Genetic mechanisms of neoplasia in MEN 2.

Several possible mechanisms for the initiation and progression of tumors in multiple endocrine neoplasia type 2 (MEN 2) merit consideration. Localization of MEN2A to the pericentromeric area of chromosome 10 indicates the site of the initial mutagenic event but does not explain the tissue specificity observed. The consistency of tissue involvement within families, despite the variability between families, suggests that the tumors result from separate but contiguous tissue-specific genes arranged in a particular linear order. Linkage studies in MEN 2A and 2B families are compatible with this contiguous gene theory. Data suggest that Knudson's two-mutational-event theory is applicable in MEN 2, with cellular hyperplasia resulting from the initial heritable mutation. The second event could be a homozygous allelic mutation, but the lack of consistent loss of heterozygosity of chromosome 10 markers in tumors suggests other mechanisms. Observations in MEN 2 may be explained by the heritable chromosome 10 mutation causing hyperplasia, with the hyperplastic cells being converted to cancer cells by second mutations at any of many possible sites. Tumor progression probably involves subsequent events at other loci. These hypotheses may have important clinical implications.