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中华结直肠疾病电子杂志 ›› 2024, Vol. 13 ›› Issue (01) : 72 -77. doi: 10.3877/cma.j.issn.2095-3224.2024.01.012

所属专题: 经典病例

病例报道

一个新的APC基因内含子c.531+6T>G变异导致的家族性腺瘤性息肉病病例报告
姚瑶1, 高扬2, 单军奇2, 李昕豫3, 韩玮1, 李增军2,(), 孙燕来2,()   
  1. 1. 250118 济南,山东第一医科大学(山东省医学科学院)研究生院;250117 济南,山东省肿瘤防治研究院(山东省肿瘤医院)结直肠外科二病区,山东第一医科大学(山东省医学科学院)
    2. 250117 济南,山东省肿瘤防治研究院(山东省肿瘤医院)结直肠外科二病区,山东第一医科大学(山东省医学科学院)
    3. 250117 济南,山东省肿瘤防治研究院(山东省肿瘤医院)结直肠外科二病区,山东第一医科大学(山东省医学科学院);261000 山东省潍坊医学院临床医学院
  • 收稿日期:2023-10-05 出版日期:2024-02-25
  • 通信作者: 李增军, 孙燕来
  • 基金资助:
    山东省自然科学基金面上项目(No. ZR2020MH254); 山东省肿瘤医院临床培育项目(No. 2020PYA05); 济南市临床医学科技创新计划项目(No. 202134062)

A case report of c.531+6T>G heterozygous mutation in familial adenomatous polyposis

Yao Yao1, Yang Gao2, Junqi Shan2, Xinyu Li3, Wei Han1, Zengjun Li2,(), Yanlai Sun2,()   

  1. 1. Department of Graduates, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji'nan 250118, China; Department of Colorectal Cancer Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji'nan 250117, China
    2. Department of Colorectal Cancer Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji'nan 250117, China
    3. Department of Colorectal Cancer Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji'nan 250117, China; Weifang Medical University School of Clinical Medicine, Weifang 261000, China
  • Received:2023-10-05 Published:2024-02-25
  • Corresponding author: Zengjun Li, Yanlai Sun
引用本文:

姚瑶, 高扬, 单军奇, 李昕豫, 韩玮, 李增军, 孙燕来. 一个新的APC基因内含子c.531+6T>G变异导致的家族性腺瘤性息肉病病例报告[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(01): 72-77.

Yao Yao, Yang Gao, Junqi Shan, Xinyu Li, Wei Han, Zengjun Li, Yanlai Sun. A case report of c.531+6T>G heterozygous mutation in familial adenomatous polyposis[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2024, 13(01): 72-77.

家族性腺瘤性息肉病(FAP)是一种常染色体显性遗传病,多于15岁左右出现肠道内息肉,后因腹痛、腹胀、便血等临床症状至医院就诊。FAP的发病机制为腺瘤性结肠息肉病(APC)基因的种系突变导致其功能丧失,无法正常调控细胞增殖,最终发展成为恶性肿瘤。我们通过外周血基因检测,发现1例FAP患者APC基因内含子区的一个新突变——c.531+6T>G杂合变异,且其两位姐姐均存在此突变位点且均已发病。APC基因突变导致下游形成一个早期终止密码子,APC蛋白发生截断改变,表达截断蛋白1,从而削弱了APC对细胞增殖的固有抑制作用,导致APC蛋白功能障碍,最终导致疾病恶化。目前尚未发现有这一突变位点的报道,笔者认为在有APC突变的FAP临床表现的患者中,此位点可以作为今后临床基因检测参考点,不应遗漏并应高度重视。

Familial adenomatous polyposis (FAP) is a autosome dominant hereditary disease. Intestinal polyps occur when people are more than 15 years old, and then they go to the hospital for clinical symptoms such as abdominal pain, abdominal distention, and hematochezia. The pathogenesis of FAP is the germline mutation of the adenomatous polyposis coli (APC) gene, which leads to its loss of function and inability to regulate cell proliferation, ultimately causing the development of malignancy. This article reports on a patient with FAP. Through peripheral blood genetic testing, we found a new mutation, c.531+6T>G heterozygous mutation, in the intron region of the APC gene. Furthermore, both of his two sisters have this mutation site. Mutation of the APC gene mainly leads that an early termination codon downstream forms, which causes the APC protein to undergo truncation changes and expresses truncation protein 1, thereby weakening the inherent inhibitory effect of APC on cell proliferation, resulting in APC protein dysfunction and ultimately leading to disease deterioration. There have been no reports of this mutation, but it can be considered in case of APC mutations as well as FAP in patients with clinical manifestations; and it may be used as a reference for preventive clinical treatment in the future.

图1 术前肠镜图片。1A:结肠肝曲,1B:横结肠,1C:降结肠,1D:直肠距肛缘8 cm
图2 术前CT图片。2A~2B:结肠肝曲占位,2C~2D:直肠占位;注:黄色箭头:结肠肿瘤,红色箭头:肿大淋巴结,蓝色箭头:直肠肿瘤
图3 手术切除范围示意图。A:切断回肠末端并行永久性回肠造瘘;B:切除肛门;AB之间全大肠切除
图4 基因检测结果。4A:患者APC基因检测结果,4B~4C:患者两位姐姐APC基因检测结果
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