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Test ID LRCCZ Hereditary Leiomyomatosis and Renal Cell Cancer Syndrome, FH, Full Gene Analysis, Varies


Ordering Guidance


For a comprehensive hereditary cancer panel that includes the FH gene, consider ordering 1 of the following tests:

-ENDCP / Hereditary Endocrine Cancer Panel, Varies

-HPGLP / Hereditary Paraganglioma/Pheochromocytoma Panel, Varies

-RENCP / Hereditary Renal Cancer Panel, Varies

 

Testing for the FH gene as part of a customized panel is available. For more information see CGPH / Custom Gene Panel, Hereditary, Next-Generation Sequencing, Varies.

 

Targeted testing for familial variants (also called site-specific or known mutations testing) is available for this gene. For more information see FMTT / Familial Mutation, Targeted Testing, Varies. To obtain more information about this testing option, call 800-533-1710.

 

If the reason for testing indicates familial hypercholesterolemia, order FHRGP / Familial Hypercholesterolemia and Related Disorders Multi-Gene Panel, Next-Generation Sequencing, Varies. If this test is ordered for familial hypercholesterolemia, LRCCZ will be canceled, and client will be notified and given the opportunity to order FHRGP as the appropriate test.



Shipping Instructions


Specimen preferred to arrive within 96 hours of collection.



Specimen Required


Patient Preparation: A previous bone marrow transplant from an allogenic donor will interfere with testing. Call 800-533-1710 for instructions for testing patients who have received a bone marrow transplant.

Specimen Type: Whole blood

Container/Tube:

Preferred: Lavender top (EDTA) or yellow top (ACD)

Acceptable: Any anticoagulant

Specimen Volume: 3 mL

Collection Instructions:

1. Invert several times to mix blood.

2. Send whole blood specimen in original tube. Do not aliquot.

Specimen Stability Information: Ambient (preferred) 4 days/Refrigerated


Forms

1. New York Clients-Informed consent is required. Document on the request form or electronic order that a copy is on file. The following documents are available:

-Informed Consent for Genetic Testing (T576)

-Informed Consent for Genetic Testing (Spanish) (T826)

2. Molecular Genetics: Inherited Cancer Syndromes Patient Information Sheet (T519)

3. If not ordering electronically, complete, print, and send a Oncology Test Request (T729) with the specimen.

Useful For

Evaluating patients with a personal or family history suggestive of hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome or fumarate hydratase deficiency (FHD)

 

Establishing a diagnosis of HLRCC or FHD allowing for targeted surveillance based on associated risks

 

Identifying genetic variants associated with increased risk for HLRCC syndrome allowing for predictive testing of at-risk family members

Method Name

Sequence Capture and Targeted Next-Generation Sequencing followed by Polymerase Chain Reaction (PCR) and Sanger Sequencing

Reporting Name

FH Full Gene Analysis

Specimen Type

Varies

Specimen Minimum Volume

1 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Varies

Clinical Information

Germline variants in the FH gene are associated with autosomal dominant hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome and autosomal recessive fumarate hydratase deficiency (FHD).(1,2)

 

HLRCC is characterized by cutaneous and uterine leiomyomas and an increased risk for aggressive renal cell carcinoma. Other reported manifestations include pheochromocytoma and paraganglioma.(2)

 

FHD, also called fumaric aciduria, is a recessive inborn error of metabolism causing severe neonatal and infantile encephalopathy. Infants often present with poor feeding, hypotonia, and lethargy. It can be accompanied by dysmorphic facies, microcephaly, and brain malformations including bilateral polymicrogyria and absence of the corpus callosum.(1)

 

There are some reports of children born with FHD whose parents were suspected to have HLRCC, suggesting that individuals with HLRCC may be carriers for FHD.(1-3) The extent of overlap between FH variants causing HLRCC and FHD is not well established for certain alterations.(1-3)

 

Recommendations regarding cancer surveillance of children and adults with HLRCC were created at the International Second Symposium on Hereditary Leiomyomatosis and Renal Cell Cancer in 2013.(2,4)

Reference Values

An interpretive report will be provided.

Interpretation

All detected variants are evaluated according to American College of Medical Genetics and Genomics recommendations.(5) Variants are classified based on known, predicted, or possible pathogenicity and reported with interpretive comments detailing their potential or known significance.

Clinical Reference

1. Kamihara J, Schultz KA, Rana HQ: FH tumor predisposition syndrome. In: Adam MP, Everman DB, Mirzaa GM, et al, eds. GeneReviews. [Internet]. University of Washington, Seattle; 2006. Updated August 13, 2020. Accessed November 7 7, 2022. Available at: www.ncbi.nlm.nih.gov/books/NBK1252/

2. Coman D, Kranc KR, Christodoulou J: Fumarate hydratase deficiency. In: Adam MP, Everman DB, Mirzaa GM, et al, eds. GeneReviews. [Internet]. University of Washington, Seattle; 2006. Updated April 23, 2020. Accessed November 7, 2022. Available at: www.ncbi.nlm.nih.gov/books/NBK1506/

3. Zhang L, Walsh MF, Jairam S, et al: Fumarate hydratase FH c.1431_1433dupAAA (p.Lys477dup) variant is not associated with cancer including renal cell carcinoma. Hum Mutat. 2020 Jan;41(1):103-109. doi: 10.1002/humu.23900

4. Menko FH, Maher ER, Schmidt LS, et al: Hereditary leiomyomatosis and renal cell cancer (HLRCC): renal cancer risk, surveillance and treatment. Fam Cancer. 2014 Dec;13(4):637-644. doi: 10.1007/s10689-014-9735-2

5. Richards S, Aziz N, Bale S, et al: Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genet Med. 2015 May;17(5):405-424

Day(s) Performed

Varies

Report Available

21 days to 28 days

Test Classification

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

81405

LOINC Code Information

Test ID Test Order Name Order LOINC Value
LRCCZ FH Full Gene Analysis In Process

 

Result ID Test Result Name Result LOINC Value
614743 Test Description 62364-5
614744 Specimen 31208-2
614745 Source 31208-2
614746 Result Summary 50397-9
614747 Result 82939-0
614748 Interpretation 69047-9
614749 Resources 99622-3
614750 Additional Information 48767-8
614751 Method 85069-3
614752 Genes Analyzed 48018-6
614753 Disclaimer 62364-5
614754 Released By 18771-6