Demystifying the Mystery of Genes: A Case Report on Constitutional Mismatch Repair Deficiency
Constitutional mismatch repair deficiency (CMMRD) is a rare childhood cancer predisposition syndrome that results from biallelic germline mutations in one of the four MMR genes, MLH1, MSH2, MSH6, or PMS2. This syndrome is characterized by a broad spectrum of early-onset malignancies, including hemat...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2024-07-01
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| author | Jose Siju Arpita Sahu Kajari Bhattacharya Maya Prasad Rajiv Sarin Tejpal Gupta |
| author_facet | Jose Siju Arpita Sahu Kajari Bhattacharya Maya Prasad Rajiv Sarin Tejpal Gupta |
| author_sort | Jose Siju |
| collection | DOAJ |
| description | Constitutional mismatch repair deficiency (CMMRD) is a rare childhood cancer predisposition syndrome that results from biallelic germline mutations in one of the four MMR genes, MLH1, MSH2, MSH6, or PMS2. This syndrome is characterized by a broad spectrum of early-onset malignancies, including hematologic malignancies, colorectal malignancies, brain tumors, and other malignancies. It is common to have more than one malignancy in an individual diagnosed with CMMRD. In addition to malignancies, primary immunodeficiency in the form of low or absent immunoglobulin levels can also be seen in CMMRD. Congenital abnormalities such as agenesis of the corpus callosum (ACC), cavernous hemangioma, and other non-neoplastic diseases can also be linked to it. In this case report, we discussed the case of a girl born out of consanguineous marriage initially identified as having T-cell acute lymphoblastic lymphoma and later found to have selective immunoglobulin A (IgA) deficiency. Her younger sibling with a pontine cavernous hemangioma was also diagnosed with lymphoma. The girl exhibited brain lesions on magnetic resonance imaging (MRI), which were initially diagnosed as posterior reversible encephalopathy syndrome (PRES) related changes; however, one of the lesions persisted and remained stable over a period of 2 years and more in favor of diffuse glioma. The younger sibling also showed a solitary lesion in the brain. Based on the clinical and radiological findings, a diagnosis of CMMRD was suspected. Next-generation sequence (NGS) analysis of her blood sample was done. The results showed a homozygous mutation in the MSH6 gene was diagnostic of CMMRD. |
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| publishDate | 2024-07-01 |
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| series | Indian Journal of Radiology and Imaging |
| spelling | doaj.art-e35394ce735d48e5ba1e02c2230077bc2024-06-18T22:43:44ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Radiology and Imaging0971-30261998-38082024-07-01340356256510.1055/s-0044-1779586Demystifying the Mystery of Genes: A Case Report on Constitutional Mismatch Repair DeficiencyJose Siju0Arpita Sahu1https://orcid.org/0000-0003-1549-3680Kajari Bhattacharya2Maya Prasad3Rajiv Sarin4Tejpal Gupta5Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, IndiaDepartment of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, IndiaDepartment of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, IndiaDepartment of Paediatric Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, IndiaDepartment of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, IndiaDepartment of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, IndiaConstitutional mismatch repair deficiency (CMMRD) is a rare childhood cancer predisposition syndrome that results from biallelic germline mutations in one of the four MMR genes, MLH1, MSH2, MSH6, or PMS2. This syndrome is characterized by a broad spectrum of early-onset malignancies, including hematologic malignancies, colorectal malignancies, brain tumors, and other malignancies. It is common to have more than one malignancy in an individual diagnosed with CMMRD. In addition to malignancies, primary immunodeficiency in the form of low or absent immunoglobulin levels can also be seen in CMMRD. Congenital abnormalities such as agenesis of the corpus callosum (ACC), cavernous hemangioma, and other non-neoplastic diseases can also be linked to it. In this case report, we discussed the case of a girl born out of consanguineous marriage initially identified as having T-cell acute lymphoblastic lymphoma and later found to have selective immunoglobulin A (IgA) deficiency. Her younger sibling with a pontine cavernous hemangioma was also diagnosed with lymphoma. The girl exhibited brain lesions on magnetic resonance imaging (MRI), which were initially diagnosed as posterior reversible encephalopathy syndrome (PRES) related changes; however, one of the lesions persisted and remained stable over a period of 2 years and more in favor of diffuse glioma. The younger sibling also showed a solitary lesion in the brain. Based on the clinical and radiological findings, a diagnosis of CMMRD was suspected. Next-generation sequence (NGS) analysis of her blood sample was done. The results showed a homozygous mutation in the MSH6 gene was diagnostic of CMMRD.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0044-1779586CMMRDIgAMMRMSH6 |
| spellingShingle | Jose Siju Arpita Sahu Kajari Bhattacharya Maya Prasad Rajiv Sarin Tejpal Gupta Demystifying the Mystery of Genes: A Case Report on Constitutional Mismatch Repair Deficiency Indian Journal of Radiology and Imaging CMMRD IgA MMR MSH6 |
| title | Demystifying the Mystery of Genes: A Case Report on Constitutional Mismatch Repair Deficiency |
| title_full | Demystifying the Mystery of Genes: A Case Report on Constitutional Mismatch Repair Deficiency |
| title_fullStr | Demystifying the Mystery of Genes: A Case Report on Constitutional Mismatch Repair Deficiency |
| title_full_unstemmed | Demystifying the Mystery of Genes: A Case Report on Constitutional Mismatch Repair Deficiency |
| title_short | Demystifying the Mystery of Genes: A Case Report on Constitutional Mismatch Repair Deficiency |
| title_sort | demystifying the mystery of genes a case report on constitutional mismatch repair deficiency |
| topic | CMMRD IgA MMR MSH6 |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0044-1779586 |
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