HNPCC-associated small bowel cancer: clinical and molecular characteristics - PubMed (original) (raw)

doi: 10.1053/j.gastro.2004.12.051.

Frank E Brasch, Erdmute Kunstmann, Christoph Engel, Constanze Pagenstecher, Holger Vogelsang, Stefan Krüger, Tilman Vogel, Hanns-Peter Knaebel, Josef Rüschoff, Stephan A Hahn, Magnus V Knebel-Doeberitz, Gabriela Moeslein, Stephen J Meltzer, Hans K Schackert, Christiane Tympner, Elisabeth Mangold, Wolff Schmiegel; German HNPCC Consortium

Affiliations

HNPCC-associated small bowel cancer: clinical and molecular characteristics

Karsten Schulmann et al. Gastroenterology. 2005 Mar.

Abstract

Background & aims: The risk for small bowel cancer (SBC) is significantly increased in hereditary nonpolyposis colorectal cancer (HNPCC). HNPCC-associated SBCs are poorly characterized.

Methods: Thirty-two SBCs were characterized according to clinical, pathologic, and germline mutation data. Histomorphologic characteristics, microsatellite instability (MSI) testing, mismatch repair (MMR) protein expression, and frameshift mutations of 7 coding mononucleotide repeats were investigated in 17 SBCs.

Results: Median age at diagnosis was 39 years. Fifty percent of SBCs were located in the duodenum. The Amsterdam criteria were fulfilled in 50% of patients; 45% of patients had no personal history of previous malignancies. Two patients had a positive family history for SBC. Pathogenic germline mutations were identified in 81%; high MSI was detected in 95% and loss of MMR protein expression in 89% of cases. TGFBR2 , BAX , MSH3 , MSH6 , ACVR2 , AIM2 , and SEC63 frameshift mutations were detected in 69%, 59%, 59%, 35%, 82%, 56%, and 56%, respectively. An expansive growth pattern of the tumor border and an intense intratumoral lymphocytic infiltrate were present in 75%, respectively.

Conclusions: HNPCC-associated SBC often manifests at a young age and may be the first disease manifestation. Endoscopy may detect 50% of tumors. Considering recent data on gastric cancer, we propose endoscopic screening of mutation carriers starting at 30 years of age because clinical criteria cannot define a high-risk group. In addition, our study shows that histopathologic criteria, MSI, and MMR immunohistochemistry are often similar to these features in HNPCC.

PubMed Disclaimer

Similar articles

Cited by

Publication types

MeSH terms

LinkOut - more resources