Familial melanoma-astrocytoma syndrome: Synchronous diffuse astrocytoma and pleomorphic xanthoastrocytoma in a patient with germline CDKN2A/B deletion and a significant family history

Andrew K. Chan, Seunggu (Jude) Han, Winward Choy, Daniah Beleford, Manish K. Aghi, Mitchel S. Berger, Joseph T. Shieh, Andrew W. Bollen, Arie Perry, Joanna J. Phillips, Nicholas Butowski, David A. Solomon

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Familial melanoma-astrocytoma syndrome is a tumor predisposition syndrome caused by inactivating germline alteration of the CDKN2A tumor suppressor gene on chromosome 9p21. While some families with germline CDKN2A mutations are prone to development of just melanomas, other families develop both melanomas, astrocytomas, and occasionally other nervous-system neoplasms including peripheral nerve sheath tumors and meningiomas. The histologic spectrum of the astrocytomas that arise as part of this syndrome is not well described, nor are the additional genetic alterations that drive these astrocytomas apart from the germline CDKN2A inactivation. Herein, we report the case of a young man with synchronous development of a pleomorphic xanthoastrocytoma, diffuse astrocytoma, and paraspinal mass radiographically consistent with a peripheral nerve sheath tumor. His paternal family history is significant for melanoma, glioblastoma, and oral squamous cell carcinoma. Genomic profiling revealed that he harbors a heterozygous deletion in the germline of chromosome 9p21.3 encompassing the CDKN2A and CDKN2B tumor suppressor genes. Both the pleomorphic xanthoastrocytoma and diffuse astrocytoma were found to have homozygous deletion of CDKN2A/B due to somatic loss of the other copy of chromosome 9p containing the remaining intact alleles. Additional somatic alterations included BRAF p. V600E mutation in the pleomorphic xanthoastrocytoma and PTPN11, ATRX, and NF1 mutations in the diffuse astrocytoma. The presence of germline CDKN2A/B inactivation together with the presence of multiple anatomically, histologically, and genetically distinct astrocytic neoplasms, both with accompanying somatic loss of heterozygosity for the CDKN2A/B deletion, led to a diagnosis of familial melanoma- astrocytoma syndrome. This remarkable case illustrates the histologic and genetic diversity that astrocytomas arising as part of this rare glioma predisposition syndrome can demonstrate.

Original languageEnglish (US)
Pages (from-to)213-221
Number of pages9
JournalClinical Neuropathology
Volume36
Issue number5
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Fingerprint

Astrocytoma
Nerve Sheath Neoplasms
Melanoma
Chromosomes
Tumor Suppressor Genes
Nervous System Neoplasms
Mutation
Germ-Line Mutation
Loss of Heterozygosity
Meningioma
Glioblastoma
Cutaneous Malignant Melanoma
Melanoma astrocytoma syndrome
Glioma
Squamous Cell Carcinoma
Neoplasms
Alleles

Keywords

  • CDKN2A
  • Diffuse astrocytoma
  • Glioma predisposition syndrome
  • Melanocytic nevi
  • Nerve sheath tumor
  • P16INK4a
  • Pleomorphic xanthoastrocytoma

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Neurology
  • Clinical Neurology

Cite this

Familial melanoma-astrocytoma syndrome : Synchronous diffuse astrocytoma and pleomorphic xanthoastrocytoma in a patient with germline CDKN2A/B deletion and a significant family history. / Chan, Andrew K.; Han, Seunggu (Jude); Choy, Winward; Beleford, Daniah; Aghi, Manish K.; Berger, Mitchel S.; Shieh, Joseph T.; Bollen, Andrew W.; Perry, Arie; Phillips, Joanna J.; Butowski, Nicholas; Solomon, David A.

In: Clinical Neuropathology, Vol. 36, No. 5, 01.01.2017, p. 213-221.

Research output: Contribution to journalArticle

Chan, AK, Han, SJ, Choy, W, Beleford, D, Aghi, MK, Berger, MS, Shieh, JT, Bollen, AW, Perry, A, Phillips, JJ, Butowski, N & Solomon, DA 2017, 'Familial melanoma-astrocytoma syndrome: Synchronous diffuse astrocytoma and pleomorphic xanthoastrocytoma in a patient with germline CDKN2A/B deletion and a significant family history', Clinical Neuropathology, vol. 36, no. 5, pp. 213-221. https://doi.org/10.5414/NP301022
Chan, Andrew K. ; Han, Seunggu (Jude) ; Choy, Winward ; Beleford, Daniah ; Aghi, Manish K. ; Berger, Mitchel S. ; Shieh, Joseph T. ; Bollen, Andrew W. ; Perry, Arie ; Phillips, Joanna J. ; Butowski, Nicholas ; Solomon, David A. / Familial melanoma-astrocytoma syndrome : Synchronous diffuse astrocytoma and pleomorphic xanthoastrocytoma in a patient with germline CDKN2A/B deletion and a significant family history. In: Clinical Neuropathology. 2017 ; Vol. 36, No. 5. pp. 213-221.
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