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Pathogenesis of Adenocarcinoma in Peutz-Jeghers Syndrome¹

Division of Molecular Medicine and Genetics, University of Michigan, Ann Arbor, Michigan 48109 [S. B. G., A. M. L., U. J. M.]; Johns Hopkins Oncology Center [S. B. G., G. M. P., S. J. L., K. W. K., B. V., S. R. H.], School of Hygiene and Public Health [G. M. P.], and Departments of Internal Medicine [F. M. G.] and Pathology [P. A. L., S. R. H.], Johns Hopkins University, Baltimore, Maryland 21287; Howard Hughes Medical Institute, Baltimore, Maryland 21231 [B. V.]; Department of Pathology and Clinical Epidemiology, Academic Medical Center, Amsterdam, the Netherlands [M. M. E., G. J. O.]; and National Center for Human Genome Research, NIH, Bethesda, Maryland 20892 [R. B., J. M. T., M. H. P.]

Peutz-Jeghers syndrome (PJS) is an autosomal dominant condition characterized by intestinal hamartomatous polyps, mucocutaneous melanin deposition, and increased risk of cancer. Families with PJS from the Johns Hopkins Polyposis Registry were studied to identify the molecular basis of this syndrome and to characterize the pathogenesis of gastrointestinal hamartomas and adenocarcinomas in PJS patients. Linkage analysis in the family originally described by Jeghers in 1949 and five other families confirmed linkage to 19p13.3 near a recently identified gene responsible for PJS. Germ-line mutations in this gene, STK11, were identified in all six families by sequencing genomic DNA. Analysis of hamartomas and adenocarcinomas from patients with PJS identified loss of heterozygosity (LOH) of 19p markers near STK11 in 70% of tumors. Haplotype analysis indicated that the retained allele carried a germ-line mutation, confirming that STK11 is a tumor suppressor gene. LOH of 17p and 18q was identified in an adenocarcinoma but not in hamartomas, implying that allelic loss of these two regions corresponds to late molecular events in the pathogenesis of cancer in PJS. The adenocarcinomas showing 17p LOH also demonstrated altered p53 by immunohistochemistry. None of the 18 PJS tumors showed microsatellite instability, LOH on 5q near APC, or mutations in codons 12 or 13 of the K-ras proto-oncogene. These data provide evidence that STK11 is a tumor suppressor gene that acts as an early gatekeeper regulating the development of hamartomas in PJS and suggest that hamartomas may be pathogenetic precursors of adenocarcinoma. Additional somatic mutational events underlie the progression of hamartomas to adenocarcinomas, and some of these somatic mutations are common to the later stages of tumor progression seen in the majority of colorectal carcinomas.

¹ This work was supported by NIH Grants (National Cancer Institute) R01 CA63721, CA62924, CA53801, and CA62924 and grants from the Clayton Fund, the Dutch Cancer Foundation, and the University of Michigan Department of Internal Medicine.

² To whom requests for reprints should be addressed, at Molecular Medicine and Genetics, University of Michigan, 4301 MSRB III, Ann Arbor, MI 48109-0652. Fax: (313) 763-7672; E-mail: sgruber@umich.edu.

Received 7/ 7/98. Accepted 10/16/98.

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