The first pancreatic neuroendocrine tumor in Li-Fraumeni syndrome: a case report

• Published in: BMC cancer Vol. 20; no. 1; pp. 256 - 6
• Main Authors: Aversa, John G., De Abreu, Francine Blumental, Yano, Sho, Xi, Liqiang, Hadley, Donald W., Manoli, Irini, Raffeld, Mark, Sadowski, Samira M., Nilubol, Naris
• Format: Journal Article
• Language: English
• Published: London BioMed Central 30.03.2020; BioMed Central Ltd; BMC
• Subjects: Abdomen; Adult; Age; Astrocytoma; Biomedical and Life Sciences; Biomedicine; Brain cancer; Breast cancer; cancer imaging; Cancer Research; Case Report; Case reports; Cell adhesion & migration; Choroid plexus; Computed tomography; Cysts; Family medical history; Female; Gene mutation; Genes, p53 - genetics; Genetic aspects; Genetic counseling; Genetic Predisposition to Disease; Genotype; Germ-Line Mutation - genetics; Health aspects; Health Promotion and Disease Prevention; Hereditary pancreatic neoplasm; Heterozygosity; Heterozygote; Humans; interventional therapeutics; Laparoscopy; Li-Fraumeni syndrome; Li-Fraumeni Syndrome - complications; Li-Fraumeni Syndrome - diagnosis; Li-Fraumeni Syndrome - genetics; Loss of heterozygosity; Magnetic resonance imaging; Mammography; Medical genetics; Medicine/Public Health; Mutation; Neuroendocrine tumors; Neuroendocrine Tumors - complications; Neuroendocrine Tumors - diagnosis; Neuroendocrine Tumors - genetics; Oncology; p53 Protein; Pancreatic cancer; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - genetics; Pancreatic neuroendocrine tumor; Papilloma; Patients; Pedigree; Positron emission tomography; Surgical Oncology; Surveillance; Temporal lobe; Testing laboratories; TP53; Tumor proteins; Tumor suppressor genes; Vigilance; Hereditary pancreatic neoplasm; TP53; Pancreatic neuroendocrine tumor; Li-Fraumeni syndrome
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-020-06723-6

Background Li-Fraumeni syndrome is a cancer predisposition syndrome caused by germline TP53 tumor suppressor gene mutations, with no previous association with pancreatic neuroendocrine tumors (PNETs). Here we present the first case of PNET associated with Li-Fraumeni syndrome. Case presentation This is a 43-year-old female who underwent laparoscopic distal pancreatectomy at age 39 for a well-differentiated grade 2 cystic PNET. When the patient was 41 years old, her seven-year-old daughter was found to have an astrocytoma and a germline TP53 mutation. While undergoing surveillance with 68 Gallium-DOTATATE positron emission tomography/computed tomography for her PNET, the patient was found to have a large choroid plexus papilloma in her right temporal lobe. She underwent genetic counseling and testing that identified a germline pathogenic variant in TP53 , leading to the diagnosis of Li-Fraumeni syndrome. Her PNET had a hemizygous pathogenic TP53 mutation with loss of the wild-type alternate allele, consistent with loss of heterozygosity and the two-hit hypothesis. She was enrolled in a Li-Fraumeni syndrome protocol and continues surveillance screening with our service. Conclusions This is the first PNET reported in association with Li-Fraumeni syndrome. Pancreatic cancer risk is elevated in this syndrome, and our case highlights the need for vigilance in screening for pancreatic neoplasms in these patients.