Phenotypic expression of a family with multiple endocrine neoplasia type 2A due to a RET mutation at codon 618.
BACKGROUND
Multiple endocrine neoplasia type 2A (MEN2A) is caused by missense mutations in the RET proto-oncogene on chromosome 10. This paper reports the phenotypic expression of a family with MEN2A, in which serine substitutes for cysteine at codon 618 in exon 10 of the RET gene. It was first claimed that medullary thyroid cancer (MTC) with this rare mutation led to mild disease; this has recently been updated to intermediate-high risk, based on stratified genetic information.


METHODS
The family was mapped over six generations. In 1971 family members were invited to join a screening programme. Genetic testing was started in 1994.


RESULTS
Twenty-two individuals with MTC were identified, 16 by the screening programme. One screened patient had a phaeochromocytoma and four had hyperparathyroidism. At surgery for MTC 12 patients had local tumour metastases and two young patients also had liver metastases. No screened patient died from MTC during a mean observation time of 19 years. Six other family members were diagnosed with MTC by signs and symptoms, five of whom died from MTC.


CONCLUSIONS
Because of the great interindividual differences in tumour aggressiveness within the family it is impossible to predict whether an individual gene carrier will have an aggressive MTC or not. This unpredictability is an additional argument, besides those obtained in stratified genetic studies, for operating on gene carriers at young age.
Lindskog
S
S
Department of Surgery, Varberg Hospital, Varberg, Sweden. stefan.lindskog@ithalland.se
Nilsson
O
O
Jansson
S
S
Nilsson
B
B
Illerskog
A-C
AC
Ysander
L
L
Ahlman
H
H
Tisell
L-E
LE
D000293:Adolescent; D000328:Adult; D000368:Aged; D002879:Chromosomes, Human, Pair 10 / Q000235:genetics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018813:Multiple Endocrine Neoplasia Type 2a / Q000235:genetics*; D009154:Mutation / Q000235:genetics*; D009362:Neoplasm Metastasis / Q000235:genetics; D015513:Oncogene Proteins / Q000235:genetics*; D010641:Phenotype; D000090063:Proto-Oncogene Mas; D051096:Proto-Oncogene Proteins c-ret; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics*
C000715470:MAS1 protein, human; D015513:Oncogene Proteins; D000090063:Proto-Oncogene Mas; D051096:Proto-Oncogene Proteins c-ret; C099282:RET protein, human; D020794:Receptor Protein-Tyrosine Kinases