SciELO - Scientific Electronic Library Online

vol.118 número2Malignant phyllodes tumor in the right breast and invasive lobular carcinoma within fibroadenoma in the other: case reportMalignant melanoma with liver and spleen metastases: case report índice de autoresíndice de assuntospesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados



  • Inglês (pdf)
  • Artigo em XML
  • Como citar este artigo
  • SciELO Analytics
  • Curriculum ScienTI
  • Tradução automática


Links relacionados


Sao Paulo Medical Journal

versão impressa ISSN 1516-3180versão On-line ISSN 1806-9460

Sao Paulo Med. J. v.118 n.2 São Paulo mar. 2000 

Case Report

Ricardo Defavery
José Alexandre Rodrigues Lemos
Simone Kashima
José Eduardo Bernardes
Carlos Alberto Scridelli
Dimas Tadeu Covas
Luiz Gonzaga Tone


Analysis of the p53 gene by PCR-SSCP in ten cases of Wilms’ tumor
Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo and Fundação Hemocentro de Ribeirão Preto, Riberão Preto, Brazil




CONTEXT: Mutations of the p53 tumor suppressor gene are the most frequent alterations observed in human neoplasias affecting adults. In pediatric oncology, however, they have seldom been identified. Wilms’ tumor is a renal neoplasia commonly occurring in children and is associated with mutations of the WT1 gene. The correlation between Wilms’ tumor and alterations of the p53 gene has not been well established, with a low frequency of mutations having been reported in this type of tumor. Mutation may be associated with advanced stage disease and unfavorable histology.
OBJECTIVE: To screen for mutations of the p53 gene by the PCR-SSCP method and DNA sequencing in cases of Wilms’ tumor sug-gestive of mutation.
DESIGN: Case Report.
CASE REPORT: Evaluations of exons 5-9 of the p53 gene in DNA samples extracted by PCR-SSCP from 10 Wilms’ tumors in children at different stages, and DNA sequencing. Changes in SSCP analy-sis were observed in exon 8 in two samples. The probable muta-tions were not confirmed by DNA sequencing. The absence of point mutations in p53 gene observed in the 10 samples of Wilms’ tumor studied agrees with literature data, with DNA sequencing being of fundamental importance for the confirmation of possible mutations.
KEY WORDS: Wilms’ tumor. p53 gene. PCR-SSCP. Solid tumors.




The p53 tumor suppressor gene is located on the short arm of human chromosome 17 (17p13) and it codes for a nuclear phosphoprotein of 53 kDa. The func-tion of wild type p53 is the negative regulation of cell proliferation, with a transcription action that inhibits the G1 phase of the cell cycle in the presence of dam-aged DNA.1-3 p53 is the most intensely investigated gene in human cancer.2 Its mutations have been identified in 50% of adult neoplasias involving the colon, lung, esophagus, stomach, liver, breast, and uterine cervix.4 However, mutations of the p53 gene have been little observed in children.5,6

Wilms’ tumor is the renal neoplasia most fre-quently occurring in children, with an incidence of 1:10,000 children, especially among those younger than 6 years.7 Approximately 5 to 10% of children with Wilms’ tumor have bilateral involvement. Wilms’ tumor is asso-ciated with congenital abnormalities including genito-urinary malformations, sporadic aniridia, mental retar-dation, and hemihypertrophy.8

Mutations of the WT1 gene are associated with Wilms’ tumor.9 The correlation between p53 gene and Wilms’ tumor is not completely understood. There are few reports on mutations of this gene in this tumor type. A possible association with unfavorable prognosis and advanced stage of the disease has been reported.6,9,10

In the present study we investigated possible mu-tation in the regions of the 5-9 exons of the p53 gene in children with Wilms’ tumor by the polymerase chain re-action – single strand conformational polymorphism (PCR-SSCP). Samples that presented anomalous migration by PCR-SSCP analysis were submitted to automatic DNA sequencing to confirm possible mutations.



Tumor samples from 10 patients with a diagnosis of Wilms’ tumor were studied by PCR-SSCP to determine the presence of possible mutations due to genetic changes in the p53 gene. The patients were seen at the Pediatric Oncology Outpatient Clinic of the University Hospital, Faculty of Medicine of Ribeirão Preto, Univer-sity of São Paulo. The clinical and histological character-istics of the patients (7 girls and 3 boys) are presented in Table 1. Mean age at diagnosis was 4.1 years. Histology was favorable in 6 cases and unfavorable in 3. In one case of bilateral Wilms’ tumor the material was insuffi-cient for histopathological analysis. The tumor was stage I in 5 cases, stage III in 1, stage IV in 3, and stage V in 1. The classification of Wilms’ tumor was based on the cri-teria of the National Wilms’ Tumor Study.11 Tumor samples were obtained during surgery and DNA was ex-tracted by the phenol/chloroform method.12

The possible alterations of the p53 gene in the re-gions corresponding to exons 5-9 were evaluated by PCR-SSCP. Each of the five regions analyzed was amplified by PCR using a pair of corresponding primers 13 (Table 2). For PCR, each DNA sample (0.1 mg/ml) was added to a mixture containing 2.5 mM buffer solution (0.2 M Tris-HCI, 0.5 M KCl, pH 8,4); 10 mM dNTPs (dATP, dCTP, dGTP, dTTP); 1.5 mM Mg for exons 5, 6, 7 and 8; 2 mM Mg for exon; a pair of primers (10 mg/ml) corresponding to the exon under study, and taq polymerase (5 U/ml), to a final volume of 25 ml. All samples were submitted to the fol-lowing amplification conditions: 35 successive cycles of denaturation (1 minute at 94ºC for all exons), annealing (1.5 minutes at 61ºC for exons 5 and 8, 54ºC for exon 6, 58ºC for exon 7 and 53ºC for exon 9) and extension (1 minute at 72ºC for all exons).

For SSCP, the PCR products were diluted 1:10 in a solution containing 0.1% SDS and 10 mM EDTA, and an equal volume of dye with 20 mM EDTA, 95% formamide, 0.05% bromophenol blue and 0.05% xylene cyanol was added. Denaturation was then carried out at 96ºC for 10 minutes. A fraction of this solution was put into 6% non-denaturing polyacrylamide gel and submitted to elec-trophoresis under the following conditions: 8 W, 40 mA and 200 V for 2-4 hours at 4ºC. The gel was stained with silver nitrate, developed, photographed, and analyzed.

For DNA sequencing of the samples with probable mutations screened by PCR-SSCP, a 100 ml aliquot of each PCR product was used for DNA purification. The purified DNA products and the primers labeled with fluorescein 13 (Table 2) were submitted to the sequencing reaction us-ing the Thermo Sequenase kit (Amersham Pharmacia, Little Chalfont, Buckinghamshire, UK) according to the manufacturer’s instructions. Electrophoresis was then car-ried out using a 7% non-denaturing gel with an automatic ALF sequencer (Amersham Pharmacia Biotech, Uppsala, Sweden) at 1500 V, 25 mA and 60 W for 4-6 hours. The DNA sequences obtained for each sample were compared to the normal sequence of the p53 gene obtained from the Gene Bank, sequencing access number x54156.

The DNA samples from the 10 Wilms’ tumor speci-mens were submitted to screening by PCR-SSCP for pos-sible mutations of the p53 gene in the regions corre-sponding to exons 5-9.

Abnormal bands were revealed by SSCP in exon 8 in 2 samples. One was from a patient with bilateral in-volvement (case 1) (Figure 1) and the other from a pa-tient with favorable histology (case 3). The clinical out-come was good for all of these patients. The DNA se-quencing analyses of these 2 samples with altered mi-gration in exon 8 were normal. Thus, point mutation al-terations were not confirmed in the sequencing of DNA from the 2 samples.



n2a04f01.gif (109064 bytes)
Figure 1 - SSCP on exon 8. Numbers 1 and 3: Normal controls. Number 2: anomalous run (case 1).




In the present study we assessed the presence of possible mutations due to genetic alteration in the re-gions between exons 5 and 9 of the p53 gene in 10 cases of Wilms’ tumors affecting children. In 2 cases, altered electrophoretic migration was observed by SSCP but was not confirmed by DNA sequencing.

For the screening of samples with probable muta-tions of the p53 gene we used PCR-SSCP, a method with approximately 90% sensitivity and specificity for the de-tection of mutations confirmed by DNA sequencing in PCR products with 200 base pairs or less.14,15 Even though the coding region of the p53 gene consist of 10 exons (the first is non-coding), the analysis of mutations was performed in the region between exons 5 and 9. The rea-son for this is that more than 98% of the mutations of the p53 gene in human neoplasias are located in these exons.5 In addition, the region between exons 5 and 8 (codons 126 and 331 with 540 base pairs) contains DNA sequences that code for evolutionarily conserved do-mains considered to be functionally important.3

The false-positive results obtained here by SSCP in 2 cases agree with reports by other investigators who have studied the p53 gene in Wilms’ tumor, such as Waber et al.16 and Malkin et al.,9 demonstrating that DNA sequenc-ing is of fundamental importance in the determination of the existence of mutations in a given DNA segment.

According to several reports, the incidence of point mutations of the p53 gene in Wilms’ tumors is small.

Kusafuka et al.6 studied 13 cases of Wilms’ tumor and detected no mutation of the p53 gene. In a study of 38 cases of Wilms’ tumor, Waber et al.16 also did not detect any mutation of the p53 gene. Malkin et al.9 detected 2 cases with mutations out of a total of 21. One of the pa-tients had an advanced stage tumor with favorable his-tology and the other had focal anaplasia. Bardeesy et al.10 did not observe mutations of the p53 gene in 92 cases of Wilms’ tumor with favorable histology.

Based on these findings, the absence of detection of mutations observed in the present study agrees with current data, despite the small number of cases analyzed. We suggest that the number of Wilms’ tumor specimens to be evaluated should be increased in future studies, es-pecially those from patients with unfavorable histology and advanced stage disease, and that more comprehen-sive studies should be performed by analyzing the remain-ing coding exons of the p53 gene and their expression, in order to better determine any possible association be-tween alterations of p53 gene and Wilms’ tumor.



1. Fields S, Jang S. Presence of a potent transcription activating sequence in the p53 protein. Science 1990;249:1046-9.

2. Levine A, Momand J, Finlay C. The p53 tumor suppressor gene. Nature (Lond) 1991;351:453-6.

3. Vogelstein B, Kinzler K. p53 function and dysfunction. Cell 1992;70:523-6.

4. Chang F, Syrjanen S, Syrjanen K. Implications of the p53 tumor-suppressor gene in clinical oncology. J Clin Oncol 1995;13:1009-22.

5. Levine AJ. The p53 tumor suppressor gene. N Engl J Med 1992;326:1350-2.

6. Kusafuka T, Fuzukawa M, Oue T, Komoto Y, Yoneda A, Okada A. Mutation analysis of the p53 gene in childhood malignant solid tumors. J Pediat Surg 1997;32:1175-80.

7. Breslow N, Beckwith JB, Ciol M, Sharples K. Age distribution of Wilms’ tumor: report from the National Wilms’ Tumor Study. Cancer Res 1988;48:1653-7.

8. Clericuzio C. Clinical phenotypes and Wilms’ tumor. Med Pediat Oncol 1993;21:182-7.

9. Malkin D, Sexsmith E, Yeger H, Williams BRG, Coppes MJ. Mutations of the p53 tumor suppressor gene occur infrequently in Wilms’ tumor. Cancer Res 1994;54:2077-9.

10. Bardeesy N, Falkoff D, Petruzzi M, et al. Anaplastic Wilms’ tumor: a subtype displaying poor prognosis harbors p53 gene mutations. Nature Genet 1994;7:91-7.

11. D’Anglio GJ, Evans A, Breslow N, et al. Treatment of Wilms’ tumor: results of the third National Wilms’ Tumor Study. Cancer (Phila) 1989;64:349-60.

12. Sambrook J, Fritsch EF, Maniats T. Molecular Cloning: a laboratory manual. 2 nd ed. Cold Spring Harbor, NY: Cold Spring Harbor; 1989.

13. Hsiao M, Yu AA, Yeargin J, Ku D, Haas M. Nonhereditary p53 mutations in t-cell acute lymphoblastic leukemia are associated with relapse phase. Blood 1994;83:2922-30.

14. Hayashi K. PCR-SSCP. A simple and sensitive method for detection of mutations in the genomic DNA. PCR Meth Applications 1991;1:34-8.

15. Greenblatt M, Bennett WP, Hollstein M, Harris CC. Mutations in the p53 tumor suppressor gene: clues to cancer etiology and molecular pathogenesis. Cancer Res 1994;54:4855-78.

16. Waber PG, Chen J, Nisen PD. Infrequency of ras, p53, WT 11 or RB gene alterations in Wilms’ tumor. Cancer 1993;72:3732-8.




CONTEXTO: Mutações do gene supressor tumoral p53 são observadas como as mais freqüentes alterações em neoplasias humanas em adultos. Em oncologia pediátrica, entretanto, são pouco identificadas. O tumor de Wilms é uma neoplasia renal comum em crianças e associa-se com mutações do gene WT1. A correlação entre tumor de Wilms e alterações do gene p53 não está bem estabelecida, sendo baixa a freqüência tumoral, podendo haver associação com doença em estágio avançado e histologia desfavorável.
TIPO DE ESTUDO: Relato de caso.
RELATO DE CASO: Foi realizar uma triagem para mutações do gene p53 pelo método de PCR-SSCP e seqüenciamento de DNA nos casos sugestivos de mutação em tumor de Wilms. Avaliação do gene p53 nos exons 5-9 em amostras de DNA extraídos de 10 tumores de Wilms de crianças em diferentes estágios pelo método de PCR-SSCP e seqüenciamento de DNA. Alterações na análise do SSCP foram observadas em duas amostras no exon 8. As prováveis mutações não foram confirmadas pelo seqüenciamento de DNA. A ausência de mutações de ponto do gene p53 observada nas 10 amostras de tumor de Wilms estudadas está de acordo com a literatura, sendo o seqüenciamento de DNA fundamental para a confirmação de possíveis mutações.
Palavras-chave: Tumor de Wilms. Gene p53. PCR-SSCP. Tumores sólidos.




Ricardo Defavery, MD. Department of Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
José Alexandre Rodrigues Lemos, PhD. Laboratory of molecular Biology, Department of Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, University of São Paulo, Ribeirão Preto, Brazil.
Simone Kashima, PhD. Laboratory of molecular Biology, Fundação Hemocentro de Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
José Eduardo Bernardes, MD. Department of Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, University of São Paulo, Ribeirão Preto, Brazil.
Carlos Alberto Scridelli, MD. Assistant Physician, Department of Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, University of São Paulo, Ribeirão Preto, Brazil.
Dimas Tadeu Covas, MD. Director of Fundação Hemocentro de Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
Luiz Gonzaga Tone, MD. Department of Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, University of São Paulo, Ribeirão Preto, Brazil.

Sources of funding: Not declared
Conflict of interest: Not declared
Last received: 17 de August 1999
Accepted: 21 September 1999

Address for correspondence:
Luiz Gonzaga Tone
Departamento de Pediatria da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo
Av. Bandeirantes, 3900
Ribeirão Preto/SP - Brasil - CEP 14049-900
publishing information

Creative Commons License Todo o conteúdo deste periódico, exceto onde está identificado, está licenciado sob uma Licença Creative Commons