Recurrent Mutations in APC and CTNNB1 and Activated Wnt/β-catenin Signaling in Intraductal Papillary Neoplasms of the Bile Duct: A Whole Exome Sequencing Study

Am J Surg Pathol. 2018 Dec;42(12):1674-1685. doi: 10.1097/PAS.0000000000001155.

Abstract

This study aimed to elucidate the genetic landscape of biliary papillary neoplasms. Of 28 cases examined, 7 underwent whole exome sequencing, while the remaining 21 were used for validation studies with targeted sequencing. In the whole exome sequencing study, 4/7 cases had mutations in either APC or CTNNB1, both of which belong to the Wnt/β-catenin pathway. Somatic mutations were also identified in genes involved in RAS signaling (KRAS, BRAF), a cell cycle regulator (CDC27), histone methyltransferase (KMT2C, KMT2D), and DNA mismatch repair (MSH3, MSH6, PMS1). Combined with discovery and validation cohorts, mutations in APC or CTNNB1 were observed in 6/28 subjects (21%) and were mutually exclusive. When the cases were classified into intraductal papillary neoplasms of the bile duct (IPNBs, n=14) and papillary cholangiocarcinomas (n=14) based on the recently proposed classification criteria, mutations in APC and CTNNB1 appeared to be entirely restricted to IPNBs with 6/14 cases (43%) harboring mutations in either gene. These genetic alterations were detected across the 3 nonintestinal histologic types. In immunohistochemistry, the aberrant cytoplasmic and/or nuclear expression of β-catenin was found in not only 5/6 IPNBs with APC or CTNNB1 mutations, but also 6/8 cases with wild-type APC and CTNNB1 (total 79%). In addition, APC and CTNNB1 alterations were exceptional in nonpapillary cholangiocarcinomas (n=29) with a single case harboring CTNNB1 mutation (3%). This study demonstrated recurrent mutations in APC and CTNNB1 in nonintestinal-type IPNBs, suggesting that activation of the Wnt/β-catenin signaling pathway is relevant to the development and progression of IPNBs.

Publication types

  • Comparative Study
  • Validation Study

MeSH terms

  • Adenomatous Polyposis Coli Protein / genetics*
  • Adult
  • Aged
  • Aged, 80 and over
  • Bile Duct Neoplasms / genetics*
  • Bile Duct Neoplasms / mortality
  • Bile Duct Neoplasms / pathology
  • Bile Duct Neoplasms / surgery
  • Biomarkers, Tumor / genetics*
  • Biopsy
  • Carcinoma, Ductal / genetics*
  • Carcinoma, Ductal / mortality
  • Carcinoma, Ductal / pathology
  • Carcinoma, Ductal / surgery
  • Carcinoma, Papillary / genetics*
  • Carcinoma, Papillary / mortality
  • Carcinoma, Papillary / pathology
  • Carcinoma, Papillary / surgery
  • Cholangiocarcinoma / genetics*
  • Cholangiocarcinoma / mortality
  • Cholangiocarcinoma / pathology
  • Cholangiocarcinoma / surgery
  • DNA Mutational Analysis / methods*
  • Exome Sequencing*
  • Female
  • Genetic Predisposition to Disease
  • Humans
  • Immunohistochemistry
  • Male
  • Middle Aged
  • Mutation Rate
  • Mutation*
  • Phenotype
  • Predictive Value of Tests
  • Prognosis
  • Reproducibility of Results
  • Wnt Signaling Pathway / genetics*
  • beta Catenin / genetics*

Substances

  • APC protein, human
  • Adenomatous Polyposis Coli Protein
  • Biomarkers, Tumor
  • CTNNB1 protein, human
  • beta Catenin