A case of von Hippel-Lindau disease with multi-organ involvement: a rare case report

Von Hippel-Lindau (VHL) disease is a rare autosomal dominant syndrome manifested by a spectrum of tumours in the central nervous system (CNS) and other visceral organs. We herein report a case of 35 years aged newly diagnosed diabetic female patient presented with headache, gait instability, loss of vision in both eyes, left sided hearing impairment and subsequently diagnosed to have VHL disease. The pathophysiology involves the inactivation of the VHL tumour suppressor gene. Early recognition and treatment remains the mainstay of management. Even many years after the complete tumour excision, newer neoplasms may develop. Increasing knowledge about the molecular enabled us to investigate the role of anti-angiogenic drugs. Continuous surveillance at regular interval must be conducted in patients with VHL disease.

Análisis de metilación en los genes supresores de tumores CDKN2B y DBC1 en pacientes colombianos con diagnóstico de leucemia / Methylation analysis of the CDKN2B and DBC1 tumour suppressor genes in leukaemia patients in Colombia

Objetivo: Analizar la metilación en los promotores de los genes CDKN2B y DBC1 en muestras de pacientes con leucemia linfoblástica aguda (LLA), leucemia mieloblástica aguda (LMA) y leucemia mieloide crónica (LMC). Además, correlacionar el perfil de metilación de los pacientes con los hallazgos citogenéticos. Materiales y métodos: Se evaluaron 56 pacientes con leucemias: 24 con LLA, 16 con LMA y 16 con LMC. El ADN extraído se modificó con bisulfito de sodio. Se realizó un análisis de metilación en los genes CDKN2B y DBC1 mediante la PCR específica de metilación (MS-PCR). Las muestras positivas por la técnica MS-PCR fueron secuenciadas. Resultados: Se encontró una frecuencia total de metilación del 87,5%. El gen CDKN2B se encontró metilado en el 75% de LLA y de LMC, y del 62% en LMA. El gen DBC1 se encontró metilado en el 96% de LLA, el 94% de LMA y del 68,8% en LMC. El gen más frecuentemente metilado en todas las muestras fue DBC1. De los tres tipos de leucemias, la LLA fue la que presentó los mayores porcentajes de metilación. El 62,5% de la muestras tenían metilado ambos genes. Las muestras con cariotipo normal presentaron una alta frecuencia de metilación de CDKN2B y DBC1. Conclusiones: En este estudio se demostró, por primera vez en pacientes colombianos con leucemias, que la metilación de los genes CDKN2B y DBC1 es un evento frecuente. Los hallazgos indican que la metilación de genes supresores de tumores es una vía molecular alterna que podría estar relacionada con el desarrollo de neoplasias hematológicas.

Objective: To perform a methylation analysis in the CDKN2B and DBC1 gene promoters in samples from Colombian patients with acute lymphoblastic leukaemia (ALL), acute myeloid leukaemia (AML), and chronic myeloid leukaemia (CML), and to correlate the methylation profile with cytogenetic findings. Material and methods: The study included a total of 56 bone marrow samples, 24 from patients with ALL, 16 from AML patients, and 16 from CML patients. DNA was extracted from these samples and converted with sodium bisulphite. Methylation analysis was performed using methylation specific PCR (MS-PCR). The samples that were positive for MS-PCR were sequenced to confirm the results. Results: A total methylation frequency of 87.5% was found. CDKN2B gene promoter hypermethylation was found in 75% of ALL and CML samples, and 62% in AML; while DBC1 gene promoter hypermethylation was found in 96% of the samples of ALL, 94% of AML, and in 68.8% of CML. The most frequently methylated gene in all samples was DBC1. ALL was the type of leukaemia that had the highest percentages of methylation. Almost two-thirds (62.5%) of the samples had both methylated genes. Samples with normal karyotype had a high frequency of methylation in CDKN2B and DBC1 genes. Conclusions: This study showed, for the first time in Colombian patients with leukaemia, that methylation of DBC1 and CDKN2B genes is a common event. Our findings indicate that methylation of tumour suppressor genes is an alternate genetic pathway related to the development of haematological malignancies.

PI3K/Akt/mTOR signaling & its regulator tumour suppressor genes PTEN & LKB1 in human uterine leiomyomas.

Background & objectives: Despite their high occurrence and associated significant level of morbidity manifesting as spectrum of clinical symptoms, the pathogenesis of uterine leiomyomas (ULs) remains unclear. We investigated expression profile of tumour suppressor genes PTEN (phosphatase and tensin homolog deleted on chromosome ten) and LKB1 (liver kinase B1), and key signaling components of P13K (phosphatidylinositol 3-kinase)/Akt (protein kinase B)/mTOR (mammalian target of rapamycin) pathway in leiomyomas and adjacent normal myometrium in women of reproductive age, to explore the possibility of targeting this pathway for future therapeutic implications. Methods: Real time PCR (qPCR) was used to quantify relative gene expression levels of PTEN, Akt1, Akt2, mTOR, LKB1 and VEGFA (vascular endothelial growth factor A) in leiomyoma as compared to adjacent normal myometrium. Immunohistochemistry was subsequently performed to analyze expression of PTEN, phospho-Akt, phospho-mTOR, phospho-S6, LKB1 and VEGFA in leiomyoma and adjacent normal myometrium. Results: Significant upregulation of PTEN (2.52 fold; P=0.03) and LKB1 (3.93 fold; P=0.01), and downregulation of VEGFA (2.95 fold; P=0.01) genes were observed in leiomyoma as compared to normal myometrium. Transcript levels of Akt1, Akt2 and mTOR did not vary significantly between leiomyoma and myometrium. An increased immunoexpression of PTEN (P=0.015) and LKB1 (P<0.001) and decreased expression of VEGFA (P=0.01) was observed in leiomyoma as compared to myometrium. Immunostaining for activated (phosphorylated) Akt, mTOR and S6 was absent or low in majority of leiomyoma and myometrium. Interpretation & conclusions: Upregulation of PTEN and LKB1 in concert with negative or low levels of activated Akt, mTOR and S6 indicates that PI3K/Akt/mTOR pathway may not play a significant role in pathogenesis of leiomyoma.

WHO Grade IV Gliofibroma: A Grading Label Denoting Malignancy for an Otherwise Commonly Misinterpreted Neoplasm

We report a 50-year-old woman with no relevant clinical history who presented with headache and loss of memory. Magnetic resonance imaging showed a left parieto-temporal mass with annular enhancement after contrast media administration, rendering a radiological diagnosis of high-grade astrocytic neoplasm. Tumour sampling was performed but the patient ultimately died as a result of disease. Microscopically, the lesion had areas of glioblastoma mixed with a benign mesenchymal constituent; the former showed hypercellularity, endothelial proliferation, high mitotic activity and necrosis, while the latter showed fascicles of long spindle cells surrounded by collagen and reticulin fibers. With approximately 40 previously reported cases, gliofibroma is a rare neoplasm defined as either glio-desmoplastic or glial/benign mesenchymal. As shown in our case, its prognosis is apparently determined by the degree of anaplasia of the glial component.

Advances in the non-genetic regulation of PTEN tumour suppressor activity / 基础医学与临床

Mutations and deletions of the tumour suppressor PTEN are frequently involved in the development of cancer.However, PTEN is also tightly controlled by various non-genomic mechanisms,such as the epigenetic silen-cing of PTEN, post-transcriptional regulation by non-coding RNAs and post-translational modification.

Mutations in tumour suppressor genes, l(2)gl and l(2)gd, alter the expression of wingless in Drosophila.

To understand the roles of two well known tumour suppressor genes. l(2)gl and l(2)gd in normal imaginal disc development in Drosophila, we have initiated a study to examine effect of mulations of these genes on the expression of genes involved in the patterning of the imaginal discs. In this study we show that the expression of wingless, the Drosophila orthologue of the mammalian oncogene Wnt, is affected in the imaginal discs of l(2)gl4 and l(2)gd1 mutant individuals. In the tumourous wing imaginal discs from l(2)gl mutant larvae, the pattern of wingless expression was progressively disrupted with an increase in the area of expression, Tumourous wing imaginal discs from l(2)gd homozygous individuals exhibited progressive broadening and extension of the wingless expressing domains. We suggest that l(2)gl and l(2)gd might be involved in regulating post embryonic expression of Wingless.

To understand the roles of two well known tumour suppressor genes. l(2)gl and l(2)gd in normal imaginal disc development in Drosophila, we have initiated a study to examine effect of mulations of these genes on the expression of genes involved in the patterning of the imaginal discs. In this study we show that the expression of wingless, the Drosophila orthologue of the mammalian oncogene Wnt, is affected in the imaginal discs of l(2)gl4 and l(2)gd1 mutant individuals. In the tumourous wing imaginal discs from l(2)gl mutant larvae, the pattern of wingless expression was progressively disrupted with an increase in the area of expression, Tumourous wing imaginal discs from l(2)gd homozygous individuals exhibited progressive broadening and extension of the wingless expressing domains. We suggest that l(2)gl and l(2)gd might be involved in regulating post embryonic expression of Wingless.

When the control is lacking—the role of tumour suppressor genes in cancer development.

The potential to genetically dissect tumorigenesis provides the major reason to study this process in the fruit fly Drosophila. Over the last 30 years genetic analysis has identified some 55 genes in which recessive mutations cause the appearance of specific tumours during development in tissues such as the imaginal discs, the brain hemispheres, the hematopoietic organs or the gonads, Since the normal allele acts dominantly over the mutated allele, these genes are designated as tumour suppressor genes. The estimate of the number of genes that can be mutated to tumour formation may be, however, much higher ranging between I00 to 200. The challenge before this field is how best to identify these genes and elucidate their function. Current molecular procedures, such as mutagenesis mediated by P-element transposon, provide new ways for tagging any gene of interest in Drosophila and thus for cloning it rapidly. Function of the gene product can be inferred by comparing its amino acid sequence with sequences of proteins with known function or can be determined by histochemical and biochemical investigations. Progress in the understanding of tumour suppression in Drosophila is most advanced in the case of genes regulating cell growth in imaginal discs. The imaginal discs are small groups of cells displaying a strong apical-basal polarity and form folded sacs of epithelia which grow throughout the larval life and give rise to the adult tegument during metamorphosis. Tumour suppressor genes regulating cell growth of imaginal discs, such as the lethal(2)giant larvae (l(2)g1), lethal(1)discs large-1 and expanded genes, were found to encode proteins localized in domains of cell to cell contact on the plasma membrane and were thus thought to maintain cell adhesion. However, recent studies of l(2)gl have revealed that the l(2)gl protein is a component of the normal cytoskeleton which can participates to the cytoskeletal matrix underlaying the plasma membrane. These findings indicate that the changes in cell shape and the loss of apical-basal polarity in imaginal disc cells result primarily from alterations in the cytoskeleton structure. Furthermore the neoplastic growth of the mutated cells may be caused by the disorganization of an intracellular communication system that ultimately controls cell proliferation and/or cell differentiation.