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Investigation of the Birt–Hogg–Dubé tumour suppressor gene (FLCN) in familial and sporadic colorectal cancer
  1. Michael S Nahorski1,
  2. Derek H K Lim1,2,
  3. Lynn Martin1,
  4. Johan J P Gille3,
  5. Kirsten McKay2,
  6. Pauline K Rehal2,
  7. H Martijn Ploeger3,
  8. Maurice van Steensel4,
  9. Ian P Tomlinson5,
  10. Farida Latif1,
  11. Fred H Menko3,
  12. Eamonn R Maher1,2
  1. 1Department of Medical & Molecular Genetics, School of Clinical and Experimental Medicine, University of Birmingham College of Medical and Dental Sciences, Edgbaston, Birmingham, UK
  2. 2West Midlands Regional Genetics Service, Birmingham Women's Hospital, Edgbaston, Birmingham, UK
  3. 3Department of Clinical Genetics, VU University Medical Centre, Amsterdam, The Netherlands
  4. 4Department of Dermatology, Maastricht University Medical Centre and GROW school for oncology and developmental biology, University of Maastricht, Maastricht, The Netherlands
  5. 5The Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
  1. Correspondence to Professor Eamonn R Maher, Department of Medical & Molecular Genetics, School of Clinical and Experimental Medicine, University of Birmingham College of Medical and Dental Sciences, Edgbaston, Birmingham B15 2TT, UK; e.r.maher{at}


Background Birt–Hogg–Dubé (BHD) syndrome is an autosomal dominant multisystem disorder with skin (fibrofolliculomas or trichodiscomas), lung (cysts and pneumothorax) and kidney (renal cell carcinoma) tumours. Although colorectal neoplasia was reported initially to be part of the BHD phenotype, some recent studies have not confirmed this association.

Methods A series of clinical and laboratory studies was undertaken to investigate possible relationships between colorectal neoplasia and the BHD gene (FLCN). The studies investigated whether individuals with familial colorectal cancer of unknown cause might have unsuspected germline FLCN mutations, looked for somatic FLCN C8 tract mutations in microsatellite unstable sporadic colorectal cancers, and assessed the risk of colorectal neoplasia and possible genotype–phenotype correlations in BHD patients.

Results Although it was found previously that germline FLCN mutations can be detected in ∼5% of patients with familial renal cell carcinoma, germline FLCN mutations were not detected in 50 patients with familial non-syndromic colorectal cancer. Analysis of genotype-phenotype correlations for two recurrent FLCN mutations identified in a subset of 51 families with BHD demonstrated a significantly higher risk of colorectal neoplasia in c.1285dupC mutation (within the exon 11 C8 mononucleotide tract) carriers than in c.610delGCinsTA mutation carriers (χ2=5.78, p=0.016). Somatic frameshift mutations in the FLCN exon 11 C8 mononucleotide tract were detected in 23% of sporadic colorectal cancers with microsatellite instability, suggesting that FLCN inactivation might contribute to colorectal tumourigenesis.

Conclusions These findings suggest that the previously reported clinical heterogeneity for colorectal neoplasia may reflect allelic heterogeneity and the risk of colorectal neoplasia in BHD syndrome requires further investigation.

  • Gastroenterology
  • clinical genetics
  • cancer: colon

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  • Funding The Myrovlytis Trust, First floor, 26 Cadogan Square London SW1X 0JP UK.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the South Birmingham REC.

  • Provenance and peer review Not commissioned; externally peer reviewed.