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Mutational status of KRAS, NRAS, and BRAF in primary clear cell ovarian carcinoma

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Abstract

Ovarian clear cell carcinoma (OCCC) is a subtype of epithelial ovarian cancer with characteristic biological features and aggressive clinical behavior. OCCCs show a pattern of gene mutations different from other type I ovarian malignancies, notably a higher frequency of PIK3CA mutations. In low grade serous ovarian cancer, KRAS and BRAF mutations are frequent, but little data are available on the mutational status of these genes in OCCCs. To clarify this issue, we designed a clinicopathological study with the aim to establish the incidence of KRAS, NRAS, and BRAF hot spot mutations in OCCC. Between December 2006 and June 2012, 22 patients with a proven diagnosis of OCCC were admitted to our Institutions. In all cases, final diagnosis was established according to FIGO and WHO criteria. All women received complete surgical staging. The PyroMark Q24 system (Qiagen GmbH, Hilden, Germany) was used for pyrosequencing analysis of KRAS, NRAS, and BRAF hot spot regions on 2.5-μm sections of formalin-fixed paraffin-embedded tissue from primary OCCC. Pyrosequencing analysis of KRAS, NRAS, and BRAF hot spot regions revealed the presence of mutations only at codon 12 in exon 2 of KRAS in 3 of 22 (14 %) cases. We found no mutations in the hot spot regions of NRAF (exons 2, 3, 4) or BRAF (exon 15). The median age of women with a KRAS mutated OCCC was 74 years. These OCCC were unilateral FIGO stage IA lesions in two cases associated with foci of endometriosis. We conclude that in 14 % of OCCCs, a KRAS mutation occurs in codon 2 exon 2. NRAS and BRAF mutations were not found.

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References

  1. Kurman RJ, Shih IM (2010) The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory. Am J Surg Pathol 34:433–443

    Article  PubMed Central  PubMed  Google Scholar 

  2. Shih IM, Kurman RJ (2004) Ovarian tumorigenesis: a proposed model based on morphological and molecular genetic analysis. Am J Pathol 164:1511–1518

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Shih IM, Kurman RJ (2005) Molecular pathogenesis of ovarian borderline tumors: new insights and old challenges. Clin Cancer Res 11:7273–7279

    Article  CAS  PubMed  Google Scholar 

  4. Bonome T, Lee JY, Park DC, Radonovich M, Pise-Masison C, Brady J, Gardner GJ, Hao K, Wong WH, Barrett JC, Lu KH, Sood AK, Gershenson DM, Mok SC, Birrer MJ (2005) Expression profiling of serous low malignant potential, low-grade, and high-grade tumors of the ovary. Cancer Res 65:10602–10612

    Article  CAS  PubMed  Google Scholar 

  5. Zorn KK, Bonome T, Gangi L, Chandramouli GV, Awtrey CS, Gardner GJ, Barrett JC, Boyd J, Birrer MJ (2005) Gene expression profiles of serous, endometrioid, and clear cell subtypes of ovarian and endometrial cancer. Clin Cancer Res 11:6422–6430

    Article  CAS  PubMed  Google Scholar 

  6. Singer G, Oldt R 3rd, Cohen Y, Wang BG, Sidransky D, Kurman RJ, Shih IM (2003) Mutations in BRAF and KRAS characterize the development of low-grade ovarian serous carcinoma. J Natl Cancer Inst 95:484–486

    Article  CAS  PubMed  Google Scholar 

  7. Obata K, Morland SJ, Watson RH, Hitchcock A, Chenevix-Trench G, Thomas EJ, Campbell IG (1998) Frequent PTEN/MMAC mutations in endometrioid but not serous or mucinous epithelial ovarian tumors. Cancer Res 58:2095–2097

    CAS  PubMed  Google Scholar 

  8. Wu R, Zhai Y, Fearon ER, Cho KR (2001) Diverse mechanisms of beta-catenin deregulation in ovarian endometrioid adenocarcinomas. Cancer Res 61:8247–8255

    CAS  PubMed  Google Scholar 

  9. Despierre E, Yesilyurt BT, Lambrechts S, Johnson N, Verheijen R, van der Burg M, Casado A, Rustin G, Berns E, Leunen K, Amant F, Moerman P, Lambrechts D, Vergote I, EORTC GCG and EORTC GCG Translational Research Group (2014) Epithelial ovarian cancer: rationale for changing the one-fits-all standard treatment regimen to subtype-specific treatment. Int J Gynecol Cancer 24:468–77

    Article  PubMed  Google Scholar 

  10. Wu RC, Ayhan A, Maeda D, Kim KR, Clarke BA, Shaw P, Chui MH, Rosen B, Shih IM, Wang TL (2014) Frequent somatic mutations of the telomerase reverse transcriptase promoter in ovarian clear cell carcinoma but not in other major types of gynaecological malignancy. J Pathol 232:473–81

    Article  CAS  PubMed  Google Scholar 

  11. Gilks CB, Bell DA, Huntsman D, Longacre TA, Oliva E, Soslow R, Tsuda H, Zannoni GF, Zhao C, Zhou X (2014) Ovarian tumors: clear cell tumors. In: Kurman R, Carcangiu ML, Young R (eds) World Health Organization classification of tumours: pathology and genetics of tumours of female genital organs. IARC, Lyon

    Google Scholar 

  12. Heublein S, Grasse K, Hessel H, Burges A, Lenhard M, Engel J, Kirchner T, Jeschke U, Mayr D (2013) KRAS, BRAF genotyping reveals genetic heterogeneity of ovarian borderline tumors and associated implants. BMC Cancer 13:483

    Article  PubMed Central  PubMed  Google Scholar 

  13. Modest DP, Jung A, Moosmann N, Laubender RP, Giessen C, Schulz C, Haas M, Neumann J, Boeck S, Kirchner T, Heinemann V, Stintzing S (2012) The influence of KRAS and BRAF mutations on the efficacy of cetuximab-based first-line therapy of metastatic colorectal cancer: an analysis of the AIO KRK-0104-trial. Int J Cancer 131:980–6

    Article  CAS  PubMed  Google Scholar 

  14. Neumann J, Zeindl-Eberhart E, Kirchner T, Jung A (2009) Frequency and type of KRAS mutations in routine diagnostic analysis of metastatic colorectal cancer. Pathol Res Pract 205:858–62

    Article  CAS  PubMed  Google Scholar 

  15. Cho KR, Shih IM (2009) Ovarian cancer. Annu Rev Pathol 4:287–313

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Chan JK, Teoh D, Hu JM, Shin JY, Osann K, Kapp DS (2008) Do clear cell ovarian carcinomas have poorer prognosis compared to other epithelial cell types? A study of 1411 clear cell ovarian cancers. Gynecol Oncol 109:370–376

    Article  PubMed  Google Scholar 

  17. Anglesio MS, Carey MS, Köbel M, Mackay H, Huntsman DG, Vancouver Ovarian Clear Cell Symposium Speakers (2011) Clear cell carcinoma of the ovary: a report from the first ovarian clear cell symposium. Gynecol Oncol 121:407–415

    Article  PubMed  Google Scholar 

  18. Pectasides D, Pectasides E, Psyrri A, Economopoulos T (2006) Treatment issues in clear cell carcinoma of the ovary: a different entity? Oncologist 11:1089–1094

    Article  PubMed  Google Scholar 

  19. Pectasides D, Fountzilas G, Aravantinos G, Kalofonos C, Efstathiou H, Farmakis D, Skarlos D, Pavlidis N, Economopoulos T, Dimopoulos MA (2006) Advanced stage clear-cell epithelial ovarian cancer: the Hellenic Cooperative Oncology Group experience. Gynecol Oncol 102:285–291

    Article  PubMed  Google Scholar 

  20. Sugiyama T, Kamura T, Kigawa J, Terakawa N, Kikuchi Y, Kita T, Suzuki M, Sato I, Taguchi K (2000) Clinical characteristics of clear cell carcinoma of the ovary: a distinct histologic type with poor prognosis and resistance to platinum-based chemotherapy. Cancer 88:2584–2589

    Article  CAS  PubMed  Google Scholar 

  21. Rauh-Hain JA, Winograd D, Growdon WB, Schorge JO, Goodman AK, Boruta DM, Berkowitz RS, Horowitz NS, Del Carmen MG (2012) Prognostic determinants in patients with uterine and ovarian clear carcinoma. Gynecol Oncol 125:376–380

    Article  PubMed  Google Scholar 

  22. Risch HA, McLaughlin JR, Cole DE, Rosen B, Bradley L, Fan I, Tang J, Li S, Zhang S, Shaw PA, Narod SA (2006) Population BRCA1 and BRCA2 mutation frequencies and cancer penetrances: a kin-cohort study in Ontario, Canada. J Natl Cancer Inst 98:1694–1706

    Article  CAS  PubMed  Google Scholar 

  23. Köbel M, Reuss A, Ad B, Kommoss S, Kommoss F, Gao D, Kalloger SE, Huntsman DG, Gilks CB (2010) The biological and clinical value of p53 expression in pelvic high-grade serous carcinomas. J Pathol 222:191–198

    Article  PubMed  Google Scholar 

  24. Salani R, Kurman RJ, Giuntoli R 2nd, Gardner G, Bristow R, Wang TL, Shih IM (2008) Assessment of TP53 mutation using purified tissue samples of ovarian serous carcinomas reveals a higher mutation rate than previously reported and does not correlate with drug resistance. Int J Gynecol Cancer 18:487–491

    Article  CAS  PubMed  Google Scholar 

  25. Ahmed AA, Etemadmoghadam D, Temple J, Lynch AG, Riad M, Sharma R, Stewart C, Fereday S, Caldas C, Defazio A, Bowtell D, Brenton JD (2010) Driver mutations in TP53 are ubiquitous in high grade serous carcinoma of the ovary. J Pathol 221:49–56

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Itamochi H, Kigawa J, Terakawa N (2008) Mechanisms of chemoresistance and poor prognosis in ovarian clear cell carcinoma. Cancer Sci 99:653–658

    Article  CAS  PubMed  Google Scholar 

  27. Köbel M, Kalloger SE, Boyd N, McKinney S, Mehl E, Palmer C, Leung S, Bowen NJ, Ionescu DN, Rajput A, Prentice LM, Miller D, Santos J, Swenerton K, Gilks CB, Huntsman D (2008) Ovarian carcinoma subtypes are different diseases: implications for biomarker studies. PLoS Med 5:e232

    Article  PubMed Central  PubMed  Google Scholar 

  28. Kuo KT, Mao TL, Jones S, Veras E, Ayhan A, Wang TL, Glas R, Slamon D, Velculescu VE, Kuman RJ, Shih IM (2009) Frequent activating mutations of PIK3CA in ovarian clear cell carcinoma. Am J Pathol 174:1597–1601

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Campbell IG, Russell SE, Choong DY, Montgomery KG, Ciavarella ML, Hooi CS, Cristiano BE, Pearson RB, Phillips WA (2004) Mutation of the PIK3CA gene in ovarian and breast cancer. Cancer Res 64:7678–7681

    Article  CAS  PubMed  Google Scholar 

  30. Zannoni GF, Morassi F, Prisco MG, De Stefano I, Vellone VG, Arena V, Scambia G, Gallo D (2012) Clinicopathologic and immunohistochemical features of ovarian clear cell carcinomas in comparison with type I and type II tumors. Int J Gynecol Pathol 31:507–516

    Article  CAS  PubMed  Google Scholar 

  31. Kajihara H, Yamada Y, Kanayama S, Furukawa N, Noguchi T, Haruta S, Yoshida S, Sado T, Oi H, Kobayashi H (2010) Clear cell carcinoma of the ovary: potential pathogenic mechanisms. Oncol Rep 23:1193–1203

    CAS  PubMed  Google Scholar 

  32. Yamaguchi K, Mandai M, Oura T, Matsumura N, Hamanishi J, Baba T, Matsui S, Murphy SK, Konishi I (2010) Identification of an ovarian clear cell carcinoma gene signature that reflects inherent disease biology and the carcinogenic processes. Oncogene 29:1741–1752

    Article  CAS  PubMed  Google Scholar 

  33. Mandai M, Matsumura N, Baba T, Yamaguchi K, Hamanishi J, Konishi I (2011) Ovarian clear cell carcinoma as a stress-responsive cancer: influence of the microenvironment on the carcinogenesis and cancer phenotype. Cancer Lett 310:129–133

    Article  CAS  PubMed  Google Scholar 

  34. Olson JM, Hallahan AR (2004) p38 MAP kinase: a convergence point in cancer therapy. Trends Mol Med 10:125–129

    Article  CAS  PubMed  Google Scholar 

  35. McCubrey JA, Steelman LS, Chappell WH, Abrams SL, Wong EW, Chang F, Lehmann B, Terrian DM, Milella M, Tafuri A, Stivala F, Libra M, Basecke J, Evangelisti C, Martelli AM, Franklin RA (2007) Roles of the Raf/MEK/ERK pathway in cell growth, malignant transformation and drug resistance. Biochim Biophys Acta 1773:1263–1284

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Gemignani ML, Schlaerth AC, Bogomolniy F, Barakat RR, Lin O, Soslow R, Venkatraman E, Boyd J (2003) Role of KRAS and BRAF gene mutations in mucinous ovarian carcinoma. Gynecol Oncol 90:378–381

    Article  CAS  PubMed  Google Scholar 

  37. Downward J (2003) Targeting RAS signalling pathways in cancer therapy. Nat Rev Cancer 3:11–22

    Article  CAS  PubMed  Google Scholar 

  38. Sieben NL, Macropoulos P, Roemen GM, Kolkman-Uljee SM, Jan Fleuren G, Houmadi R, Diss T, Warren B, Al Adnani M, De Goeij AP, Krausz T, Flanagan AM (2004) In ovarian neoplasms, BRAF, but not KRAS, mutations are restricted to low-grade serous tumours. J Pathol 202:336–340

    Article  CAS  PubMed  Google Scholar 

  39. Pohl G, Ho CL, Kurman RJ, Bristow R, Wang TL, Shih IM (2005) Inactivation of the mitogen-activated protein kinase pathway as a potential target-based therapy in ovarian serous tumors with KRAS or BRAF mutations. Cancer Res 65:1994–2000

    Article  CAS  PubMed  Google Scholar 

  40. Mayr D, Hirschmann A, Löhrs U, Diebold J (2006) KRAS and BRAF mutations in ovarian tumors: a comprehensive study of invasive carcinomas, borderline tumors and extraovarian implants. Gynecol Oncol 103:883–887

    Article  CAS  PubMed  Google Scholar 

  41. Ichikawa Y, Nishida M, Suzuki H, Yoshida S, Tsunoda H, Kubo T, Uchida K, Miwa M (1994) Mutation of K-ras protooncogene is associated with histological subtypes in human mucinous ovarian tumors. Cancer Res 54:33–35

    CAS  PubMed  Google Scholar 

  42. Wu R, Hendrix-Lucas N, Kuick R, Zhai Y, Schwartz DR, Akyol A, Hanash S, Misek DE, Katabuchi H, Williams BO, Fearon ER, Cho KR (2007) Mouse model of human ovarian endometrioid adenocarcinoma based on somatic defects in the Wnt/beta-catenin and PI3K/Pten signaling pathways. Cancer Cell 11:321–333

    Article  CAS  PubMed  Google Scholar 

  43. Enomoto T, Weghorst CM, Inoue M, Tanizawa O, Rice JM (1991) K-ras activation occurs frequently in mucinous adenocarcinomas and rarely in other common epithelial tumors of the human ovary. Am J Pathol 139:777–785

    CAS  PubMed Central  PubMed  Google Scholar 

  44. Caduff RF, Svoboda-Newman SM, Bartos RE, Ferguson AW, Frank TS (1998) Comparative analysis of histologic homologues of endometrial and ovarian carcinoma. Am J Surg Pathol 22:319–326

    Article  CAS  PubMed  Google Scholar 

  45. Amemiya S, Sekizawa A, Otsuka J, Tachikawa T, Saito H, Okai T (2004) Malignant transformation of endometriosis and genetic alterations of K-ras and microsatellite instability. Int J Gynaecol Obstet 86:371–376

    Article  CAS  PubMed  Google Scholar 

  46. Willner J, Wurz K, Allison KH, Galic V, Garcia RL, Goff BA, Swisher EM (2007) Alternate molecular genetic pathways in ovarian carcinomas of common histological types. Hum Pathol 38:607–613

    Article  CAS  PubMed  Google Scholar 

  47. Jones S, Wang TL, Shih IM, Mao TL, Nakayama K, Roden R, Glas R, Slamon D, Diaz LA Jr, Vogelstein B, Kinzler KW, Velculescu VE, Papadopoulos N (2010) Frequent mutations of chromatin remodeling gene ARID1A in ovarian clear cell carcinoma. Science 330:228–231

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  48. Auner V, Kriegshäuser G, Tong D, Horvat R, Reinthaller A, Mustea A, Zeillinger R (2009) KRAS mutation analysis in ovarian samples using a high sensitivity biochip assay. BMC Cancer 9:111

    Article  PubMed Central  PubMed  Google Scholar 

  49. Rechsteiner M, Zimmermann AK, Wild PJ, Caduff R, von Teichman A, Fink D, Moch H, Noske A (2013) TP53 mutations are common in all subtypes of epithelial ovarian cancer and occur concomitantly with KRAS mutations in the mucinous type. Exp Mol Pathol 95:235–241

    Article  CAS  PubMed  Google Scholar 

  50. Kurman RJ, Seidman JD, Shih IM (2005) Serous borderline tumours of the ovary. Histopathology 47:310–315

    Article  CAS  PubMed  Google Scholar 

  51. Russell SE, McCluggage WG (2004) A multistep model for ovarian tumorigenesis: the value of mutation analysis in the KRAS and BRAF genes. J Pathol 203:617–619

    Article  CAS  PubMed  Google Scholar 

  52. Nodin B, Zendehrokh N, Sundström M, Jirström K (2013) Clinicopathological correlates and prognostic significance of KRAS mutation status in a pooled prospective cohort of epithelial ovarian cancer. Diagn Pathol 8:106

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  53. Tsang YT, Deavers MT, Sun CC, Kwan SY, Kuo E, Malpica A, Mok SS, Gershenson DM, Wong KK (2013) KRAS (but not BRAF) mutations in ovarian serous borderline tumor are associated with recurrent low-grade serous carcinoma. J Pathol 231:449–56

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  54. Ardighieri L, Zeppernick F, Hannibal CG, Vang R, Cope L, Junge J, Kjaer SK, Kurman RJ, Shih IM (2014) Mutational analysis of BRAF and KRAS in ovarian serous borderline (atypical proliferative) tumours and associated peritoneal implants. J Pathol 232:16–22

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  55. Wong KK, Tsang YT, Deavers MT, Mok SC, Zu Z, Sun C, Malpica A, Wolf JK, Lu KH, Gershenson DM (2010) BRAF mutation is rare in advanced-stage low-grade ovarian serous carcinomas. Am J Pathol 177:1611–1617

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  56. Ross JS, Ali SM, Wang K, Palmer G, Yelensky R, Lipson D, Miller VA, Zajchowski D, Shawver LK, Stephens PJ (2013) Comprehensive genomic profiling of epithelial ovarian cancer by next generation sequencing-based diagnostic assay reveals new routes to targeted therapies. Gynecol Oncol 130:554–559

    Article  CAS  PubMed  Google Scholar 

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Zannoni, G.F., Improta, G., Chiarello, G. et al. Mutational status of KRAS, NRAS, and BRAF in primary clear cell ovarian carcinoma. Virchows Arch 465, 193–198 (2014). https://doi.org/10.1007/s00428-014-1599-1

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