Hereditary and sporadic medullary thyroid carcinoma (MTC) are closely associated with RET proto-oncogene mutations. However, the role of additional changes in the tumor genomes remains unclear. Our objective was the identification of chromosomal regions involved in MTC tumorigenesis and to assess their significance by using MTC-derived cell lines. We used array-CGH (comparative genomic hybridization) to map chromosomal imbalances in 52 primary tumors and ten metastases. Eleven tumors (11/52, 21%) were hereditary and 41 (41/52, 79%) were sporadic. Among the latter, 15 tumors (15/41, 37%) harbored RET mutations. Furthermore, we characterized five MTC cell lines in detail and evaluated the tumorigenicity by severe combined immunodeficiency (SCID)-mouse experiments. Most MTCs had only few copy number changes, and losses of chromosomes 1p, 4q, 19p and 22q were observed most frequently. The number of chromosomal aberrations increased in metastases. Twenty-three percent (12/52) of the primary tumors did not even show any chromosomal gains and losses. We injected three cell lines (two of these were without chromosomal changes and pathogenic RET mutations) into immune deficient SCID mice, and in each case, we observed rapid tumor growth at the injection sites. Our data suggest that MTCs-in contrast to most other tumor entities-do not acquire a multitude of genomic imbalances. SCID mouse experiments performed with chromosomally normal cell lines and without RET mutations suggest that presently unknown submicroscopic genomic changes are sufficient in MTC tumorigenesis.Human medullary thyroid carcinoma (MTC) is a calcitoninproducing tumor originating from the parafollicular C-cells. It constitutes about 5-8% of all thyroid cancers and may occur sporadic (70-80% of cases) or hereditary (20-30%).
1Hereditary MTC is inherited in an autosomal-dominant pattern, either as familial MTC (FMTC) without other endocrinopathies or as part of multiple endocrine neoplasia syndrome type 2A (MEN-2A), or in multiple endocrine neoplasia type 2B (MEN-2B).
2As the disease may develop over many years without clinical signs, lymph node metastasis are documented in more than 50% of patients, and distant metastasis are found in at least in one quarter of patients at the time of diagnosis. With 5-and 10-year survival reported at 86% and 78%, respectively, prognosis is less favorable than for follicular cellderived carcinomas. Patients with distant metastases have only a 35% survival after 5 years. MTC, both in patients and in preclinical models, is resistant to chemotherapy and radiation therapy. Surgical removal of all malignant tissue is the only potentially curative treatment in localized disease.1 Management guidelines for treatment of MTC were recently published by the American Thyroid Association.
3MTC is closely associated with mutations in the REarranged during Transfection (RET) proto-oncogene in chromosome 10q11.2. The hereditary variants MEN-2/FMTC are associated with activating germline point mutations in the RET proto-oncogene and near...