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Brief Report
April 24, 2019

Association of PDGFRB Mutations With Pediatric Myofibroma and Myofibromatosis

Author Affiliations
  • 1Experimental Medicine Unit, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
  • 2Department of Pathology, Princess Maxima Centre for Pediatric Oncology and University Medical Centre, Utrecht, Netherlands
  • 3Department of Pathology, Hôpital Necker-Enfants Malades, Assistance Publique–Hôpitaux de Paris, Paris, France
  • 4Department of Pathology, Institut de Pathologie et de Génétique, Gosselies, Belgium
  • 5Department of Pediatric Hematology and Oncology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
  • 6Department of Pediatrics, University of Maryland School of Medicine, Baltimore
  • 7Department of Pathology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
  • 8Human Molecular Genetics, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
  • 9Walloon Excellence in Lifesciences and Biotechnology, Wallonia, Belgium
  • 10Genetics of Autoimmune Disease and Cancer, de Duve Institute, Université catholique de Louvain, Brussels, Belgium
JAMA Dermatol. 2019;155(8):946-950. doi:10.1001/jamadermatol.2019.0114
Key Points

Questions  What is the frequency of PDGFRB mutations in sporadic solitary myofibroma and multifocal myofibromatosis, and what are the implications for clinical management?

Findings  In this international study of 69 patient samples, we identified activating PDGFRB mutations in children and infants but not adults, and the presence of mutations was strongly associated with multicentric disease. Most PDGFRB mutations were sensitive to the tyrosine kinase inhibitor imatinib, suggesting that they were attractive therapeutic targets.

Meaning  The findings suggest that the presence of PDGFRB activating mutations provides a molecular diagnostic test and a basis for targeted therapy of infantile myofibromatosis.

Abstract

Importance  Myofibroma is the most frequent fibrous tumor in children. Multicentric myofibroma (referred to as infantile myofibromatosis) is a life-threatening disease.

Objective  To determine the frequency, spectrum, and clinical implications of mutations in the PDGFRB receptor tyrosine kinase found in sporadic myofibroma and myofibromatosis.

Design, Setting, and Participants  In this retrospective study of 69 patients with sporadic myofibroma or myofibromatosis, 85 tumor samples were obtained and analyzed by targeted deep sequencing of PDGFRB. Mutations were confirmed by an alternative method of sequencing and were experimentally characterized to confirm gain of function and sensitivity to the tyrosine kinase inhibitor imatinib.

Main Outcomes and Measures  Frequency of gain-of-function PDGFRB mutations in sporadic myofibroma and myofibromatosis. Sensitivity to imatinib, as assessed experimentally.

Results  Of the 69 patients with tumor samples (mean [SD] age, 7.8 [12.7] years), 60 were children (87%; 29 girls [48%]) and 9 were adults (13%; 4 women [44%]). Gain-of-function PDGFRB mutations were found in samples from 25 children, with no mutation found in samples from adults. Mutations were particularly associated with severe multicentric disease (13 of 19 myofibromatosis cases [68%]). Although patients had no familial history, 3 of 25 mutations (12%) were likely to be germline, suggesting de novo heritable alterations. All of the PDGFRB mutations were associated with ligand-independent receptor activation, and all but one were sensitive to imatinib at clinically relevant concentrations.

Conclusions and Relevance  Gain-of-function mutations of PDGFRB in myofibromas may affect only children and be more frequent in the multicentric form of disease, albeit present in solitary pediatric myofibromas. These alterations may be sensitive to tyrosine kinase inhibitors. The PDGFRB sequencing appears to have a high value for diagnosis, prognosis, and therapy of soft-tissue tumors in children.

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