title: Translocational renal cell carcinoma (t(6;11)(p21;q12) with transcription factor EB (TFEB) amplification and an integrated precision approach: a case report.
abstract: BACKGROUND
  Renal cell carcinoma with the distinct type of t(6;11)(p21;q12) translocation (transcription factor EB) is a rare neoplasm. In the present case study, we show for the first time an autophagy signature in a patient with transcription factor EB renal cell carcinoma. We attempted to characterize the mutational and expressional features of a t(6;11)(p21;q12) renal cell carcinoma, in an effort to address the potential for molecular guidance of personalized medical decision for a case in this renal cell carcinoma category.
  
  
  METHODS
  We report the case of a 42-year-old white man who had a late relapse of his renal cell carcinoma. The first diagnosis of clear cell renal carcinoma was derived from a histological examination; analyzing the metastasis and going back to the primary tumor it turned out to be a transcription factor EB-renal cell carcinoma. The treatment plan included local radiation and systemic therapy. As part of the multimodal approach, tumor samples for genetic assessment were obtained. However, there is no recommended standard therapy for transcription factor EB-renal cell carcinoma. Despite four lines of medical treatment with targeted therapy and one checkpoint inhibitor, all attempts to prolong the patient's survival failed.
  
  
  CONCLUSIONS
  During the course of this unusual disease, we gained insights which, to the best of our knowledge, were unknown before in the expression of the gene signature linked to autophagy. This might in part explain the resistance to conventional targeted therapy acknowledged in our patient.
authors.affiliation: Department of Oncology, Oslo University Hospital, Nydalen, Postboks 4950, 0424, Oslo, Norway. wolfgang.lilleby@ous-hf.no.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lilleby
authors.affiliation: Department of Pathology, Oslo University Hospital, Nydalen, Postboks 4950, 0424, Oslo, Norway. ljiljana.vlatkovic@ous-hf.no.
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Vlatkovic
authors.affiliation: Department of Tumor Biology, Institute for Cancear Research, Oslo, Oslo University Hospital, Nydalen, Postboks 4950, 0424, Oslo, Norway. Leonardo.Meza-Zepeda@rr-research.no.|Department of Core Facilities, Institute for Cancer Research, Oslo University Hospital, Nydalen, Postboks 4950, 0424, Oslo, Norway. Leonardo.Meza-Zepeda@rr-research.no.
authors.forename: Leonardo A
authors.initials: LA
authors.lastname: Meza-Zepeda
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Nydalen, Postboks 4950, 0424, Oslo, Norway. monar@ous-hf.no.
authors.forename: Mona-Elisabeth
authors.initials: ME
authors.lastname: Revheim
authors.affiliation: Department of Oncology, Oslo University Hospital, Nydalen, Postboks 4950, 0424, Oslo, Norway. ehovig@ifi.uio.no.|Department of Cancer Genetics and Informatics, University of Oslo, Oslo University Hospital, Nydalen, Postboks 4950, 0424, Oslo, Norway. ehovig@ifi.uio.no.|Department of Informatics, University of Oslo, Blindern, Postboks 1080, 0316, Oslo, Norway. ehovig@ifi.uio.no.
authors.forename: Eivind
authors.initials: E
authors.lastname: Hovig
mesh_terms: D000328:Adult; D001343:Autophagy; D051778:Basic Helix-Loop-Helix Leucine Zipper Transcription Factors / Q000235:genetics*; D014408:Biomarkers, Tumor / Q000235:genetics*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000235:genetics / Q000473:pathology*; D002880:Chromosomes, Human, Pair 11; D002896:Chromosomes, Human, Pair 6; D004273:DNA, Neoplasm; D017809:Fatal Outcome; D015321:Gene Rearrangement; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000235:genetics / Q000473:pathology*; D008297:Male; D058990:Molecular Targeted Therapy; D014178:Translocation, Genetic
chemical_list: D051778:Basic Helix-Loop-Helix Leucine Zipper Transcription Factors; D014408:Biomarkers, Tumor; D004273:DNA, Neoplasm; C064972:TFEB protein, human