A unique case of transitional cell carcinoma of renal pelvis in a patient with Lynch syndrome

C. Sanwal, K. Nooruddin, T. Nguyen, Michael Bailey, Aaron Moon, A. Guzman, J. Phillips
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Abstract

Lynch syndrome-associated transitional cell carcinoma of the upper urinary tract is uncommon. Lynch syndrome is a well-known inherited condition with particularly increased risk of colorectal cancers and a lesser extent other types of cancers. We present a rare case of urothelial cancer associated with Lynch syndrome from the time of its diagnosis to its multidisciplinary management to date. This case report outlines the unique characteristics of the case. The patient was positive for a mutation in the MLH1 gene, a known mutation of Lynch syndrome, which has a sparse association to Lynch syndrome-related urothelial carcinoma compared to other genes, e.g., MSH2. The patient's second-degree relative had confirmed Lynch syndrome with the same MLH1 genetic mutation and had colorectal cancer. The first-degree female relative of the patient with urothelial cancer had breast cancer, also not commonly associated with Lynch syndrome. The patient's age at the time of diagnosis of urothelial cancer was 46 years, which is at the lower end of the spectrum of the average age of Lynch syndrome associated with urothelial cancers. This paper also presents a review of the literature regarding upper urinary tract transitional cell carcinoma, its association with Lynch syndrome and various opinions on screening guidelines for urothelial cancer in relatives of a patient diagnosed with Lynch syndrome.
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一例独特的肾盂移行细胞癌患者林奇综合征
Lynch综合征相关的上尿路移行细胞癌并不常见。Lynch综合征是一种众所周知的遗传性疾病,其患结肠直肠癌的风险特别高,其他类型癌症的风险较小。我们提出一个罕见的病例尿路上皮癌相关的林奇综合征,从时间的诊断到其多学科的管理到目前为止。本病例报告概述了该病例的独特特征。该患者MLH1基因突变呈阳性,这是Lynch综合征的一种已知突变,与其他基因(如MSH2)相比,该基因与Lynch综合征相关的尿路上皮癌的相关性较低。患者的二度亲属已确诊Lynch综合征,具有相同的MLH1基因突变,并患有结直肠癌。尿路上皮癌患者的一级女性亲属患有乳腺癌,也不常与Lynch综合征相关。患者诊断为尿路上皮癌时的年龄为46岁,处于与尿路上皮癌相关的Lynch综合征平均年龄谱的低端。本文还综述了有关上尿路移行细胞癌及其与Lynch综合征的关系的文献,以及对Lynch综合征患者亲属尿路上皮癌筛查指南的各种意见。
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