M, Schirwani S. Mosaic Muir Torre Syndrome: Keratoacanthoma as a Piece of the Puzzle. Am J Dermatopathol 2024; 46:162-166. [PMID: 38170727 DOI: 10.1097/dad.0000000000002612] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
ABSTRACT Lynch syndrome is an inherited condition, which increases the risk of numerous visceral malignancies and cutaneous tumors such as keratoacanthomas and sebaceous tumors. It is typically identified by immunohistochemistry of tissue taken from tumors or through genetic testing with next-generation sequencing. Diagnosing Lynch syndrome becomes more complex when the individual is mosaic for the relevant pathogenic variant. There are very few cases of this reported in the medical literature. It is even more unusual for the diagnosis to be made based on testing of a keratoacanthoma lesion. We report a case where immunohistochemistry of a keratoacanthoma helped make a diagnosis of mosaic Lynch syndrome. We will explore how mosaicism should be considered when a phenotype is strong, even if next-generation sequencing reports no pathogenic or likely pathogenic variant and how lesions such as keratoacanthomas can have a role in the early detection and treatment of future malignancies.
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Affiliation(s)
- Amber O'Brien
- Faculty of Medicine, University of Southampton, Southampton, England
| | | | - Matthew Sommerlad
- Dermatology Department
- Pathology Department, University Hospital Southampton NHS Foundation Trust, Southampto, England
| | - Schaida Schirwani
- Dermatology Department
- Wessex Clinical Genetics Service, Southampton, England; and
- Human Development & Health, Faculty of Medicine, University of Southampton, Institute of Developmental Sciences Building, Southampton, England
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Díaz-Calvillo P, Gómez-Jiménez C, Sabushimike D, González-Sarmiento R, Roncero-Riesco M, Santos-Briz Á. Expanding the Spectrum of Skin Neoplasms in Muir-Torre Syndrome: Beyond Sebaceous Tumours. Am J Dermatopathol 2024; 46:189-191. [PMID: 38354387 DOI: 10.1097/dad.0000000000002627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Pablo Díaz-Calvillo
- Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | - Rogelio González-Sarmiento
- Molecular Medicine Unit, Department of Medicine, Universidad de Salamanca, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Hospital Universitario de Salamanca-USAL-CSIC and Institute of Molecular and Cellular Biology of Cancer (IBMCC), Universidad de Salamanca-CSIC, Salamanca, Spain
| | - Mónica Roncero-Riesco
- Dermatology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Ángel Santos-Briz
- Pathology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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Shaker N, Shaker N, Abid A, Shah S, Shakra RA, Sangueza OP. Muir-Torre syndrome and recent updates on screening guidelines: The link between colorectal tumors and sebaceous adenomas in unusual locations. J Surg Oncol 2023; 128:1380-1384. [PMID: 37706607 DOI: 10.1002/jso.27440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/13/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Muir-Torre syndrome (MTS) is a rare genetic disorder that is caused by mismatch repair (MMR) protein mutations. MTS increases the risk of developing skin and gastrointestinal tumors such as sebaceous adenomas (SAs), sebaceous carcinomas, colorectal cancer, endometrial cancer, and ovarian cancer. The risk of developing these types of tumors varies depending on the involved mutation and the individual's family history risk. CASE PRESENTATION A 47-year-old male presented with multiple skin lesions on the scalp, face, flank, and back. The examination revealed well-circumscribed, dome-shaped papules with a yellowish appearance with white oily material in the center. Histopathologic examination showed a well-circumscribed sebaceous neoplasm consistent with a mixture of basaloid cells and lobules of bland-appearing mature adipocytes that communicate directly to the surface epithelium. Focal cystic changes and peritumoral lymphocytic infiltrate were noted. Increased mitotic figures were seen in the basaloid cell component. The overall findings were consistent with the diagnosis of SAs. MMR staining showed preserved expression in MLH1 and PMS2 proteins, while MSH2 and MSH6 staining showed loss of protein expression. A screening colonoscopy showed numerous colon and rectal tumors, prompting concerns about the likelihood of MTS. Surgical intervention was pursued for complete resection. Histology revealed a diagnosis of mucinous adenocarcinoma/adenocarcinoma with mucinous features of the colon. The diagnosis of MTS was supported by molecular testing that revealed MSH2 germline mutation. The increased likelihood of MTS was attributed to the occurrence of SAs in unusual locations of the head and neck regions, unlike typical cases. CONCLUSION MTS is a rare clinical condition that necessitates prompt thorough evaluation and periodic surveillance. When SA is encountered in atypical locations, it is important to consider additional testing supported by immunohistochemical staining, molecular testing, and regular screening to exclude the likelihood of MTS.
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Affiliation(s)
- Nada Shaker
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nuha Shaker
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Abdul Abid
- Department of Pathology, University of Virginia Health, Charlottesville, Virginia, USA
| | - Sahrish Shah
- Department of Pathology, Geisenger Medical Center, Mechanicsville, Pennsylvania, USA
| | - Rafat Abu Shakra
- Department of Pathology, International Medical Center Hospital, Al-Ruwais, Jeddah, Saudi Arabia
| | - Omar P Sangueza
- Departments of Dermatology and Dermatopathology, Wake Forest University, School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
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Guo Z, Cai Y, Yin W, Huang J. A locally advanced colon cancer patient with Muir-Torre syndrome obtains durable response to neoadjuvant and adjuvant immunotherapy. Tumori 2023; 109:NP27-NP31. [PMID: 37880978 DOI: 10.1177/03008916231204735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Muir-Torre syndrome, presenting with cutaneous tumors and visceral malignancies, is a variant of Lynch syndrome. The development of immune checkpoint inhibitors provided novel effective treatment options for metastatic colorectal cancer patients with microsatellite instability and deficient mismatch repair. However, the use of immune checkpoint inhibitors in neoadjuvant and adjuvant settings for patients with locally advanced colorectal cancer remains undefined because of limited follow-ups in current studies. CASE PRESENTATION In the present study, we reported a 33-year-old Muri-Torre syndrome patient with stage ⅢC (c.T4N2M0) colorectal cancer and keratoacanthoma. Microsatellite instability / deficient mismatch repair, high tumor mutation burden, and MSH2 germline mutation were identified by next-generation sequencing. Pembrolizumab monotherapy was used as neoadjuvant treatment and the patient achieved a major pathological response. After surgical resection, pembrolizumab was continuously used in an adjuvant setting for 12 months. The patient remained disease-free with a durable disease-free survival for 44 months. To our knowledge, this is the first and longest follow-up study reporting pembrolizumab as a single-agent neoadjuvant therapy for locally advanced colon cancer. CONCLUSIONS The results demonstrate promising performance in neoadjuvant and adjuvant settings. Further studies are needed to confirm its potential usefulness as an outcome measure in clinical practice.
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Affiliation(s)
- Zhihua Guo
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Institute of Respiratory Disease and State Key Laboratory for Respiratory Disease, Guangzhou, China
- Research Center for Translational Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yue Cai
- Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Weiqiang Yin
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Institute of Respiratory Disease and State Key Laboratory for Respiratory Disease, Guangzhou, China
- Research Center for Translational Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jun Huang
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Sinson H, Karayan-Tapon L, Godet J, Rivet P, Alleyrat C, Battistella M, Pierron H, Morel F, Lecron JC, Favot L, Frouin E. Immunohistochemistry, Molecular Biology, and Clinical Scoring for the Detection of Muir-Torre Syndrome in Cutaneous Sebaceous Tumors: Which Strategy? Dermatology 2023; 239:889-897. [PMID: 37717564 DOI: 10.1159/000534126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 09/08/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Sebaceous neoplasms (SNs) always raise the possibility of an association with Muir-Torre syndrome (MTS) and permit to screen internal malignancies, colorectal and endometrial carcinomas, before they become symptomatic. Immunohistochemistry (IHC), molecular biology, and clinical examination are different approaches for detection of MTS. We conducted a retrospective analysis of non-selected SNs in order to determine the optimal tools to implement for MTS screening. METHODS Deficient MMR phenotype (dMMR) was determined by either IHC using antibodies directed to four mismatch repair (MMR) antigens on tissue microarray or molecular biology using pentaplex PCR. The Mayo Clinic risk score of MTS was calculated from medical records. Sensibility and specificity of each test for the detection of MTS were determined. RESULTS We included 107 patients, 8 with multiple SNs, for a total of 123 SNs (43 sebaceous adenomas, 19 sebaceomas, and 61 sebaceous carcinomas (SC)). Loss of at least one MMR protein was observed in 70.7% of tumors, while 48% had a microsatellite instable phenotype. Concordance between both techniques was 92.9%, with a 0.85 Cohen's kappa coefficient. Nineteen patients (20.2%) had a ≥2 points Mayo Clinic risk score, one having a pMMR SC. Among the 13 patients with confirmed MTS, 2 had a low Mayo Clinic risk score (1 point). IHC had the highest sensitivity for MTS screening (100%) with a specificity of 34.1%, while a >2-point Mayo Clinic risk score had a lower sensitivity (92%) but a higher specificity (89%). CONCLUSION To detect MTS in SN patients, the first-line Mayo Clinic risk score followed by IHC appears to be the most accurate strategy with lower cost for society. This strategy should be adapted to the medico-economic resources of each country.
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Affiliation(s)
- Hélinie Sinson
- Department of Pathology, University Hospital of Poitiers, Poitiers, France
| | - Lucie Karayan-Tapon
- ProDiCeT, University of Poitiers, Poitiers, France
- CHU De Poitiers, Department of Cancer Biology, Poitiers, France
| | - Julie Godet
- Department of Pathology, University Hospital of Poitiers, Poitiers, France
| | - Pierre Rivet
- ProDiCeT, University of Poitiers, Poitiers, France
- CHU De Poitiers, Department of Cancer Biology, Poitiers, France
| | - Camille Alleyrat
- Plateforme Méthodologie Biostatistiques, Data-Management, University Hospital of Poitiers, Poitiers, France
| | - Maxime Battistella
- Department of Pathology, Saint-Louis Hospital, AP-HP, Université Paris Cité, INSERM U976, Paris, France
| | - Hugo Pierron
- Department of Pathology, University Hospital of Poitiers, Poitiers, France
- CHU De Poitiers, Department of Cancer Biology, Poitiers, France
| | | | - Jean-Claude Lecron
- LITEC, University of Poitiers, Poitiers, France
- Department of Immunology and Inflammation, University Hospital of Poitiers, Poitiers, France
| | - Laure Favot
- LITEC, University of Poitiers, Poitiers, France
| | - Eric Frouin
- Department of Pathology, University Hospital of Poitiers, Poitiers, France
- LITEC, University of Poitiers, Poitiers, France
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Luo L, Hu Y, Liu F, Yang J, Bai Y, Meng Y, Ding R, Hu M, Wu L. Breast Carcinoma with a Special Histological Pattern of Sebaceous Differentiation and High-Frequency Microsatellite Instability: A Case Report and Review of the Literature. Ann Clin Lab Sci 2022; 52:850-857. [PMID: 36261174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The World Health Organization in its 2019 Classification of Breast Tumors termed breast sebaceous carcinoma as invasive breast carcinoma of no special type (IBC-NST), with a sebaceous pattern. Approximately 30 cases of IBC-NST with a sebaceous pattern have been reported in the literature, and in all cases the expression of mismatch repair proteins in tumors was normal. Here, we report a case of IBC-NST with a sebaceous pattern and high-frequency microsatellite instability (MSI-H). This case was a sporadic sebaceous pattern of IBC-NST with MSI-H and was unrelated to Muir-Torre syndrome. Its histopathological characteristics were similar to those of MSI-H-associated triple-negative breast carcinoma (TNBC) with a high histological grade but were without tumor-infiltrating lymphocytes (TILs). The tumor did not recur after 20 months of follow-up.
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Affiliation(s)
- Li Luo
- Department of Pathology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yanping Hu
- Department of Pathology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Fengge Liu
- Department of Pathology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jianjie Yang
- Department of Pathology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yang Bai
- Department of Pathology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yutong Meng
- Department of Pathology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Ran Ding
- Department of Pathology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Mingzhu Hu
- Department of Pathology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Linguo Wu
- Department of Pathology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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Tresserra F, Elizalde J, Ferre B, Gómez-Benlloch A, Martínez-Lanao MÁ, López R. [Isolated conjunctival sebaceous adenoma associated with acute endophtalmitis]. Rev Esp Patol 2022; 55:68-72. [PMID: 34980445 DOI: 10.1016/j.patol.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/07/2019] [Accepted: 01/19/2019] [Indexed: 06/14/2023]
Abstract
Sebaceous adenoma of the conjunctiva is a very rare lesion of uncertain origin. It is usually associated with Muir-Torre syndrome in which neoplasms are also found in other parts of the body. We present the case of a 71-year-old man without a previous or family history of neoplasia, who presented with severe inflammation and an infection in his right eye associated with a tumor of the conjunctiva near the caruncle. The lesion was excised and histopathology revealed a sebaceous adenoma. Microsatellite instability was not observed immunohistochemically. He remains alive and well.
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Affiliation(s)
- Francisco Tresserra
- Servicio de Anatomía Patológica, Hospital Universitario Dexeus, Barcelona, España.
| | - Javier Elizalde
- Servicio de Anatomía Patológica, Hospital Universitario Dexeus, Barcelona, España; Centro de Oftalmología Barraquer, Barcelona, España
| | - Berta Ferre
- Departamento de Patología, Hospital Universitario del Valle de Hebrón, Barcelona, España
| | | | | | - Rocío López
- Servicio de Anatomía Patológica, Hospital Universitario Dexeus, Barcelona, España
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Simic D, Dummer R, Freiberger SN, Ramelyte E, Barysch MJ. Clinical and Molecular Features of Skin Malignancies in Muir-Torre Syndrome. Genes (Basel) 2021; 12:genes12050781. [PMID: 34065301 PMCID: PMC8160778 DOI: 10.3390/genes12050781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We investigated the mutational landscape of skin tumors in patients with Muir-Torre Syndrome (MTS) a hereditary autosomal dominant mismatch repair disorder of increased cancer susceptibility, and examined mutations other than in the DNA mismatch repair (MMR) genes. METHODS This retrospective single-center case series included seven patients with the diagnosis of Muir-Torre Syndrome with precise medical history and family history. Mutational analysis of tumor samples Formalin-fixed paraffin-embedded tissue blocks of skin lesions associated with Muir-Torre Syndrome were used for further analysis. All skin tumors were analyzed with the Oncomine Comprehensive Assay v3 (Life Technologies), which includes 161 of the most relevant cancer driver genes. RESULTS Eleven skin neoplasms (nine sebaceous tumors, one melanoma, one cutaneous squamous cell carcinoma) were diagnosed in seven patients. In two patients, visceral malignancies preceded the diagnosis of the skin tumors and one patient was diagnosed with a visceral malignancy after a sebaceous tumor. History of familial cancer of Lynch Syndrome (LS) was reported in three patients. The most frequently detected mutation was in the MSH2 gene, followed by mutations in the NOTCH1/2 and TP53 gene. Conclusion, this study provides a molecular analysis of Muir-Torre Syndrome associated and non-associated skin tumors in patients with Muir-Torre Syndrome. Patients with sebaceous lesions should undergo microsatellite instability analysis and accurate evaluation of personal and family history to detect a possible Muir-Torre syndrome. As secondary malignancies may appear years after the first occurrence of sebaceous tumors, lifelong screening is mandatory.
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Affiliation(s)
- Dario Simic
- Department of Dermatology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (D.S.); (E.R.); (M.-J.B.)
- Faculty of Medicine, University of Zurich, Raemistrasse 71, 8006 Zurich, Switzerland;
| | - Reinhard Dummer
- Faculty of Medicine, University of Zurich, Raemistrasse 71, 8006 Zurich, Switzerland;
- Correspondence:
| | - Sandra N. Freiberger
- Faculty of Medicine, University of Zurich, Raemistrasse 71, 8006 Zurich, Switzerland;
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091 Zurich, Switzerland
| | - Egle Ramelyte
- Department of Dermatology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (D.S.); (E.R.); (M.-J.B.)
- Faculty of Medicine, University of Zurich, Raemistrasse 71, 8006 Zurich, Switzerland;
| | - Marjam-Jeanette Barysch
- Department of Dermatology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (D.S.); (E.R.); (M.-J.B.)
- Faculty of Medicine, University of Zurich, Raemistrasse 71, 8006 Zurich, Switzerland;
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Gamret AC, Klingbeil KD, Fertig RM, Jahan-Tigh RR, Silapunt S, Uzoma M, Gaudi S, Romanelli P. Muir-Torre Syndrome. Skinmed 2020; 18:382-384. [PMID: 33397571] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 64-year-old man was referred to our dermatology clinic with a diagnosis of Muir-Torre syndrome (MTS), he had a history of multiple sebaceous carcinomas and sebaceous adenomas removed over the years. The patient has also had visceral cancer and had undergone a colon resection 17 years before to treat colon cancer and was recently diagnosed with invasive high-grade urothelial carcinoma of the right ureter. In addition, the patient has an extensive family history of cancer; a pedigree was constructed to document this history (Figure 1). Of note is that the patient's mother and father were second cousins. The patient's father was diagnosed with lung cancer at age 57 and died of colon cancer at the age of 72. The patient's mother died of colon cancer at age 74. The patient has three siblings: a sister and two brothers. The sister died of bone cancer at age 42. One brother had a number of cancers including colon, kidney, and skin cancers and died at age 53. His other brother is alive and has a history of colon cancer, kidney cancer, and ureteral cancer. The patient has five children. He has a 40-year-old son who, at the age of 30, was diagnosed with testicular cancer. His daughters are 47, 44, 39, and 34, with no history of malignancy to date. The patient had three maternal aunts, all of whom succumbed to colon cancer, as well as two paternal uncles who died of lung cancer. The patient's maternal grandfather was a smoker and he also died of lung cancer.
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Affiliation(s)
- A Caresse Gamret
- Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL;
| | - Kyle D Klingbeil
- Department of Surgical Oncology, University of Miami Miller School of Medicine, Miami, FL
| | - Raymond M Fertig
- Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Richard R Jahan-Tigh
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX
| | - Sirunya Silapunt
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX
| | - Miranda Uzoma
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX
| | - Sudeep Gaudi
- Pathology and Laboratory Medicine Service, James A. Haley VA Hospital, Tampa, FL
| | - Paolo Romanelli
- Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
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Chen Q, Wang M, Xu Z, Wang M, Jin S, Tian S, Xiao S. Muir-Torre Syndrome With a Frame-shift Mutation in the MSH2 Gene: A Rare Case Report and Literature Review. Int J Gynecol Pathol 2020; 39:136-140. [PMID: 32039937 DOI: 10.1097/pgp.0000000000000572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Muir-Torre syndrome is a rare subtype of Lynch syndrome characterized by coincidence of skin neoplasm and visceral malignancies. Here, we report a case of this rare disease, whose diagnosis of the syndrome was first suspected by the pathologist. This was a 60-yr-old woman who presented with an axillary skin nodule, which was diagnosed as basal cell carcinoma. Further inquiry revealed that she was hospitalized for evaluation of a recurrent vaginal stump endometrial carcinoma. Histologic workup and immunohistochemistry for mismatch repair proteins of both the skin and vaginal tumor suggested the possibility of Muir-Torre syndrome. NexGen sequencing identified a frame-shift mutation in the MSH2 gene. The patient was found to have a metachronous colorectal carcinoma, uterine endometrial carcinoma, and skin cancer from 1998 to 2016. Five family members had also suffered from colorectal cancer or glioma. This case report illustrates the importance of the multidisciplinary care approach, mismatch repair protein and gene testing, and detailed medical history taking into consideration the diagnosis of Muir-Torre syndrome.
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Kudibal MT, Venzo A. [Muir-Torre syndrome]. Ugeskr Laeger 2018; 180:V10170738. [PMID: 29984696] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Muir-Torre syndrome (MTS) is an autosomal dominant disease with approximately 200 reported cases worldwide, which is characterised by multiple neoplasms of the skin and internal organs. This is a case report of a 57-year-old woman with MTS, who was referred to a plastic surgery department from a gastroenterology department due to a neoplasm of the skin. After treatment, she was referred to a dermatology department for follow-up. MTS is a rare disease, which is now reported in Denmark. Doctors treating any of the composing elements should have basic knowledge of the condition in order to refer patients appropriately.
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13
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Haber R, Battistella M, Pages C, Bagot M, Lebbe C, Basset-Seguin N. Sebaceous Carcinomas of the Skin: 24 Cases and a Literature Review. Acta Derm Venereol 2017; 97:959-961. [PMID: 28448096 DOI: 10.2340/00015555-2685] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Roger Haber
- Department of Dermatology and Venereology, Université Paris 7, Saint Louis Hospital, FR-75010 Paris, France
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14
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Pollinger TH, Kieliszak CR, Logemann N, Gratrix ML. Analysis of Sebaceous Neoplasms for DNA Mismatch Repair Proteins in Muir-Torre Syndrome. Skinmed 2017; 15:259-264. [PMID: 28859734] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Muir-Torre syndrome is a rare genodermatosis inherited most frequently in an autosomal dominant fashion. Current criteria for its diagnosis include at least one sebaceous tumor and an underlying visceral malignancy. Muir-Torre syndrome is strongly associated with a germline mutation in DNA mismatch repair genes. We report two patients with a history of colorectal carcinoma who presented with sebaceous neoplasms on the face and trunk. Immunohistochemical staining of the sebaceous neoplasms demonstrated absence of mismatch repair proteins MSH2 and MSH6. Genetic studies confirmed deletions in the MSH2 gene, and a diagnosis of Lynch syndrome was made. Immunohistochemical staining for mismatch repair genes MLH1, MSH2, MSH6 and PMS2 may aid in the diagnosis of Muir-Torre syndrome in cases where there is high suspicion. Genetic testing is an important final step in the confirmation of Muir-Torre syndrome.
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Affiliation(s)
- Tess H Pollinger
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda MD
| | - Christopher R Kieliszak
- Department of Otolaryngology Head and Neck Surgery, OhioHealth Doctors Hospital, Columbus, OH;
| | - Nicholas Logemann
- Department of Dermatopathology, Walter Reed National Military Medical Center Bethesda, MD
| | - Max L Gratrix
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda MD
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15
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Abstract
Sebaceous skin tumors are classified into sebaceous adenoma, sebaceoma, and sebaceous carcinoma. An additional group of cystic sebaceous tumors indicate the Muir-Torre syndrome (MTS). Cystic sebaceous tumors are considered as morphologic variants of the 3 main categories. Multilineage adnexal tumors with partly sebaceous differentiation may pose a challenge to categorize. Sebaceous hyperplasia and nevus sebaceus are not considered as true sebaceous tumor entities. Recently, attention has been drawn to morphologic clues of sebaceous differentiation. Immunohistochemistry using the mismatch repair proteins and/or genetic microsatellite instability testing should be performed on sebaceous neoplasms to diagnose MTS as early as possible.
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Affiliation(s)
- Katharina Flux
- Department of Dermatology, University of Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany; Labor für Dermatohistologie und Oralpathologie, Bayerstrasse 69, 80335 München, Munich, Germany.
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16
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Neelakantan IV, Di Palma S, Smith CET, McCoombe A. Parotid Sebaceous Carcinoma in Patient with Muir Torre Syndrome, Caused by MSH2 Mutation. Head Neck Pathol 2016; 10:354-61. [PMID: 26577210 PMCID: PMC4972744 DOI: 10.1007/s12105-015-0670-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 11/06/2015] [Indexed: 02/04/2023]
Abstract
Sebaceous carcinoma of parotid gland are extremely rare with only 29 cases reported so far. The development of parotid sebaceous carcinoma in association with mutation in the mismatch repair gene that causes Muir Torre Syndrome (MTS), a subset of Lynch Syndrome, is still unclear. This study describes such a case and reviews the literature to see if an association between parotid sebaceous carcinoma and multiple visceral malignancies seen in Lynch Syndrome has ever been described. MTS represents a small subset of the Hereditary Non Polyposis Colorectal Carcinoma family, thought to be a subtype of Lynch Syndrome, where patients are prone to develop multiple visceral cancers involving gastrointestinal and genitourinary tract along with sebaceous and non-sebaceous tumours of the skin. MTS is a rare hereditary, autosomal dominant cancer syndrome caused by Microsatellite Instability and defect in DNA mismatch repair protein. The germline mutation involves mostly hMSH2 and hMLH1 genes. In MTS the skin of the head and neck area with the periocular region in particular, is affected but sebaceous carcinomas of the parotid associated with visceral malignancies has not yet been reported in literature. Here we report an index case of sebaceous carcinoma of parotid gland in a patient with MTS.
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Affiliation(s)
| | - Silvana Di Palma
- Department of Histopathology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 8DY UK
| | - C. E. T. Smith
- Department of Histopathology, Frimley Park Hospital, Camberley, Surrey UK
| | - A. McCoombe
- Department of ENT, Frimley Park Hospital, Camberley, Surrey UK
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17
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Švec J, Schwarzová L, Janošíková B, Štekrová J, Mandys V, Kment M, Vodička P. Synchronous gastric and sebaceous cancers, a rare manifestation of MLH1-related Muir-Torre syndrome. Int J Clin Exp Pathol 2014; 7:5196-5202. [PMID: 25197397 PMCID: PMC4152087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 07/23/2014] [Indexed: 06/03/2023]
Abstract
Muir-Torre syndrome (MTS), a rare variant of the hereditary non polyposis colorectal cancer syndrome, is an autosomal dominant genodermatosis characterised by coincidence of sebaceous gland neoplasms (sebaceous adenoma, epithelioma, or carcinoma) and at least one internal malignancy. The underlying cause of MTS is a germline mutation in DNA mismatch repair genes MSH2, MLH1 and MSH6. We report the case of a 52-year-old caucasian woman with the development of metachronous colon cancer at the age of 38 years, uterine cancer at the age of 43 years, and unique occurrence of synchronous gastric and sebaceous carcinomas related to germline point mutation c. 2194A>T in the last exon of MLH1 gene, resulting in truncated protein in C-terminal region p. Lys732X due to premature stop codon. This mutation, not previously reported in MTS, disrupts the function of MutL complexes presumably by preventing the interaction with PMS1/PMS2 and impairing the endonuclease active site. This case points out the importance of sebaceous neoplasia, especially sebaceous adenocarcinoma, as cutaneous markers of MTS for timely implementation of cancer screening programs.
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Affiliation(s)
- Jiří Švec
- 2nd Department of Internal Medicine, 3rd Faculty of Medicine, Charles UniversityPrague
- Department of Molecular Biology of Cancer, Institute of Experimental Medicine, Academy of Sciences of the Czech RepublicPrague
| | - Lucie Schwarzová
- Institute of Biology and Medical Genetics, 1st Faculty of Medicine and General Teaching Hospital, Charles UniversityPrague
| | - Bohumila Janošíková
- Institute of Biology and Medical Genetics, 1st Faculty of Medicine and General Teaching Hospital, Charles UniversityPrague
| | - Jitka Štekrová
- Institute of Biology and Medical Genetics, 1st Faculty of Medicine and General Teaching Hospital, Charles UniversityPrague
| | - Václav Mandys
- Department of Pathology, 3rd Faculty of Medicine, Charles UniversityPrague
| | - Milan Kment
- 2nd Department of Internal Medicine, 3rd Faculty of Medicine, Charles UniversityPrague
| | - Pavel Vodička
- Department of Molecular Biology of Cancer, Institute of Experimental Medicine, Academy of Sciences of the Czech RepublicPrague
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18
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Wachter DL, Rauh C, Wenkel E, Fasching PA, Beckmann MW, Hartmann A. [Sebaceous breast carcinoma: report of a rare histological special subtype]. Pathologe 2014; 35:72-6. [PMID: 24414613 DOI: 10.1007/s00292-013-1844-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report on a case of sebaceous carcinoma of the breast as a rare histological special subtype of breast cancer. Because these tumors are uncommon, differential diagnostic considerations and the exclusion of Muir-Torre syndrome are emphasized. Finally possible mechanisms of development and therapeutic strategies for this carcinoma are discussed.
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MESH Headings
- Adenocarcinoma, Sebaceous/diagnosis
- Adenocarcinoma, Sebaceous/pathology
- Biomarkers, Tumor/analysis
- Biopsy, Needle
- Breast/pathology
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Diagnosis, Differential
- Female
- Humans
- Mammography
- Middle Aged
- Muir-Torre Syndrome/diagnosis
- Muir-Torre Syndrome/pathology
- Neoplasms, Hormone-Dependent/diagnosis
- Neoplasms, Hormone-Dependent/pathology
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/pathology
- Prognosis
- Receptor, ErbB-2/analysis
- Receptors, Estrogen/analysis
- Receptors, Progesterone/analysis
- Ultrasonography, Mammary
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Affiliation(s)
- D L Wachter
- Pathologisches Institut, Universitätsklinikum Erlangen, Krankenhausstr. 8-10, 91054, Erlangen, Deutschland
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19
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Voigt E, Sommer F, Geiger KD, Pillunat LE. [Sebaceous gland tumor with a rare gene mutation within a tumor syndrome: Muir-Torre syndrome]. Ophthalmologe 2013; 111:369-72. [PMID: 23774967 DOI: 10.1007/s00347-013-2879-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Muir-Torre syndrome is a rare autosomal dominant subtype of hereditary nonpolyposis colorectal carcinoma and is characterized by the simultaneous occurrence of sebaceous gland neoplasms with visceral and urogenital malignancies. This article describes the case of a 72-year-old patient who was referred to our clinic for removal of an upper eyelid tumor, showing the course from the clinical findings to the rare diagnosis of Muir-Torre syndrome.
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Affiliation(s)
- E Voigt
- Universitäts-Augenklinik Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland,
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20
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Becker-Schiebe M, Hannig H, Hoffmann W, Donhuijsen K. Muir-Torre syndrome - an uncommon localization of sebaceous carcinomas following irradiation. Acta Oncol 2012; 51:265-8. [PMID: 21864048 DOI: 10.3109/0284186x.2011.602644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Ang JM, Alai NN, Ritter KR, Machtinger LA. Muir-Torre syndrome: case report and review of the literature. Cutis 2011; 87:125-128. [PMID: 21488569] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Muir-Torre syndrome (MTS), a subtype of Lynch syndrome II, presents as at least one internal malignancy associated with at least one sebaceous skin tumor. This autosomal-dominant genetic disorder is thought to arise from microsatellite instability. Although not all patients with sebaceous tumors have MTS, even a single biopsy-proven sebaceous adenoma may warrant evaluation for MTS. We report the case of a 76-year-old man with a marked family history of colon cancer; a personal history of colon cancer status post-partial resection of the colon; and multiple cutaneous neoplasms including sebaceous adenomas, sebaceous gland hyperplasia, and basal and squamous cell carcinomas. We review the literature describing MTS and highlight the important role of dermatologists and dermatopathologists in the potential early detection and initial diagnosis of this familial or hereditary colon cancer in patients presenting with cutaneous sebaceous adenomas. Correct diagnosis may be lifesaving in patients with MTS and their at-risk relatives who would benefit from earlier colonoscopy, tumor surveillance, and potential early cancer detection. Muir-Torre syndrome represents yet another dermatologic symptom of an internal disease.
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Affiliation(s)
- Jennifer M Ang
- University of California, Irvine, School of Medicine, USA.
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22
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Kacerovská D, Kazakov DV, Cerná K, Hadravský L, Michal M, Dostál J, Skálová A, Michal M. [Muir-Torre syndrome--a phenotypic variant of Lynch syndrome]. Cesk Patol 2010; 46:86-94. [PMID: 21313735] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Muir-Torre syndrome (MTS) represents an autosomal dominantly inherited condition and is considered a phenotypic variant of the more common hereditary nonpolyposis colorectal cancer syndrome (HNPCC), or Lynch syndrome. MTS combines at least one cutaneous neoplasm with sebaceous differentiation (e.g. sebaceoma, sebaceous adenoma, and sebaceous carcinoma), and at least one visceral malignancy. MTS is a genetic disorder caused by a germline mutation in one of the DNA mismatch repair (MMR) genes. Tumors in MTS patients are characteristically associated with the loss of MMR protein expression and/or microsatellite instability (70%). Patients who are suspected to have MTS/Lynch syndrome are often identified by dermatologists, dermatopathologists/pathologists, gastroenterologists and gynecologists. If MTS is suspected on a clinicopathological ground, necessary additional laboratory investigations should be performed only in specialized pathological departments providing immunohistochemistry and molecular biologic analysis service.
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Affiliation(s)
- D Kacerovská
- Siklův patologicko-anatomický ústav, Fakultní nemocnice a Lékarská fakulta Univerzity Karlovy, Plzen
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