Zhang Hui-Fen, Huang Shu-Ling, Wang Wen-Li, Zhou Yu-Qing, Jiang Jun, Dai Zhuo-Jin
Department of Endocrinology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan 523003, Guangdong Province, China.
Department of Science and Technology Services, Beijing Macro and Micro Test Co., Ltd., Beijing 100318, China.
World J Clin Cases. 2024 May 26;12(15):2627-2635. doi: 10.12998/wjcc.v12.i15.2627.
Multiple endocrine neoplasia type 2 (MEN2) is a rare, autosomal dominant endocrine disease. Currently, the proto-oncogene is the only gene implicated in MEN2A pathogenesis. Once an carrier is detected, family members should be screened to enable early detection of medullary thyroid carcinoma, pheochromocytoma, and hyperparatitity. Among these, medullary thyroid carcinoma is the main factor responsible for patient mortality. Accordingly, delineating strategies to inform clinical follow-up and treatment plans based on genes is paramount for clinical practitioners.
Herein, we present proto-oncogene mutations, clinical characteristics, and treatment strategies in a family with MEN2A. A family study was conducted on patients diagnosed with MEN2A. DNA was extracted from the peripheral blood of family members, and first-generation exon sequencing of the proto-oncogene was conducted. The mutation was identified in three family members spanning three generations. Two patients were sequentially diagnosed with pheochromocytomas and bilateral medullary thyroid carcinomas. A 9-year-old child harboring the gene mutation was diagnosed with medullary thyroid carcinoma. Surgical resection of the tumors was performed. All family members were advised to undergo complete genetic testing related to the mutation, and the corresponding treatments administered based on test results and associated clinical guidelines.
Advancements in MEN2A research are important for familial management, assessment of medullary thyroid cancer invasive risk, and deciding surgical timing.
2型多发性内分泌腺瘤病(MEN2)是一种罕见的常染色体显性内分泌疾病。目前,原癌基因是唯一与MEN2A发病机制相关的基因。一旦检测到携带者,就应对家庭成员进行筛查,以便早期发现甲状腺髓样癌、嗜铬细胞瘤和甲状旁腺功能亢进。其中,甲状腺髓样癌是导致患者死亡的主要因素。因此,为临床医生制定基于基因的临床随访和治疗计划的策略至关重要。
在此,我们展示了一个MEN2A家系中的原癌基因突变、临床特征及治疗策略。对诊断为MEN2A的患者进行了家系研究。从家庭成员的外周血中提取DNA,并对原癌基因进行一代外显子测序。在三代中的三名家庭成员中鉴定出了该突变。两名患者先后被诊断出患有嗜铬细胞瘤和双侧甲状腺髓样癌。一名携带该基因突变的9岁儿童被诊断出患有甲状腺髓样癌。对肿瘤进行了手术切除。建议所有家庭成员进行与该突变相关的全面基因检测,并根据检测结果和相关临床指南进行相应治疗。
MEN2A研究的进展对于家族管理、评估甲状腺髓样癌侵袭风险以及决定手术时机非常重要。