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Neurofibromatosis with Gastrointestinal Stromal Tumors: Insights into the Association

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Abstract

The frequent association of stromal tumors with neurofobromatosis raises high suspicion of a possible correlation between the two entities. The aim of this study was to analyze clinicopathologic features of patients with concomitant neurofibromatosis and gastrointestinal stromal tumors and to discuss the molecular basis for their possible pathogenesis. Detailed information about clinical presentation, histology, immunostains, polymerase chain reaction amplification, and sequencing in three of our own cases was obtained. Stromal tumors presented with abdominal pain in one case and hemorrhage in another. One patient underwent surgery for malignant transformation of neurofibroma and stromal tumors were found incidentally. Stromal tumors were consistently positive for CD117, while the malignant peripheral sheath tumor was not. Mutation in the KIT juxtamembrane domain was found in one case. In this respect, some stromal tumors lack demonstrable KIT mutations but KIT remains activated. We reasoned that other mechanisms, like the Ras pathway involved in neurofibromatosis type 1, might play a role in KIT activation.

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REFERENCES

  1. Fuller CE, Williams GT: Gastrointestinal manifestations of type 1 neurofibromatosis (von Recklinghausen's disease). Histopathology 19:1–11, 1991

    Google Scholar 

  2. Barker D, Wright E, Nguyen K, et al.: Gene for von Recklinghausen neurofibromatosis is in the pericentromeric region of chromosome 17. Science 236:1100–1102, 1987

    Google Scholar 

  3. RiccardiVM:Von Recklinghausen neurofibromatosis.NEngl JMed 305:1617–1627, 1981

    Google Scholar 

  4. Rouleau GA, Wertelecki W, Haines JL, Hobbs WJ, Trofatter JA, Seizinger BR, Martuza RL, Superneau DW, Conneally PM, Gusella JF: Genetic linkage of bilateral acoustic neurofibromatosis to aDNA marker on chromosome 22. Nature 329:246–248, 1987

    Google Scholar 

  5. Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW: Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33:459–465, 2002

    Google Scholar 

  6. Lin SC, Huang MJ, Zeng CY, Wang TI, Liu ZL, Shiay RK: Clinical manifestations and prognostic factors in patients with gastrointestinal stromal tumors. World J Gastroenterol 9:2809–2812, 2003

    Google Scholar 

  7. Heinrich MC, Blanke CD, Druker BJ, Corless CL: Inhibition of KIT tyrosine kinase activity:Anovel molecular approach to the treatment of KIT-positive malignancies. J Clin Oncol 20:1692–1703, 2002

    Google Scholar 

  8. Walsh NM, Bodurtha A: Auerbach's myenteric plexus. A possible site of origin for gastrointestinal stromal tumors in von Recklinghausen's neurofibromatosis. Arch Pathol Lab Med 114:522–525, 1990

    Google Scholar 

  9. Min KW, Balaton AJ: Small intestinal stromal tumors with skeinoid fibers in neurofibromatosis: Report of four cases with ultrastructural study of skeinoid fibers from paraffin blocks. Ultrastruct Pathol 17:307–314, 1993

    Google Scholar 

  10. Ishida T, Wada I, Horiuchi H, Oka T, Machinami R: Multiple small intestinal stromal tumors with skeinoid fibers in association with neurofibromatosis 1 (von Recklinghausen's disease). Pathol Int 46:689–695, 1996

    Google Scholar 

  11. NIH conference: Neurofibromatosis 1 (Recklinghausen disease) and neurofibromatosis 2 (bilateral acoustic neurofibromatosis): an update. Ann Intern Med 113:39–52, 1990

    Google Scholar 

  12. Davis GB, Berk RN: Intestinal neurofibromas in von Recklinghausen's disease. Am J Gastroenterol 60:410–414, 1973

    Google Scholar 

  13. Huson SM, Harper PS, Compston DA: Von Recklinghausen neurofibromatosis. A clinical and population study in south-eastWales. Brain 111:1355–1381, 1988</del>

    Google Scholar 

  14. Ghrist TD: Gastrointestinal involvement in neurofibromatosis. Arch Intern Med 112:357–362, 1963

    Google Scholar 

  15. Hochberg FH, Dasilva AB, Galdabini J, Richardson EP Jr: Gastrointestinal involvement in von Recklinghausen's neurofibromatosis. Neurology 24:1144–1151, 1974

    Google Scholar 

  16. Rutgeerts P, Hendrickx H, Geboes K, Ponette E, Broeckaert L, Vantrappen G: Involvement of the upper digestive tract by systemic neurofibromatosis. Gastrointest Endosc 27:22–25, 1981

    Google Scholar 

  17. Melin MM, Grotz RL, Nivatvongs S: Gastrointestinal hemorrhage complicating systemic neurofibromatosis.Am J Gastroenterol 89:1888–1890, 1994

    Google Scholar 

  18. Bernardis V, Sorrentino D, Snidero D, Avellini C, Paduano R, Beltrami CA, Digito F, Bartoli E: Intestinal leiomyosarcoma and gastroparesis associated with von Recklinghausen's disease. Digestion 60:82–85, 1999

    Google Scholar 

  19. Croker JR, Greenstein RJ: Malignant schwannoma of the stomach in a patient with von Recklinghausen's disease. Histopathology 3:79–85, 1979

    Google Scholar 

  20. Gennatas CS, Exarhakos G, Kondi-Pafiti A, Kannas D, Athanassas G, Politi HD: Malignant schwannoma of the stomach in a patient with neurofibromatosis. Eur J Surg Oncol 14:261–264, 1988

    Google Scholar 

  21. Xu W, Mulligan LM, Ponder MA, Liu L, Smith BA, Mathew CG, Ponder BA: Loss of NF1 alleles in phaeochromocytomas from patients with type 1 neurofibromatosis. Genes Chromosomes Cancer 4:337–342, 1992

    Google Scholar 

  22. Legius E, Marchuk DA, Collins FS, Glover TW: Somatic deletion of the neurofibromatosis type 1 gene in a neurofibrosarcoma supports a tumour suppressor gene hypothesis. Nat Genet 3:122–126, 1993

    Google Scholar 

  23. Viskochil D: Genetics of neurofibromatosis 1 and the NF1 gene. J Child Neurol 17:562–570, 2002

    Google Scholar 

  24. Xu GF, O'Connell P, Viskochil D, et al.: The neurofibromatosis type 1 gene encodes a protein related to GAP. Cell 62:599–608, 1990

    Google Scholar 

  25. Basu TN, Gutmann DH, Fletcher JA, Glover TW, Collins FS, Downward J: Aberrant regulation of ras proteins in malignant tumour cells from type 1 neurofibromatosis patients. Nature 356:713–715, 1992

    Google Scholar 

  26. McCormick F: Ras signaling and NF1. Curr Opin Genet Dev 5:51–55, 1995

    Google Scholar 

  27. Bollag G, Clapp DW, Shih S, Adler F, Zhang YY, Thompson P, Lange BJ, Freedman MH, McCormick F, Jacks T, Shannon K: Loss of NF1 results in activation of the Ras signaling pathway and leads to aberrant growth in haematopoietic cells. Nat Genet 12:144–148, 1996

    Google Scholar 

  28. Nakahara M, Isozaki K, Hirota S, Miyagawa J, Hase-Sawada N, Taniguchi M, Nishida T, Kanayama S, Kitamura Y, Shinomura Y, Matsuzawa Y: A novel gain-of-function mutation of c-kit gene in gastrointestinal stromal tumors. Gastroenterology 115:1090–1095, 1998

    Google Scholar 

  29. Miettinen M, Majidi M, Lasota J: Pathology and diagnostic criteria of gastrointestinal stromal tumors (GISTs): A review. Eur J Cancer 38 (Suppl 5):S39–S51, 2002

    Google Scholar 

  30. Heinrich MC, Rubin BP, Longley BJ, Fletcher JA: Biology and genetic aspects of gastrointestinal stromal tumors: KIT activation and cytogenetic alterations. Hum Pathol 33:484–495, 2002

    Google Scholar 

  31. Miettinen M, Sarlomo-Rikala M, Lasota J: Gastrointestinal stromal tumors: Recent advances in understanding of their biology. Hum Pathol 30:1213–1220, 1999

    Google Scholar 

  32. Heinrich MC, Corless CL, Duensing A, McGreevey L, Chen C-J, Joseph N, Singer S, Griffith DJ, Haley A, Town A, Demetri GD, Fletcher CDM, Fletcher JA: PDGFRaactivating mutations in gastrointestinal stromal tumors. Science 299:708–710, 2003

    Google Scholar 

  33. Rubin BP, Singer S, Tsao C, Duensing A, Lux ML, Ruiz R, Hibbard MK, Chen CJ, Xiao S, Tuveson DA, Demetri GD, Fletcher CD, Fletcher JA: KIT activation is a ubiquitous feature of gastrointestinal stromal tumors. Cancer Res 61:8118–8121, 2001

    Google Scholar 

  34. Miyazawa K, Hendrie PC, Mantel C, Wood K, Ashman LK, Broxmeyer HE: Comparative analysis of signaling pathways between mast cell growth factor (c-kit ligand) and granulocytemacrophage colony-stimulating factor in a human factor-dependent myeloid cell line involves phosphorylation of Raf-1, GTPaseactivating protein and mitogen-activated protein kinase. Exp Hematol 19:1110–1123, 1991

    Google Scholar 

  35. Cutler RL, Liu L, Damen JE, Krystal G: Multiple cytokines induce the tyrosine phosphorylation of Shc and its association with Grb2 in hemopoietic cells. J Biol Chem 268:21463–21465, 1993

    Google Scholar 

  36. Liu L, Damen JE, Cutler RL, Krystal G: Multiple cytokines stimulate the binding of a common 145-kilodalton protein to She at the Grb2 recognition site of She. Mol Cell Biol 14:6926–6935, 1994

    Google Scholar 

  37. Hemesath TJ, Price ER, Takemoto C, Badalian T, Fisher DE: MAP kinase links the transcription factor Microphthalmia to c-kit signalling in melanocytes. Nature 391:298–301, 1998

    Google Scholar 

  38. Lennartsson J, Blume-Jensen P, Hermanson M, Ponten E, Carlberg M, Ronnstrand L: Phosphorylation of She by Src family kinases is necessary for stem cell factor receptor/c-kit mediated activation of the Ras/MAP kinase pathway and c-fos induction. Oncogene 18:5546–5553, 1999

    Google Scholar 

  39. Ingram DA, Yang FC, Travers JB, Wenning MJ, Hiatt K, New S, Hood A, Shannon K, Williams DA, Clapp DW: Genetic and biochemical evidence that haploinsufficiency of the Nf1 tumor suppressor gene modulates melanocyte and mast cell fates in vivo. J Exp Med 191:181–188, 2000

    Google Scholar 

  40. Zhang YY, Vik TA, Ryder JW, Srour EF, Jacks T, Shannon K, Clapp DW: Nf1 regulates hematopoietic progenitor cell growth and ras signaling in response to multiple cytokines. J Exp Med 187:1893–1902, 1998

    Google Scholar 

  41. Zoller M, Rembeck B, Akesson HO, Angervall L: Life expectancy, mortality and prognostic factors in neurofibromatosis type 1: A twelve-year follow-up of an epidemiological study in Goteborg, Sweden. Acta Derm Venereol 75:136–140, 1995

    Google Scholar 

  42. Ferner RE, Gutmann DH: International consensus statement on malignant peripheral nerve sheath tumors in neurofibromatosis. Cancer Res 62:1573–1577, 2002

    Google Scholar 

  43. Hornick JL, Fletcher CDM: Immunohistochemical staining for KIT (CD117) in soft tissue sarcomas is very limited in distribution. Am J Clin Pathol 117:188–193, 2002

    Google Scholar 

  44. Ryan JJ, Klein KA, Neuberger TJ, Leftwich JA, Westin EH, Kauma S, Fletcher JA, DeVries GH, Huff TF: Role for the stem cell factor/ KIT complex in Schwann cell neoplasia and mast cell proliferation associated with neurofibromatosis. J Neurosci Res 37:415–432, 1994

    Google Scholar 

  45. Badache A, Muja N, De Vries GH: Expression of Kit in neurofibromin-deficient human Schwann cells: role in Schwann cell hyperplasia associated with type 1 neurofibromatosis. Oncogene 17:795–800, 1998

    Google Scholar 

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Correspondence to Tsen-Long Yang.

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Cheng, SP., Huang, MJ., Yang, TL. et al. Neurofibromatosis with Gastrointestinal Stromal Tumors: Insights into the Association. Dig Dis Sci 49, 1165–1169 (2004). https://doi.org/10.1023/B:DDAS.0000037806.14471.a2

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  • DOI: https://doi.org/10.1023/B:DDAS.0000037806.14471.a2

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