title: Germline E-cadherin gene mutations: is prophylactic total gastrectomy indicated?
abstract: BACKGROUND
  The CDH1 gene encodes E-cadherin, an epithelial cell adhesion molecule. Germline CDH1 mutations recently were identified in families with hereditary diffuse gastric carcinoma in a pattern suggestive of autosomal dominant inheritance with incomplete penetrance.
  
  
  METHODS
  The proband was a woman age 47 years with a strong family history of diffuse gastric carcinoma. A germline E-cadherin gene mutation was identified in this patient, her brother, and three first cousins. All five family members underwent endoscopic evaluations, which were negative for malignancy, and elected to undergo a prophylactic total gastrectomy with Roux-en-Y esophagojejunostomy.
  
  
  RESULTS
  Pathologic examination of the proband's stomach revealed several microscopic foci of intramucosal signet ring cell adenocarcinoma in the cardia and proximal gastric body. Postgastrectomy specimens from the proband's brother and three first cousins all showed intramucosal signet ring cell adenocarcinoma in various regions of the stomach. Immunoperoxidase studies performed on gastric tissue from these five patients demonstrated diminished or absent E-cadherin reactivity in the cancerous mucosa.
  
  
  CONCLUSIONS
  Although total gastrectomy was performed as a prophylactic intervention, occult gastric carcinoma was discovered in all five patients. Thus, total gastrectomy should be curative for gastric carcinoma in these patients. Based on their successful outcomes and the lack of efficacious surveillance methods for diffuse gastric carcinoma, prophylactic total gastrectomy may be the management of choice for germline E-cadherin gene mutation carriers. However, prophylactic total gastrectomy should be undertaken cautiously because the procedure may be associated with considerable morbidity.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Y S
authors.initials: YS
authors.lastname: Chun
authors.forename: N M
authors.initials: NM
authors.lastname: Lindor
authors.forename: T C
authors.initials: TC
authors.lastname: Smyrk
authors.forename: B T
authors.initials: BT
authors.lastname: Petersen
authors.forename: L J
authors.initials: LJ
authors.lastname: Burgart
authors.forename: P J
authors.initials: PJ
authors.lastname: Guilford
authors.forename: J H
authors.initials: JH
authors.lastname: Donohue
mesh_terms: D000328:Adult; D015820:Cadherins / Q000235:genetics*; D005260:Female; D005743:Gastrectomy; D020022:Genetic Predisposition to Disease; D018095:Germ-Line Mutation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention; D013274:Stomach Neoplasms / Q000235:genetics* / Q000473:pathology / Q000517:prevention & control
chemical_list: D015820:Cadherins