title: The heterogeneous distribution of BRAF mutation supports the independent clonal origin of distinct tumor foci in multifocal papillary thyroid carcinoma.
abstract: BACKGROUND
  Papillary thyroid carcinoma (PTC) is frequently multifocal. Independent PTC foci may occur either from intraglandular metastases from a single dominant tumor or as unrelated neoplastic clones. In rare cases, the simultaneous presence of PTC foci of different histopathological subtypes points to independent sites of tumor formation.
  
  
  OBJECTIVE
  We examined the pattern of BRAF mutations in noncontiguous tumor foci and node metastases from 69 patients affected by multicentric PTC. These included 19 cases characterized by the simultaneous presence of different PTC histopathological variants.
  
  
  METHODS
  BRAF (exon 15) mutation was examined by PCR-single strand conformational polymorphism followed by DNA sequencing in laser-capture microdissected tissue samples.
  
  
  RESULTS
  Discordant patterns of BRAF mutation were found in about 40% of the multifocal PTCs. In node metastases, BRAF mutations were, in most but not all the cases, concordant with the dominant tumor. A discordant pattern of BRAF mutation was also found in about 50% of the cases in which multiple foci of different histopathological variants were present.
  
  
  CONCLUSIONS
  The heterogeneous distribution of BRAF mutations suggests that discrete tumor foci in multifocal PTC may occur as independent tumors. This information has to be considered in the design of targeted therapeutic approaches with BRAF pathway inhibitors.
authors.affiliation: Departments of Surgery, University of Pisa, 56126 Pisa, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Giannini
authors.forename: Clara
authors.initials: C
authors.lastname: Ugolini
authors.forename: Cristiana
authors.initials: C
authors.lastname: Lupi
authors.forename: Agnese
authors.initials: A
authors.lastname: Proietti
authors.forename: Rossella
authors.initials: R
authors.lastname: Elisei
authors.forename: Giuliana
authors.initials: G
authors.lastname: Salvatore
authors.forename: Piero
authors.initials: P
authors.lastname: Berti
authors.forename: Gabriele
authors.initials: G
authors.lastname: Materazzi
authors.forename: Paolo
authors.initials: P
authors.lastname: Miccoli
authors.forename: Massimo
authors.initials: M
authors.lastname: Santoro
authors.forename: Fulvio
authors.initials: F
authors.lastname: Basolo
mesh_terms: D000328:Adult; D002291:Carcinoma, Papillary / Q000235:genetics* / Q000473:pathology; D002999:Clone Cells / Q000378:metabolism / Q000473:pathology*; D004252:DNA Mutational Analysis; D004273:DNA, Neoplasm / Q000032:analysis; D005260:Female; D018740:Genetic Heterogeneity; D006801:Humans; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009378:Neoplasms, Multiple Primary / Q000235:genetics*; D014411:Neoplastic Stem Cells / Q000378:metabolism / Q000473:pathology*; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics*; D013964:Thyroid Neoplasms / Q000235:genetics* / Q000473:pathology
chemical_list: D004273:DNA, Neoplasm; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf