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Original research
Clinicopathological and molecular features of hereditary leiomyomatosis and renal cell cancer-associated renal cell carcinomas
  1. Mitsuko Furuya1,
  2. Yasuhiro Iribe2,
  3. Yoji Nagashima3,
  4. Naotomo Kambe4,
  5. Chisato Ohe5,
  6. Hidefumi Kinoshita6,
  7. Chika Sato5,
  8. Takeshi Kishida7,
  9. Yoichiro Okubo8,
  10. Kazuyuki Numakura9,
  11. Hiroshi Nanjo10,
  12. Noboru Nakaigawa2,
  13. Kazuhide Makiyama2,
  14. Hisashi Hasumi2,
  15. Hiromichi Iwashita11,
  16. Junichi Ohta12,
  17. Hiroshi Kitamura13,
  18. Takahiko Nakajima14,
  19. Takahiro Yoshida15,
  20. Masahiro Nakagawa15,
  21. Reiko Tanaka16,
  22. Masahiro Yao2
  1. 1 Molecular Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
  2. 2 Urology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
  3. 3 Surgical Pathology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
  4. 4 Dermatology, Kansai Medical University Hirakata Hospital, Hirakata, Osaka, Japan
  5. 5 Pathology and Laboratory Medicine, Kansai Medical University Hirakata Hospital, Hirakata, Osaka, Japan
  6. 6 Urology, Kansai Medical University Hirakata Hospital, Hirakata, Osaka, Japan
  7. 7 Urology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
  8. 8 Pathology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
  9. 9 Urology, Akita University Graduate School of Medicine School of Medicine, Akita, Akita, Japan
  10. 10 Pathology, Akita University Graduate School of Medicine School of Medicine, Akita, Akita, Japan
  11. 11 Pathology, Yokohama Municipal Citizens Hospital, Yokohama, Kanagawa, Japan
  12. 12 Urology, Yokohama Municipal Citizens Hospital, Yokohama, Kanagawa, Japan
  13. 13 Urology, University of Toyama Faculty of Medicine Graduate School of Medicine and Pharmaceutical Science for Education, Toyama, Toyama, Japan
  14. 14 Diagnostic Pathology, University of Toyama Faculty of Medicine Graduate School of Medicine and Pharmaceutical Science for Education, Toyama, Toyama, Japan
  15. 15 Urology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan
  16. 16 Chiba University Medical Mycology Research Center, Chiba, Chiba, Japan
  1. Correspondence to Dr Mitsuko Furuya, Molecular Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan; mfuruya{at}yokohama-cu.ac.jp

Abstract

Aims Hereditary leiomyomatosis and renal cell cancer (HLRCC) is an autosomal dominant disorder caused by germline mutations in fumarate hydratase (FH). Affected families have an increased risk of renal cell carcinoma (RCC). HLRCC-associated RCC (HLRCC-RCC) is highly aggressive. Clinicopathological information of genetically diagnosed patients with HLRCC-RCC contributes to the establishment of effective therapies.

Methods Ten Japanese patients with HLRCC-RCC were enrolled in the study. Genetic testing for FH was carried out. Somatic mutations in FH and immunohistochemical analyses of FH and B7 family ligands (PD-L1 and B7-H3) were investigated in 13 tumours. Copy number variations were evaluated in two tumours.

Results All patients had FH germline mutations. Regarding histology, most tumours had type 2 papillary architecture or tubulocystic pattern or both. All tumours were FH deficient by immunohistochemistry. Ten tumours were positive for PD-L1, and 12 tumours were positive for B7-H3. Somatic mutation analysis demonstrated loss of heterozygosity of FH in 10 tumours. Copy number variation analysis revealed uniparental disomy between 1q24.2 and 1q44 encompassing FH; gain of chromosome 2 p was also common. All patients had either metastases or residual tumours. Three patients died of HLRCC-RCC and one of colon cancer, whereas the other six are currently alive, including two without recurrence.

Conclusions HLRCC-RCCs appear to have unique molecular profiles, including PD-L1 expression. One patient had complete response to immunotherapy, which may be an option for HLRCC-RCC.

  • genetics
  • histopathology
  • tumour biology
  • kidney neoplasms

https://doi.org/10.1136/jclinpath-2020-206548

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    Footnotes

    • Handling editor Runjan Chetty.

    • Correction notice This article has been corrected since it appeared Online First. Title spelling of Clinicopathologicalal has been corrected to Clinicopathological

    • Contributors MF, YI and RT performed the research. MF designed the research study. YN, NK, CO, HK, CS, TK, YO, KN, HN, NN, KM, HH, HI, JO, HK, TN, TY and MN summarised clinicopathological information. MF and MY wrote the paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval The study was approved by the Institutional Review Boards of Yokohama City University, Kansai Medical University, Akita University, and University of Toyama.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. Corresponding author MF. Department of Molecular Pathology, Yokohama City University Graduate School of Medicine.mfuruya@yokohama-cu.ac.jp.