RESUMO
Gastric cancer (GC) has long been a 'Cinderella' among hereditary cancers. Until recently, single-gene testing (SGT) was the only approach to identify high-risk individuals. With the spread of multigene panel testing (MGPT), a debate arose on the involvement of other genes, particularly those pertaining to homologous recombination (HR) repair. We report our mono-institutional experience in genetic counseling and SGT for 54 GC patients, with the detection of nine pathogenic variants (PVs) (9/54:16.7%). Seven out of fifty (14%) patients who underwent SGT for unknown mutations were carriers of a PV in CDH1 (n = 3), BRCA2 (n = 2), BRCA1 (n = 1), and MSH2 (n = 1), while one patient (2%) carried two variants of unknown significance (VUSs). CDH1 and MSH2 emerged as genes involved in early-onset diffuse and later-onset intestinal GCs, respectively. We additionally conducted MGPT on 37 patients, identifying five PVs (13.5%), including three (3/5:60%) in an HR gene (BRCA2, ATM, RAD51D) and at least one VUS in 13 patients (35.1%). Comparing PV carriers and non-carriers, we observed a statistically significant difference in PVs between patients with and without family history of GC (p-value: 0.045) or Lynch-related tumors (p-value: 0.036). Genetic counseling remains central to GC risk assessment. MGPT appeared advantageous in patients with unspecific phenotypes, although it led to challenging results.
Assuntos
Neoplasias Gástricas , Humanos , Neoplasias Gástricas/genética , Predisposição Genética para Doença , Proteína 2 Homóloga a MutS/genética , Testes Genéticos/métodos , MutaçãoRESUMO
BACKGROUND: Tumor testing utility in Lynch syndrome (LS) diagnosis is established. AIMS: Analyze the differences between tumor testing efficiency in rectal (RC) and colon cancer (CC). METHODS: We performed immunohistochemistry (IHC) for MisMatch Repair (MMR) proteins (IHC-MMR) and MicroSatellite Instability analysis (MSI) on 482 unselected primary tumors: 320 CCs and 162 RCs. Samples had proficient-IHC, deficient-IHC or borderline-IHC ("patchy" expression). MSI-H borderline-IHC tumors were considered as likely MMR-deficient. Germline testing was offered to MMR-deficient patients without BRAF mutation or MLH1 promoter hypermetilation (MLH1-Hy). RESULTS: We identified 51/482 (10.6%) MMR-defective tumors. Multivariable analysis demonstrated a significant correlation between tumor testing results with histotype, lymph-node involvement and tumor location. In particular, RC showed a lower MMR-deficiency rate than CC (p<0.0001). Interestingly, MLH1 loss was detected in 0% RCs and 76.1% CCs, with 80% of them showing BRAF mutation/MLH1-Hy. A germline variant was detected in 12 out of 18 patients (mutation detection rate of 66.7%). CONCLUSION: Tumor testing results showed molecular differences between CCs and RCs, in terms of MMR proteins expression, and presence of BRAF mutation/MLH1-Hy. MSH6 variants were the most frequent ones (50%). Although young age at diagnosis was associated with mutation detection (pâ¯=â¯0.045), 33.3% of LS patients were >50 years.
Assuntos
Neoplasias do Colo/genética , Neoplasias Colorretais Hereditárias sem Polipose/diagnóstico , Reparo de Erro de Pareamento de DNA/genética , Detecção Precoce de Câncer/métodos , Neoplasias Retais/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/diagnóstico , Neoplasias Colorretais Hereditárias sem Polipose/genética , Neoplasias Colorretais Hereditárias sem Polipose/patologia , Metilação de DNA/genética , Feminino , Testes Genéticos/métodos , Humanos , Imuno-Histoquímica , Modelos Logísticos , Masculino , Instabilidade de Microssatélites , Pessoa de Meia-Idade , Análise Multivariada , Proteína 1 Homóloga a MutL/genética , Mutação , Proteínas Proto-Oncogênicas B-raf/genética , Neoplasias Retais/diagnósticoRESUMO
Neural stem cells (NSCs) in the murine subventricular zone (SVZ) niche allow life-long neurogenesis. During the first postnatal month and throughout aging, the decrease of neuroblasts and the rise of astrocytes results in diminished neurogenesis and increased astrocyte:neuron ratio. Also, a different neurogenic activity characterizes the SVZ periventricular region (LV, lateral ventricle) as compared to its rostral extension (RE). In order to investigate whether and to what extent these physiological modifications may be ascribed to intrinsic changes of the endogenous NSC/progenitor features, we performed a functional analysis on NSCs isolated and cultured from LV and RE tissues at distinct postnatal stages that are marked by striking modifications to the SVZ niche in vivo. We evaluated the effect of age and brain region on long-term proliferation and multipotency, and characterized the cell type composition of NSC-derived progeny, comparing this make-up to that of region- and age-matched primary neural cultures. Furthermore, we analyzed the effect of prolonged in vitro expansion on NSC functional properties. We documented age- and region-dependent differences on the clonogenic efficiency and on the long-term proliferative capacity of NSCs. Also, we found age- and region-dependent quantitative changes in the cell composition of NSC progeny (decreased quantity of neurons and oligodendrocytes; increased amount of astroglial cells) and these differences were maintained in long-term cultured NSC populations. Overall, these data strengthen the hypothesis that age- and region-dependent differences in neurogenesis (observed in vivo) may be ascribed to the changes in the intrinsic developmental program of the NSC populations.