Abstract
Germline pathogenic variants in the tumor suppressor gene BAP1 are associated with the hereditary tumor predisposition syndrome with susceptibility to uveal melanoma, mesothelioma, cutaneous melanoma, renal cell carcinoma, and other cancers. Germline BAP1 pathogenic variants are rare in the non-cancer general population with an estimated carrier frequency of 1:19,898 but more common in cancer patients with a carrier frequency of 1:1299. In the following we present the first report of a family with two unique BAP1 pathogenic variants. Retrospective case report of a family with two unique pathogenic variants in BAP1. A male (proband) was referred to our ocular oncology clinic for second opinion for his multiple independent uveal melanomas at ages 65, 68 and 71. Given his personal history of squamous cell carcinoma at age 61, renal cell carcinoma at age 63, and family history of atypical meningioma, basal cell carcinoma, pancreatic and prostate cancers he was assessed for germline pathogenic variants in BAP1 through our ongoing research study. Sanger sequencing identified the American founder pathogenic variant, c.1717delC, pL573Wfs*3, that was confirmed in a clinical laboratory. Both the proband’s brother and nephew tested negative for the familial variant through single site cascade genetic testing. However, based on the personal history of multiple basal cell carcinoma in the nephew and family history of pancreatic and laryngeal cancers (both not known to be associated with BAP1-TPDS), a large cancer panel testing was recommended for the nephew. His panel testing revealed a different BAP1 pathogenic variant, c.605G>A, p. Trp202*. This variant was not detected in the proband or the proband’s brother. Based on the frequency of germline BAP1 variants in the cancer population, the chance of occurrence of two different BAP1 variants in a family with cancer history is 5.9 × 10−7. This case report provides support for the importance of offering large panel cascade genetic testing, rather than single site testing for only the family pathogenic variant, for all at risk family members especially when the family variant cannot explain all the cancers in the family.
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Funding
This work was supported by the Patti Blow Research Fund in Ophthalmology, and funds from the Ohio Lions Eye Research Foundation, R21CA191943, and R01CA255323-01 Grants from the National Cancer Institute (PI: Abdel-Rahman, MH), a U.S. Department of Defense Grant ME200199 (PI: Abdel-Rahman, MH) a cancer center core Grant 2P30CA016058-40 and Award Number 8UL1TR000090-05 from the National Center For Advancing Translational Sciences.
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MA-R, CC and LB contributed to the study conception and design. Material preparation, data collection and analysis were performed by CI, TD, DS, LB, CC and MA-R. The first draft of the manuscript was written by CI, MA-R and LB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Byrne, L., Ingalls, C., Ansari, A. et al. Two unique BAP1 pathogenic variants identified in the same family by panel cascade testing. Familial Cancer 22, 307–311 (2023). https://doi.org/10.1007/s10689-022-00321-0
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DOI: https://doi.org/10.1007/s10689-022-00321-0