Concurrent germline and somatic pathogenic BAP1 variants in a patient with metastatic bladder cancer.

Germline pathogenic variants in the BRCA1-associated protein-1 () gene cause the BAP1 tumor predisposition syndrome (TPDS). BAP1 TPDS is associated with an increased risk of uveal and cutaneous melanoma, mesothelioma, renal cell carcinoma, and several other cancer subtypes. Here, we report a germline nonsense variant (c.850G>T, p.Glu284Ter) in a patient with bladder cancer and a strong family history of malignancy. Concurrently, we identified a somatic frameshift variant, and as expected, immunostaining validated the loss of BAP1 protein in patient-derived tumor specimens. Together, these data provide strong evidence of pathogenicity in this case. With the addition of bladder cancer to the tumor types reported with germline mutations, our understanding of the BAP1 TPDS continues to evolve, and may affect future screening and surveillance guidelines.