Estimated Prevalence, Tumor Spectrum, and Neurofibromatosis Type 1–Like Phenotype of CDKN2A-Related Melanoma-Astrocytoma Syndrome

Abstract

ImportanceKnowledge about the prevalence and tumor types of CDKN2A-related melanoma-astrocytoma syndrome (MAS) is limited and could improve disease recognition.ObjectiveTo estimate the prevalence and describe the tumor types of MAS.Design, Setting, and ParticipantsThis retrospective cohort study analyzed all available MAS cases from medical centers in the US (2 sites) and Europe (2 sites) and from biomedical population genomic databases (UK Biobank [United Kingdom], Geisinger MyCode [US]) between January 1, 1976, and December 31, 2020. Patients with MAS with CDKN2A germline pathogenic variants and 1 or more neural tumors were included. Data were analyzed from June 1, 2022, to January 31, 2023.Main Outcomes and MeasuresDisease prevalence and tumor frequency.ResultsPrevalence of MAS ranged from 1 in 170 503 (n = 1 case; 95% CI, 1:30 098-1:965 887) in Geisinger MyCode (n = 170 503; mean [SD] age, 58.9 [19.1] years; 60.6% women; 96.2% White) to 1 in 39 149 (n = 12 cases; 95% CI, 1:22 396-1:68 434) in UK Biobank (n = 469 789; mean [SD] age, 70.0 [8.0] years; 54.2% women; 94.8% White). Among UK Biobank patients with MAS (n = 12) identified using an unbiased genomic ascertainment approach, brain neoplasms (4 of 12, 33%; 1 glioblastoma, 1 gliosarcoma, 1 astrocytoma, 1 unspecified type) and schwannomas (3 of 12, 25%) were the most common malignant and benign neural tumors, while cutaneous melanoma (2 of 12, 17%) and head and neck squamous cell carcinoma (2 of 12, 17%) were the most common nonneural malignant neoplasms. In a separate case series of 14 patients with MAS from the US and Europe, brain neoplasms (4 of 14, 29%; 2 glioblastomas, 2 unspecified type) and malignant peripheral nerve sheath tumor (2 of 14, 14%) were the most common neural cancers, while cutaneous melanoma (4 of 14, 29%) and sarcomas (2 of 14, 14%; 1 liposarcoma, 1 unspecified type) were the most common nonneural cancers. Cutaneous neurofibromas (7 of 14, 50%) and schwannomas (2 of 14, 14%) were also common. In 1 US family, a father and son with MAS had clinical diagnoses of neurofibromatosis type 1 (NF1). Genetic testing of the son detected a pathogenic CDKN2A splicing variant (c.151-1G>C) and was negative for NF1 genetic alterations. In UK Biobank, 2 in 150 (1.3%) individuals with clinical NF1 diagnoses had likely pathogenic variants in CDKN2A, including 1 individual with no detected variants in the NF1 gene.Conclusions and RelevanceThis cohort study estimates the prevalence and describes the tumors of MAS. Additional studies are needed in genetically diverse populations to further define population prevalence and disease phenotypes.

CDKN2A promoter methylation enhances self-renewal of glioblastoma stem cells and confers resistance to carmustine

“…CDKN2A, located on chromosome 9p21, is a complex locus that produces two distinct proteins: p16INK4a (p16) and p14ARF (p14)[ 7 ]. These proteins play critical roles in controlling cell proliferation and suppressing tumorigenesis.…”

Somatic mosaic SOX10 indel mutations underlie a form of segmental schwannomatosis

“…Patients with SMARCB1 - and LZTR1 -associated schwannomatosis often develop multiple painful non-vestibular schwannomas in the absence of meningiomas or other tumor types [ 8 , 14 ]. Germline mutation/deletion of the CDKN2A gene on chromosome 9p21.3 (which encodes a negative regulator of the cell cycle p16 INK4a ) or the DGCR8 gene on chromosome 22q11.21 (which encodes a subunit of the microRNA processing complex) causes rare tumor predisposition syndromes that may be associated with development of multiple schwannoma or schwannoma-like nerve sheath tumors [ 1 , 12 , 13 ]. However, many patients and families with schwannomatosis do not have identifiable germline variants in NF2 , SMARCB1 , LZTR1 , CDKN2A , or DGCR8, and efforts have been underway to identify other responsible molecular drivers of schwannoma predisposition [ 9 , 15 , 18 ].…”