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KRAS and GNAS Co-Mutation in Metastatic Low-Grade Appendiceal Mucinous Neoplasm (LAMN) to the Ovaries: A Practical Role for Next-Generation Sequencing
Patient: Female, 49 Final Diagnosis: Metastatic LAMN Symptoms: Abdominal discomfort Medication: — Clinical Procedure: Laparoscopic total abdominal hysterectomy • bilateral salpingo-oophorectomy • complete supracolic omentectomy • appendectomy Specialty: Oncology OBJECTIVE: Unknown ethiology BACKGROU...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Scientific Literature, Inc.
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447665/ https://www.ncbi.nlm.nih.gov/pubmed/28526814 http://dx.doi.org/10.12659/AJCR.903581 |
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author | Matson, Daniel R. Xu, Jin Huffman, Laura Barroilhet, Lisa Accola, Molly Rehrauer, William M. Weisman, Paul |
author_facet | Matson, Daniel R. Xu, Jin Huffman, Laura Barroilhet, Lisa Accola, Molly Rehrauer, William M. Weisman, Paul |
author_sort | Matson, Daniel R. |
collection | PubMed |
description | Patient: Female, 49 Final Diagnosis: Metastatic LAMN Symptoms: Abdominal discomfort Medication: — Clinical Procedure: Laparoscopic total abdominal hysterectomy • bilateral salpingo-oophorectomy • complete supracolic omentectomy • appendectomy Specialty: Oncology OBJECTIVE: Unknown ethiology BACKGROUND: Low-grade appendiceal mucinous neoplasms (LAMNs) are cytologically low-grade tumors of the appendix and are a frequent cause of pseudomyxoma peritonei. They can become a diagnostic challenge when they metastasize to the ovaries, where they may mimic primary ovarian mucinous tumors. CASE REPORT: We report the case of a patient with very large bilateral ovarian mucinous tumors and a concurrent minute LAMN incidentally discovered in a grossly normal appendix. A primary ovarian tumor was suspected, but histological analysis of the ovaries suggested an appendiceal origin. Immunohistochemical studies were not informative and a consensus regarding the source of the ovarian tumors could not be reached within our department. Subsequent next-generation sequencing of tumors from the right ovary, left ovary, appendix, and matched normal tissue demonstrated identical somatic point mutations in KRAS and GNAS present in all tumors. The patient was diagnosed with metastatic LAMN and did not receive further treatment. She remains disease-free after 15 months of close observation. CONCLUSIONS: Determining the tissue of origin in low-grade mucinous tumors of the ovaries can be challenging when a concurrent LAMN is identified in the appendix. In cases where histology and immunohistochemistry are insufficient to render a diagnosis, the presence of concurrent KRAS and GNAS mutations in both tumors strongly favors a diagnosis of metastatic LAMN. We emphasize the utility of targeted next-generation sequencing to establish tissue of origin in challenging cases when LAMN is suspected as the source of mucinous ovarian tumors. |
format | Online Article Text |
id | pubmed-5447665 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | International Scientific Literature, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-54476652017-06-08 KRAS and GNAS Co-Mutation in Metastatic Low-Grade Appendiceal Mucinous Neoplasm (LAMN) to the Ovaries: A Practical Role for Next-Generation Sequencing Matson, Daniel R. Xu, Jin Huffman, Laura Barroilhet, Lisa Accola, Molly Rehrauer, William M. Weisman, Paul Am J Case Rep Articles Patient: Female, 49 Final Diagnosis: Metastatic LAMN Symptoms: Abdominal discomfort Medication: — Clinical Procedure: Laparoscopic total abdominal hysterectomy • bilateral salpingo-oophorectomy • complete supracolic omentectomy • appendectomy Specialty: Oncology OBJECTIVE: Unknown ethiology BACKGROUND: Low-grade appendiceal mucinous neoplasms (LAMNs) are cytologically low-grade tumors of the appendix and are a frequent cause of pseudomyxoma peritonei. They can become a diagnostic challenge when they metastasize to the ovaries, where they may mimic primary ovarian mucinous tumors. CASE REPORT: We report the case of a patient with very large bilateral ovarian mucinous tumors and a concurrent minute LAMN incidentally discovered in a grossly normal appendix. A primary ovarian tumor was suspected, but histological analysis of the ovaries suggested an appendiceal origin. Immunohistochemical studies were not informative and a consensus regarding the source of the ovarian tumors could not be reached within our department. Subsequent next-generation sequencing of tumors from the right ovary, left ovary, appendix, and matched normal tissue demonstrated identical somatic point mutations in KRAS and GNAS present in all tumors. The patient was diagnosed with metastatic LAMN and did not receive further treatment. She remains disease-free after 15 months of close observation. CONCLUSIONS: Determining the tissue of origin in low-grade mucinous tumors of the ovaries can be challenging when a concurrent LAMN is identified in the appendix. In cases where histology and immunohistochemistry are insufficient to render a diagnosis, the presence of concurrent KRAS and GNAS mutations in both tumors strongly favors a diagnosis of metastatic LAMN. We emphasize the utility of targeted next-generation sequencing to establish tissue of origin in challenging cases when LAMN is suspected as the source of mucinous ovarian tumors. International Scientific Literature, Inc. 2017-05-20 /pmc/articles/PMC5447665/ /pubmed/28526814 http://dx.doi.org/10.12659/AJCR.903581 Text en © Am J Case Rep, 2017 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) ) |
spellingShingle | Articles Matson, Daniel R. Xu, Jin Huffman, Laura Barroilhet, Lisa Accola, Molly Rehrauer, William M. Weisman, Paul KRAS and GNAS Co-Mutation in Metastatic Low-Grade Appendiceal Mucinous Neoplasm (LAMN) to the Ovaries: A Practical Role for Next-Generation Sequencing |
title | KRAS and GNAS Co-Mutation in Metastatic Low-Grade Appendiceal Mucinous Neoplasm (LAMN) to the Ovaries: A Practical Role for Next-Generation Sequencing |
title_full | KRAS and GNAS Co-Mutation in Metastatic Low-Grade Appendiceal Mucinous Neoplasm (LAMN) to the Ovaries: A Practical Role for Next-Generation Sequencing |
title_fullStr | KRAS and GNAS Co-Mutation in Metastatic Low-Grade Appendiceal Mucinous Neoplasm (LAMN) to the Ovaries: A Practical Role for Next-Generation Sequencing |
title_full_unstemmed | KRAS and GNAS Co-Mutation in Metastatic Low-Grade Appendiceal Mucinous Neoplasm (LAMN) to the Ovaries: A Practical Role for Next-Generation Sequencing |
title_short | KRAS and GNAS Co-Mutation in Metastatic Low-Grade Appendiceal Mucinous Neoplasm (LAMN) to the Ovaries: A Practical Role for Next-Generation Sequencing |
title_sort | kras and gnas co-mutation in metastatic low-grade appendiceal mucinous neoplasm (lamn) to the ovaries: a practical role for next-generation sequencing |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447665/ https://www.ncbi.nlm.nih.gov/pubmed/28526814 http://dx.doi.org/10.12659/AJCR.903581 |
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