Novel fumarate hydratase mutation in a family with atypical uterine leiomyomas and hereditary leiomyomatosis and renal cell cancer

Capsule:
Three sisters presented with atypical uterine leiomyomas and were diagnosed with hereditary leiomyomatosis and renal cell cancer. They carry a novel mutation in the fumarate hydratase gene.

Authors:
Karen C. Wheeler, M.D., Dillon J. Warr, Sarah I. Warsetsky, M.D., Larry I. Barmat, M.D.

Volume 105, Issue 1, Pages 144-148

Abstract:

Objective:
To describe a novel mutation in the fumarate hydratase (FH) gene in a family with atypical uterine leiomyomas.

Design:
Case report and review of the literature.

Setting:
Academic community hospital.

Patient(s):
Three sisters who presented as nulligravidas aged 27–30 years with large atypical uterine leiomyomas.

Intervention(s):
Abdominal myomectomy, robotic myomectomy, hysterectomy, gene sequencing.

Main Outcome Measure(s):
Identification of a family with hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome and a novel mutation in the FH gene.

Result(s):
Two of the three sisters tested positive for a novel FH mutation p.Leu99Glufsx6. The eldest sister was clinically diagnosed with HLRCC. The patients’ father also carries the same mutation in the FH gene. The patients and their father are now undergoing yearly screening for renal cancer.

Conclusion(s):
Patients with HLRCC are at risk for developing renal cancer as well as losing their fertility via early hysterectomy. Physicians must be aware of this condition and refer at-risk individuals for genetic testing.

  • Daniel J. Kaser, MD

    Dear Dr. Wheeler and colleagues,

    Congratulations on this nice case series describing a novel mutation in the fumarate hydratase gene in a family with HLRCC. In your experience, when is testing for this syndrome indicated? Is the initial step in making the diagnosis one that is driven by histology, prompting special stains for FH, and then a referral to genetic testing if there is loss of FH staining?

    Thanks very much for your comments.

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