title: Upper urinary tract carcinoma in Lynch syndrome cases.
abstract: OBJECTIVE
  Patients with Lynch syndrome are much more likely to have generally rare upper urinary tract urothelial carcinoma but not bladder urothelial carcinoma. While the risk has been quantified, to our knowledge there is no description of how this population of patients with Lynch syndrome and upper urinary tract cancer differs from the general population with upper urinary tract cancer.
  
  
  METHODS
  We obtained retrospective data on a cohort of patients with Lynch syndrome from the Hereditary Cancer Center in Omaha, Nebraska and compared the data to those on a control general population from western Sweden. These data were supplemented by a new survey about exposure to known risk factors.
  
  
  RESULTS
  Of the patients with Lynch syndrome 91% had mutations in MSH2 rather than in MSH1 and 79% showed upper tract urothelial carcinoma a mean of 15.85 years after prior Lynch syndrome-type cancer. Median age at diagnosis was 62 years vs 70 in the general population (p <0.0001). Only half of our patients had a significant smoking history and the male-to-female ratio was 0.95. Of patients with Lynch syndrome 51% had urothelial carcinoma in the ureter while it occurred in the renal pelvis in 65% of the general population (p = 0.0013). Similar numbers of high grade tumors were found in the Lynch syndrome and general populations (88% and 74%, respectively, p = 0.1108).
  
  
  CONCLUSIONS
  Upper urinary tract tumors develop at a younger age and are more likely to be in the ureter with an almost equal gender ratio in patients with Lynch syndrome. It has high grade potential similar to that in the general population.
authors.affiliation: Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA. david.crockett@unmc.edu
authors.forename: David G
authors.initials: DG
authors.lastname: Crockett
authors.forename: David G
authors.initials: DG
authors.lastname: Wagner
authors.forename: Sten
authors.initials: S
authors.lastname: Holmäng
authors.forename: Sonny L
authors.initials: SL
authors.lastname: Johansson
authors.forename: Henry T
authors.initials: HT
authors.lastname: Lynch
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics / Q000473:pathology; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000150:complications* / Q000453:epidemiology / Q000235:genetics / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics / Q000473:pathology; D008297:Male; D008875:Middle Aged; D051718:MutS Homolog 2 Protein / Q000235:genetics; D009154:Mutation; D009329:Nebraska / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D014516:Ureteral Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics / Q000473:pathology
chemical_list: C497172:MSH2 protein, human; D051718:MutS Homolog 2 Protein