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Recurrent KRAS mutations are early events in the development of papillary renal neoplasm with reverse polarity

KI. Al-Obaidy, RM. Saleeb, K. Trpkov, SR. Williamson, AR. Sangoi, M. Nassiri, O. Hes, R. Montironi, A. Cimadamore, AM. Acosta, ZI. Alruwaii, A. Alkashash, O. Hassan, N. Gupta, AO. Osunkoya, JD. Sen, LA. Baldrige, WA. Sakr, MT. Idrees, JN. Eble,...

. 2022 ; 35 (9) : 1279-1286. [pub] 20220212

Language English Country United States

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc22024638

We evaluated the clinicopathologic and molecular characteristics of mostly incidentally detected, small, papillary renal neoplasms with reverse polarity (PRNRP). The cohort comprised 50 PRNRP from 46 patients, divided into 2 groups. The clinically undetected (<5 mm) neoplasms (n = 34; 68%) had a median size of 1.1 mm (range 0.2-4.3 mm; mean 1.4 mm), and the clinically detected (≥5 mm) neoplasms (n = 16; 32%) which had a median size of 13 mm (range 9-30 mm; mean 16 mm). Neoplasms were positive for GATA3 (n = 47; 100%) and L1CAM (n = 34/38; 89%) and were negative for vimentin (n = 0/44; 0%) and, to a lesser extent, AMACR [(n = 12/46; 26%; weak = 9, weak/moderate = 3)]. KRAS mutations were found in 44% (n = 15/34) of the clinically undetected PRNRP and 88% of the clinically detected PRNRP (n = 14/16). The two clinically detected PRNRP with wild-type KRAS gene were markedly cystic and contained microscopic intracystic tumors. In the clinically undetected PRNRP, the detected KRAS mutations rate was higher in those measuring ≥1 mm vs <1 mm [n = 14/19 (74%) vs n = 1/15 (7%)]. Overall, the KRAS mutations were present in exon 2-codon 12: c.35 G > T (n = 21), c.34 G > T (n = 3), c.35 G > A (n = 2), c.34 G > C (n = 2) resulting in p.Gly12Val, p. Gly12Asp, p.Gly12Cys and p.Gly12Arg, respectively. One PRNRP had a G12A/V/D complex mutation. Twenty-six PRNRP were concurrently present with other tumors of different histologic subtypes in the ipsilateral kidney; molecular testing of 8 of the latter showed wild-type KRAS gene despite the presence of KRAS mutations in 5 concurrent PRNRP. On follow up, no adverse pathologic events were seen (range 1-160 months; mean 44 months). In conclusion, the presence of KRAS mutations in small, clinically undetected PRNRP provides a unique finding to this entity and supports its being an early event in the development of these neoplasms.

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$a Recurrent KRAS mutations are early events in the development of papillary renal neoplasm with reverse polarity / $c KI. Al-Obaidy, RM. Saleeb, K. Trpkov, SR. Williamson, AR. Sangoi, M. Nassiri, O. Hes, R. Montironi, A. Cimadamore, AM. Acosta, ZI. Alruwaii, A. Alkashash, O. Hassan, N. Gupta, AO. Osunkoya, JD. Sen, LA. Baldrige, WA. Sakr, MT. Idrees, JN. Eble, DJ. Grignon, L. Cheng
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$a We evaluated the clinicopathologic and molecular characteristics of mostly incidentally detected, small, papillary renal neoplasms with reverse polarity (PRNRP). The cohort comprised 50 PRNRP from 46 patients, divided into 2 groups. The clinically undetected (<5 mm) neoplasms (n = 34; 68%) had a median size of 1.1 mm (range 0.2-4.3 mm; mean 1.4 mm), and the clinically detected (≥5 mm) neoplasms (n = 16; 32%) which had a median size of 13 mm (range 9-30 mm; mean 16 mm). Neoplasms were positive for GATA3 (n = 47; 100%) and L1CAM (n = 34/38; 89%) and were negative for vimentin (n = 0/44; 0%) and, to a lesser extent, AMACR [(n = 12/46; 26%; weak = 9, weak/moderate = 3)]. KRAS mutations were found in 44% (n = 15/34) of the clinically undetected PRNRP and 88% of the clinically detected PRNRP (n = 14/16). The two clinically detected PRNRP with wild-type KRAS gene were markedly cystic and contained microscopic intracystic tumors. In the clinically undetected PRNRP, the detected KRAS mutations rate was higher in those measuring ≥1 mm vs <1 mm [n = 14/19 (74%) vs n = 1/15 (7%)]. Overall, the KRAS mutations were present in exon 2-codon 12: c.35 G > T (n = 21), c.34 G > T (n = 3), c.35 G > A (n = 2), c.34 G > C (n = 2) resulting in p.Gly12Val, p. Gly12Asp, p.Gly12Cys and p.Gly12Arg, respectively. One PRNRP had a G12A/V/D complex mutation. Twenty-six PRNRP were concurrently present with other tumors of different histologic subtypes in the ipsilateral kidney; molecular testing of 8 of the latter showed wild-type KRAS gene despite the presence of KRAS mutations in 5 concurrent PRNRP. On follow up, no adverse pathologic events were seen (range 1-160 months; mean 44 months). In conclusion, the presence of KRAS mutations in small, clinically undetected PRNRP provides a unique finding to this entity and supports its being an early event in the development of these neoplasms.
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$a Saleeb, Rola M $u Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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$a Trpkov, Kiril $u Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada $1 https://orcid.org/0000000331428846
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$a Nassiri, Mehdi $u Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA
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$a Hes, Ondrej $u Department of Pathology, Charles University in Prague, Faculty of Medicine and University Hospital in Plzen, Plzen, Czech Republic
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$a Montironi, Rodolfo $u Section of Pathological Anatomy, School of Medicine, United Hospitals, Marche Polytechnic University, Ancona, Italy
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$a Cimadamore, Alessia $u Section of Pathological Anatomy, School of Medicine, United Hospitals, Marche Polytechnic University, Ancona, Italy
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$a Sen, Joyashree D $u Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA
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$a Baldrige, Lee Ann $u Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA
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$a Sakr, Wael A $u Department of Pathology, Wayne State University/ Detroit Medical Center, Detroit, MI, USA
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$a Idrees, Muhammad T $u Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada $1 https://orcid.org/0000000166116389
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$a Eble, John N $u Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA
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$a Grignon, David J $u Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN, USA
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