Renal Cell Carcinoma Unclassified with Medullary Phenotype in a Patient with Neurofibromatosis Type 2

Current Oncology · 9 authors, 1 centre

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TL;DR

The patient achieved a complete response to platinum-based chemotherapy, which is unusual for this typically aggressive cancer.

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Diagnosis was confirmed by pathology, showing loss of SMARCB1 expression. The authors discuss the potential genetic interplay between the adjacent SMARCB1 and NF2 genes on chromosome 22q11.2. The patient was treated with platinum-based chemotherapy, to which she showed a profoundly rare complete response. The discussion suggests that SMARCB1-deficient malignancies like RCCU-MP should be considered in NF2 patients with unusual tumors, and pathological evaluation should include staining for SMARCB1 loss.

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case_report

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oncology

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ORIGINAL PAPER

PMC10047671

Renal Cell Carcinoma Unclassified with Medullary Phenotype in a Patient with Neurofibromatosis Type 2

Current Oncology

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ABSTRACT

Abstract We present, to our knowledge, the first reported case of germline neurofibromatosis Type 2 (NF2) associated with renal cell carcinoma unclassified with medullary phenotype (RCCU-MP) with somatic loss by immunohistochemistry of the SMARCB1 tumor suppressor gene located centromeric to NF2 on chromosome 22q. Our patient is a 15-year-old with germline neurofibromatosis Type 2 (NF2) confirmed by pathogenic mutation of c.-854-??46+??deletion. Her NF2 history is positive for a right optic nerve sheath meningioma, CNIII schwannoma requiring radiation therapy and post gross total resection of right frontotemporal anaplastic meningioma followed by radiation. At age 15 she developed new onset weight loss and abdominal pain due to RCCU-MP. Hemoglobin electrophoresis was negative for sickle hemoglobinopathy. Chemotherapy (cisplatin, gemcitabine and paclitaxel) was initiated followed by radical resection. Given the unique renal pathology of a high grade malignancy with loss of SMARCB1 expression via immunohistochemistry, and history of meningioma with MLH1 loss of expression and retained expression of PMS2, MSH2 and MSH6, further germline genetic testing was sent for SMARCB1 and mismatch repair syndromes. Germline testing was negative for mutation in SMARCB1 . Therefore, this is the first reported case of RCCU-MP associated with germline NF2 mutation. This suggests the importance of closer surveillance in the adolescent and young adult population with NF2 with any suspicious findings of malignancy outside of the usual scope of practice with NF2. Keywords: NF2, renal cell carcinoma, medullary phenotype

CITATION EXPORT

Sanila Sarkar, Whitney Throckmorton, Racheal Bingham et al.. Renal Cell Carcinoma Unclassified with Medullary Phenotype in a Patient with Neurofibromatosis Type 2. Current Oncology. (2023). https://doi.org/10.3390/curroncol30030255

AUTHORS

9 · 1 CENTRES

Sanila Sarkar, Whitney Throckmorton, Racheal Bingham, Pavlos Msaouel, Giannicola Genovese, John Slopis, Priya Rao, Zsila Sadighi, Cynthia E Herzog

1MD Anderson Cancer Care Center, University of Texas, Houston, TX 77030, USA