Downloaded from molecularcasestudies.cshlp.org on October 6, 2021 - Published by Cold Spring Harbor Laboratory Press Germline POLE mutation in a child with hypermutated medulloblastoma and features of constitutional mismatch repair deficiency Holly Lindsay1,2, Sarah Scollon1,2, Jacquelyn Reuther3, Horatiu Voicu3, Surya P. Rednam1,2, Frank Y. Lin1,2, Kevin E. Fisher3, Murali Chintagumpala1,2, Adekunle M. Adesina1,3, D. Will Parsons1-4, Sharon E. Plon1-4, Angshumoy Roy1,3 1Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston, Texas 77030, USA; 2Texas Children’s Cancer Center, Texas Children’s Hospital, Houston, Texas 77030, USA; 3Department of Pathology & Immunology, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas 77030, USA; 4Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA Corresponding author: Angshumoy Roy, MD, PhD Assistant Professor of Pathology & Immunology and Pediatrics Baylor College of Medicine 1102 Bates Avenue, FT 830 Houston, TX 77030 832-824-0901 – Work 832-825-0132 – Fax
[email protected] Running title: Germline POLE mutation in a patient with CMMRD 1 Downloaded from molecularcasestudies.cshlp.org on October 6, 2021 - Published by Cold Spring Harbor Laboratory Press ABSTRACT Ultra-hypermutation (>100 mutations/Mb) is rare in childhood cancer genomes and has been primarily reported in patients with constitutional mismatch repair deficiency (CMMRD) caused by biallelic germline mismatch repair (MMR) gene mutations. We report a 5-year-old child with classic clinical features of CMMRD and an ultra- hypermutated medulloblastoma with retained MMR protein expression and absence of germline MMR mutations. Mutational signature analysis of tumor panel sequencing data revealed a canonical DNA polymerase-deficiency-associated signature, prompting further genetic testing that uncovered a germline POLE p.A456P missense variant, which has previously been reported as a recurrent somatic driver mutation in cancers.