Skip to main content
Top
Published in: Hereditary Cancer in Clinical Practice 1/2009

Open Access 01-12-2009 | Case report

Unusual presentation of Lynch Syndrome

Authors: Veronica PCC Yu, Marco Novelli, Stewart J Payne, Sam Fisher, Rebecca A Barnetson, Ian M Frayling, Ann Barrett, David Goudie, Audrey Ardern-Jones, Ros Eeles, Susan Shanley

Published in: Hereditary Cancer in Clinical Practice | Issue 1/2009

Login to get access

Abstract

Lynch Syndrome/HNPCC is a syndrome of cancer predisposition linked to inherited mutations of genes participating in post-replicative DNA mismatch repair (MMR). The spectrum of cancer associated with Lynch Syndrome includes tumours of the colorectum, endometrium, ovary, upper gastrointestinal tract and the urothelium although other cancers are rarely described. We describe a family of Lynch Syndrome with an hMLH1 mutation, that harbours an unusual tumour spectrum and its diagnostic and management challenges.
Appendix
Available only for authorised users
Literature
1.
go back to reference Aarnio M, Mecklin JP, Aaltonen LA, Nystrom-Lahti M, Jarvinen HJ: Life-time risk of different cancers in hereditary non-polyposis colorectal cancer (HNPCC) syndrome. Int J Cancer 1995, 64: 430–433. 10.1002/ijc.2910640613CrossRefPubMed Aarnio M, Mecklin JP, Aaltonen LA, Nystrom-Lahti M, Jarvinen HJ: Life-time risk of different cancers in hereditary non-polyposis colorectal cancer (HNPCC) syndrome. Int J Cancer 1995, 64: 430–433. 10.1002/ijc.2910640613CrossRefPubMed
2.
go back to reference Lynch HT, Smyrk T: Hereditary nonpolyposis colorectal cancer (Lynch syndrome). An updated review. Cancer 1996, 78: 1149–1167. Publisher Full Text 10.1002/(SICI)1097-0142(19960915)78:6<1149::AID-CNCR1>3.0.CO;2-5CrossRefPubMed Lynch HT, Smyrk T: Hereditary nonpolyposis colorectal cancer (Lynch syndrome). An updated review. Cancer 1996, 78: 1149–1167. Publisher Full Text 10.1002/(SICI)1097-0142(19960915)78:6<1149::AID-CNCR1>3.0.CO;2-5CrossRefPubMed
3.
go back to reference Vasen HF, Moslein G, Alonso A, Bernstein I, Bertario L, Blanco I, Burn J, Capella G, Engel C, Frayling I, et al.: Guidelines for the clinical management of Lynch syndrome (hereditary non-polyposis cancer). J Med Genet 2007, 44: 353–362. 10.1136/jmg.2007.048991CrossRefPubMedPubMedCentral Vasen HF, Moslein G, Alonso A, Bernstein I, Bertario L, Blanco I, Burn J, Capella G, Engel C, Frayling I, et al.: Guidelines for the clinical management of Lynch syndrome (hereditary non-polyposis cancer). J Med Genet 2007, 44: 353–362. 10.1136/jmg.2007.048991CrossRefPubMedPubMedCentral
4.
go back to reference Aarnio M, Sankila R, Pukkala E, Salovaara R, Aaltonen LA, de laChapelle A, Peltomaki P, Mecklin JP, Jarvinen HJ: Cancer risk in mutation carriers of DNA-mismatch-repair genes. Int J Cancer 1999, 81: 214–218. 10.1002/(SICI)1097-0215(19990412)81:2<214::AID-IJC8>3.0.CO;2-LCrossRefPubMed Aarnio M, Sankila R, Pukkala E, Salovaara R, Aaltonen LA, de laChapelle A, Peltomaki P, Mecklin JP, Jarvinen HJ: Cancer risk in mutation carriers of DNA-mismatch-repair genes. Int J Cancer 1999, 81: 214–218. 10.1002/(SICI)1097-0215(19990412)81:2<214::AID-IJC8>3.0.CO;2-LCrossRefPubMed
5.
go back to reference Watson P, Vasen HF, Mecklin JP, Jarvinen H, Lynch HT: The risk of endometrial cancer in hereditary nonpolyposis colorectal cancer. Am J Med 1994, 96: 516–520. 10.1016/0002-9343(94)90091-4CrossRefPubMed Watson P, Vasen HF, Mecklin JP, Jarvinen H, Lynch HT: The risk of endometrial cancer in hereditary nonpolyposis colorectal cancer. Am J Med 1994, 96: 516–520. 10.1016/0002-9343(94)90091-4CrossRefPubMed
6.
go back to reference Lynch HT, Deters CA, Hogg D, Lynch JF, Kinarsky Y, Gatalica Z: Familial sarcoma: challenging pedigrees. Cancer 2003, 98: 1947–1957. 10.1002/cncr.11743CrossRefPubMed Lynch HT, Deters CA, Hogg D, Lynch JF, Kinarsky Y, Gatalica Z: Familial sarcoma: challenging pedigrees. Cancer 2003, 98: 1947–1957. 10.1002/cncr.11743CrossRefPubMed
7.
go back to reference Boyd J, Rhei E, Federici MG, Borgen PI, Watson P, Franklin B, Karr B, Lynch J, Lemon SJ, Lynch HT: Male breast cancer in the hereditary nonpolyposis colorectal cancer syndrome. Breast Cancer Res Treat 1999, 53: 87–91. 10.1023/A:1006030116357CrossRefPubMed Boyd J, Rhei E, Federici MG, Borgen PI, Watson P, Franklin B, Karr B, Lynch J, Lemon SJ, Lynch HT: Male breast cancer in the hereditary nonpolyposis colorectal cancer syndrome. Breast Cancer Res Treat 1999, 53: 87–91. 10.1023/A:1006030116357CrossRefPubMed
8.
go back to reference Peltomaki P, Vasen H: Mutations associated with HNPCC predisposition – Update of ICG-HNPCC/INSiGHT mutation database. Dis Markers 2004, 20: 269–276.CrossRefPubMedPubMedCentral Peltomaki P, Vasen H: Mutations associated with HNPCC predisposition – Update of ICG-HNPCC/INSiGHT mutation database. Dis Markers 2004, 20: 269–276.CrossRefPubMedPubMedCentral
9.
go back to reference Lynch HT, de la Chapelle A: Genetic susceptibility to non-polyposis colorectal cancer. J Med Genet 1999, 36: 801–818.PubMedPubMedCentral Lynch HT, de la Chapelle A: Genetic susceptibility to non-polyposis colorectal cancer. J Med Genet 1999, 36: 801–818.PubMedPubMedCentral
10.
go back to reference Li FP, Fraumeni JF Jr: Soft-tissue sarcomas, breast cancer, and other neoplasms. A familial syndrome? Ann Intern Med 1969, 71: 747–752.CrossRefPubMed Li FP, Fraumeni JF Jr: Soft-tissue sarcomas, breast cancer, and other neoplasms. A familial syndrome? Ann Intern Med 1969, 71: 747–752.CrossRefPubMed
11.
go back to reference Birch JM, Hartley AL, Tricker KJ, Prosser J, Condie A, Kelsey AM, Harris M, Jones PH, Binchy A, Crowther D, et al.: Prevalence and diversity of constitutional mutations in the p53 gene among 21 Li-Fraumeni families. Cancer Res 1994, 54: 1298–1304.PubMed Birch JM, Hartley AL, Tricker KJ, Prosser J, Condie A, Kelsey AM, Harris M, Jones PH, Binchy A, Crowther D, et al.: Prevalence and diversity of constitutional mutations in the p53 gene among 21 Li-Fraumeni families. Cancer Res 1994, 54: 1298–1304.PubMed
12.
go back to reference Ford D, Easton DF, Stratton M, Narod S, Goldgar D, Devilee P, Bishop DT, Weber B, Lenoir G, Chang-Claude J, et al.: Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. The Breast Cancer Linkage Consortium. Am J Hum Genet 1998, 62: 676–689. 10.1086/301749CrossRefPubMedPubMedCentral Ford D, Easton DF, Stratton M, Narod S, Goldgar D, Devilee P, Bishop DT, Weber B, Lenoir G, Chang-Claude J, et al.: Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. The Breast Cancer Linkage Consortium. Am J Hum Genet 1998, 62: 676–689. 10.1086/301749CrossRefPubMedPubMedCentral
13.
go back to reference The Breast Cancer Linkage Consortium: Cancer risks in BRCA2 mutation carriers. J Natl Cancer Inst 1999, 91: 1310–1316. 10.1093/jnci/91.15.1310CrossRef The Breast Cancer Linkage Consortium: Cancer risks in BRCA2 mutation carriers. J Natl Cancer Inst 1999, 91: 1310–1316. 10.1093/jnci/91.15.1310CrossRef
14.
15.
go back to reference Tai YC, Domchek S, Parmigiani G, Chen S: Breast cancer risk among male BRCA1 and BRCA2 mutation carriers. J Natl Cancer Inst 2007, 99: 1811–1814. 10.1093/jnci/djm203CrossRefPubMedPubMedCentral Tai YC, Domchek S, Parmigiani G, Chen S: Breast cancer risk among male BRCA1 and BRCA2 mutation carriers. J Natl Cancer Inst 2007, 99: 1811–1814. 10.1093/jnci/djm203CrossRefPubMedPubMedCentral
16.
go back to reference Niell BL, Rennert G, Bonner JD, Almog R, Tomsho LP, Gruber SB: BRCA1 and BRCA2 founder mutations and the risk of colorectal cancer. J Natl Cancer Inst 2004, 96: 15–21.CrossRefPubMed Niell BL, Rennert G, Bonner JD, Almog R, Tomsho LP, Gruber SB: BRCA1 and BRCA2 founder mutations and the risk of colorectal cancer. J Natl Cancer Inst 2004, 96: 15–21.CrossRefPubMed
17.
go back to reference Thompson D, Easton DF: Cancer Incidence in BRCA1 mutation carriers. J Natl Cancer Inst 2002, 94: 1358–1365.CrossRefPubMed Thompson D, Easton DF: Cancer Incidence in BRCA1 mutation carriers. J Natl Cancer Inst 2002, 94: 1358–1365.CrossRefPubMed
18.
go back to reference Clyne M, Offman J, Shanley S, Virgo JD, Radulovic M, Wang Y, Ardern-Jones A, Eeles R, Hoffmann E, Yu VP: The G67E mutation in hMLH1 is associated with an unusual presentation of Lynch syndrome. Br J Cancer 2009, 100: 376–380. 10.1038/sj.bjc.6604860CrossRefPubMedPubMedCentral Clyne M, Offman J, Shanley S, Virgo JD, Radulovic M, Wang Y, Ardern-Jones A, Eeles R, Hoffmann E, Yu VP: The G67E mutation in hMLH1 is associated with an unusual presentation of Lynch syndrome. Br J Cancer 2009, 100: 376–380. 10.1038/sj.bjc.6604860CrossRefPubMedPubMedCentral
19.
go back to reference Barnetson RA, Cartwright N, van Vliet A, Haq N, Drew K, Farrington S, Williams N, Warner J, Campbell H, Porteous ME, et al.: Classification of ambiguous mutations in DNA mismatch repair genes identified in a population-based study of colorectal cancer. Hum Mutat 2008, 29: 367–374. 10.1002/humu.20635CrossRefPubMed Barnetson RA, Cartwright N, van Vliet A, Haq N, Drew K, Farrington S, Williams N, Warner J, Campbell H, Porteous ME, et al.: Classification of ambiguous mutations in DNA mismatch repair genes identified in a population-based study of colorectal cancer. Hum Mutat 2008, 29: 367–374. 10.1002/humu.20635CrossRefPubMed
20.
go back to reference Shimodaira H, Filosi N, Shibata H, Suzuki T, Radice P, Kanamaru R, Friend SH, Kolodner RD, Ishioka C: Functional analysis of human MLH1 mutations in Saccharomyces cerevisiae. Nat Genet 1998, 19: 384–389. 10.1038/1277CrossRefPubMed Shimodaira H, Filosi N, Shibata H, Suzuki T, Radice P, Kanamaru R, Friend SH, Kolodner RD, Ishioka C: Functional analysis of human MLH1 mutations in Saccharomyces cerevisiae. Nat Genet 1998, 19: 384–389. 10.1038/1277CrossRefPubMed
21.
go back to reference Medina Arana V, Barrios del Pino Y, Garcia-Castro C, Gonzalez-Aguilera JJ, Fernandez-Peralta A, Gonzalez Hermoso F: Highly aggressive leiomyosarcoma associated with Lynch II syndrome: increasing the range of extracolonic cancers related with hereditary non-polyposis colonic cancer. Ann Oncol 2002, 13: 807–808. 10.1093/annonc/mdf163CrossRefPubMed Medina Arana V, Barrios del Pino Y, Garcia-Castro C, Gonzalez-Aguilera JJ, Fernandez-Peralta A, Gonzalez Hermoso F: Highly aggressive leiomyosarcoma associated with Lynch II syndrome: increasing the range of extracolonic cancers related with hereditary non-polyposis colonic cancer. Ann Oncol 2002, 13: 807–808. 10.1093/annonc/mdf163CrossRefPubMed
22.
go back to reference Nilbert M, Therkildsen C, Nissen A, Akerman M, Bernstein I: Sarcomas associated with hereditary nonpolyposis colorectal cancer: broad anatomical and morphological spectrum. Fam Cancer 2009, in press. Nilbert M, Therkildsen C, Nissen A, Akerman M, Bernstein I: Sarcomas associated with hereditary nonpolyposis colorectal cancer: broad anatomical and morphological spectrum. Fam Cancer 2009, in press.
23.
go back to reference Hirata K, Kanemitsu S, Nakayama Y, Nagata N, Itoh H, Ohnishi H, Ishikawa H, Furukawa Y: A novel germline mutation of MSH2 in a hereditary nonpolyposis colorectal cancer patient with liposarcoma. Am J Gastroenterol 2006, 101: 193–196. 10.1111/j.1572-0241.2005.00308.xCrossRefPubMed Hirata K, Kanemitsu S, Nakayama Y, Nagata N, Itoh H, Ohnishi H, Ishikawa H, Furukawa Y: A novel germline mutation of MSH2 in a hereditary nonpolyposis colorectal cancer patient with liposarcoma. Am J Gastroenterol 2006, 101: 193–196. 10.1111/j.1572-0241.2005.00308.xCrossRefPubMed
24.
go back to reference Scott RJ, McPhillips M, Meldrum CJ, Fitzgerald PE, Adams K, Spigelman AD, du Sart D, Tucker K, Kirk J: Hereditary nonpolyposis colorectal cancer in 95 families: differences and similarities between mutation-positive and mutation-negative kindreds. Am J Hum Genet 2001, 68: 118–127. 10.1086/316942CrossRefPubMed Scott RJ, McPhillips M, Meldrum CJ, Fitzgerald PE, Adams K, Spigelman AD, du Sart D, Tucker K, Kirk J: Hereditary nonpolyposis colorectal cancer in 95 families: differences and similarities between mutation-positive and mutation-negative kindreds. Am J Hum Genet 2001, 68: 118–127. 10.1086/316942CrossRefPubMed
25.
go back to reference Scott RJ: Modifier Genes and HNPCC: Variable phenotypic expression in HNPCC and the search for modifier genes. Eur J Hum Genet 2008, 16: 531–532. 10.1038/ejhg.2008.46CrossRefPubMed Scott RJ: Modifier Genes and HNPCC: Variable phenotypic expression in HNPCC and the search for modifier genes. Eur J Hum Genet 2008, 16: 531–532. 10.1038/ejhg.2008.46CrossRefPubMed
26.
go back to reference Barrow E, Robinson L, Alduaij W, Shenton A, Clancy T, Lalloo F, Hill J, Evans DG: Cumulative lifetime incidence of extracolonic cancers in Lynch syndrome: a report of 121 families with proven mutations. Clin Genet 2009, 75: 141–149. 10.1111/j.1399-0004.2008.01125.xCrossRefPubMed Barrow E, Robinson L, Alduaij W, Shenton A, Clancy T, Lalloo F, Hill J, Evans DG: Cumulative lifetime incidence of extracolonic cancers in Lynch syndrome: a report of 121 families with proven mutations. Clin Genet 2009, 75: 141–149. 10.1111/j.1399-0004.2008.01125.xCrossRefPubMed
27.
go back to reference Fredriksson H, Ikonen T, Autio V, Matikainen MP, Helin HJ, Tammela TL, Koivisto PA, Schleutker J: Identification of germline MLH1 alterations in familial prostate cancer. Eur J Cancer 2006, 42: 2802–2806. 10.1016/j.ejca.2006.04.024CrossRefPubMed Fredriksson H, Ikonen T, Autio V, Matikainen MP, Helin HJ, Tammela TL, Koivisto PA, Schleutker J: Identification of germline MLH1 alterations in familial prostate cancer. Eur J Cancer 2006, 42: 2802–2806. 10.1016/j.ejca.2006.04.024CrossRefPubMed
28.
go back to reference Soravia C, Klift H, Brundler MA, Blouin JL, Wijnen J, Hutter P, Fodde R, Delozier-Blanchet C: Prostate cancer is part of the hereditary non-polyposis colorectal cancer (HNPCC) tumor spectrum. Am J Med Genet. 2003, 121A(2):159–162. 10.1002/ajmg.a.20106CrossRefPubMed Soravia C, Klift H, Brundler MA, Blouin JL, Wijnen J, Hutter P, Fodde R, Delozier-Blanchet C: Prostate cancer is part of the hereditary non-polyposis colorectal cancer (HNPCC) tumor spectrum. Am J Med Genet. 2003, 121A(2):159–162. 10.1002/ajmg.a.20106CrossRefPubMed
29.
go back to reference Wang Q, Lasset C, Desseigne F, Saurin JC, Maugard C, Navarro C, Ruano E, Descos L, Trillet-Lenoir V, Bosset JF, Puisieux A: Prevalence of germline mutations of hMLH1, hMSH2, hPMS1, hPMS2, and hMSH6 genes in 75 French kindreds with nonpolyposis colorectal cancer. Hum Genet 1999, 105: 79–85. 10.1007/s004390051067PubMed Wang Q, Lasset C, Desseigne F, Saurin JC, Maugard C, Navarro C, Ruano E, Descos L, Trillet-Lenoir V, Bosset JF, Puisieux A: Prevalence of germline mutations of hMLH1, hMSH2, hPMS1, hPMS2, and hMSH6 genes in 75 French kindreds with nonpolyposis colorectal cancer. Hum Genet 1999, 105: 79–85. 10.1007/s004390051067PubMed
30.
go back to reference Tokairin Y, Kakinuma S, Arai M, Nishimura M, Okamoto M, Ito E, Akashi M, Miki Y, Kawano T, Iwai T, Shimada Y: Accelerated growth of intestinal tumours after radiation exposure in Mlh1-knockout mice: evaluation of the late effect of radiation on a mouse model of HNPCC. Int J Exp Pathol 2006, 87: 89–99. 10.1111/j.0959-9673.2006.00464.xCrossRefPubMedPubMedCentral Tokairin Y, Kakinuma S, Arai M, Nishimura M, Okamoto M, Ito E, Akashi M, Miki Y, Kawano T, Iwai T, Shimada Y: Accelerated growth of intestinal tumours after radiation exposure in Mlh1-knockout mice: evaluation of the late effect of radiation on a mouse model of HNPCC. Int J Exp Pathol 2006, 87: 89–99. 10.1111/j.0959-9673.2006.00464.xCrossRefPubMedPubMedCentral
31.
go back to reference Franchitto A, Pichierri P, Genuardi M, De Santis A, Palitti F: Investigation of G2-phase chromosomal radiosensitivity in hereditary non-polyposis colorectal cancer cells. Int J Radiat Biol 2001, 77: 773–780. 10.1080/09553000110050056CrossRefPubMed Franchitto A, Pichierri P, Genuardi M, De Santis A, Palitti F: Investigation of G2-phase chromosomal radiosensitivity in hereditary non-polyposis colorectal cancer cells. Int J Radiat Biol 2001, 77: 773–780. 10.1080/09553000110050056CrossRefPubMed
32.
go back to reference Myrhoj T, Andersen MB, Bernstein I: Screening for urinary tract cancer with urine cytology in Lynch syndrome and familial colorectal cancer. Fam Cancer 2008. Myrhoj T, Andersen MB, Bernstein I: Screening for urinary tract cancer with urine cytology in Lynch syndrome and familial colorectal cancer. Fam Cancer 2008.
Metadata
Title
Unusual presentation of Lynch Syndrome
Authors
Veronica PCC Yu
Marco Novelli
Stewart J Payne
Sam Fisher
Rebecca A Barnetson
Ian M Frayling
Ann Barrett
David Goudie
Audrey Ardern-Jones
Ros Eeles
Susan Shanley
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Hereditary Cancer in Clinical Practice / Issue 1/2009
Electronic ISSN: 1897-4287
DOI
https://doi.org/10.1186/1897-4287-7-12

Other articles of this Issue 1/2009

Hereditary Cancer in Clinical Practice 1/2009 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine