open access: Lynch syndrome and exposure to aristolochic acid in upper-tract urothelial carcinoma: its clinical impact? Ovarian Cancer and Us OVARIAN CANCER and US Ovarian Cancer and Us

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Sunday, April 24, 2016

open access: Lynch syndrome and exposure to aristolochic acid in upper-tract urothelial carcinoma: its clinical impact?



open access: (abstract + pdf)
Lynch syndrome and exposure to aristolochic acid in upper-tract urothelial carcinoma: its clinical impact? - Colin - Translational Andrology and Urology

 There is a lack of appreciation of the association of LS
and a wide variety of extra-colonic tumors: thus, some
hereditary cancers are probably misclassified as sporadic and
the incidence of LS may be underestimated.
 An hMSH2 gene mutation is the most common (60%)
in patients with LS and UTUC. Other mutations are also
described, but at smaller proportions: i.e., hMLH1 (30%)
and hMSH6 (5–8%). Mutations of other genes (hMSH3,
hPMS1, and hPSM2) are less common (6).


 The purpose of the current review was to describe the clinical risk for Lynch syndrome (LS) after exposure to aristolochic acid (AA) in cases of upper urinary-tract urothelial carcinoma (UTUC). A systematic review of the scientific literature was performed using the Medline database (National Library of Medicine, PubMed) using the following keywords: epidemiology, risk factor, AA, Balkan nephropathy (BNe), LS, hereditary cancer, hereditary non-polyposis colorectal cancer (HNPCC), mismatch repair genes, urothelial carcinomas, upper urinary tract, renal pelvis, ureter, Amsterdam criteria, genetic counselling, mismatch repair genes, genetic instability, microsatellite, and Bethesda guidelines. LS is a specific risk for UTUC, which is the third most frequent cancer (in its tumor spectrum) after colon and uterine lesions. Mutation of the MSH2 gene is the most commonly described cause of UTUC in LS. Diagnosis is based on clinical suspicion and is guided by Bethesda and Amsterdam criteria. It is secondarily confirmed by immunohistochemical analyses of the tumor and a search for gene mutations. The presence of LS in patients with UTUC is a favorable prognosis factor for survival during follow-ups. AA is a specific environmental risk factor for UTUC and tubulo-interstitial nephropathy. It has been involved in the development of nephropathies in link with the Balkan disease and intake of Chinese herbal medicine. More broadly, the use of traditional plant medicines from the genus Aristolochia has created worldwide public-health concerns. UTUCs share common risk factors with other urothelial carcinomas such as tobacco or occupational exposure. However, these tumors have also specific risk factors such as AA exposure and LS that clinicians should be aware of because of their clinical implication in further management and follow-up.

1) plants containing aristolochia 
2) plants (2015)

 http://makrokuvahetki.kuvat.fi/kuvat/Kasvit+Plants/Puutarhakasvit+Garden+plants/Aristolochia+clematitis+2.jpg?img=full

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