Revisitando la indicación de la mastectomía profiláctica contralateral en pacientes con Síndrome de Li-Fraumeni y cáncer de mama. Reporte de un caso / Revisiting the indication for prophylactic contralateral mastectomy in patients with Li-Fraumeni syndrome and breast cáncer. Case report

Objetivo: describir el caso de una paciente con Síndrome de Li-Fraumeni (SLF) y cáncer de mama, en quien se cuestionó el beneficio en la supervivencia de la mastectomía profiláctica contralateral (MPC); asimismo, se pretende hacer una discusión crítica acerca de la evidencia que soporta este procedimiento en esta población. Presentación del caso: mujer de 37 años con cáncer de mama y múltiples antecedentes familiares de cánceres de temprana aparición del espectro del SLF, en quien, durante la adyuvancia hormonal, se confirmó una variante patogénica en el gen TP53. La paciente fue presentada en la Junta Multidisciplinaria del Servicio de Mama de un Centro Oncológico de referencia en Colombia, con el fin de discutir el beneficio de la MPC. La decisión de la junta fue no realizar la MPC. Después de 30 meses de seguimiento la paciente se encuentra libre de enfermedad. Conclusión: no existe evidencia que analice, de forma particular, el impacto de la MPC en la supervivencia de las pacientes con SLF y cáncer de mama. Sin embargo, a la luz del conocimiento actual no es posible generalizar la conducta de omitir esta cirugía profiláctica. Es importante reportar los casos en los que se decida realizar u omitir este procedimiento con el fin de incrementar el cuerpo de la evidencia, dado que existen limitaciones para construir grandes cohortes o estudios experimentales exclusivos para esta alteración genética.

Objective: To describe the case of a patient with Li-Fraumeni syndrome (LFS) and breast cancer in whom the benefit of contralateral prophylactic mastectomy (CPM) was challenged; and to offer a critical discussion regarding the evidence supporting this procedure in this patient population. Case presentation: A 37-year-old woman with breast cancer and a family history of multiple early onset cancer of the LFS spectrum in whom a pathogenic variant of the TP53 gene was confirmed during adjuvant hormonal therapy. The case was presented during the multidisciplinary meeting of the Breast Service of a referral oncology center in Colombia, in order to discuss the benefit of CPM. The decision of the board meeting was not to perform CPM. After 30 months of follow-up, the patient is disease-free. Conclusion: There is no evidence on the impact of CPM on survival of patients with LFS and breast cancer in particular. However, in light of the current knowledge, it is not possible to generalize the approach of withholding this prophylactic surgery. It is important to report those cases in which the decision is made to either perform or omit this procedure in order to increase the body of evidence, considering the limitations that make it difficult to build large cohorts or conduct trials exclusively for this genetic disorder.

Importancia del síndrome de Li-Fraumeni, un síndrome genético de predisposición al cáncer / The importance of Li-Fraumeni syndrome, a hereditary cancer predisposition disorder

El cáncer en pediatría es una entidad infrecuente. Se estima que más de un 10-15 % de los tumores son secundarios a una variante patogénica en un gen de predisposición al cáncer.Se conocen más de 100 genes de predisposición al cáncer y su asociación con síndromes o tumores aislados. Uno de los más descritos es el síndrome de Li-Fraumeni.Los pacientes con este síndrome tienen alto riesgo de desarrollar uno o más tumores. Su conocimiento permite realizar un protocolo de seguimiento del paciente y de sus familiares afectos, con el que detectar precozmente nuevos tumores y disminuir la morbimortalidad del tumor y de su tratamiento.Esta revisión pretende ser una guía útil para el pediatra. Utilizando como caso guía a una familia, se revisarán los motivos de sospecha de un síndrome de Li-Fraumeni, su diagnóstico clínico y genético, y el protocolo de seguimiento de los familiares portadores de la misma mutación

Pediatric cancer is rare. It is estimated that more than 10-15 % of tumors are secondary to a pathogenic variant in a cancer predisposition gene.More than 100 cancer predisposition genes and their association with syndromes or isolated tumors have been identified. Li-Fraumeni syndrome is one of those who have been most widely described.Patients with this syndrome present a high risk of developing one or more tumors. Its knowledge allows to establish a follow-up protocol for the patient and affected family members, so as to detect new tumors in an early manner and reduce tumor- and treatment-related morbidity and mortality.The objective of this review is to offer useful guidelines for pediatricians. Based on a family case, reasons for Li-Fraumeni syndrome suspicion, clinical and genetic diagnosis, and the follow-up protocol of family members who carry the same mutation will be reviewed.

Metachronic breast and cerebellar neoplasm in a young patient / Neoplasias mamária e cerebelar metacrônicas em uma paciente jovem

Abstract Several factors trigger the development of genetic mutations that are responsible for causing a neoplasm. Medulloblastoma is a malignant and invasive cerebellar neoplasm, that affects children and young adults. Mucinous carcinoma is a special type of breast cancer. Being a special atypical subtype of invasive carcinoma, it most frequently affects women of advanced age and represents 1 to 7% of all breast cancers. The reported case aims to show the rarity of the occurrence of desmoplastic medulloblastoma and mammary mucinous carcinoma in a young patient in a short period of time, in different sites, without direct anatomical attachment and without occurrence of metastasis. Initially, this patient had a desmoplastic medulloblastoma and was treated with lumpectomy and radiotherapy. After 13 months, the patient was diagnosed with a mucinous breast carcinoma, underwent mastectomy, adjuvant chemotherapy and is currently undergoing endocrinotherapy. We conclude, based on the metachronous characteristic of the neoplasia and clinical characteristics, that the patient is likely to have Li-Fraumeni syndrome, an autosomal dominant disease with mutation of the TP53 gene, which is the the main involved. Because the patient does not present all the characteristics of the phenotype of the syndrome, she can thus be classified as having Li-Fraumeni variant or Li-Fraumeni-like syndrome.

Resumo Diversos fatores desencadeiam o desenvolvimento de mutações genéticas que são responsáveis por originar uma neoplasia. O meduloblastoma é uma neoplasia cerebelar maligna e invasiva que acomete crianças e adultos jovens. O carcinoma mucinoso é um tipo de câncer de mama especial por ser um subtipo atípico de carcinoma invasivo, que acomete com maior frequência mulheres de idade avançada e representa entre 1 a 7% do total de neoplasias mamárias. O caso relatado tem como objetivo mostrar a raridade da ocorrência do meduloblastoma desmoplásico e carcinoma mucinoso mamário em uma paciente jovem em um curto período de tempo, em diferentes sítios sem ligação anatômica direta e sem ocorrência de metástase. Inicialmente, esta paciente possuía um meduloblastoma desmoplásico e foi tratada com tumorectomia e radioterapia. Após 13 meses, a paciente foi diagnosticada com carcinoma mucinoso de mama, sendo submetida a mastectomia, quimioterapia adjuvante e atualmente está sendo tratada com endocrinoterapia. Concluímos, com base na característica metacrônica da neoplasia e características clínicas, que a paciente apresenta a síndrome de Li-Fraumeni, doença autossômica dominante com mutação do gene TP53, que é o principal gene envolvido nesta síndrome. Por não apresentar as características completas do fenótipo da síndrome, a paciente pode assim ser classificada como portadora de uma variante da síndorme de Li-Fraumeni ou síndrome do tipo Li-Fraumeni.

Alterações genômicas no carcinoma adrenocortical de pacientes portadores da Síndrome de Li-Fraumeni / Genomic alterations profile in adrenocortical carcinoma of Li-Fraumeni Syndrome patients

A Síndrome de Li Fraumeni (LFS) tem caráter autossômico dominante associada ao risco aumentado de câncer hereditário. Embora rara no mundo, no Brasil é frequente devido à ocorrência de uma mutação fundadora, a p.R337H TP53. A ocorrência de câncer e a idade de acometimento são variáveis mesmo em portadores da mesma mutação. Pacientes com mutações no gene TP53 podem desenvolver um amplo espectro de tumores, incluindo o carcinoma adrenocortical (ADR). Os mecanismos moleculares envolvidos na carcinogênese adrenocortical assim como os dados epidemiológicos associados a estes tumores são pouco explorados em literatura. Neste estudo, foram coletados e analisados os dados epidemiológicos dos ADR incluindo os efeitos de idade, período e coorte utilizando o banco de dados SEER, o qual reúne dados de 18 registros de câncer de base populacional dos EUA. Foi avaliado o perfil de alterações genômicas (CytoScan HD Array, Affymetrix) em ADR de pacientes com e sem a mutação p.R337H. Foi também comparado o perfil mutacional (sequenciamento do genoma) de três pacientes (tumor e tecido normal de 2 adultos e 1 criança) com ADR portadores da mutação TP53 p.R337H. Entre os casos de ADR diagnosticados nos EUA, aproximadamente 80% ocorreram após a quarta década de vida. Nas análises de sobrevida, houve diferença estatística (p<0,05) para gênero, com uma melhor sobrevida para as mulheres. Pacientes diagnosticados até os 19 anos e com doença localizada apresentaram uma sobrevida maior. A análise genômica em sete casos revelou 644 alterações. Os três casos positivos para a mutação p.R337H apresentaram 175 alterações genômicas (127 ganhos, 27 cnLOH e 21 perdas). Os quatros casos negativos para a mutação apresentaram 469 alterações (326 ganhos, 63 cnLOH e 80 perdas). Apesar do pequeno número amostral, os casos ADR positivos para a mutação TP53 p.R337H apresentaram um baixo nível de instabilidade genômica quando comparados com os casos não mutados. A análise de sequenciamento do genoma revelou alterações em genes previamente associados o ADR (como TP53, CTNNB1 e ATRX). Foram identificadas alterações em cinco genes com potencial associação ao desenvolvimento do ADR: HBB, MSR1, SH3TC2, LSS e ABCA4. Apesar do pequeno número amostral, foram identificados novos genes que podem estar associados ao ADR, no entanto esses achados deverão ser confirmados em estudos conduzidos em um grupo amostral maior (AU)

Li-Fraumeni syndrome (LFS) is an autosomal dominant disease with high risk to develop hereditary tumors. Although LFS is a worldwide rare disorder, in Brazil its incidence is higher due to the occurrence of a founder mutation, TP53 p.R337H. The cancer occurrence and age of onset are variable even considering patients with the same mutation. Patients carrying TP53 mutations can develop a large spectrum of tumors, including the adrenocortical carcinoma (ADR). The main molecular mechanisms and the epidemiological factors associated with these tumors are poorly explored in literature. In this study, epidemiological data of ADR were collected and analyzed, including the effects of age, period and cohort. The SEER database, which collects and publishes cancer incidence and survival data from 18 cancer registries from the USA, was used for this analysis. The genomic profile (CytoScan HD Array, Affymetrix) of ADR positive or negative for TP53 p.R337H was also investigated. Furthermore, the mutational profile (Whole Genome Sequencing- WGS) of three ADR patients (normal and tumor samples - 2 adults and 1 pediatric case), all of them positive for TP53 p.R337H mutation, were analyzed. Approximately 80% of the ADR cases diagnosed in the USA developed after the fourth decade of life. In the survival analyses, a statistical difference (p <0.05) was observed for gender, with women showing better survival. Patients diagnosed up to the age of 19 and with localized disease presented better survival. The genomic analysis of seven cases revealed 644 genomic alterations. The three TP53 p.R337H positive cases showed 175 genomic alterations (127 gains, 27 cnLOH and 21 losses). The four negative mutated cases presented 469 alterations (369 gains, 63 cnLOH and 80 losses). Despite the small set of samples, mutated cases presented lower level of chromosome instability compared to cases not carrying this mutation. The WGS analysis identified alterations in genes previously associated with ADR (as TP53, CTNNB1 and ATRX). In addition, five genes (HBB, MSR1, SH3TC2, LSS and ABCA4) potentially associated with the development of ADR were identified. This study revealed new genes that might be associated with ADR. However, further analysis are necessary in a larger number of samples to confirm our findings (AU)

Report on the External Quality Assessment Scheme for Molecular Diagnostics in Korea (2017)

Quality control for genetic analysis has become more important with a drastic increase in testing volume and clinical demands. The molecular diagnostics division of the Korean Association of Quality Assurance for Clinical Laboratory conducted two trials in 2017 on the basis of molecular diagnostics surveys, involving 53 laboratories. The molecular diagnostics surveys included 37 tests: gene rearrangement tests for leukemia (BCR-ABL1, PML-RARA, AML1-ETO, and TEL-AML1), genetic tests for Janus kinase 2, FMS-like tyrosine kinase 3-internal tandem duplication, FMS-like tyrosine kinase 3-tyrosine kinase domain, nucleophosmin, cancer-associated genes (KRAS, EGFR, KIT, and BRAF), hereditary breast and ovarian cancer genes (BRCA1 and BRCA2), Li-Fraumeni syndrome (TP53), Wilson disease (ATP7B), achondroplasia (FGFR3), hearing loss and deafness (GJB2), Avellino (TGFBI), multiple endocrine neoplasia 2 (RET), Huntington disease, spinocerebellar ataxia, spinal and bulbar muscular atrophy, mitochondrial encephalopathy with lactic acidosis and stroke-like episodes, myoclonic epilepsy ragged red fibre, Leber hereditary optic neuropathy, Prader-raderd Angelman syndrome, Duchenne muscular dystrophy, spinal muscular atrophy, fragile X syndrome, apolipoprotein E genotyping, methylenetetrahydrofolate reductase genotyping, and ABO genotyping. Molecular genetic surveys revealed excellent results for most participants. The external quality assessment program for genetic analysis in 2017 proved useful for continuous education and the evaluation of quality improvement.

Pediatric High Grade Gliomas in the Context of Cancer Predisposition Syndromes

Germline mutations in cancer causing genes result in high risk of developing cancer throughout life. These cancer predisposition syndromes (CPS) are especially prevalent in childhood brain tumors and impact both the patient's and other family members' survival. Knowledge of specific CPS may alter the management of the cancer, offer novel targeted therapies which may improve survival for these patients, and enables early detection of other malignancies. This review focuses on the role of CPS in pediatric high grade gliomas (PHGG), the deadliest group of childhood brain tumors. Genetic aspects and clinical features are depicted, allowing clinicians to identify and diagnose these syndromes. Challenges in the management of PHGG in the context of each CPS and the promise of innovative options of treatment and surveillance guidelines are discussed with the hope of improving outcome for individuals with these devastating syndromes.

Pediatric High Grade Gliomas in the Context of Cancer Predisposition Syndromes

Germline mutations in cancer causing genes result in high risk of developing cancer throughout life. These cancer predisposition syndromes (CPS) are especially prevalent in childhood brain tumors and impact both the patient's and other family members' survival. Knowledge of specific CPS may alter the management of the cancer, offer novel targeted therapies which may improve survival for these patients, and enables early detection of other malignancies. This review focuses on the role of CPS in pediatric high grade gliomas (PHGG), the deadliest group of childhood brain tumors. Genetic aspects and clinical features are depicted, allowing clinicians to identify and diagnose these syndromes. Challenges in the management of PHGG in the context of each CPS and the promise of innovative options of treatment and surveillance guidelines are discussed with the hope of improving outcome for individuals with these devastating syndromes.

Prevalência populacional de variantes germinativas patogênicas no gene TP53 / Population prevalence of pathogenic germline TP53 variants

Recentes indicações de um fenótipo mais variável e uma menor penetrância de câncer na síndrome de Li-Fraumeni (LFS) levantaram questões a respeito da verdadeira prevalência populacional da síndrome. Investigações anteriores, baseadas em contextos clínicos, propuseram que as estimativas de prevalência populacional de LFS poderiam variar entre um portador a cada 5.000 a 20.000 indivíduos. O primeiro artigo demonstrou que a prevalência populacional de variantes patogênicas e provavelmente patogênicas no gene TP53, as principais causas de LFS, é mais alta do que a esperada em uma população não selecionada pelo histórico de câncer. Nós sugerimos que a prevalência populacional poderia ser de até 10x mais alta do que previamente descrita. O segundo artigo teve como objetivo avaliar e validar as estimativas de prevalência de variantes germinativas em TP53 no banco de dados do gnomAD, que inclui variações genéticas de mais de 130.000 individuos. Variantes em TP53 foram selecionadas e classificadas com base em nosso algoritmo previamente descrito. Além disso, nós fornecemos estimativas de prevalência alternativas com base na classificação de três bancos de dados, ClinVar, HGMD e o portal UMD_TP53. Com base nessa nova análise, nós observamos que a prevalência populacional de variantes germinativas patogênicas e provavelmente patogênicas no gene TP53 é, de fato, maior do que previamente descrita. Contudo, as estimativas podem variar drasticamente (0,02-0,25%) devido a diferentes classificações e a algumas variantes específicas em TP53 que podem estar associadas a um risco inflacionado (p.N235S, p.V31I e p.R290H). Abordagens interdisciplinares são necessárias para melhor entender a interação entre classificação de variantes em TP53, estimativas de prevalência, penetrância de câncer e fenótipo em LFS

Recent suggestions of a variable Li-Fraumeni syndrome (LFS) phenotype and a lower LFS-associated cancer penetrance have raised questions regarding the true disease population prevalence. Earlier investigations, based on clinical contexts, had proposed that the estimated population prevalence of LFS could be between the range of one carrier in every 5,000-20,000 individuals. The first article reported a higher-than-expected population prevalence of pathogenic and likely pathogenic germline TP53 variants in a population unselected for cancer history. We suggested that the population prevalence could be up to 10x higher than previously described in clinically-based studies. The second article aimed to further evaluate germline TP53 variant prevalence estimates in the gnomAD database, which includes germline variation from over 130,000 individuals. Variants were selected and classified based on our previously published algorithm. In addition, we provided alternative prevalence estimates based on three other classifications databases, ClinVar, HGMD, and the UMD_TP53 website. Based on the new analysis, we observed that the population prevalence of pathogenic and likely pathogenic TP53 variants is indeed higher than previously described. However, the estimates can vary widely (0.02-0.25%) due to differences in variant classifications and due to some specific TP53 variants that may be associated with inflated risk (p.N235S, p.V31I, and p.R290H). Comprehensive approaches are needed to better understand the interplay of germline TP53 variant classification, prevalence estimates, cancer penetrance and phenotype of LFS

A rhabdomyosarcoma patient from a Li-Fraumeni syndrome family: a case report and literature review / 中国当代儿科杂志

Li-Fraumeni syndrome (LFS) is a hereditary cancer predisposition syndrome, with the characteristics of early onset of cancer and high cancer incidence. TP53 is widely accepted as a pathogenic gene of LFS. A 2 years and 6 months old boy is reported in this article, who was diagnosed with embryonal rhabdomyosarcoma (RMS) in the left submandibular region. His brother died of RMS, and his grandmother was diagnosed with breast cancer. TP53 gene mutation detection was performed in this patient and some family members, indicating a missense mutation in exon 8 of the patient: c.844C>T (p.Arg282Trp, heterozygous). TP53 mutation was also found in his mother and sister. The boy met the diagnostic criteria for LFS. Among pediatric patients, the most common LFS diseases include osteosarcoma, adrenocortical cancer, central nervous system tumor, and soft tissue tumor. Additionally, leukemia and lymphoma are also involved. LFS patients have a high risk to suffer secondary or even multiple cancers. Therefore, it is necessary to perform genetic detection for pediatric cancer patients, especially those with hereditary predisposition cancers. TP53 mutation often indicates poor prognosis, so it is important to take active treatment and systematic monitoring for LFS family.

Síndrome de Li-Fraumeni / Li-Fraumeni syndrome

El síndrome de Li-Fraumeni se caracteriza por la aparición de tumores en múltiples órganos, generalmente a temprana edad. Esta condición hereditaria es causada por mutaciones germinales en el gen TP53 , que codifica el gen supresor tumoral p53 . Se presenta el caso de una paciente de 31 años con diagnóstico clínico y molecular de síndrome de Li-Fraumeni, que presentó dos tumores sincrónicos a los 31 años: un leiomiosarcoma de antebrazo y un tumor filoides de mama. Tenía el antecedente de un hijo con diagnóstico de carcinoma cortical suprarrenal a los tres años, que falleció a los cinco años debido a la enfermedad. Además, su abuela y su bisabuela maternas habían fallecido de cáncer gástrico a los 56 y 60 años, respectivamente, y la madre y una hermana de su abuelo materno presentaron cáncer de mama pasados los 60 y los 40 años de edad, respectivamente. Después de una asesoría genética, se ordenó hacer la secuenciación completa y el análisis de duplicaciones y deleciones en el gen TP53 . El estudio molecular en una muestra de ADN proveniente de linfocitos de sangre periférica reveló la mutación germinal c.527G>T (p.Cys176Phe) en el exón 5 del gen, mutación deletérea descrita anteriormente en tejidos tumorales. Hasta donde se sabe, este es el primer caso que se publica en Colombia de síndrome de Li-Fraumeni con diagnóstico molecular confirmado. El diagnóstico y el manejo del síndrome de Li-Fraumeni deben estar a cargo de un equipo multidisciplinario, y debe contarse con asesoría genética para el paciente y sus familiares.

The Li-Fraumeni syndrome is characterized clinically by the appearance of tumors in multiple organs generally at an early age. This hereditary condition is caused by germinal mutations in the TP53 gene, which codifies for the tumoural suppressor gene p53 . We present the case of a patient aged 31 with clinical and molecular diagnosis of Li-Fraumeni syndrome who presented two synchronous tumors: a leiomyosarcoma on the forearm and a phyllodes breast tumour. She had a family history of cancer, including a son diagnosed with a cortical adrenal carcinoma when he was three years old, who died at five from the disease. Furthermore, her maternal grandmother and great-grandmother died of stomach cancer at 56 and 60 years old, respectively, while her other great-grandmother and a great aunt presented with breast cancer at the ages of 60 and 40, respectively. After genetic counseling, complete sequencing and analysis of duplications and deletions in the TP53 gene were ordered prior to diagnosis. The molecular analysis of a DNA sample taken from peripheral blood lymphocytes revealed the germinal mutation c.527G>T (p.Cys176Phe) on exon 5 of the TP53 gene, a deleterious mutation described previously in tumoural tissues. To our knowledge, this is the first published case in Colombia of Li-Fraumeni syndrome with confirmed molecular diagnosis. The diagnosis and management of Li-Fraumeni syndrome should be performed by a multidisciplinary team, and genetic counselling should be offered to patients and their relatives.

Germline TP53 Mutation and Clinical Characteristics of Korean Patients With Li-Fraumeni Syndrome

BACKGROUND: Little is known of the mutation and tumor spectrum of Korean patients with Li-Fraumeni syndrome (LFS). Owing to the rarity of LFS, few cases have been reported in Korea thus far. This study aimed to retrospectively review the mutations and clinical characteristics of Korean patients with LFS. METHODS: TP53 mutation was screened in 89 unrelated individuals at the Samsung Medical Center in Korea, from 2004 to 2015. Six additional mutation carriers were obtained from the literature. RESULTS: We identified nine different mutations in 14 Korean patients (male to female ratio=0.3:1). Two such frameshift mutations (p.Pro98Leufs*25, p.Pro27Leufs*17) were novel. The recurrent mutations were located at codons 31 (n=2; p.Val31Ile), 175 (n=3; p.Arg175His), and 273 (n=4; p.Arg273His and p.Arg273Cys). The median age at the first tumor onset was 25 yr. Ten patients (71%) developed multiple primary tumors. A diverse spectrum of tumors was observed, including breast (n=6), osteosarcoma (n=4), brain (n=4), leukemia (n=2), stomach (n=2), thyroid (n=2), lung (n=2), skin (n=2), bladder (n=1), nasal cavity cancer (n=1), and adrenocortical carcinoma (n=1). CONCLUSIONS: There was considerable heterogeneity in the TP53 mutations and tumor spectrum in Korean patients with LFS. Our results suggest shared and different LFS characteristics between Caucasian and Korean patients. This is the first report on the mutation spectrum and clinical characteristics from the largest series of Korean LFS patients.

CARACTERIZAÇÃO MOLECULAR DE PACIENTES COM SUSPEITA CLÍNICA DE SÍNDROME DE LI-FRAUMENI E LI-FRAUMENI LIKE / [MOLECULAR CHARACTERIZATION OF PATIENTS WITH SUSPICIOUS CLINICAL SYNDROME OF LI-FRAUMENI AND LI-FRAUMENI LIKE]

A síndrome de Li-Fraumeni (SLF) e sua variante, Li-Fraumeni like (LFL), compõem uma condição clinicamente heterogênea de predisposição a cânceres diversos em idade precoce. O único gene conclusivamente associado à SLF/LFL é o supressor tumoral TP53. O estudo da SLF/LFL é importante por diversas razões: (1) o elevado risco de desenvolvimento de câncer em portadores de mutação em TP53 torna essencial que esses indivíduos sejam identificados e recebam aconselhamento genético; (2) a epidemiologia da SLF/LFL no mundo ainda não está determinada, o que é importante para o desenvolvimento de estratégias de manejo dos pacientes, especialmente no caso do Brasil, onde uma mutação fundadora em TP53, a R337H, mostra-se muito frequente em alguns Estados; (3) a SLF/LFL é um modelo para estudo da predisposição genética ao câncer, visto que sua heterogeneidade suscita dúvidas, como quais fatores modificam a penetrância da síndrome, e quais outros genes podem estar associados a ela nos pacientes que não apresentam mutação em TP53. A finalidade deste estudo foi realizar a caracterização fenotípica e molecular de pacientes com suspeita clínica da SLF/LFL, além de investigar a frequência da mutação fundadora R337H em diferentes coortes de pacientes oncológicos. Cinquenta e oito pacientes com suspeita clínica da SLF/LFL foram investigados quanto à presença de mutações em TP53 por sequenciamento direto e MLPA. O gene CDKN1A, mediador de TP53 na regulação do ciclo celular, também foi investigado por sequenciamento direto. Adicionalmente, três coortes de pacientes acompanhados pelo aconselhamento genético do INCA foram investigadas quanto à presença da mutação R337H de TP53: 46 pacientes com tumor de Wilms, 81 pacientes com retinoblastoma e 126 pacientes com suspeita clínica de câncer de mama e ovário hereditários...

Li-Fraumeni syndrome (LFS) and its variant, Li-Fraumeni like (LFL), comprise a clinically heterogeneous condition of predisposition to various cancers at an early age. The only conclusively gene associated to LFS/LFL is the tumor suppressor TP53. The study of LFS/LFL is important for several reasons: (1) the high risk of cancer development in patients with TP53 mutation makes it essential that these individuals be identified and receive genetic counseling; (2) the worldwide epidemiology of LFS/LFL is not yet determined, which is important for the development of management strategies for patients, especially in the case of Brazil, where a founder mutation in TP53, the R337H mutation, has shown to be very frequent in some States; (3) LFS/LFL is a model for the study of genetic predisposition to cancer, since its heterogeneity raises questions such as what factors modify the penetrance of the syndrome, and what other genes may be associated with it in patients without mutations in TP53. The purpose of this study was to perform the phenotypic and molecular characterization of patients with clinical suspicion of LFS/LFL, and to investigate the frequency of the R337H founder mutation in different cohorts of cancer patients. Fifty-eight patients with clinical suspicion of LFS/LFL were investigated for the presence of mutations in TP53 by direct sequencing and MLPA. The CDKN1A gene, TP53 mediator in cell cycle regulation, was also investigated by direct sequencing...

Caracterização de pacientes submetidos a aconselhamento genético para síndromes de câncer hereditário no Ceará e análise de modificadores de penetrância na síndrome de Li-Fraumeni / Description of patientes submitted to genetic couseling for hereditary cancer syndromes in Ceará and analysis of penetrance modifiers in Li-fraumeni syndrome

O diagnóstico de pacientes portadores de síndromes de predisposição hereditária ao câncer (SPHC) possibilita a abordagem diferenciada de rastreamento e prevenção e fornece valiosas informações prognósticas e preditivas de resposta a tratamentos oncológicos. Objetivos: Os objetivos deste estudo foram introduzir a assistência em oncogenética no Ceará e caracterizar a população atendida. Também pretendemos, em colaboração com o National Cancer Institute (NCI/NIH), analisar modificadores de penetrância na Síndrome de Li-Fraumeni (LFS) e o impacto psicológico do diagnóstico desta síndrome nos pacientes acompanhados em São Paulo e no NCI. Resultados: No período de agosto de 2013 a agosto de 2016, 193 pacientescearenses foram submetidos a aconselhamento genético. Em 95 (63%) dos 149 probandos com suspeita clínica de SPHC, foi realizada investigação molecular em 24 (25%) dos casos foram encontradas mutações germinativas patogênicas: 14 em BRCA1 (58%), 6 em BRCA2 (25%), 1 em PALB2 (4%), 1 em NEM1 (4%), 1 em R ET(4%) e 1 em NF1 (4%). Entre as pacientes cearenses com síndrome de câncer de mama e ovário hereditários (HBOC), houve um padrão recorrente de mutações, sendo as mais frequentes: c.5074+2T>C (4 probandos) e c.3331_3334delCAAG (5 probandos) em BRCA1, e c.4808delA (4 probandos) em BRCA2. Para a análise de modificadores de penetrância na LFS, foram incluídos 50 pacientes portadores de LFS acompanhados no AC Camargo Cancer Center. A análise psicológica conjunta destes pacientes brasileiros e dos pacientes americanos com diagnóstico de LFS revelou um nível médio de estresse. Conclusão: Este estudo evidenciou uma elevada prevalência de HBOC no Ceará, com mutações germinativas recorrentes nos genes BRCA1/2. O impacto psicológico do diagnóstico de uma SPHC como a LFS não gera um nível elevado de estresse.

Recognizing patients with hereditary predisposition to cancer (HCP) allows targeted efforts in cancer surveillence and prevention, and may also provide important information towards prognosis and response to some systemic oncological treatments. Purpose: The purpose of this study is to introduce genetic counseling in Ceará, characterizing this population, and also, in collaboration with the National Cancer Institute (NCI/NIH), to analyse penetrance modifiers in Li-Fraumeni Syndrome (LFS). Results:Between August 2013 and August 2016, 193 patients from Ceará were included in this study.95 (63%) from the 149 probands with suspected HCP were submitted to molecular investigation and in 24 (25%) germline pathogenic variantswere detected: 14 inBRCA1 (58%), 6 inBRCA2 (25%), 1 inPALB2 (4%), 1 inNEM1 (4%), 1 inR ET(4%) and 1 inNF1 (4%). Among patients with Hereditary Breast and Ovarian Cancer syndrome (HBOC), there was a recurrent pattern of mutations, and the most frequent were: c.5074+2T>C (4 probands) andc.3331_3334delCAAG (5 probands) inBRCA1, andc.4808delA (4 probands) inBRCA2. For the penetrance modifiers analysis in LFS, 50 patients were included, all of them from A.C.Camargo Cancer Center (São Paulo). The joint analysis of Brazilian and American patients revealed that the stress level of this population is medium.Conclusion: This study showed a high prevalence of HBOC among Cearense patients with a pattern of recurrent mutations that need further investigation. After the diagnosis of a high penetrant HCP syndrome like LFS, patients experience median levels of stress.

Caracterização clínica e histopatológica da síndrome de Li-Fraumeni e síndrome Li-Fraumeni like em pacientes brasileiros / Clinical and histopathologic characterization of Li-Fraumeni syndrome and Li-Fraumeni like syndrome in Brazilian patients

INTRODUÇÃO: a Síndrome de Li-Fraumeni (LFS; OMIM#151623) é uma síndrome rara de predisposição hereditária ao câncer, de caráter autossômico dominante e de alta penetrância, relacionada a mutações germinativas no gene TP53. Os tumores típicos da LFS são sarcomas de partes moles e ósseos, leucemias, tumores do sistema nervoso central (SNC), tumores adrenocorticais e tumores de mama. No entanto, há uma variação no espectro tumoral de acordo com o genótipo. No Brasil, há uma alta prevalência da mutação germinativa p.R337H (presente em 0.3% da população do Sul e Sudeste) devido a um efeito fundador. O conhecimento do real espectro tumoral da síndrome associada a esta mutação fundadora ainda é objeto de discussão. PACIENTES E MÉTODOS: foram avaliados dados clínicos, retrospectivamente, a partir de prontuários médicos, de 247 pacientes com LFS e LFS portadores de mutações germinativas no gene TP53, atendidos no Departamento de Oncogenética do A.C.Camargo Cancer Center de 2001 a 2015. As características dos tumores apresentados pelos pacientes portadores de mutação (espectro tumoral, idade do diagnóstico do primeiro tumor e dos tumores subsequentes, tipo histológico dos tumores) foram comparadas entre o grupo de portadores da mutação p.R337H e o grupo de pacientes com as demais mutações patogênicas no gene TP53. As taxas de frequência das mutações (p.R337H versus outras mutações), assim como sexo (masculino e feminino) foram correlacionados com o status de óbito, desenvolvimento ou não de câncer, a idade do diagnóstico do primeiro câncer, tempo do primeiro câncer até aparecimento do segundo câncer, através do teste qui-quadrado ou teste exato de Fisher. Foi aplicado o Teste T para amostras independentes. O estimador de Kaplan-Meier e o teste de log rank foram utilizados para avaliar a influência das variáveis nos tempos de sobrevida global, tempo de aparecimento do primeiro câncer e tempo do primeiro câncer até aparecimento do segundo câncer. RESULTADOS: de 247 portadores de LFS incluídos no estudo, 193 pacientes eram portadores da mutação p.R337H. Deste total de 193 portadores da mutação p.R337H, 101 pacientes apresentaram câncer (52.3%) e 23,8% dos pacientes com câncer tiveram dois ou mais tumores ao longo da vida; enquanto dos 54 pacientes portadores de outras mutações no gene TP53 (21.9% da população total), 39 pacientes tiveram câncer (72.2%), p=0.009. A idade média de diagnóstico do primeiro câncer nos portadores da mutação p.R337H foi de 30.8 anos, comparada a 28.9 anos nos portadores de outras mutações no gene TP53, p=0.604. nos portadores da mutação p.R337H, o primeiro tumor também ocorreu em idade mais precoce nas pacientes femininas (média de 34.7 anos versus 50.4 anos, p<0.001). Em relação ao espectro dos tumores p.R337H na nossa população, câncer de mama e sarcoma de partes moles foram os tumores mais frequentes, seguidos de carcinoma adrenocortical, perfazendo 70,5% dos tumores apresentados nesta população. Nos portadores de outras mutações no gene TP53 , câncer de mama, sarcoma de partes moles, tumor de sistema nervoso central e sarcoma ósseo corresponderam a 69.3% de todos os tumores observados. Nossos dados revelam uma alta frequência de carcinoma adrenocortical (21.5%), carcinoma papilífero de tireoide (6.8%), adenocarcinoma de pulmão (4.9%) e carcinoma renal (4.3%) nos portadores da mutação p.R337H. Interessantemente carcinoma colorretal foi observado apenas nos portadores de outras mutações não-p.R337H. O sarcoma de partes moles nos portadores p.R337H mais frequente foi o leiomiossarcoma e a idade média de diagnóstico foi 46.8 anos; nos portadores das outras mutações, rabdomiossarcoma e leiomiossarcoma foram os subtipos mais frequentes e a idade média do diagnóstico foi 24 anos (p=0.001). A idade média de diagnóstico de câncer de mama foi 42.8 anos nos portadores da mutação p.R337H e 37 anos nos portadores das demais mutações no gene TP53 (p=0.029). O câncer de mama nos portadores das outras mutações apresentavam hiperexpressão de HER2 em 62.5% dos casos, comparado a 19% nos tumores de mama das portadoras da mutação p.R337H. CONCLUSÕES: nossos dados mostram um espectro tumoral distinto para os portadores da LFS com a mutação p.R337H. Esses dados podem ajudar a estabelecer um programa de rastreamento para esses portadores diferente do preconizado para os portadores das demais mutações no gene TP53.

INTRODUCTION: Li Fraumeni syndrome (LFS, OMIM #151623) is a rare autosomal dominant genetic disorder inherited by germline TP53 mutations. Carriers have a high lifetime risk of developing multiple early-onset childhood and adult cancers, including soft tissue and bone sarcomas, central nervous system (CNS) tumors, adrenocortical tumors (ACT), breast cancer and leucemia. However, tumor spectrum may have difference according to genotype. In Brazil, it is observed a high prevalence of a founder germline mutation p.R337H (present in 0.3% of the population in South and Southeast). The exact tumor profile associated to p.R337H carriers is unknown. PATIENTS AND METHODS: we have analyzed medical records of a cohort of 247 germline TP53 mutation carriers, members of Brazilian families who fulfilled LFS/LFL clinical criteria, between 2001 and 2015 from the Oncogenetics Department at A.C.Camargo Cancer Center, Sao Paulo, Brazil. Clinical data were retrospectively evaluated and the tumor characteristics of carriers (tumor spectrum, age at diagnosis, histological subtype) were compared between p.R337H carriers and carriers of other mutations in TP53 gene. The mutation status (p.R337H and other mutations) and gender (male and female) were correlated with death rate, cancer risk, age at diagnosis of cancer, interval between the first and the second cancer diagnosis, using the chi-squared test or Fisher's exact test. The T test was used for independent samples analysis. The Kaplan-Meier and log rank test were used to evaluate the influence of variables on overall survival, time and cancer the first time until onset of the second cancer. RESULTS: the study evaluated 247 patients with LFS, 193 patients had the mutation p.R337H. Among 193 p.R337H carriers, 101 patients had cancer (52.3%) and 23.8% of cancer-affected carriers had two or more tumors lifetime; whereas from 54 non-p.R337H mutation carriers, 39 patients were cancer-affected (72.2%), p = 0.009. The mean age at diagnosis of first cancer in p.R337H carriers was 30.8 years old (yo) compared to 28.9 yo in non-p.R337H mutation carriers, p = 0.604. In p.R337H patients, the first tumor occurred at an earlier age in female patients (mean age at 34.7 yo vs. 50.4 yo, p <0.001). Regarding the tumor spectrum in p.R337H carriers, breast cancer and soft tissue sarcoma were the most frequent tumors, followed by adrenocortical carcinoma (70.5% of the total of tumors). In non-p.R337H mutation carriers, breast cancer, soft tissue sarcoma, central nervous system tumor and bone sarcoma accounted for 69.3% of all tumors observed. Our results showed a high frequency of adrenocortical carcinoma (21.5%), papillary thyroid carcinoma (6.8%), lung adenocarcinoma (4.9%) and renal cell carcinoma (4.3%) in p.R337H patients. Interestingly, colorectal carcinoma was observed only in nonp.R337H mutation patients. Leiomyosarcoma was the most frequent sarcoma subtype in p.R337H carriers and the mean age at diagnosis was 46.8 yo; in non-p.R337H mutation patients, rhabdomyosarcoma and leiomyosarcoma were the most frequent subtypes and the mean age at diagnosis was 24 yo (p = 0.001). The mean age at diagnosis of breast cancer was 42.8 yo in p.R337H patients and 37 yo in non-p.R337H mutation patients (p = 0.029). The breast cancer in non-p.R337H mutation patients showed overexpression of HER2 in 62.5% of cases, compared to 19% in breast tumors from p.R337H carriers. CONCLUSIONS: our clinical cohort revealed a different tumor spectrum associated with p.R337H TP53 mutation. The major limitation in our study was the relatively small sample of nonp.R337H mutation carriers to compare with p.R337H carriers. Notwithstanding, our findings offer insight into exploring a distinct cancer screening protocol for p.R337H mutation carriers in Brazil.

Annual Report on the External Quality Assessment of Diagnostic Genetics in Korea (2015)

The Diagnostic Genetics Subcommittee of Korean Association of External Quality Assessment Service conducted two trials in 2015 based on cytogenetics and molecular genetics surveys. A total of 43 laboratories participated in the chromosome surveys, 31 laboratories participated in the fluorescence in situ hybridization surveys, and 133 laboratories participated in the molecular genetics surveys. All except one laboratory showed acceptable results in the cytogenetics surveys. The molecular genetics surveys included the following tests: Mycobacterium tuberculosis detection, hepatitis B and C virus detection and quantification, human papilloma virus genotyping, gene rearrangement tests for leukaemias and lymphomas, genetic tests for JAK2, FMS-like tyrosine kinase 3, nucleophosmin, cancer-associated genes (KRAS, EGFR, KIT, and BRAF), hereditary breast and ovarian cancer genes (BRCA1 and BRCA2), Li-Fraumeni syndrome (TP53), Wilson disease (ATP7B), achondroplasia (FGFR3), hearing loss and deafness (GJB2 ), multiple endocrine neoplasia 2 (RET), Huntington disease, spinocerebellar ataxia, spinal and bulbar muscular atrophy, mitochondrial encephalopathy with lactic acidosis and stroke like episodes, myoclonic epilepsy ragged red fibre, Leber hereditary optic neuropathy, Prader-Willi/Angelman syndrome, Duchenne muscular dystrophy, spinal muscular atrophy, fragile X syndrome (FMR1), apolipoprotein E genotyping, methylenetetrahydrofolate reductase genotyping, ABO genotyping, cytochrome P450 2C9 genotyping, cytochrome P450 2C19 genotyping, and DNA sequencing analysis. The molecular genetics surveys showed excellent results for most of the participants. The external quality assessment program for genetics analysis in 2015 proved to be helpful for continuous education and the evaluation of quality improvement.

Tumores e hiperplasias adrenocorticais: identificação de possíveisdoenças hereditárias / Recognition of hereditary diseases related to adrenocortical tumors andhyperplasias

A alta prevalência de tumores da glândula adrenal deve-se, em parte, ao avanço dos métodos de imagem. Os adenomas, carcinomas e hiperplasias oriundos do córtex adrenal são responsáveis por 80 a 90% dos processos tumorais. Alguns casos são herdados e podem estar associados a efeito compressivo de massa tumoral, hipersecreção de esteroides ou manifestações clínicas em outros órgãos. Considerando as hiperplasias e tumores adrenocorticais, o objetivo desse trabalho foi auxiliar os médicos na identificação de pacientes que apresentem risco para doença hereditária. As neoplasias e hiperplasias adrenocorticais podem ser encontradas em síndromes hereditárias, como a síndrome de Li-Fraumeni, síndrome de Beckwith-Wiedemann, neoplasia endócrina múltipla do tipo I, síndrome de Gardner e no complexo de Carney. A hereditariedade também está associada com doenças adrenocorticais na hiperplasia adrenal congênita, no aldosteronismo primário e/ou na síndrome de Cushing (doença clínica ou subclínica) na hiperplasia adrenal macronodular primária. Essa revisão descreve as características clínicas e os defeitos genéticos responsáveis pelas síndromes hereditárias. Relacionamos também a classificação histopatológica dos processos expansivos com os principais sinais clínicos e os genes relacionados. A identificação de defeitos genéticos em células germinativas nessas doenças familiais permite o conhecimento de alterações somáticas em alguns tipos de processos tumorais adrenocorticais de etiologia esporádica. Considerando a prevalência dos tumores do córtex adrenal, a identificação de predisposição hereditária é essencial para assegurar a conduta clínica correta do paciente e o aconselhamento genético de seus familiares.

The adrenal gland tumors are prevalent due in part by the widespread use of imaging studies. Adenomas, carcinomas and hyperplasias, originating from the adrenal cortex, account for 80-90% of adrenal tumoral processes. Some cases are inherited and may be associated with local mass effect, steroid hypersecretion and/or clinical manifestation in other organs. In the context of adrenocortical tumors and hyperplasias, the purpose of this article is to assist physicians in identifying patients who may be at risk of hereditary diseases. Adrenocortical hyperplasias and neoplasias can be found in familial tumor syndromes, such as Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome, multiple endocrine neoplasia type 1, Gardner syndrome and Carney complex. Heredity has been also associated with adrenocortical lesions in congenital adrenal hyperplasia, primary aldosteronism and/or Cushing syndrome (overt or subclinical disease) in primary macronodular adrenal hyperplasia (PMAH). This review describes the clinical recognition and genetic defects that have been found to be responsible for these hereditary diseases. Furthermore, we present the histopathologic classification of adrenocortical expansive processes in correlation to the main clinical features and related genes. The identification of germline genetic defects in such familial diseases lead to the identification of somatic alterations in a subgroup of sporadic adrenocortical lesions. Considering the prevalence of adrenocortical tumors, identification of a hereditary predisposition is essential to assure the adequate clinical management of the patient and to offer the genetic counselling to family members.

Pediatric cancer and Li-Fraumeni/Li-Fraumeni-like syndromes: a review for the pediatrician / Câncer pediátrico e síndrome de Li-Fraumeni/Li-Fraumeni- like: uma revisão para o pediatra.

Summary Introduction: cancer is the second leading cause of death in children between the ages of 0 and 14 years, corresponding to approximately 3% of all cases diagnosed in Brazil. A significant percentage (5-10%) of pediatric cancers are associated with hereditary cancer syndromes, including Li-Fraumeni/Li-Fraumeni-like syndromes (LFS/LFL), both of which are caused by TP53 germline mutations. Recent studies have shown that a specific TP53 mutation, known as p.R337H, is present in 1 in 300 newborns in Southern and Southeast Brazil. In addition, a significant percentage of children with LFS/LFL spectrum tumors in the region have a family history compatible with LFS/LFL. Objective: to review clinical relevant aspects of LFS/LFL by our multidisciplinary team with focus on pediatric cancer. Methods: the NCBI (PubMed) and SciELO databases were consulted using the keywords Li-Fraumeni syndrome, Li-Fraumeni-like syndrome and pediatric cancer; and all manuscripts published between 1990 and 2014 using these keywords were retrieved and reviewed. Conclusion: although LFS/LFL is considered a rare disease, it appears to be substantially more common in certain geographic regions. Recognition of population- specific risks for the syndrome is important for adequate management of hereditary cancer patients and families. In Southern and Southeastern Brazil, LFS/ LFL should be considered in the differential diagnosis of children with cancer, especially if within the spectrum of the syndrome. Due to the complexities of these syndromes, a multidisciplinary approach should be sought for the counseling, diagnosis and management of patients and families affected by these disorders. Pediatricians and pediatric oncologists in areas with high prevalence of hereditary cancer syndromes have a central role in the recognition and proper referral of patients and families to genetic cancer risk evaluation and management programs. .

Resumo Introdução: o câncer é a segunda principal causa de morte em crianças com idades entre 0 e 14 anos, correspondendo a cerca de 3% de todos os casos diagnosticados no Brasil. Um percentual significativo (5-10%) dos cânceres pediátricos são associados a síndromes hereditárias para câncer, incluindo Li-Fraumeni/Li-Fraumeni-like síndromes (LFS/LFL), causadas por mutações germinativas no gene TP53. Estudos recentes têm demonstrado que uma mutação específica em TP53, conhecida como p.R337H, está presente em 1 em 300 recém-nascidos no Sul e Sudeste do Brasil. Além disso, um percentual significativo de crianças com tumores do espectro LFS/LFL na região têm uma história familiar compatível com a síndrome. Objetivos: revisão dos aspectos clínicos relevantes da LFS/LFL por equipe multidisciplinar, com foco no câncer pediátrico. Métodos: o NCBI (PubMed) e SciELO foram consultados, usando as palavras-chave síndrome de Li-Fraumeni, síndrome de Li-Fraumeni-like e câncer pediátrico. Todos os artigos publicados entre 1990 e 2014 usando essas palavras- chave foram recuperados e revisados. Conclusão: apesar de LFS/LFL ser considerada uma doença rara, ela parece ser mais frequente em certas regiões. Reconhecer os critérios e condutas para identificação de pacientes em risco para LFS/LFL é fundamental para o manejo adequado dos pacientes com câncer hereditários e suas famílias. Devido à complexidade dessas síndromes, a abordagem multidisciplinar deve ser realizada. Pediatras e oncologistas pediátricos em áreas com alta prevalência de síndromes hereditárias de câncer têm um papel central no reconhecimento e encaminhamento adequado dos pacientes e famílias para programas de avaliação do risco de câncer genético e de gestão. .

Angiosarcoma in previously irradiated breast in patient with Li-Fraumeni syndrome. A case report / Angiossarcoma em mama previamente irradiada em paciente portadora da síndrome de Li-Fraumeni. Um relato de caso

CONTEXT: Li-Fraumeni syndrome is a rare disease with an autosomal dominant inheritance pattern and high penetrance that defines a 50% chance of developing cancer before the age of 30 years, including cases of breast sarcoma. Patients with this syndrome who require radiotherapy have an increased risk of developing secondary malignancies including angiosarcomas. CASE REPORT: This was a case report on a female patient with Li-Fraumeni syndrome. In October 2005, she was diagnosed with invasive ductal carcinoma of the right breast and underwent sectorectomy. She then received chemotherapy and adjuvant radiotherapy. Trastuzumab and tamoxifen were also part of the treatment. She recently sought care at our hospital, complaining of hyperemia and nodulation in the right breast, and underwent surgical resection that revealed epithelioid angiosarcoma. CONCLUSIONS: When genetic predisposition due to Li-Fraumeni syndrome is documented, the therapy should be adapted so as to minimize the risk. Thus, conservative surgical treatments should be avoided and mastectomy without radiation should be prioritized. In cases in which use of radiotherapy is justified, patients should be followed up intensively. .

CONTEXTO: A síndrome de Li-Fraumeni é doença rara que apresenta padrão de herança autossômica dominante e alta penetrância, definindo possibilidade de 50% no desenvolvimento de neoplasias antes dos 30 anos, incluindo nesses casos os sarcomas em mama. Pacientes portadoras dessa síndrome que requerem tratamento radioterápico têm risco aumentado de desenvolver neoplasias secundárias, incluindo os angiossarcomas. RELATO DE CASO: Este é um relato de caso de paciente feminina, portadora da síndrome de Li-Fraumeni. Em outubro de 2005, ela teve diagnóstico de carcinoma ductal invasor da mama direita, sendo submetida à setorectomia. Recebeu quimioterapia e radioterapia adjuvante; trastuzumabe e tamoxifeno também fizeram parte do tratamento. Recentemente, procurou atendimento em nosso serviço, com queixa de hiperemia e nodulação em mama direita, e foi submetida a ressecção cirúrgica que revelou angiossarcoma epitelioide. CONCLUSÕES: Quando a predisposição genética da síndrome de Li-Fraumeni está documentada, devese adequar a terapêutica a fim de minimizar riscos, evitando tratamentos cirúrgicos conservadores e priorizando a mastectomia sem radioterapia. Nos casos em que se justifica o uso de radioterapia, os pacientes devem ser acompanhados de forma intensiva. .

Annual Report on the External Quality Assessment Scheme for Diagnostic Genetics in Korea (2014)

Quality control for genetic tests has become more important as testing volume and clinical demands have increased dramatically. The diagnostic genetics subcommittee of Korean Association of External Quality Assessment Service conducted two trials in 2014 based on cytogenetics and molecular genetics surveys. A total of 44 laboratories participated in the chromosome surveys, 33 laboratories participated in the fl uorescence in situ hybridization (FISH) surveys, and 130 laboratories participated in the molecular genetics surveys as a part of these trials. All laboratories showed acceptable results in the chromosome and FISH surveys. The molecular genetics surveys included various tests: Mycobacterium tuberculosis detection, hepatitis B and C virus detection and quantification, human papilloma virus genotyping, gene rearrangement tests for leukaemia and lymphomas, genetic tests for JAK2, FMS-like tyrosine kinase 3, nucleophosmin, cancer-associated genes (KRAS, EGFR, KIT, and BRAF), hereditary breast and ovarian cancer genes (BRCA1 and BRCA2), Li-Fraumeni syndrome (TP53), Wilson disease (ATP7B), achondroplasia (FGFR3), Huntington disease, spinocerebellar ataxia, spinal and bulbar muscular atrophy, mitochondrial encephalopathy with lactic acidosis and stroke like episodes, myoclonic epilepsy ragged red fibre, Prader-Willi/Angelman syndrome, Duchenne muscular dystrophy, spinal muscular atrophy, fragile X syndrome, nonsyndromic hearing loss and deafness (GJB2), multiple endocrine neoplasia 2 (RET), Leber hereditary optic neuropathy (major mutation), apolipoprotein E genotyping, methylenetetrahydrofolate reductase genotyping, ABO genotyping, and DNA sequencing analysis. Molecular genetic surveys showed excellent results for most of the participants. The external quality assessment program for genetic analysis in 2014 proved to be helpful for continuous education and the evaluation of quality improvement.

Germline mutations of TP53 gene among Chinese families with high risk for breast cancer / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To evaluate the role of germline mutations of TP53 gene among a Chinese population with high risk for breast cancer.</p><p><b>METHODS</b>A total of 81 BRCA-negative breast cancer probands from cancer families were analyzed using targeted capture and next-generation sequencing. Candidate mutations were verified with Sanger sequencing. Co-segregation analyses were carried out to explore the likely pathogenicity of the mutation.</p><p><b>RESULTS</b>Of the 81 BRCA-negative patients, 3 exonic mutations in the TP53 gene were identified in 3 breast cancer patients. Of these, 2 mutations were previously reported and 1 was novel. One family with TP53 mutation has met the criteria for Li-Fraumeni syndrome (LFS) and accounted for 9.1% of all families who fulfilled the diagnostic criteria for LFS. Two of the carriers were diagnosed with breast cancer under the age of 30, and have accounted for 11.8% (2/17) of all very young (≤30 years) breast cancer patients in our study.</p><p><b>CONCLUSION</b>The TP53 germline mutation is more common in Chinese population with a high risk for breast cancer than previously thought. TP53 gene mutation screening should be considered particularly for patients with a family history of LFS and very young age of onset.</p>