BRAF mutation is associated with DNA methylation in serrated polyps and cancers of the colorectum

Abstract

Background and aims: Mutations in BRAF have been linked with colorectal cancers (CRC) showing high level microsatellite instability (MSI-H). However, the distribution of BRAF mutations in MSI-H cancers remains to be clarified with respect to precursor lesions and the CpG island methylator phenotype (CIMP).

Methods: Forty three hyperplastic polyps (HP), nine mixed polyps (MP), five serrated adenomas (SA), 28 conventional adenomas (AD), 18 hereditary non-polyposis colorectal cancers (HNPCC), and 127 sporadic CRC (46 MSI-H and 81 non-MSI-H) were collected from patients undergoing colectomy for either CRC or hyperplastic polyposis. Twenty five of 57 serrated lesions were derived from four patients with hyperplastic polyposis. HP were further subdivided according to recently documented morphological criteria into 27 classical HP and 16 variant lesions described as "sessile serrated adenoma" (SSA). All tumours were screened for BRAF activating mutations.

Results: The BRAF mutation was more frequent in SSA (75%) and MP (89%) than in classical HP (19%), SA (20%), and AD (0%) (p<0.0001), and also in sporadic MSI-H cancers (76%) compared with HNPCC (0%) and sporadic non-MSI-H cancers (9%) (p<0.0001). The BRAF mutation was identified more often in CIMP-high serrated polyps (72%) and CIMP-high CRC (77%) than in CIMP-low (30%) and CIMP-negative (13%) polyps (p = 0.002) as well as CIMP-low (18%) and CIMP-negative (0%) CRC (p<0.0001).

Conclusions: The BRAF mutation was frequently seen in SSA and in sporadic MSI-H CRC, both of which were associated with DNA methylation. Sporadic MSI-H cancers may originate in SSA and not adenomas, and BRAF mutation and DNA methylation are early events in this "serrated" pathway.

Figure 1

Representative sequence showing the BRAF V599E (T1796A) mutation.

Figure 2

Haematoxylin and eosin stains of two hyperplastic polyps (HP) showing the atypical features described as sessile serrated adenoma (SSA) by Torlakovic et al and Goldstein et al. (A) Low power view of a variant HP in which there is a hypermucinous epithelium showing crypt dilatation and horizontal extension of crypts immediately above the muscularis mucosae. (B) Medium power magnification of a variant HP showing exaggerated serration, crypt dilatation, and crypt branching, but no definite evidence of dysplasia.

Figure 3

Histogram showing the frequency of the BRAF (V599E) mutation in hereditary non-polyposis colorectal cancer (HNPCC), sporadic high level microsatellite instability (MSI-H) cancer, and non-MSI-H cancers stratified according to CpG island methylator phenotype (CIMP) status. The percentage of BRAF mutation in each group of cancers is indicated and the frequency of the mutation is represented in black. Indicated are p values comparing CIMP-high, CIMP-low, and CIMP-negative cancers within sporadic MSI-H and non-MSI-H cases.