MutYH-ассоциированный полипоз является единственным полипозным синдромом с аутосомно-рецессивным типом наследования, часто фенотипически схожим с ослабленной формой семейного аденоматоза толстой кишки. Для развития заболевания необходимы мутации в обоих аллелях гена, однако отмечен повышенный риск развития колоректального рака у носителей моноаллельных мутаций. Диагноз MutYH-ассоциированного полипоза должен подозреваться при колоректальном раке у больного старше 45 лет на фоне полипов в толстой кишке. В обзоре представлены современные алгоритмы диагностики и лечения заболевания.
MutYH-associated polyposis is the only polyposis syndrome with an autosomal recessive type of inheritance, often phenotypically similar to a weakened form of familial adenomatous polyposis. For the development of the disease mutations in both alleles of the gene are required, but an increased risk of developing colorectal cancer in carriers of monoallelic mutations is noted. The diagnosis of MutYH-associated polyposis should be suspected in a patient with colorectal cancer over 45 years old on the background of polyps in the colon. The review presents modern algorithms for diagnostic and treatment of the disease.
1. Цуканов А.С., Шелыгин Ю.А., Фролов С.А., Кузьминов А.М. Семейный аденоматоз толстой кишки. Хирург. 2017;(3):14-24 [Tsukanov AS, Shelygin YuA, Frolov SA, Kuz'minov AM. Familial adenomatous polyposis. Khirurg. 2017;(3):14-24 (In Russ.)].
2. Boparai KS, Dekker E, van Eeden S, et al. Hyperplastic polyps and sessile serrated adenomas as a phenotypic expression of MYH-associated polyposis. Gastroenterology. 2008;135(6):2014-8. doi: 10.1053/j.gastro.2008.09.020
3. Pezzi A, Roncucci L, Benatti P, et al. Relative role of APC and MUTYH mutations in the pathogenesis of familial adenomatous polyposis. Scand J Gastroenterol. 2009;44(9):1092-100. doi: 10.1080/00365520903100481
4. Шелыгин Ю.А., Кашников В.Н., Фролов С.А. и др. Молекулярно-генетическое исследование наследственной предрасположенности к разным формам полипоза толстой кишки. Колопроктология. 2013;43(1):9-14 [Shelygin YuA, Kashnikov VN, Frolov SA, et al. Molecular genetic investigation of hereditary predisposition to different forms of colonic polyposis. Koloproktologiya. 2013;43(1):9-14 (In Russ.)].
5. Ozdemir Y, Kalady M, Aytac E, et al. Anal transitional zone neoplasia in patients with familial adenomatous polyposis after restorative proctocolectomy and IPAA: incidence, management, and oncologic and functional outcomes. Dis Colon Rectum. 2013;56:808-14. doi: 10.1097/DCR.0b013e31829005db
6. Sampson JR, Dolwani S, Jones S, et al. Autosomal recessive colorectal adenomatous polyposis due to inherited mutations of MYH. Lancet. 2003;362(9377):39-41. doi: 10.1016/S0140-6736(03)13805-6
7. Sieber OM, Lipton L, Crabtree M, et al. Multiple colorectal adenomas, classic adenomatous polyposis, and germline mutations in MYH. New Engl J Med. 2003;348(9):791-9. doi: 10.1056/NEJMoa025283
8. Nielson M, Morreau H, Vasen H, et al. MUTYH-associated polyposis (MAP). Crit Rev Oncol Hematol. 2011;79(1):1-16. doi: 10.1016/j.critrevonc.2010.05.011
9. Sampson JR, Jones S, Dolwani S, et al. MutYH (MYH) and colorectal cancer. Biochem Soc Transact. 2005;33(4):679-83. doi: 10.1042/BST0330679
10. Syngal S, Brand RE, Church JM, et al. ACG clinical guideline: genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol. 2015;110(2):223-62. doi: 10.1038/ajg.2014.435
11. Kastrinos F, Syngal S. Inherited Colorectal Cancer Syndromes. Cancer J. 2011;17(6):405-15. doi: 10.1097/PPO.0b013e318237e408
12. Al-Tassan N, Chmiel NH, Maynard J, et al. Inherited variants of MYH associated with somatic G:C/T:A mutations in colorectal tumors. Nat Genet. 2002;30(2):227-32. doi: 10.1038/ng828
13. Win AK, Dowty JG, Cleary SP, et al. Risk of colorectal cancer for carriers of mutations in MUTYH, with and without a family history of cancer. Gastroenterology. 2014;146(5):1208-11. doi: 10.1053/j.gastro.2014.01.022
14. Leoz M, Carballal S, Moreira L, et al. The genetic basis of familial adenomatous polyposis and its implications for clinical practice and risk management. Applicat Clin Genet. 2015;8:95-107. doi: 10.2147/TACG.S51484
15. Guarinos C, Juarez M, Egoavil C, et al. Prevalence and characteristics of MUTYH-associated polyposis in patients with multiple adenomatous and serrated polyps. Clin Cancer Res. 2014;20(5):1158-68. doi: 10.1158/1078-0432.CCR-13-1490
16. Balaguer F, Castellvi-Bel S, Castells A, et al. Identification of MYH mutation carriers in colorectal cancer: a multicenter, case-control, population-based study. Clin Gastroenterol Hepatol. 2007;5(3):379-87. doi: 10.1016/j.cgh.2006.12.025
17. Wang L, Baudhuin LM, Boardman LA, et al. MYH mutations in patients with attenuated and classic polyposis and with young-onset colorectal cancer without polyps. Gastroenterology. 2004;127:9-16.
18. Schlussel A, Gagliano R, Seto-Donlon S, et al. The evolution of colorectal сancer genetics – Part 2: clinical implications and applications. Gastrointest Oncol. 2014;5:336-44. doi: 10.3978/j.issn.2078-6891.2014.068
19. Kantor M, Sobrado J, Patel S, et al. Hereditary Colorectal Tumors: A Literature Review on MUTYH-associated Polyposis. Gastroenterol Res Pract. 2017;2017:Article ID 8693182, 4 p. doi: 10.1155/2017/8693182
20. Цуканов А.С., Поспехова Н.И., Шубин В.П. и др. Мутации в гене АРС у российских пациентов с классической формой семейного аденоматоза толстой кишки. Генетика. 2017;53(3):356-63 [Tsukanov AS, Pospekhova NI, Shubin VP’ et al. Mutations in the ARS gene in Russian patients with the classic form of familial adenomatosis of the colon. Genetika. 2017;53(3):356-63 (In Russ.)]. doi: 10.7868/S0016675817030134
21. Чернышов С.В., Орлова Л.П., Жданкина С.Н. и др. Высокая частота малигнизации ворсинчатых опухолей, как фактор риска, определяющий необходимость трансанальных эндоскопических операций. Колопроктология. 2013;44(2):3-8 [Chernyshov SV, Orlova LP, Zhdankina SN, et al. High frequency of malignancy of villous tumors, as a risk factor, which determines the need for transanal endoscopic operations. Koloproktologiya. 2013;44(2):3-8 (In Russ.)].
22. Nielson M, Hes FJ, Nagengast FM, et al. Germline mutations in APC and MUTYH are responsible for the majority of families with attenuated familial adenomatous polyposis. Clin Genet. 2007;71(5):427-33. doi: 10.1111/j.1399-0004.2007.00766.x
23. Vogt S, Jones N, Christian D, et al. Expanded extracolonic tumor spectrum in MUTYH-associated polyposis. Gastroenterology. 2009;137(6):1976-85. doi: 10.1053/j.gastro.2009.08.052
24. Poulsen ML, Bisgaard ML. MUTYH-associated polyposis (MAP). Curr Genom. 2009;9(6):420-35. doi: 10.2174/138920208785699562
25. Goodenberger M, Lindor NM. Lynch syndrome and MYH-associated polyposis: review and testing strategy. J Clin Gastroenterol. 2011;45(6):488-500. doi: 10.1097/MCG.0b013e318206489c
26. Leite J, Isidro G, Martins M, et al. Is prophylactic colectomy indicated in patients with MYH-associated polyposis? Colorectal Dis. 2005;7:327-31. doi: 10.1111/j.1463-1318.2005.00811.x
27. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. Genetic/familial high-risk assessment: Colorectal. National Comprehensive Cancer Network, 2014.
28. Vasen HF, Moslein G, Alonso A, et al. Guidelines for the clinical management of familial adenomatous polyposis (FAP). Gut. 2008;57(5):704-13. doi: 10.1136/gut.2007.136127
29. Brosens L, Keller J, Offerhaus G, et al. Prevention and management of duodenal polyps in familial adenomatous polyposis. Gut. 2005;54:1034-43. doi: 10.1136/gut.2004.053843
30. Шелыгин Ю.А. Клинические рекомендации. Колопроктология. 2-е изд., испр. и доп. М.: ГЭОТАР-Медиа; 2017. С. 352-68 [Shelygin YuA. Klinicheskie rekomendatsii. Koloproktologiya [Clinical guidelines. Coloproctology]. 2nd ed. Moscow: GEOTAR-Media; 2017. P. 352-68 (In Russ.)].
31. Setti-Carraro P, Nicholls R. Choice of prophylactic surgery for the large bowel component of familial adenomatous polyposis. Br J Surg. 1996;83:885-92.
32. Кайзер Андреас М. Колоректальная хирургия. М.: Изд-во БИНОМ; 2011. 737 с. [Kayzer Andreas M. Kolorektal'naya khirurgiya [Colorectal surgery]. Moscow: BINOM; 2011. 737 p. (In Russ.)].
33. Browning SM, Nivatvongs S. Intraoperative abandonment of ileal pouch to anal anastomosis – the Mayo Clinic experience. J Am Coll Surg. 1998;186:441-5.
34. Wallace M, Phillips R. Preventative strategies for periampullary tumours in FAP. Ann Oncol. 1999;10:201-3.
35. Kartheuser A, Stangherlin H, Brandt L, et al. Restorative proctocolectomy and ileal pouch – anal anastomosis for familial adenomatous polyposis revisited. Fam Cancer. 2006;5:241-60.
36. Uyeda J, Lebedis C, Penn D, et al. Ileal pouch-anal anastomosis surgery: anatomy, postoperative complications, and image-guided intervention. Semin Ultrasound CT MR. 2013;34:299-310. doi: 10.1053/j.sult.2013.03.003
37. Al-Sanea N, Alfaifi J, Homoud S, et al. Outcome after ileal pouch-anal anastomosis for familial adenomatous polyposis compared to mucosal ulcerative colitis in a Middle Eastern population. Ann Saudi Med. 2013;33:268-72. doi: 10.5144/0256-4947.2013.268
38. Thompson-Fawcett M, Marcus V, Redston M, et al. Adenomatous polyps develop commonly in the ileal pouch of patients with familial adenomatous polyposis. Dis Colon Rectum. 2001;44:347-53.
________________________________________________
1. Tsukanov AS, Shelygin YuA, Frolov SA, Kuz'minov AM. Familial adenomatous polyposis. Khirurg. 2017;(3):14-24 (In Russ.)
2. Boparai KS, Dekker E, van Eeden S, et al. Hyperplastic polyps and sessile serrated adenomas as a phenotypic expression of MYH-associated polyposis. Gastroenterology. 2008;135(6):2014-8. doi: 10.1053/j.gastro.2008.09.020
3. Pezzi A, Roncucci L, Benatti P, et al. Relative role of APC and MUTYH mutations in the pathogenesis of familial adenomatous polyposis. Scand J Gastroenterol. 2009;44(9):1092-100. doi: 10.1080/00365520903100481
4. Shelygin YuA, Kashnikov VN, Frolov SA, et al. Molecular genetic investigation of hereditary predisposition to different forms of colonic polyposis. Koloproktologiya. 2013;43(1):9-14 (In Russ.)
5. Ozdemir Y, Kalady M, Aytac E, et al. Anal transitional zone neoplasia in patients with familial adenomatous polyposis after restorative proctocolectomy and IPAA: incidence, management, and oncologic and functional outcomes. Dis Colon Rectum. 2013;56:808-14. doi: 10.1097/DCR.0b013e31829005db
6. Sampson JR, Dolwani S, Jones S, et al. Autosomal recessive colorectal adenomatous polyposis due to inherited mutations of MYH. Lancet. 2003;362(9377):39-41. doi: 10.1016/S0140-6736(03)13805-6
7. Sieber OM, Lipton L, Crabtree M, et al. Multiple colorectal adenomas, classic adenomatous polyposis, and germline mutations in MYH. New Engl J Med. 2003;348(9):791-9. doi: 10.1056/NEJMoa025283
8. Nielson M, Morreau H, Vasen H, et al. MUTYH-associated polyposis (MAP). Crit Rev Oncol Hematol. 2011;79(1):1-16. doi: 10.1016/j.critrevonc.2010.05.011
9. Sampson JR, Jones S, Dolwani S, et al. MutYH (MYH) and colorectal cancer. Biochem Soc Transact. 2005;33(4):679-83. doi: 10.1042/BST0330679
10. Syngal S, Brand RE, Church JM, et al. ACG clinical guideline: genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol. 2015;110(2):223-62. doi: 10.1038/ajg.2014.435
11. Kastrinos F, Syngal S. Inherited Colorectal Cancer Syndromes. Cancer J. 2011;17(6):405-15. doi: 10.1097/PPO.0b013e318237e408
12. Al-Tassan N, Chmiel NH, Maynard J, et al. Inherited variants of MYH associated with somatic G:C/T:A mutations in colorectal tumors. Nat Genet. 2002;30(2):227-32. doi: 10.1038/ng828
13. Win AK, Dowty JG, Cleary SP, et al. Risk of colorectal cancer for carriers of mutations in MUTYH, with and without a family history of cancer. Gastroenterology. 2014;146(5):1208-11. doi: 10.1053/j.gastro.2014.01.022
14. Leoz M, Carballal S, Moreira L, et al. The genetic basis of familial adenomatous polyposis and its implications for clinical practice and risk management. Applicat Clin Genet. 2015;8:95-107. doi: 10.2147/TACG.S51484
15. Guarinos C, Juarez M, Egoavil C, et al. Prevalence and characteristics of MUTYH-associated polyposis in patients with multiple adenomatous and serrated polyps. Clin Cancer Res. 2014;20(5):1158-68. doi: 10.1158/1078-0432.CCR-13-1490
16. Balaguer F, Castellvi-Bel S, Castells A, et al. Identification of MYH mutation carriers in colorectal cancer: a multicenter, case-control, population-based study. Clin Gastroenterol Hepatol. 2007;5(3):379-87. doi: 10.1016/j.cgh.2006.12.025
17. Wang L, Baudhuin LM, Boardman LA, et al. MYH mutations in patients with attenuated and classic polyposis and with young-onset colorectal cancer without polyps. Gastroenterology. 2004;127:9-16.
18. Schlussel A, Gagliano R, Seto-Donlon S, et al. The evolution of colorectal сancer genetics – Part 2: clinical implications and applications. Gastrointest Oncol. 2014;5:336-44. doi: 10.3978/j.issn.2078-6891.2014.068
19. Kantor M, Sobrado J, Patel S, et al. Hereditary Colorectal Tumors: A Literature Review on MUTYH-associated Polyposis. Gastroenterol Res Pract. 2017;2017:Article ID 8693182, 4 p. doi: 10.1155/2017/8693182
20. Tsukanov AS, Pospekhova NI, Shubin VP’ et al. Mutations in the ARS gene in Russian patients with the classic form of familial adenomatosis of the colon. Genetika. 2017;53(3):356-63 (In Russ.) doi: 10.7868/S0016675817030134
21. Chernyshov SV, Orlova LP, Zhdankina SN, et al. High frequency of malignancy of villous tumors, as a risk factor, which determines the need for transanal endoscopic operations. Koloproktologiya. 2013;44(2):3-8 (In Russ.)
22. Nielson M, Hes FJ, Nagengast FM, et al. Germline mutations in APC and MUTYH are responsible for the majority of families with attenuated familial adenomatous polyposis. Clin Genet. 2007;71(5):427-33. doi: 10.1111/j.1399-0004.2007.00766.x
23. Vogt S, Jones N, Christian D, et al. Expanded extracolonic tumor spectrum in MUTYH-associated polyposis. Gastroenterology. 2009;137(6):1976-85. doi: 10.1053/j.gastro.2009.08.052
24. Poulsen ML, Bisgaard ML. MUTYH-associated polyposis (MAP). Curr Genom. 2009;9(6):420-35. doi: 10.2174/138920208785699562
25. Goodenberger M, Lindor NM. Lynch syndrome and MYH-associated polyposis: review and testing strategy. J Clin Gastroenterol. 2011;45(6):488-500. doi: 10.1097/MCG.0b013e318206489c
26. Leite J, Isidro G, Martins M, et al. Is prophylactic colectomy indicated in patients with MYH-associated polyposis? Colorectal Dis. 2005;7:327-31. doi: 10.1111/j.1463-1318.2005.00811.x
27. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. Genetic/familial high-risk assessment: Colorectal. National Comprehensive Cancer Network, 2014.
28. Vasen HF, Moslein G, Alonso A, et al. Guidelines for the clinical management of familial adenomatous polyposis (FAP). Gut. 2008;57(5):704-13. doi: 10.1136/gut.2007.136127
29. Brosens L, Keller J, Offerhaus G, et al. Prevention and management of duodenal polyps in familial adenomatous polyposis. Gut. 2005;54:1034-43. doi: 10.1136/gut.2004.053843
30. Shelygin YuA. Klinicheskie rekomendatsii. Koloproktologiya [Clinical guidelines. Coloproctology]. 2nd ed. Moscow: GEOTAR-Media; 2017. P. 352-68 (In Russ.)
31. Setti-Carraro P, Nicholls R. Choice of prophylactic surgery for the large bowel component of familial adenomatous polyposis. Br J Surg. 1996;83:885-92.
32. Kayzer Andreas M. Kolorektal'naya khirurgiya [Colorectal surgery]. Moscow: BINOM; 2011. 737 p. (In Russ.)
33. Browning SM, Nivatvongs S. Intraoperative abandonment of ileal pouch to anal anastomosis – the Mayo Clinic experience. J Am Coll Surg. 1998;186:441-5.
34. Wallace M, Phillips R. Preventative strategies for periampullary tumours in FAP. Ann Oncol. 1999;10:201-3.
35. Kartheuser A, Stangherlin H, Brandt L, et al. Restorative proctocolectomy and ileal pouch – anal anastomosis for familial adenomatous polyposis revisited. Fam Cancer. 2006;5:241-60.
36. Uyeda J, Lebedis C, Penn D, et al. Ileal pouch-anal anastomosis surgery: anatomy, postoperative complications, and image-guided intervention. Semin Ultrasound CT MR. 2013;34:299-310. doi: 10.1053/j.sult.2013.03.003
37. Al-Sanea N, Alfaifi J, Homoud S, et al. Outcome after ileal pouch-anal anastomosis for familial adenomatous polyposis compared to mucosal ulcerative colitis in a Middle Eastern population. Ann Saudi Med. 2013;33:268-72. doi: 10.5144/0256-4947.2013.268
38. Thompson-Fawcett M, Marcus V, Redston M, et al. Adenomatous polyps develop commonly in the ileal pouch of patients with familial adenomatous polyposis. Dis Colon Rectum. 2001;44:347-53.
1 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
2 ФГБУ «Государственный научный центр колопроктологии им. А.Н. Рыжих» Минздрава России, Москва, Россия
________________________________________________
M.Kh. Toboeva1,2, Yu.A. Shelygin1,2, S.A. Frolov2, M.A. Kuzminov2, A.S. Tsukanov2
1 Russian Medical Academy of Continuing Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russia;
2 A.N. Ryzhikh State Scientific Centre of Coloproctology of the Ministry of Health of the Russian Federation, Moscow, Russia