Juvenile hyaline fibromatosis (JHF) is rare disease of autosomal recessive inheritance.

MAIN CLINICAL FEATURES: Xeroderma pigmentosum is a rare, recessive disorder clinically characterized by extreme photosensitivity, pigmented abnormalities of the skin-exposed areas, and frequent ocular and neurological abnormalities. Xeroderma pigmentosum syndrome is associated with an estimated 2000-fold increase in the risk to develop skin cancer (basal cell carcinoma, squamous cell carcinoma and melanoma).

Genetic epidemiology and position cloning techniques have made it possible to estimate the risk women with a family history of breast cancer have of developing a breast tumor. THREE PREDISPOSITION GENES: Three BReast CAncer genes (BRCA1, BRCA2 and BRCA3) have been localized on chromosomes 17 13 and 8. It is highly likely that other genes also have an influence. GENETIC TESTING: When an altered BRCA1 or BRCA2 gene is identified in a family, a gene test can be proposed to recognize predisposition in relatives. A negative test means the subject is not predisposed to breast cancer and that transmission to offspring is not possible. Inversely, the risk of breast cancer is high if the mutation is detected, raising the difficult problem of counselling, particularly in young subjects. PROBLEMS RELATED TO SCREENING TESTS: Screening tests can only be undertaken if the "candidate" is aware of the consequences of the screening results and has had enough time to make a fully informed decision. Confidentiality must be particularly strict, particularly in the field of employment and insurance.

A gene with remarkable sequence homology with the tumour suppressor gene p53 is located at the tip of the short arm of human chromosome 1 which is often found to be deleted in neuroblastomas, melanomas and breast cancers. Despite their structural and functional similarities, p53 and p73 may have distinct roles in cell grow regulation.

Microsatellite instabilities (MIN) represent a new type of mutation characterized by genomic instability (or replication error phenotype, RER+). First identified in sporadic and familial colorectal tumors, the RER+ phenotype has been sought in multiple types of cancers. Thus, two types of instability mechanisms have been shown: one due to inactivation of the mismatch repair system (phenotype RER+) and a second still unclear (instability of tri- and tetra-nucleotide repeats). In both cases, MIN seem to be the reflect of a new tumorigenesis pathway. In the context of mismatch repair defect, numerous observations show that, although instabilities seem to be random, they play a direct role in the tumoral process by altering genes that control cell growth and apoptosis. Today, MIN, as well as the detection of mutations in the DNA mismatch repair genes, can be used as diagnosis tools in oncology and provide usefull indications to adapt the chemotherapy to the disease.

The adenomatous polyposis coli (APC) gene has been found to be mutated during the development of sporadic colorectal cancers as well as in familial adenomatous polyposis (FAP). These conditions result from initially somatic and germ line mutations respectively. In both cases, the expressed protein is truncated at its carboxyterminal region. Investigations into the role of wild-type APC have led to a better understanding of the importance of mutations in the genesis and progression of adenomas. APC was shown to regulate cell growth and cell death, to bind beta-catenin, and to colocalize with microtubules. APC truncation was therefore hypothesized to alter cell multiplication and cells are no longer able to undergo apoptosis. Owing to its beta-catenin binding, APC can modify the pool of beta-catenin which is in part utilized in the assembly of adherens junctions and in nuclear signalling. Truncated APC is unable to regulate this pool thereby altering adhesion and cell signalling. Finally, APC involvement in microtubule-dependent locomotion may explain some changes in cell movement which are observed in adenomas. The establishment of murine mutants and of normal and malignant intestinal cell cultures have allowed to assess biochemical and physiological properties of APC and its putative role in the genesis of colorectal carcinogenesis. Moreover, these experimental models have suggested a variety of possible therapeutic approaches.

Lipoblastoma is a rare type of benign tumor occurring in infants. We report a case of mesenteric lipoblastoma with histologic, electron microscopic and cytogenetic studies. The microscopic features of this tumor including lipoblastic proliferation and prominent immature capillary beds were typical of lipoblastoma. Cytogenetic study showed a karyotype 46,XX, inv (8) (p 21.1; q 24.2). We discuss the usefulness of cytogenetic study associated to fluorescent in situ hybridization, in the diagnosis of the lipoblastic tumors, i.e. myoxoid liposarcoma and lipoblastoma.

The ERBB2 (HER-2/neu) protooncogene encodes a transmembrane protein with an intracellular tyrosine kinase activity. It is principally activated by gene amplification and its product, the erbB2 protein, becomes oncogenic when overexpressed. Quantitative PCR is both a simple and reliable method for the evaluation of ERBB2 activation, whereas immunoenzymatic methods allow quantitative determination of erbB2 protein in tissue and sera. ERBB2 amplification and/or surexpression is actually recognized as a prognostic factor in breast cancer and would be predictive in the therapeutic response. It might lead also to new therapeutic modalities using specific targeted drugs.

Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal dominant inherited disorder characterized by tumors of the parathyroids, endocrine pancreas, anterior pituitary, thymic, bronchic and digestive neuro-endocrine tissues and adrenal glands. The MEN1 gene has been recently cloned by two independent groups. The function of the protein encoded by the MEN1 gene is unknown until now. Germline mutations associated to the diseases in MEN1 families are distributed throughout all the open reading frame, suggesting the absence of founder effect. No consistent genotype-phenotype correlations have been yet recognized. Further studies on the functional domains of the MEN1 encoded protein could be useful to relate clinical expression of the disease with each type of mutation.

Bladder cancers display different forms from superficial to aggressive tumours with muscle invasion. Many studies on this disease have been carried out in order to better understand the molecular mechanisms involved in its progression. Two loci are frequently associated with bladder tumorigenesis. The chromosome 9 lesions seem to be earlier involved in carcinogenesis, and suggest the presence of a tumour suppressor gene, and on the other hand the TP53 gene mutations (17q13.1) are later but take place in tumour progression. These alterations could be used as early diagnosis tool in bladder tumours and orientate the search for the bladder cancer gatekeeper gene(s).

ACTH-secreting non-pituitary tumors are a rare cause of Cushing's disease. We report the clinical course, prognostic aspects and molecular analysis data in three patients for whom the diagnosis was confirmed but who had variable clinical features and laboratory results.

Ataxia-telangiectasia is a rare recessive disorder which, among other clinical signs, is characterized by an extreme sensitivity to ionising radiation. Cells isolated from AT patients show radioresistant DNA synthesis and this has lead to the hypothesis that the product of the genetic determinant of AT may play a role in the detection, signalling or repair of double stranded DNA breaks. The gene to AT, called ATM has been recently cloned and characterized. It codes for a large RNA transcript of 13,000 bp of which a 3,500 aa protein is translated. The gene itself covers 150 kb, spread over 64 exons. The amino acid sequence has revealed the existence, at the carboxyterminal end of the protein, of a domain presenting homology to PI-3 kinase. This characteristic has allowed the description of a new family of nuclear protein, in yeast, drosophila an human, functionally involved in DNA damage signalling. It is interesting to note that a vast majority of mutations described in AT patients lead to the truncation of the protein and consequently to the elimination of the PI-3K domain, thus suggesting an important role in the normal function of the protein. An important question linked to AT mutation concerns the cancer risk associated to heterozygous mutations. It is well established that AT patients, homozygous for the mutation, present a 100-200 fold increased risk of cancer. Epidemiological studies have described a 3-5 fold increase risk of cancer (particular breast cancer in women) associated to the heterozygous mutation. Knowing that the incidence of the heterozygotes can be estimated to range 0.5 to 1% in the general population this question is of great importance in terms of public health.