Familial gastrointestinal stromal tumors, lentigines, and café-au-lait macules associated with germline c-kit mutation treated with imatinib

Divya Gupta, Laxmisha Chandrashekar, Lidia Larizza, Elisa A. Colombo, Laura Fontana, Cristina Gervasini, Devinder M. Thappa, Medha Rajappa, Kalai Selvi Rajendiran, Gubbi Shamanna Sreenath, Vikram Kate

Research output: Contribution to journalArticle

Abstract

Background: Familial lentiginosis syndromes are characterized by a wide array of manifestations resulting from activation of molecular pathways which control growth, proliferation, and differentiation of a broad range of tissues. Familial gastrointestinal stromal tumors (GISTs) are often accompanied by additional features like hyperpigmentation, mastocytosis, and dysphagia. They have been described with mutations in c-kit (most commonly), platelet-derived growth factor receptor A, neurofibromatosis-1, and succinate dehydrogenase genes. Materials and Methods: We report on molecular characterization and tumor histopathology of two siblings in whom lentigines and café-au-lait macules were present along with multifocal GIST. Immuhistochemical analysis of CD34 and CD117 was performed on GIST biopsy samples from both siblings, while c-kit mutational analysis was done by PCR and direct sequencing on DNA from peripheral blood leukocytes of all family members and from paraffin-embedded gastric biopsy specimens of affected siblings. Results: Histopathology revealed positive expression of CD117 and CD34. Mutational analysis showed the germline c.1676T>C mutation in c-kit exon 11, (p.(Val559Ala)), in the peripheral blood of both siblings and a second exon 11 mutation, c.1669T>A (p.(Trp557Arg)) in the tumor biopsy of one of them. Initiation of imatinib treatment resulted in striking resolution of their hyperpigmentation and a stable gastrointestinal disease in one of them. Conclusions: A c-kit mutational test in familial GISTs is indicated before initiation of imatinib therapy, as it can help predict tumor response to treatment.

Original languageEnglish
Pages (from-to)195-201
Number of pages7
JournalInternational Journal of Dermatology
Volume56
Issue number2
DOIs
Publication statusPublished - Feb 1 2017

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Lentigo
Gastrointestinal Stromal Tumors
Siblings
Hyperpigmentation
Mutation
Biopsy
Exons
Mastocytosis
Platelet-Derived Growth Factor Receptors
Neoplasms
Neurofibromatosis 1
Succinate Dehydrogenase
Gastrointestinal Diseases
Deglutition Disorders
DNA Sequence Analysis
Paraffin
Stomach
Leukocytes
Therapeutics
Polymerase Chain Reaction

ASJC Scopus subject areas

  • Dermatology

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Familial gastrointestinal stromal tumors, lentigines, and café-au-lait macules associated with germline c-kit mutation treated with imatinib. / Gupta, Divya; Chandrashekar, Laxmisha; Larizza, Lidia; Colombo, Elisa A.; Fontana, Laura; Gervasini, Cristina; Thappa, Devinder M.; Rajappa, Medha; Rajendiran, Kalai Selvi; Sreenath, Gubbi Shamanna; Kate, Vikram.

In: International Journal of Dermatology, Vol. 56, No. 2, 01.02.2017, p. 195-201.

Research output: Contribution to journalArticle

Gupta, D, Chandrashekar, L, Larizza, L, Colombo, EA, Fontana, L, Gervasini, C, Thappa, DM, Rajappa, M, Rajendiran, KS, Sreenath, GS & Kate, V 2017, 'Familial gastrointestinal stromal tumors, lentigines, and café-au-lait macules associated with germline c-kit mutation treated with imatinib', International Journal of Dermatology, vol. 56, no. 2, pp. 195-201. https://doi.org/10.1111/ijd.13516
Gupta, Divya ; Chandrashekar, Laxmisha ; Larizza, Lidia ; Colombo, Elisa A. ; Fontana, Laura ; Gervasini, Cristina ; Thappa, Devinder M. ; Rajappa, Medha ; Rajendiran, Kalai Selvi ; Sreenath, Gubbi Shamanna ; Kate, Vikram. / Familial gastrointestinal stromal tumors, lentigines, and café-au-lait macules associated with germline c-kit mutation treated with imatinib. In: International Journal of Dermatology. 2017 ; Vol. 56, No. 2. pp. 195-201.
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T1 - Familial gastrointestinal stromal tumors, lentigines, and café-au-lait macules associated with germline c-kit mutation treated with imatinib

AU - Gupta, Divya

AU - Chandrashekar, Laxmisha

AU - Larizza, Lidia

AU - Colombo, Elisa A.

AU - Fontana, Laura

AU - Gervasini, Cristina

AU - Thappa, Devinder M.

AU - Rajappa, Medha

AU - Rajendiran, Kalai Selvi

AU - Sreenath, Gubbi Shamanna

AU - Kate, Vikram

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background: Familial lentiginosis syndromes are characterized by a wide array of manifestations resulting from activation of molecular pathways which control growth, proliferation, and differentiation of a broad range of tissues. Familial gastrointestinal stromal tumors (GISTs) are often accompanied by additional features like hyperpigmentation, mastocytosis, and dysphagia. They have been described with mutations in c-kit (most commonly), platelet-derived growth factor receptor A, neurofibromatosis-1, and succinate dehydrogenase genes. Materials and Methods: We report on molecular characterization and tumor histopathology of two siblings in whom lentigines and café-au-lait macules were present along with multifocal GIST. Immuhistochemical analysis of CD34 and CD117 was performed on GIST biopsy samples from both siblings, while c-kit mutational analysis was done by PCR and direct sequencing on DNA from peripheral blood leukocytes of all family members and from paraffin-embedded gastric biopsy specimens of affected siblings. Results: Histopathology revealed positive expression of CD117 and CD34. Mutational analysis showed the germline c.1676T>C mutation in c-kit exon 11, (p.(Val559Ala)), in the peripheral blood of both siblings and a second exon 11 mutation, c.1669T>A (p.(Trp557Arg)) in the tumor biopsy of one of them. Initiation of imatinib treatment resulted in striking resolution of their hyperpigmentation and a stable gastrointestinal disease in one of them. Conclusions: A c-kit mutational test in familial GISTs is indicated before initiation of imatinib therapy, as it can help predict tumor response to treatment.

AB - Background: Familial lentiginosis syndromes are characterized by a wide array of manifestations resulting from activation of molecular pathways which control growth, proliferation, and differentiation of a broad range of tissues. Familial gastrointestinal stromal tumors (GISTs) are often accompanied by additional features like hyperpigmentation, mastocytosis, and dysphagia. They have been described with mutations in c-kit (most commonly), platelet-derived growth factor receptor A, neurofibromatosis-1, and succinate dehydrogenase genes. Materials and Methods: We report on molecular characterization and tumor histopathology of two siblings in whom lentigines and café-au-lait macules were present along with multifocal GIST. Immuhistochemical analysis of CD34 and CD117 was performed on GIST biopsy samples from both siblings, while c-kit mutational analysis was done by PCR and direct sequencing on DNA from peripheral blood leukocytes of all family members and from paraffin-embedded gastric biopsy specimens of affected siblings. Results: Histopathology revealed positive expression of CD117 and CD34. Mutational analysis showed the germline c.1676T>C mutation in c-kit exon 11, (p.(Val559Ala)), in the peripheral blood of both siblings and a second exon 11 mutation, c.1669T>A (p.(Trp557Arg)) in the tumor biopsy of one of them. Initiation of imatinib treatment resulted in striking resolution of their hyperpigmentation and a stable gastrointestinal disease in one of them. Conclusions: A c-kit mutational test in familial GISTs is indicated before initiation of imatinib therapy, as it can help predict tumor response to treatment.

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