51
|
Role of MDH2 pathogenic variant in pheochromocytoma and paraganglioma patients. Genet Med 2018; 20:1652-1662. [PMID: 30008476 DOI: 10.1038/s41436-018-0068-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 05/07/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE MDH2 (malate dehydrogenase 2) has recently been proposed as a novel potential pheochromocytoma/paraganglioma (PPGL) susceptibility gene, but its role in the disease has not been addressed. This study aimed to determine the prevalence of MDH2 pathogenic variants among PPGL patients and determine the associated phenotype. METHODS Eight hundred thirty patients with PPGLs, negative for the main PPGL driver genes, were included in the study. Interpretation of variants of unknown significance (VUS) was performed using an algorithm based on 20 computational predictions, by implementing cell-based enzymatic and immunofluorescence assays, and/or by using a molecular dynamics simulation approach. RESULTS Five variants with potential involvement in pathogenicity were identified: three missense (p.Arg104Gly, p.Val160Met and p.Ala256Thr), one in-frame deletion (p.Lys314del), and a splice-site variant (c.429+1G>T). All were germline and those with available biochemical data, corresponded to noradrenergic PPGL. CONCLUSION This study suggests that MDH2 pathogenic variants may play a role in PPGL susceptibility and that they might be responsible for less than 1% of PPGLs in patients without pathogenic variants in other major PPGL driver genes, a prevalence similar to the one recently described for other PPGL genes. However, more epidemiological data are needed to recommend MDH2 testing in patients negative for other major PPGL genes.
Collapse
|
52
|
Tevosian SG, Ghayee HK. Pheochromocytoma/Paraganglioma: A Poster Child for Cancer Metabolism. J Clin Endocrinol Metab 2018; 103:1779-1789. [PMID: 29409060 DOI: 10.1210/jc.2017-01991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/26/2018] [Indexed: 12/26/2022]
Abstract
CONTEXT Pheochromocytomas (PCCs) are tumors that are derived from the chromaffin cells of the adrenal medulla. Extra-adrenal PCCs called paragangliomas (PGLs) are derived from the sympathetic and parasympathetic chain ganglia. PCCs secrete catecholamines, which cause hypertension and have adverse cardiovascular consequences as a result of catecholamine excess. PGLs may or may not produce catecholamines depending on their genetic type and anatomical location. The most worrisome aspect of these tumors is their ability to become aggressive and metastasize; there are no known cures for metastasized PGLs. METHODS Original articles and reviews indexed in PubMed were identified by querying with specific PCC/PGL- and Krebs cycle pathway-related terms. Additional references were selected through the in-depth analysis of the relevant publications. RESULTS We primarily discuss Krebs cycle mutations that can be instrumental in helping investigators identify key biological pathways and molecules that may serve as biomarkers of or treatment targets for PCC/PGL. CONCLUSION The mainstay of treatment of patients with PCC/PGLs is surgical. However, the tide may be turning with the discovery of new genes associated with PCC/PGLs that may shed light on oncometabolites used by these tumors.
Collapse
Affiliation(s)
- Sergei G Tevosian
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
| | - Hans K Ghayee
- Department of Medicine, Division of Endocrinology, University of Florida, Gainesville, Florida
- Malcom Randall VA Medical Center, Gainesville, Florida
| |
Collapse
|
53
|
Pang Y, Gupta G, Yang C, Wang H, Huynh TT, Abdullaev Z, Pack SD, Percy MJ, Lappin TRJ, Zhuang Z, Pacak K. A novel splicing site IRP1 somatic mutation in a patient with pheochromocytoma and JAK2 V617F positive polycythemia vera: a case report. BMC Cancer 2018. [PMID: 29534684 PMCID: PMC5850917 DOI: 10.1186/s12885-018-4127-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The role of the hypoxia signaling pathway in the pathogenesis of pheochromocytoma/paraganglioma (PPGL)-polycythemia syndrome has been elucidated. Novel somatic mutations in hypoxia-inducible factor type 2A (HIF2A) and germline mutations in prolyl hydroxylase type 1 and type 2 (PHD1 and PHD2) have been identified to cause upregulation of the hypoxia signaling pathway and its target genes including erythropoietin (EPO) and its receptor (EPOR). However, in a minority of patients presenting with this syndrome, the genetics and molecular pathogenesis remain unexplained. The aim of the present study was to uncover novel genetic causes of PPGL-polycythemia syndrome. Case presentation A female presented with a history of JAK2V617F positive PV, diagnosed in 2007, and right adrenal pheochromocytoma diagnosed and resected in 2011. Her polycythemia symptoms and hematocrit levels continued to worsen from 2007 to 2011, with an increased frequency of phlebotomies. Postoperatively, until early 2013, her hematocrit levels remained normalized. Following this, the hematocrit levels ranged between 46.4 and 48.9% [35–45%]. Tumor tissue from the patient was further tested for mutations in genes related to upregulation of the hypoxia signaling pathway including iron regulatory protein 1 (IRP1), which is a known regulator of HIF-2α mRNA translation. Functional studies were performed to investigate the consequences of these mutations, especially their effect on the HIF signaling pathway and EPO. Indel mutations (c.267-1_267delGGinsTA) were discovered at the exon 3 splicing site of IRP1. Minigene construct and splicing site analysis showed that the mutation led to a new splicing site and a frameshift mutation of IRP1, which caused a truncated protein. Fluorescence in situ hybridization analysis demonstrated heterozygous IRP1 deletions in tumor cells. Immunohistochemistry results confirmed the truncated IRP1 and overexpressed HIF-2α, EPO and EPOR in tumor cells. Conclusions This is the first report which provides direct molecular genetic evidence of association between a somatic IRP1 loss-of-function mutation and PHEO and secondary polycythemia. In patients diagnosed with PHEO/PGL and polycythemia with negative genetic testing for mutations in HIF2A, PHD1/2, and VHL, IRP1 should be considered as a candidate gene.
Collapse
Affiliation(s)
- Ying Pang
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Garima Gupta
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Chunzhang Yang
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892, USA
| | - Herui Wang
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892, USA
| | - Thanh-Truc Huynh
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Ziedulla Abdullaev
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD, 20892, USA
| | - Svetlana D Pack
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD, 20892, USA
| | - Melanie J Percy
- Department of Haematology, Belfast City Hospital, Belfast, Northern Ireland, BT9 7AB, UK
| | - Terence R J Lappin
- Centre for Cancer Research and Cell Biology, Queen's University, Belfast, Northern Ireland, BT9 7AB, UK
| | - Zhengping Zhuang
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892, USA
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA.
| |
Collapse
|
54
|
Kennel KB, Burmeister J, Schneider M, Taylor CT. The PHD1 oxygen sensor in health and disease. J Physiol 2018; 596:3899-3913. [PMID: 29435987 DOI: 10.1113/jp275327] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/31/2018] [Indexed: 12/13/2022] Open
Abstract
The hypoxia-inducible factor (HIF) co-ordinates the adaptive transcriptional response to hypoxia in metazoan cells. The hypoxic sensitivity of HIF is conferred by a family of oxygen-sensing enzymes termed HIF hydroxylases. This family consists of three prolyl hydroxylases (PHD1-3) and a single asparagine hydroxylase termed factor inhibiting HIF (FIH). It has recently become clear that HIF hydroxylases are functionally non-redundant and have discrete but overlapping physiological roles. Furthermore, altered abundance or activity of these enzymes is associated with a number of pathologies. Pharmacological HIF-hydroxylase inhibitors have recently proven to be both tolerated and therapeutically effective in patients. In this review, we focus on the physiology, pathophysiology and therapeutic potential of the PHD1 isoform, which has recently been implicated in diseases including inflammatory bowel disease, ischaemia and cancer.
Collapse
Affiliation(s)
- Kilian B Kennel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Julius Burmeister
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Cormac T Taylor
- UCD Conway Institute & School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| |
Collapse
|
55
|
Dias Pereira B, Nunes da Silva T, Bernardo AT, César R, Vara Luiz H, Pacak K, Mota-Vieira L. A Clinical Roadmap to Investigate the Genetic Basis of Pediatric Pheochromocytoma: Which Genes Should Physicians Think About? Int J Endocrinol 2018; 2018:8470642. [PMID: 29755524 PMCID: PMC5884154 DOI: 10.1155/2018/8470642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/18/2018] [Indexed: 01/06/2023] Open
Abstract
Pheochromocytoma is very rare at a pediatric age, and when it is present, the probability of a causative genetic mutation is high. Due to high costs of genetic surveys and an increasing number of genes associated with pheochromocytoma, a sequential genetic analysis driven by clinical and biochemical phenotypes is advised. The published literature regarding the genetic landscape of pediatric pheochromocytoma is scarce, which may hinder the establishment of genotype-phenotype correlations and the selection of appropriate genetic testing at this population. In the present review, we focus on the clinical phenotypes of pediatric patients with pheochromocytoma in an attempt to contribute to an optimized genetic testing in this clinical context. We describe epidemiological data on the prevalence of pheochromocytoma susceptibility genes, including new genes that are expanding the genetic etiology of this neuroendocrine tumor in pediatric patients. The clinical phenotypes associated with a higher pretest probability for hereditary pheochromocytoma are presented, focusing on differences between pediatric and adult patients. We also describe new syndromes, as well as rates of malignancy and multifocal disease associated with these syndromes and pheochromocytoma susceptibility genes published more recently. Finally, we discuss new tools for genetic screening of patients with pheochromocytoma, with an emphasis on its applicability in a pediatric population.
Collapse
Affiliation(s)
- Bernardo Dias Pereira
- Serviço de Endocrinologia e Nutrição, Hospital do Divino Espírito Santo de Ponta Delgada (EPER), Av. D. Manuel I, 9500-370 Ponta Delgada, Açores, Portugal
| | - Tiago Nunes da Silva
- Serviço de Endocrinologia e Diabetes, Hospital Garcia de Orta (EPE), Av. Torrado da Silva, 2851-951 Almada, Setúbal, Portugal
| | - Ana Teresa Bernardo
- Serviço de Cirurgia Geral, Hospital do Divino Espírito Santo de Ponta Delgada (EPER), Av. D. Manuel I, 9500-370 Ponta Delgada, Açores, Portugal
| | - Rui César
- Serviço de Endocrinologia e Nutrição, Hospital do Divino Espírito Santo de Ponta Delgada (EPER), Av. D. Manuel I, 9500-370 Ponta Delgada, Açores, Portugal
| | - Henrique Vara Luiz
- Serviço de Endocrinologia e Diabetes, Hospital Garcia de Orta (EPE), Av. Torrado da Silva, 2851-951 Almada, Setúbal, Portugal
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver NICHD, NIH, Building 10 CRC 1E-3140 10 Center Drive MSC-1109, Bethesda, MD 20892-1109, USA
| | - Luísa Mota-Vieira
- Unidade de Genética e Patologia Moleculares, Hospital do Divino Espírito Santo de Ponta Delgada (EPER), Av. D. Manuel I, 9500-370 Ponta Delgada, Açores, Portugal
- Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisbon, Lisbon, Portugal
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
| |
Collapse
|
56
|
Evenepoel L, van Nederveen FH, Oudijk L, Papathomas TG, Restuccia DF, Belt EJT, de Herder WW, Feelders RA, Franssen GJH, Hamoir M, Maiter D, Ghayee HK, Shay JW, Perren A, Timmers HJLM, van Eeden S, Vroonen L, Aydin S, Robledo M, Vikkula M, de Krijger RR, Dinjens WNM, Persu A, Korpershoek E. Expression of Contactin 4 Is Associated With Malignant Behavior in Pheochromocytomas and Paragangliomas. J Clin Endocrinol Metab 2018; 103:46-55. [PMID: 28938490 DOI: 10.1210/jc.2017-01314] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/14/2017] [Indexed: 02/06/2023]
Abstract
CONTEXT Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine, usually benign, tumors. Currently, the only reliable criterion of malignancy is the presence of metastases. OBJECTIVE The aim of this study was to identify genes associated with malignancy in PPGLs. DESIGN Transcriptomic profiling was performed on 40 benign and 11 malignant PPGLs. Genes showing a significantly different expression between benign and malignant PPGLs with a ratio ≥4 were confirmed and tested in an independent series by quantitative real-time polymerase chain reaction (qRT-PCR). Immunohistochemistry was performed for the validated genes on 109 benign and 32 malignant PPGLs. Functional assays were performed with hPheo1 cells. SETTING This study was conducted at the Department of Pathology of the Erasmus MC University Medical Center Rotterdam Human Molecular Genetics laboratory of the de Duve Institute, University of Louvain. PATIENTS PPGL samples from 179 patients, diagnosed between 1972 and 2015, were included. MAIN OUTCOME MEASURES Associations between gene expression and malignancy were tested using supervised clustering approaches. RESULTS Ten differentially expressed genes were selected based on messenger RNA (mRNA) expression array data. Contactin 4 (CNTN4) was overexpressed in malignant vs benign tumors [4.62-fold; false discovery rate (FDR), 0.001]. Overexpression at the mRNA level was confirmed using qRT-PCR (2.90-fold, P = 0.02; validation set: 4.26-fold, P = 0.005). Consistent findings were obtained in The Cancer Genome Atlas cohort (2.7-fold; FDR, 0.02). CNTN4 protein was more frequently expressed in malignant than in benign PPGLs by immunohistochemistry (58% vs 17%; P = 0.002). Survival after 7 days of culture under starvation conditions was significantly enhanced in hPheo1 cells transfected with CNTN4 complementary DNA. CONCLUSION CNTN4 expression is consistently associated with malignant behavior in PPGLs.
Collapse
Affiliation(s)
- Lucie Evenepoel
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
- Human Molecular Genetics, de Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | | | - Lindsey Oudijk
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Thomas G Papathomas
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
- Department of Histopathology, King's College Hospital, London, United Kingdom
| | - David F Restuccia
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Eric J T Belt
- Department of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Wouter W de Herder
- Internal Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Richard A Feelders
- Internal Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Gaston J H Franssen
- Department of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Marc Hamoir
- Otolaryngology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Dominique Maiter
- Endocrinology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Hans K Ghayee
- Department of Internal Medicine, Division of Endocrinology, University of Florida, Gainesville, Florida
| | - Jerry W Shay
- Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aurel Perren
- Clinical Pathology Division, University of Bern, Bern, Switzerland
| | - Henri J L M Timmers
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Susanne van Eeden
- Department of Pathology, Academic Medical Center, Amsterdam, Netherlands
| | - Laurent Vroonen
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, University of Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Selda Aydin
- Department of Pathology, Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre, Madrid, Spain
- Centre for Biomedical Network Research on Rare Diseases, Madrid, Spain
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Ronald R de Krijger
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
- Department of Pathology, Reinier de Graaf Hospital, Delft, Netherlands
| | - Winand N M Dinjens
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Alexandre Persu
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Esther Korpershoek
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| |
Collapse
|
57
|
Alrezk R, Suarez A, Tena I, Pacak K. Update of Pheochromocytoma Syndromes: Genetics, Biochemical Evaluation, and Imaging. Front Endocrinol (Lausanne) 2018; 9:515. [PMID: 30538672 PMCID: PMC6277481 DOI: 10.3389/fendo.2018.00515] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/16/2018] [Indexed: 12/12/2022] Open
Abstract
Pheochromocytomas and paragangliomas (PCCs/PGLs) are rare commonly benign neuroendocrine tumors that share pathology features and clinical behavior in many cases. While PCCs are chromaffin-derived tumors that arise within the adrenal medulla, PGLs are neural-crest-derived tumors that originate at the extraadrenal paraganglia. Pheochromocytoma-paraganglioma (PPGL) syndromes are rapidly evolving entities in endocrinology and oncology. Discoveries over the last decade have significantly improved our understanding of the disease. These include the finding of new hereditary forms of PPGL and their associated susceptibility genes. Additionally, the availability of new functional imaging tools and advances in targeted radionuclide therapy have improved diagnostic accuracy and provided us with new therapeutic options. In this review article, we present the most recent advances in this field and provide an update of the biochemical classification that further reflects our understanding of the disease.
Collapse
Affiliation(s)
- Rami Alrezk
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
- Cleveland Clinic, Adrenal Center, Endocrinology and Metabolism Institute, Cleveland, OH, United States
| | - Andres Suarez
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Isabel Tena
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
- Provincial Hospital, Castellon, Spain
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
- *Correspondence: Karel Pacak
| |
Collapse
|
58
|
Affiliation(s)
- Anthony J Gill
- Department of Anatomical Pathology; Royal North Shore Hospital; St Leonards NSW Australia
- Cancer Diagnosis and Pathology Research Group; Kolling Institute of Medical Research; Royal North Shore Hospital; St Leonards NSW Australia
- University of Sydney; Sydney NSW Australia
| |
Collapse
|
59
|
Crona J, Taïeb D, Pacak K. New Perspectives on Pheochromocytoma and Paraganglioma: Toward a Molecular Classification. Endocr Rev 2017; 38:489-515. [PMID: 28938417 PMCID: PMC5716829 DOI: 10.1210/er.2017-00062] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023]
Abstract
A molecular biology-based taxonomy has been proposed for pheochromocytoma and paraganglioma (PPGL). Data from the Cancer Genome Atlas revealed clinically relevant prognostic and predictive biomarkers and stratified PPGLs into three main clusters. Each subgroup has a distinct molecular-biochemical-imaging signature. Concurrently, new methods for biochemical analysis, functional imaging, and medical therapies have also become available. The research community now strives to match the cluster biomarkers with the best intervention. The concept of precision medicine has been long awaited and holds great promise for improved care. Here, we review the current and future PPGL classifications, with a focus on hereditary syndromes. We discuss the current strengths and shortcomings of precision medicine and suggest a condensed manual for diagnosis and treatment of both adult and pediatric patients with PPGL. Finally, we consider the future direction of this field, with a particular focus on how advanced molecular characterization of PPGL can improve a patient's outcome, including cures and, ultimately, disease prevention.
Collapse
Affiliation(s)
- Joakim Crona
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.,Department of Medical Sciences, Uppsala University, Sweden
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, European Center for Research in Medical Imaging, Aix Marseille Université, France
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
| |
Collapse
|
60
|
Taïeb D, Pacak K. New Insights into the Nuclear Imaging Phenotypes of Cluster 1 Pheochromocytoma and Paraganglioma. Trends Endocrinol Metab 2017; 28:807-817. [PMID: 28867159 PMCID: PMC5673583 DOI: 10.1016/j.tem.2017.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/05/2017] [Accepted: 08/07/2017] [Indexed: 12/11/2022]
Abstract
Pheochromocytomas and paragangliomas (PPGLs) belong to the family of neural crest cell-derived neoplasms. In up to 70% of cases they are associated with germline and somatic mutations in 15 well-characterized PPGL driver or fusion genes. PPGLs can be grouped into three main clusters, where cluster 1 includes PPGLs characterized by a pseudohypoxic signature. Although cluster 1 tumors share several common features, they exhibit unique behaviors. We present here unique insights into the imaging phenotypes of cluster 1 PPGLs based on glucose uptake, catecholamine metabolism, and somatostatin receptor expression. Recent data suggest that succinate is a major player in the imaging phenotype of succinate dehydrogenase-deficient PPGLs. This review emphasizes the emerging stromal cell-succinate interaction and highlights new perspectives in PPGL theranostics.
Collapse
Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, European Center for Research in Medical Imaging (CERIMED), Aix-Marseille University, Marseille, France.
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
61
|
Abstract
An absolute erythrocytosis is present when the red cell mass is greater than 125 % of the predicted value for sex and body mass. It can have a primary or secondary and congenital or acquired cause. New causes particularly congenital continue to be discovered and investigated. Investigation for the cause starts with repeat and confirmation of the raised hemoglobin and measurement of an erythropoietin level to indicate whether to pursue primary or secondary causes and then further investigations as appropriate. Management options include low dose aspirin and venesection. Specific management advice is available for certain specific clinical situations.
Collapse
Affiliation(s)
- Mary Frances McMullin
- Haematology, Belfast City Hospital, Queen's University Belfast, C Floor, Lisburn Road, Belfast, BT9 7AB, Ireland.
| |
Collapse
|
62
|
Pang Y, Yang C, Schovanek J, Wang H, Bullova P, Caisova V, Gupta G, Wolf KI, Semenza GL, Zhuang Z, Pacak K. Anthracyclines suppress pheochromocytoma cell characteristics, including metastasis, through inhibition of the hypoxia signaling pathway. Oncotarget 2017; 8:22313-22324. [PMID: 28423608 PMCID: PMC5410225 DOI: 10.18632/oncotarget.16224] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/03/2017] [Indexed: 01/08/2023] Open
Abstract
Pheochromocytomas (PHEOs) and paragangliomas (PGLs) are rare, neuroendocrine tumors derived from adrenal or extra-adrenal chromaffin cells, respectively. Metastases are discovered in 3-36% of patients at the time of diagnosis. Currently, only suboptimal treatment options exist. Therefore, new therapeutic compounds targeting metastatic PHEOs/PGLs are urgently needed. Here, we investigated if anthracyclines were able to suppress the progression of metastatic PHEO. We explored their effects on experimental mouse PHEO tumor cells using in vitro and in vivo models, and demonstrated that anthracyclines, particularly idarubicin (IDA), suppressed hypoxia signaling by preventing the binding of hypoxia-inducible factor 1 and 2 (HIF-1 and HIF-2) to the hypoxia response element (HRE) sites on DNA. This resulted in reduced transcriptional activation of HIF target genes, including erythropoietin (EPO), phosphoglycerate kinase 1 (PGK1), endothelin 1 (EDN1), glucose transporter 1 (GLUT1), lactate dehydrogenase A (LDHA), and vascular endothelial growth factor (VEGFA), which consequently inhibited the growth of metastatic PHEO. Additionally, IDA downregulated hypoxia signaling by interfering with the transcriptional activation of HIF1A and HIF2A. Furthermore, our animal model demonstrated the dose-dependent suppressive effect of IDA on metastatic PHEO growth in vivo. Our results indicate that anthracyclines are prospective candidates for inclusion in metastatic PHEO/PGL therapy, especially in patients with gene mutations involved in the hypoxia signaling pathway.
Collapse
Affiliation(s)
- Ying Pang
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Chunzhang Yang
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Jan Schovanek
- Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Herui Wang
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Petra Bullova
- Department of Molecular Medicine, Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Veronika Caisova
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Garima Gupta
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Katherine I Wolf
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Gregg L Semenza
- McKusick-Nathans Institute of Genetic Medicine and Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zhengping Zhuang
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
63
|
Toledo RA. New HIF2α inhibitors: potential implications as therapeutics for advanced pheochromocytomas and paragangliomas. Endocr Relat Cancer 2017; 24:C9-C19. [PMID: 28667082 DOI: 10.1530/erc-16-0479] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 06/23/2017] [Indexed: 12/21/2022]
Abstract
Two recent independent studies published in Nature show robust responses of clear cell renal cell carcinoma (ccRCC) cell lines, preclinical ccRCC xenograft models and, remarkably, a patient with progressive ccRCC despite receiving multiple lines of treatment, to the long-awaited, recently developed inhibitors of hypoxia-inducible factor 2-alpha (HIF2α). This commentary published in Endocrine-Related Cancer is based on the recognition of similar molecular drivers in ccRCC and the endocrine neoplasias pheochromocytomas and paragangliomas (PPGLs), ultimately leading to stabilization of HIFs. HIF-stabilizing mutations have been detected in the von Hippel-Lindau (VHL) gene, as well as in other genes, such as succinate dehydrogenase (SDHx), fumarate hydratase (FH) and transcription elongation factor B subunit 1 (TCEB1), as well as the gene that encodes HIF2α itself: EPAS1HIF2α Importantly, the recent discovery of EPAS1 mutations in PPGLs and the results of comprehensive in vitro and in vivo studies revealing their oncogenic roles characterized a hitherto unknown direct mechanism of HIF2α activation in human cancer. The now available therapeutic opportunity to successfully inhibit HIF2α pharmacologically with PT2385 and PT2399 will certainly spearhead a series of investigations in several types of cancers, including patients with SDHB-related metastatic PPGL for whom limited therapeutic options are currently available. Future studies will determine the efficacy of these promising drugs against the hotspot EPAS1 mutations affecting HIF2α amino acids 529-532 (in PPGLs) and amino acids 533-540 (in erythrocytosis type 4), as well as against HIF2α protein activated by VHL, SDHx and FH mutations in PPGL-derived chromatin cells.
Collapse
Affiliation(s)
- Rodrigo Almeida Toledo
- Division of Hematology and Medical OncologyDepartment of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas, USA
| |
Collapse
|
64
|
Ologun GO, Patel ZM, Adeboye A, Guduru M, Trostle D, Vandermeer T, Bertsch D. A Giant Adrenal Mass in a Super Obese Patient. Cureus 2017; 9:e1572. [PMID: 29057184 PMCID: PMC5642812 DOI: 10.7759/cureus.1572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Giant pheochromocytomas (Pheo) are rare entities requiring clinical suspicion coupled with strategic diagnostic evaluation to confirm the diagnosis. The majority of cases are discovered incidentally. The diagnosis consists of biochemical evaluation and imaging study to localize the mass. Pathological examination confirms the diagnosis. The female patient in this case report presented with chest pain, palpitation of three weeks duration and was found on evaluation to have an abdominal mass concerning for pheochromocytoma. She was treated with surgical resection. The pheo measured 20.5 x 18 x 10 cm and weighed 2,582 grams. Pathological examination confirmed the diagnosis of pheochromocytoma.
Collapse
Affiliation(s)
| | | | | | | | | | | | - David Bertsch
- Surgical Oncology, Guthrie Clinic/Robert Packer Hospital
| |
Collapse
|
65
|
Fliedner SMJ, Shankavaram U, Marzouca G, Elkahloun A, Jochmanova I, Daerr R, Linehan WM, Timmers H, Tischler AS, Papaspyrou K, Brieger J, de Krijger R, Breza J, Eisenhofer G, Zhuang Z, Lehnert H, Pacak K. Hypoxia-Inducible Factor 2α Mutation-Related Paragangliomas Classify as Discrete Pseudohypoxic Subcluster. Neoplasia 2017; 18:567-76. [PMID: 27659016 PMCID: PMC5031903 DOI: 10.1016/j.neo.2016.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/22/2016] [Accepted: 07/25/2016] [Indexed: 01/06/2023] Open
Abstract
Recently, activating mutations of the hypoxia-inducible factor 2α gene (HIF2A/EPAS1) have been recognized to predispose to multiple paragangliomas (PGLs) and duodenal somatostatinomas associated with polycythemia, and ocular abnormalities. Previously, mutations in the SDHA/B/C/D, SDHAF2, VHL, FH, PHD1, and PHD2 genes have been associated with HIF activation and the development of pseudohypoxic (cluster-1) PGLs. These tumors overlap in terms of tumor location, syndromic presentation, and noradrenergic phenotype to a certain extent. However, they also differ especially by clinical outcome and by presence of other tumors or abnormalities. In the present study, we aimed to establish additional molecular differences between HIF2A and non-HIF2A pseudohypoxic PGLs. RNA expression patterns of HIF2A PGLs (n = 6) from 2 patients were compared with normal adrenal medullas (n = 8) and other hereditary pseudohypoxic PGLs (VHL: n = 13, SDHB: n = 15, and SDHD: n = 14). Unsupervised hierarchical clustering showed that HIF2A PGLs made up a separate cluster from other pseudohypoxic PGLs. Significance analysis of microarray yielded 875 differentially expressed genes between HIF2A and other pseudohypoxic PGLs after normalization to adrenal medulla (false discovery rate 0.01). Prediction analysis of microarray allowed correct classification of all HIF2A samples based on as little as three genes (TRHDE, LRRC63, IGSF10; error rate: 0.02). Genes with the highest expression difference between normal medulla and HIF2A PGLs were selected for confirmatory quantitative reverse transcriptase polymerase chain reaction. In conclusion, HIF2A PGLs show a characteristic expression signature that separates them from non-HIF2A pseudohypoxic PGLs. Unexpectedly, the most significantly differentially expressed genes have not been previously described as HIF target genes.
Collapse
Affiliation(s)
- Stephanie M J Fliedner
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; Section of Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
| | - Uma Shankavaram
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Geena Marzouca
- Section of Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Abdel Elkahloun
- Cancer Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ivana Jochmanova
- Section of Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA; 1st Department of Internal Medicine Medical Faculty of P. J. Šafárik University in Košice, Košice, Slovakia
| | - Roland Daerr
- Section of Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA; Institute of Clinical Chemistry & Laboratory Medicine and Department of Medicine III, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Henri Timmers
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Konstantinos Papaspyrou
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jürgen Brieger
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ronald de Krijger
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC-University Medical Center, Rotterdam, The Netherlands; Department of Pathology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Jan Breza
- Department of Urology, Comenius University, Bratislava, Slovak Republic
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry & Laboratory Medicine and Department of Medicine III, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Zhengping Zhuang
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Hendrik Lehnert
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Karel Pacak
- Section of Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
66
|
Remacha L, Comino-Méndez I, Richter S, Contreras L, Currás-Freixes M, Pita G, Letón R, Galarreta A, Torres-Pérez R, Honrado E, Jiménez S, Maestre L, Moran S, Esteller M, Satrústegui J, Eisenhofer G, Robledo M, Cascón A. Targeted Exome Sequencing of Krebs Cycle Genes Reveals Candidate Cancer-Predisposing Mutations in Pheochromocytomas and Paragangliomas. Clin Cancer Res 2017; 23:6315-6324. [PMID: 28720665 DOI: 10.1158/1078-0432.ccr-16-2250] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 05/22/2017] [Accepted: 07/12/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Mutations in Krebs cycle genes are frequently found in patients with pheochromocytomas/paragangliomas. Disruption of SDH, FH or MDH2 enzymatic activities lead to accumulation of specific metabolites, which give rise to epigenetic changes in the genome that cause a characteristic hypermethylated phenotype. Tumors showing this phenotype, but no alterations in the known predisposing genes, could harbor mutations in other Krebs cycle genes.Experimental Design: We used downregulation and methylation of RBP1, as a marker of a hypermethylation phenotype, to select eleven pheochromocytomas and paragangliomas for targeted exome sequencing of a panel of Krebs cycle-related genes. Methylation profiling, metabolite assessment and additional analyses were also performed in selected cases.Results: One of the 11 tumors was found to carry a known cancer-predisposing somatic mutation in IDH1 A variant in GOT2, c.357A>T, found in a patient with multiple tumors, was associated with higher tumor mRNA and protein expression levels, increased GOT2 enzymatic activity in lymphoblastic cells, and altered metabolite ratios both in tumors and in GOT2 knockdown HeLa cells transfected with the variant. Array methylation-based analysis uncovered a somatic epigenetic mutation in SDHC in a patient with multiple pheochromocytomas and a gastrointestinal stromal tumor. Finally, a truncating germline IDH3B mutation was found in a patient with a single paraganglioma showing an altered α-ketoglutarate/isocitrate ratio.Conclusions: This study further attests to the relevance of the Krebs cycle in the development of PCC and PGL, and points to a potential role of other metabolic enzymes involved in metabolite exchange between mitochondria and cytosol. Clin Cancer Res; 23(20); 6315-24. ©2017 AACR.
Collapse
Affiliation(s)
- Laura Remacha
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Iñaki Comino-Méndez
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Susan Richter
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Laura Contreras
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain.,Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa UAM-CSIC, Universidad Autónoma de Madrid and Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
| | - María Currás-Freixes
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Guillermo Pita
- Human Genotyping Unit-CeGen, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Rocío Letón
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Antonio Galarreta
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Rafael Torres-Pérez
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | | | - Scherezade Jiménez
- Monoclonal Antibodies Unit, Biotechnology Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Lorena Maestre
- Monoclonal Antibodies Unit, Biotechnology Program, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Sebastian Moran
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - Manel Esteller
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - Jorgina Satrústegui
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain.,Departamento de Biología Molecular, Centro de Biología Molecular Severo Ochoa UAM-CSIC, Universidad Autónoma de Madrid and Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Alberto Cascón
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| |
Collapse
|
67
|
Angelousi A, Dimitriadis GK, Zografos G, Nölting S, Kaltsas G, Grossman A. Molecular targeted therapies in adrenal, pituitary and parathyroid malignancies. Endocr Relat Cancer 2017; 24:R239-R259. [PMID: 28400402 DOI: 10.1530/erc-16-0542] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/10/2017] [Indexed: 12/15/2022]
Abstract
Tumourigenesis is a relatively common event in endocrine tissues. Currently, specific guidelines have been developed for common malignant endocrine tumours, which also incorporate advances in molecular targeted therapies (MTT), as in thyroid cancer and in gastrointestinal neuroendocrine malignancies. However, there is little information regarding the role and efficacy of MTT in the relatively rare malignant endocrine tumours mainly involving the adrenal medulla, adrenal cortex, pituitary, and parathyroid glands. Due to the rarity of these tumours and the lack of prospective studies, current guidelines are mostly based on retrospective data derived from surgical, locoregional and ablative therapies, and studies with systemic chemotherapy. In addition, in many of these malignancies the prognosis remains poor with individual patients responding differently to currently available treatments, necessitating the development of new personalised therapeutic strategies. Recently, major advances in the molecular understanding of endocrine tumours based on genomic, epigenomic, and transcriptome analysis have emerged, resulting in new insights into their pathogenesis and molecular pathology. This in turn has led to the use of novel MTTs in increasing numbers of patients. In this review, we aim to present currently existing and evolving data using MTT in the treatment of adrenal, pituitary and malignant parathyroid tumours, and explore the current utility and effectiveness of such therapies and their future evolution.
Collapse
Affiliation(s)
- Anna Angelousi
- Department of PathophysiologySector of Endocrinology, National & Kapodistrian University of Athens, Athens, Greece
| | - Georgios K Dimitriadis
- Division of Translational and Experimental MedicineUniversity of Warwick Medical School, Clinical Sciences Research Laboratories, Coventry, UK
| | - Georgios Zografos
- Third Department of SurgeryAthens General Hospital "Georgios Gennimatas", Athens, Greece
| | - Svenja Nölting
- Department of Internal Medicine IICampus Grosshadern, University-Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Gregory Kaltsas
- Department of PathophysiologySector of Endocrinology, National & Kapodistrian University of Athens, Athens, Greece
- Division of Translational and Experimental MedicineUniversity of Warwick Medical School, Clinical Sciences Research Laboratories, Coventry, UK
- Department of EndocrinologyOxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK
| | - Ashley Grossman
- Department of EndocrinologyOxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK
| |
Collapse
|
68
|
Toledo RA. Genetics of Pheochromocytomas and Paragangliomas: An Overview on the Recently Implicated Genes MERTK, MET, Fibroblast Growth Factor Receptor 1, and H3F3A. Endocrinol Metab Clin North Am 2017; 46:459-489. [PMID: 28476232 DOI: 10.1016/j.ecl.2017.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Genomic studies conducted by different centers have uncovered various new genes mutated in pheochromocytomas and paragangliomas (PPGLs) at germline, mosaic, and/or somatic levels, greatly expanding our knowledge of the genetic events occurring in these tumors. The current review focuses on very new findings and discusses the previously not recognized role of MERTK, MET, fibroblast growth factor receptor 1, and H3F3A genes in syndromic and nonsyndromic PPGLs. These 4 new genes were selected because although their association with PPGLs is very recent, mounting evidence was generated that rapidly consolidated the prominence of these genes in the molecular pathogenesis of PPGLs.
Collapse
Affiliation(s)
- Rodrigo Almeida Toledo
- Division of Hematology and Medical Oncology, Department of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio (UTHSCSA), 7703 Floyd Curl Dr, San Antonio, TX 78229, USA; Clinical Research Program, Spanish National Cancer Research Centre, CNIO, Calle de Melchor Fernández Almagro, 3, Madrid 28029, Spain.
| |
Collapse
|
69
|
Currás-Freixes M, Piñeiro-Yañez E, Montero-Conde C, Apellániz-Ruiz M, Calsina B, Mancikova V, Remacha L, Richter S, Ercolino T, Rogowski-Lehmann N, Deutschbein T, Calatayud M, Guadalix S, Álvarez-Escolá C, Lamas C, Aller J, Sastre-Marcos J, Lázaro C, Galofré JC, Patiño-García A, Meoro-Avilés A, Balmaña-Gelpi J, De Miguel-Novoa P, Balbín M, Matías-Guiu X, Letón R, Inglada-Pérez L, Torres-Pérez R, Roldán-Romero JM, Rodríguez-Antona C, Fliedner SMJ, Opocher G, Pacak K, Korpershoek E, de Krijger RR, Vroonen L, Mannelli M, Fassnacht M, Beuschlein F, Eisenhofer G, Cascón A, Al-Shahrour F, Robledo M. PheoSeq: A Targeted Next-Generation Sequencing Assay for Pheochromocytoma and Paraganglioma Diagnostics. J Mol Diagn 2017; 19:575-588. [PMID: 28552549 DOI: 10.1016/j.jmoldx.2017.04.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/07/2017] [Indexed: 12/26/2022] Open
Abstract
Genetic diagnosis is recommended for all pheochromocytoma and paraganglioma (PPGL) cases, as driver mutations are identified in approximately 80% of the cases. As the list of related genes expands, genetic diagnosis becomes more time-consuming, and targeted next-generation sequencing (NGS) has emerged as a cost-effective tool. This study aimed to optimize targeted NGS in PPGL genetic diagnostics. A workflow based on two customized targeted NGS assays was validated to study the 18 main PPGL genes in germline and frozen tumor DNA, with one of them specifically directed toward formalin-fixed paraffin-embedded tissue. The series involved 453 unrelated PPGL patients, of whom 30 had known mutations and were used as controls. Partial screening using Sanger had been performed in 275 patients. NGS results were complemented with the study of gross deletions. NGS assay showed a sensitivity ≥99.4%, regardless of DNA source. We identified 45 variants of unknown significance and 89 pathogenic mutations, the latter being germline in 29 (7.2%) and somatic in 58 (31.7%) of the 183 tumors studied. In 37 patients previously studied by Sanger sequencing, the causal mutation could be identified. We demonstrated that both assays are an efficient and accurate alternative to conventional sequencing. Their application facilitates the study of minor PPGL genes, and enables genetic diagnoses in patients with incongruent or missing clinical data, who would otherwise be missed.
Collapse
Affiliation(s)
- Maria Currás-Freixes
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Elena Piñeiro-Yañez
- Translational Bioinformatics Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - Cristina Montero-Conde
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - María Apellániz-Ruiz
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Bruna Calsina
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Veronika Mancikova
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Laura Remacha
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Susan Richter
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universitat Dresden, Dresden, Germany
| | - Tonino Ercolino
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence and Istituto Toscano Tumori, Florence, Italy
| | - Natalie Rogowski-Lehmann
- Department of Internal Medicine IV Campus Innenstadt, University-Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - María Calatayud
- Department of Endocrinology and Nutrition Service, University Hospital 12 de Octubre, Madrid, Spain
| | - Sonsoles Guadalix
- Department of Endocrinology and Nutrition Service, University Hospital 12 de Octubre, Madrid, Spain
| | | | - Cristina Lamas
- Department of Endocrinology, Albacete University Hospital Complex, Albacete, Spain
| | - Javier Aller
- Department of Endocrinology, University Hospital Puerta de Hierro, Madrid, Spain
| | - Julia Sastre-Marcos
- Department of Endocrinology, Virgen de la Salud Hospital-Toledo Hospital Complex, Toledo, Spain
| | - Conxi Lázaro
- Molecular Diagnostics Units of the Hereditary Cancer Program at the Catalan Institute of Oncology, Barcelona, Spain
| | - Juan C Galofré
- Department of Endocrinology, University of Navarra Clinic, Navarra, Spain
| | - Ana Patiño-García
- Department of Pediatrics and Clinical Genetics Unit, University of Navarra Clinic, Navarra, Spain
| | | | - Judith Balmaña-Gelpi
- High Risk and Cancer Prevention Group, Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Milagros Balbín
- Department of Molecular Oncology, Central University Hospital of Asturias and University Institute of Oncology of Asturias, University of Oviedo, Oviedo, Spain
| | - Xavier Matías-Guiu
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, IRBLLEIDA, Lleida, Spain; Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Rocío Letón
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Lucía Inglada-Pérez
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain; Biomedical Research Networking Center on Rare Diseases (CIBERER), Madrid, Spain
| | - Rafael Torres-Pérez
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Juan M Roldán-Romero
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Cristina Rodríguez-Antona
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain; Biomedical Research Networking Center on Rare Diseases (CIBERER), Madrid, Spain
| | - Stephanie M J Fliedner
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Giuseppe Opocher
- Department of Endocrinology, Department of Medical and Surgical Sciences University of Padova, Padova, Italy
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
| | - Esther Korpershoek
- Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ronald R de Krijger
- Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Pathology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Laurent Vroonen
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Massimo Mannelli
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence and Istituto Toscano Tumori, Florence, Italy
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Felix Beuschlein
- Department of Internal Medicine IV Campus Innenstadt, University-Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universitat Dresden, Dresden, Germany; Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Alberto Cascón
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain; Biomedical Research Networking Center on Rare Diseases (CIBERER), Madrid, Spain
| | - Fátima Al-Shahrour
- Translational Bioinformatics Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain; Biomedical Research Networking Center on Rare Diseases (CIBERER), Madrid, Spain.
| |
Collapse
|
70
|
Casey RT, Ascher DB, Rattenberry E, Izatt L, Andrews KA, Simpson HL, Challis B, Park S, Bulusu VR, Lalloo F, Pires DEV, West H, Clark GR, Smith PS, Whitworth J, Papathomas TG, Taniere P, Savisaar R, Hurst LD, Woodward ER, Maher ER. SDHA related tumorigenesis: a new case series and literature review for variant interpretation and pathogenicity. Mol Genet Genomic Med 2017; 5:237-250. [PMID: 28546994 PMCID: PMC5441402 DOI: 10.1002/mgg3.279] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/06/2017] [Accepted: 01/13/2017] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the role of germline SDHA mutation analysis by (1) comprehensive literature review, (2) description of novel germline SDHA mutations and (3) in silico structural prediction analysis of missense substitutions in SDHA. PATIENTS AND METHODS A systematic literature review and a retrospective review of the molecular and clinical features of patients identified with putative germline variants in UK molecular genetic laboratories was performed. To evaluate the molecular consequences of SDHA missense variants, a novel model of the SDHA/B/C/D complex was generated and the structural effects of missense substitutions identified in the literature, our UK novel cohort and a further 32 "control missense variants" were predicted by the mCSM computational platform. These structural predictions were correlated with the results of tumor studies and other bioinformatic predictions. RESULTS Literature review revealed reports of 17 different germline SDHA variants in 47 affected individuals from 45 kindreds. A further 10 different variants in 15 previously unreported cases (seven novel variants in eight patients) were added from our UK series. In silico structural prediction studies of 11 candidate missense germline mutations suggested that most (63.7%) would destabilize the SDHA protomer, and that most (78.1%) rare SDHA missense variants present in a control data set (ESP6500) were also associated with impaired protein stability. CONCLUSION The clinical spectrum of SDHA-associated neoplasia differs from that of germline mutations in other SDH-subunits. The interpretation of the significance of novel SDHA missense substitutions is challenging. We recommend that multiple investigations (e.g. tumor studies, metabolomic profiling) should be performed to aid classification of rare missense variants before genetic testing results are used to influence clinical management.
Collapse
Affiliation(s)
- Ruth T. Casey
- Department of Medical GeneticsUniversity of Cambridge and NIHR Cambridge Biomedical Research CentreCambridgeCB2 2QQUK
- Department of EndocrinologyUniversity of Cambridge and NIHR Cambridge Biomedical Research CentreAddenbrooke's HospitalCambridgeCB2 2QQUK
| | - David B. Ascher
- Department of BiochemistryUniversity of CambridgeSanger Building, 80 Tennis Court RoadCambridgeCB2 1GAUK
- Department of BiochemistryBio21 InstituteUniversity of MelbourneMelbourneVictoria3010Australia
| | - Eleanor Rattenberry
- West Midlands Region Genetics ServiceBirmingham Women's HospitalBirminghamUK
| | - Louise Izatt
- Department of Medical GeneticsGuy's HospitalLondonUK
| | - Katrina A. Andrews
- Department of Medical GeneticsUniversity of Cambridge and NIHR Cambridge Biomedical Research CentreCambridgeCB2 2QQUK
| | - Helen L. Simpson
- Department of EndocrinologyUniversity of Cambridge and NIHR Cambridge Biomedical Research CentreAddenbrooke's HospitalCambridgeCB2 2QQUK
| | - Benjamen Challis
- Department of EndocrinologyUniversity of Cambridge and NIHR Cambridge Biomedical Research CentreAddenbrooke's HospitalCambridgeCB2 2QQUK
| | - Soo‐Mi Park
- Department of Medical GeneticsUniversity of Cambridge and NIHR Cambridge Biomedical Research CentreCambridgeCB2 2QQUK
| | | | - Fiona Lalloo
- Manchester Centre for Genomic MedicineSt Mary's HospitalCentral Manchester University Hospitals NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - Douglas E. V. Pires
- Centro de Pesquisas René RachouFundação Oswaldo CruzBelo Horizonte30190‐002Brazil
| | - Hannah West
- Department of Medical GeneticsUniversity of Cambridge and NIHR Cambridge Biomedical Research CentreCambridgeCB2 2QQUK
| | - Graeme R. Clark
- Department of Medical GeneticsUniversity of Cambridge and NIHR Cambridge Biomedical Research CentreCambridgeCB2 2QQUK
| | - Philip S. Smith
- Department of Medical GeneticsUniversity of Cambridge and NIHR Cambridge Biomedical Research CentreCambridgeCB2 2QQUK
| | - James Whitworth
- Department of Medical GeneticsUniversity of Cambridge and NIHR Cambridge Biomedical Research CentreCambridgeCB2 2QQUK
| | | | - Phillipe Taniere
- Histopathology and Cellular PathologyUniversity Hospitals Birmingham NHS Foundation TrustQueen Elizabeth HospitalBirminghamUK
| | - Rosina Savisaar
- The Milner Centre for EvolutionDepartment of Biology and BiochemistryUniversity of BathBathBA2 7AYUK
| | - Laurence D. Hurst
- The Milner Centre for EvolutionDepartment of Biology and BiochemistryUniversity of BathBathBA2 7AYUK
| | - Emma R. Woodward
- West Midlands Region Genetics ServiceBirmingham Women's HospitalBirminghamUK
- Manchester Centre for Genomic MedicineSt Mary's HospitalCentral Manchester University Hospitals NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - Eamonn R. Maher
- Department of Medical GeneticsUniversity of Cambridge and NIHR Cambridge Biomedical Research CentreCambridgeCB2 2QQUK
| |
Collapse
|
71
|
Zhikrivetskaya SO, Snezhkina AV, Zaretsky AR, Alekseev BY, Pokrovsky AV, Golovyuk AL, Melnikova NV, Stepanov OA, Kalinin DV, Moskalev AA, Krasnov GS, Dmitriev AA, Kudryavtseva AV. Molecular markers of paragangliomas/pheochromocytomas. Oncotarget 2017; 8:25756-25782. [PMID: 28187001 PMCID: PMC5421967 DOI: 10.18632/oncotarget.15201] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/23/2017] [Indexed: 12/14/2022] Open
Abstract
Paragangliomas/pheochromocytomas comprise rare tumors that arise from the extra-adrenal paraganglia, with an incidence of about 2 to 8 per million people each year. Approximately 40% of cases are due to genetic mutations in at least one out of more than 30 causative genes. About 25-30% of pheochromocytomas/paragangliomas develop under the conditions of a hereditary tumor syndrome a third of which are caused by mutations in the VHL gene. Together, the gene mutations in this disorder have implicated multiple processes including signaling pathways, translation initiation, hypoxia regulation, protein synthesis, differentiation, survival, proliferation, and cell growth. The present review contemplates the mutations associated with the development of pheochromocytomas/paragangliomas and their potential to serve as specific markers of these tumors and their progression. These data will improve our understanding of the pathogenesis of these tumors and likely reveal certain features that may be useful for early diagnostics, malignancy prognostics, and the determination of new targets for disease therapeutics.
Collapse
Affiliation(s)
| | | | - Andrew R Zaretsky
- M.M. Shemyakin - Yu.A. Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Moscow, Russia
| | - Boris Y Alekseev
- National Medical Research Radiological Center, Ministry of Health of the Russian Federation, Moscow, Russia
| | | | | | - Nataliya V Melnikova
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Oleg A Stepanov
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
- National Medical Research Radiological Center, Ministry of Health of the Russian Federation, Moscow, Russia
| | | | - Alexey A Moskalev
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - George S Krasnov
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Alexey A Dmitriev
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Anna V Kudryavtseva
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
- National Medical Research Radiological Center, Ministry of Health of the Russian Federation, Moscow, Russia
| |
Collapse
|
72
|
Toledo RA, Burnichon N, Cascon A, Benn DE, Bayley JP, Welander J, Tops CM, Firth H, Dwight T, Ercolino T, Mannelli M, Opocher G, Clifton-Bligh R, Gimm O, Maher ER, Robledo M, Gimenez-Roqueplo AP, Dahia PLM. Consensus Statement on next-generation-sequencing-based diagnostic testing of hereditary phaeochromocytomas and paragangliomas. Nat Rev Endocrinol 2017; 13:233-247. [PMID: 27857127 DOI: 10.1038/nrendo.2016.185] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Phaeochromocytomas and paragangliomas (PPGLs) are neural-crest-derived tumours of the sympathetic or parasympathetic nervous system that are often inherited and are genetically heterogeneous. Genetic testing is recommended for patients with these tumours and for family members of patients with hereditary forms of PPGLs. Due to the large number of susceptibility genes implicated in the diagnosis of inherited PPGLs, next-generation sequencing (NGS) technology is ideally suited for carrying out genetic screening of these individuals. This Consensus Statement, formulated by a study group comprised of experts in the field, proposes specific recommendations for the use of diagnostic NGS in hereditary PPGLs. In brief, the study group recommends target gene panels for screening of germ line DNA, technical adaptations to address different modes of disease transmission, orthogonal validation of NGS findings, standardized classification of variant pathogenicity and uniform reporting of the findings. The use of supplementary assays, to aid in the interpretation of the results, and sequencing of tumour DNA, for identification of somatic mutations, is encouraged. In addition, the study group launches an initiative to develop a gene-centric curated database of PPGL variants, with annual re-evaluation of variants of unknown significance by an expert group for purposes of reclassification and clinical guidance.
Collapse
Affiliation(s)
| | - Rodrigo A Toledo
- Division of Hematology and Medical Oncology, Department of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio (UTHSCSA), 7703 Floyd Curl Drive, MC7880, San Antonio, Texas 78229, USA
- Spanish National Cancer Research Centre, CNIO, Calle de Melchor Fernández Almagro, 3, 28029, Madrid, Spain
| | - Nelly Burnichon
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, 20 Rue Leblanc, 75015 Paris, France
- INSERM, UMR970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75015, Paris, France
| | - Alberto Cascon
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO) and ISCIII Center for Biomedical Research on Rare Diseases (CIBERER), Calle de Melchor Fernández Almagro, 3, 28029, Madrid, Spain
| | - Diana E Benn
- Cancer Genetics Unit, Kolling Institute, Royal North Shore Hospital, St Leonards, University of Sydney, Reserve Road, St Leonards, Sydney, New South Wales 2065, Australia
| | - Jean-Pierre Bayley
- Department of Human Genetics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, Netherlands
| | - Jenny Welander
- Department of Clinical and Experimental Medicine, Linköping University, 58183 Linköping, Sweden
| | - Carli M Tops
- Department of Clinical Genetics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, Netherlands
| | - Helen Firth
- Department of Medical Genetics, University of Cambridge, Cambridge and NIHR Cambridge Biomedical Research Centre, Hills Road, Cambridge, CB2 0QQ, UK
| | - Trish Dwight
- Cancer Genetics Unit, Kolling Institute, Royal North Shore Hospital, St Leonards, University of Sydney, Reserve Road, St Leonards, Sydney, New South Wales 2065, Australia
| | - Tonino Ercolino
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale GB Morgagni 50, 50134, Florence, Italy
| | - Massimo Mannelli
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale GB Morgagni 50, 50134, Florence, Italy
| | - Giuseppe Opocher
- Familial Cancer Clinic, Veneto Institute of Oncology, IRCCS, Via Gattamelata, 64 Padova, Veneto 35128, Padova, Italy
| | - Roderick Clifton-Bligh
- Cancer Genetics Unit, Kolling Institute, Royal North Shore Hospital, St Leonards, University of Sydney, Reserve Road, St Leonards, Sydney, New South Wales 2065, Australia
| | - Oliver Gimm
- Department of Surgery, Region Östergötland, Linköping University, 581 83 Linköping, Sweden
| | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge, Cambridge and NIHR Cambridge Biomedical Research Centre, Hills Road, Cambridge, CB2 0QQ, UK
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO) and ISCIII Center for Biomedical Research on Rare Diseases (CIBERER), Calle de Melchor Fernández Almagro, 3, 28029, Madrid, Spain
| | - Anne-Paule Gimenez-Roqueplo
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, 20 Rue Leblanc, 75015 Paris, France
- INSERM, UMR970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75015, Paris, France
| | - Patricia L M Dahia
- Division of Hematology and Medical Oncology, Department of Medicine, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio (UTHSCSA), 7703 Floyd Curl Drive, MC7880, San Antonio, Texas 78229, USA
| |
Collapse
|
73
|
Janssen I, Chen CC, Zhuang Z, Millo CM, Wolf KI, Ling A, Lin FI, Adams KT, Herscovitch P, Feelders RA, Fojo AT, Taieb D, Kebebew E, Pacak K. Functional Imaging Signature of Patients Presenting with Polycythemia/Paraganglioma Syndromes. J Nucl Med 2017; 58:1236-1242. [PMID: 28336782 DOI: 10.2967/jnumed.116.187690] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/10/2017] [Indexed: 01/08/2023] Open
Abstract
Pheochromocytoma/paraganglioma (PPGL) syndromes associated with polycythemia have previously been described in association with mutations in the von Hippel-Lindau gene. Recently, mutations in the prolyl hydroxylase gene (PHD) 1 and 2 and in the hypoxia-inducible factor 2 α (HIF2A) were also found to be associated with multiple and recurrent PPGL. Such patients also presented with PPGL and polycythemia, and later on, some presented with duodenal somatostatinoma. In additional patients presenting with PPGL and polycythemia, no further mutations have been discovered. Because the functional imaging signature of patients with PPGL-polycythemia syndromes is still unknown, and because these tumors (in most patients) are multiple, recurrent, and metastatic, the goal of our study was to assess the optimal imaging approach using 4 different PET radiopharmaceuticals and CT/MRI in these patients. Methods: Fourteen patients (10 women, 4 men) with confirmed PPGL and polycythemia prospectively underwent 68Ga-DOTATATE (13 patients), 18F-FDG (13 patients), 18F-fluorodihydroxyphenylalanine (18F-FDOPA) (14 patients), 18F-fluorodopamine (18F-FDA) (11 patients), and CT/MRI (14 patients). Detection rates of PPGL lesions were compared between all imaging studies and stratified between the underlying mutations. Results:18F-FDOPA and 18F-FDA PET/CT showed similar combined lesion-based detection rates of 98.7% (95% confidence interval [CI], 92.7%-99.8%) and 98.3% (95% CI, 90.9%-99.7%), respectively. The detection rates for 68Ga-DOTATATE (35.3%; 95% CI, 25.0%-47.2%), 18F-FDG (42.3; 95% CI, 29.9%-55.8%), and CT/MRI (60.3%; 95% CI, 48.8%-70.7%) were significantly lower (P < 0.01), irrespective of the mutation status. Conclusion:18F-FDOPA and 18F-FDA are superior to 18F-FDG, 68Ga-DOTATATE, and CT/MRI and should be the radiopharmaceuticals of choice in this rare group of patients.
Collapse
Affiliation(s)
- Ingo Janssen
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.,Department of Radiology and Nuclear Medicine, Section of Nuclear Medicine, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Clara C Chen
- Nuclear Medicine Division, Radiology & Imaging Sciences, National Institutes of Health, Bethesda, Maryland
| | - Zhenping Zhuang
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Corina M Millo
- Positron Emission Tomography Department, National Institutes of Health, Bethesda, Maryland
| | - Katherine I Wolf
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Alexander Ling
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Frank I Lin
- Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Karen T Adams
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Peter Herscovitch
- Positron Emission Tomography Department, National Institutes of Health, Bethesda, Maryland
| | - Richard A Feelders
- Division of Endocrinology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Antonio T Fojo
- Endocrine Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - David Taieb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France; and
| | - Electron Kebebew
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
74
|
Abstract
The ability of cells to sense and adapt to changes in oxygen is mediated by hypoxia-inducible factor (HIF). Immune cells function in physiologically complex and varying environments whereby oxygen, pH, nutrients, metabolites and cytokines are continuously fluctuating. HIF is well known to play an important role in coordinating the adaptation and function of both innate immune cells and T cells in these complex environments. This review summarises recent discoveries concerning how hypoxia and HIF control B cell behaviour, and regulate antibody quality and decisions concerning tolerance. Hypoxia and HIF activation may provide an important context; coordinating metabolism with variable demands for quiescence, rapid proliferation, and differentiation. Understanding when and how HIF is activated during B cell development and response is important as drugs targeting HIF could influence antibody responses, providing novel therapeutic opportunities for vaccine adjuvants and in treating autoimmunity.
Collapse
Affiliation(s)
- Natalie Burrows
- School of Clinical Medicine, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0XY, United Kingdom.
| | - Patrick Henry Maxwell
- School of Clinical Medicine, Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0XY, United Kingdom.
| |
Collapse
|
75
|
Osinga TE, Links TP, Dullaart RPF, Pacak K, van der Horst-Schrivers ANA, Kerstens MN, Kema IP. Emerging role of dopamine in neovascularization of pheochromocytoma and paraganglioma. FASEB J 2017; 31:2226-2240. [PMID: 28264974 DOI: 10.1096/fj.201601131r] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/07/2017] [Indexed: 01/11/2023]
Abstract
Dopamine is a catecholamine that acts both as a neurotransmitter and as a hormone, exerting its functions via dopamine (DA) receptors that are present in a broad variety of organs and cells throughout the body. In the circulation, DA is primarily stored in and transported by blood platelets. Recently, the important contribution of DA in the regulation of angiogenesis has been recognized. In vitro and in vivo studies have shown that DA inhibits angiogenesis through activation of the DA receptor type 2. Overproduction of catecholamines is the biochemical hallmark of pheochromocytoma (PCC) and paraganglioma (PGL). The increased production of DA has been shown to be an independent predictor of malignancy in these tumors. The precise relationship underlying the association between DA production and PCC and PGL behavior needs further clarification. Herein, we review the biochemical and physiologic aspects of DA with a focus on its relations with VEGF and hypoxia inducible factor related angiogenesis pathways, with special emphasis on DA producing PCC and PGL.-Osinga, T. E., Links, T. P., Dullaart, R. P. F., Pacak, K., van der Horst-Schrivers, A. N. A., Kerstens, M. N., Kema, I. P. Emerging role of dopamine in neovascularization of pheochromocytoma and paraganglioma.
Collapse
Affiliation(s)
- Thamara E Osinga
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robin P F Dullaart
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karel Pacak
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Michiel N Kerstens
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ido P Kema
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
76
|
Liu Q, Wang Y, Tong D, Liu G, Yuan W, Zhang J, Ye J, Zhang Y, Yuan G, Feng Q, Zhang D, Jiang J. A Somatic HIF2α Mutation-Induced Multiple and Recurrent Pheochromocytoma/Paraganglioma with Polycythemia: Clinical Study with Literature Review. Endocr Pathol 2017; 28:75-82. [PMID: 28116635 DOI: 10.1007/s12022-017-9469-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A syndrome known as pheochromocytomas (PCC)/paragangliomas (PGL) and polycythemia resulted from gain-of-function mutation of hypoxia-inducible factor 2α (HIF2α) has been reported recently. However, clinical features of this syndrome vary from patient to patient. In our study, we described the clinical features of the patient within 15-year follow-up with a literature review. The patient presented with "red face" since childhood and was diagnosed with polycythemia and pheochromocytoma in 2000, and then, tumor was removed at his age of 27 (year 2000). However, 13 years later (2013), he was diagnosed with multiple paragangliomas. Moreover, 2 years later (2015), another two paragangaliomas were also confirmed. Genetic analysis of hereditary PCC/PGL-related genes was conducted. A somatic heterozygous missense mutation of HIF2α (c.1589C>T) was identified at exon 12, which is responsible for the elevated levels of HIF2α and erythropoietin (EPO) and subsequent development of paragangaliomas. However, this mutation was only found in the tumors from three different areas, not in the blood. So far, 13 cases of PCC/PGL with polycythemia have been reported. Among them, somatic mutations of HIF2α at exon 12 are responsible for 12 cases, and only 1 case was caused by germline mutation of HIF2α at exon 9. The HIF2α mutation-induced polycythemia with PCC/PGL is a rare syndrome with no treatment for cure. Comprehensive therapies for this disease include removal of the tumors and intermittent phlebotomies; administration of medications to control blood pressure and to prevent complications or death resulted from high concentration of red blood cell (RBC). Genetic test is strongly recommended for patients with early onset of polycythemia and multiple/recurrent PCC/PGL.
Collapse
Affiliation(s)
- Qiuli Liu
- Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, No. 10 Changjiangzhilu, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Yan Wang
- Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, No. 10 Changjiangzhilu, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Dali Tong
- Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, No. 10 Changjiangzhilu, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Gaolei Liu
- Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, No. 10 Changjiangzhilu, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Wenqiang Yuan
- Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, No. 10 Changjiangzhilu, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Jun Zhang
- Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, No. 10 Changjiangzhilu, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Jin Ye
- Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, No. 10 Changjiangzhilu, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Yao Zhang
- Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, No. 10 Changjiangzhilu, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Gang Yuan
- Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, No. 10 Changjiangzhilu, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Qingxing Feng
- Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, No. 10 Changjiangzhilu, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Dianzheng Zhang
- Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, 4170 City Ave., Philadelphia, PA, 19131, USA
| | - Jun Jiang
- Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, No. 10 Changjiangzhilu, Yuzhong District, Chongqing, 400042, People's Republic of China.
| |
Collapse
|
77
|
Därr R, Nambuba J, Del Rivero J, Janssen I, Merino M, Todorovic M, Balint B, Jochmanova I, Prchal JT, Lechan RM, Tischler AS, Popovic V, Miljic D, Adams KT, Prall FR, Ling A, Golomb MR, Ferguson M, Nilubol N, Chen CC, Chew E, Taïeb D, Stratakis CA, Fojo T, Yang C, Kebebew E, Zhuang Z, Pacak K. Novel insights into the polycythemia-paraganglioma-somatostatinoma syndrome. Endocr Relat Cancer 2016; 23:899-908. [PMID: 27679736 PMCID: PMC5096964 DOI: 10.1530/erc-16-0231] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 09/27/2016] [Indexed: 12/14/2022]
Abstract
Worldwide, the syndromes of paraganglioma (PGL), somatostatinoma (SOM) and early childhood polycythemia are described in only a few patients with somatic mutations in the hypoxia-inducible factor 2 alpha (HIF2A). This study provides detailed information about the clinical aspects and course of 7 patients with this syndrome and brings into perspective these experiences with the pertinent literature. Six females and one male presented at a median age of 28 years (range 11-46). Two were found to have HIF2A somatic mosaicism. No relatives were affected. All patients were diagnosed with polycythemia before age 8 and before PGL/SOM developed. PGLs were found at a median age of 17 years (range 8-38) and SOMs at 29 years (range 22-38). PGLs were multiple, recurrent and metastatic in 100, 100 and 29% of all cases, and SOMs in 40, 40 and 60%, respectively. All PGLs were primarily norepinephrine-producing. All patients had abnormal ophthalmologic findings and those with SOMs had gallbladder disease. Computed tomography (CT) and magnetic resonance imaging revealed cystic lesions at multiple sites and hemangiomas in 4 patients (57%), previously thought to be pathognomonic for von Hippel-Lindau disease. The most accurate radiopharmaceutical to detect PGL appeared to be [18F]-fluorodihydroxyphenylalanine ([18F]-FDOPA). Therefore, [18F]-FDOPA PET/CT, not [68Ga]-(DOTA)-[Tyr3]-octreotate ([68Ga]-DOTATATE) PET/CT is recommended for tumor localization and aftercare in this syndrome. The long-term prognosis of the syndrome is unknown. However, to date no deaths occurred after 6 years follow-up. Physicians should be aware of this unique syndrome and its diagnostic and therapeutic challenges.
Collapse
Affiliation(s)
- Roland Därr
- Section on Medical NeuroendocrinologyEunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Joan Nambuba
- Section on Medical NeuroendocrinologyEunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Jaydira Del Rivero
- Section on Medical NeuroendocrinologyEunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Ingo Janssen
- Section on Medical NeuroendocrinologyEunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Maria Merino
- Laboratory of PathologyNational Institutes of Health, Bethesda, Maryland, USA
| | - Milena Todorovic
- Institute of HematologyClinical Center of Serbia and Medical Faculty University of Belgrade, Belgrade, Serbia
| | - Bela Balint
- Institute of Transfusiology and Hemobiology of Military Medical Academy and Institute for Medical ResearchUniversity of Belgrade, Belgrade, Serbia
| | - Ivana Jochmanova
- Section on Medical NeuroendocrinologyEunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
- 1st Department of Internal MedicineFaculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| | - Josef T Prchal
- Division of HematologyUniversity of Utah, Salt Lake City, Utah, USA
| | - Ronald M Lechan
- Tupper Research Institute and Department of MedicineDivision of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USA
| | - Arthur S Tischler
- Department of Pathology and Laboratory MedicineTufts Medical Center, Boston, Massachusetts, USA
| | - Vera Popovic
- Institute of EndocrinologyClinical Center of Serbia, Medical Faculty, University Belgrade, Belgrade, Serbia
| | - Dragana Miljic
- Institute of EndocrinologyClinical Center of Serbia, Medical Faculty, University Belgrade, Belgrade, Serbia
| | - Karen T Adams
- Section on Medical NeuroendocrinologyEunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - F Ryan Prall
- Department of OphthalmologyEugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alexander Ling
- Department of Radiology and Imaging SciencesClinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Meredith R Golomb
- Division of Child NeurologyDepartment of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael Ferguson
- Riley Hospital for Children at Indiana University HealthIndianapolis, Indiana, USA
| | - Naris Nilubol
- Endocrine Oncology BranchNational Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Clara C Chen
- Division of Nuclear MedicineDepartment of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Emily Chew
- Division of Epidemiology and Clinical ApplicationsNational Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - David Taïeb
- Department of Nuclear MedicineLa Timone University Hospital & CERIMED & Inserm UMR1068 Marseille Cancerology Research Center, Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France
| | - Constantine A Stratakis
- Division of Intramural ResearchEunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Tito Fojo
- Medical Oncology BranchNational Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Chunzhang Yang
- Neuro-Oncology BranchCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Electron Kebebew
- Endocrine Oncology BranchNational Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Zhengping Zhuang
- Neuro-Oncology BranchCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Karel Pacak
- Section on Medical NeuroendocrinologyEunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
78
|
Björklund P, Pacak K, Crona J. Precision medicine in pheochromocytoma and paraganglioma: current and future concepts. J Intern Med 2016; 280:559-573. [PMID: 27165774 PMCID: PMC7441825 DOI: 10.1111/joim.12507] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pheochromocytoma and paraganglioma (PPGL) are rare diseases but are also amongst the most characterized tumour types. Hence, patients with PPGL have greatly benefited from precision medicine for more than two decades. According to current molecular biology and genetics-based taxonomy, PPGL can be divided into three different clusters characterized by: Krebs cycle reprogramming with oncometabolite accumulation or depletion (group 1a); activation of the (pseudo)hypoxia signalling pathway with increased tumour cell proliferation, invasiveness and migration (group 1b); and aberrant kinase signalling causing a pro-mitogenic and anti-apoptotic state (group 2). Categorization into these clusters is highly dependent on mutation subtypes. At least 12 different syndromes with distinct genetic causes, phenotypes and outcomes have been described. Genetic screening tests have a documented benefit, as different PPGL syndromes require specific approaches for optimal diagnosis and localization of various syndrome-related tumours. Genotype-tailored treatment options, follow-up and preventive care are being investigated. Future new developments in precision medicine for PPGL will mainly focus on further identification of driver mechanisms behind both disease initiation and malignant progression. Identification of novel druggable targets and prospective validation of treatment options are eagerly awaited. To achieve these goals, we predict that collaborative large-scale studies will be needed: Pheochromocytoma may provide an example for developing precision medicine in orphan diseases that could ultimately aid in similar efforts for other rare conditions.
Collapse
Affiliation(s)
- P Björklund
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - K Pacak
- Section on Medical Neuroendocrinology, Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - J Crona
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
79
|
Pandit R, Khadilkar K, Sarathi V, Kasaliwal R, Goroshi M, Khare S, Nair S, Raghavan V, Dalvi A, Hira P, Fernandes G, Sathe P, Rojekar A, Malhotra G, Bakshi G, Prakash G, Bhansali A, Walia R, Kamalanathan S, Sahoo J, Desai A, Bhagwat N, Mappa P, Rajput R, Chandrashekhar SR, Shivane V, Menon P, Lila A, Bandgar T, Shah N. Germline mutations and genotype-phenotype correlation in Asian Indian patients with pheochromocytoma and paraganglioma. Eur J Endocrinol 2016; 175:311-23. [PMID: 27539324 DOI: 10.1530/eje-16-0126] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/15/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Genetic aetiology of pheochromocytoma (PCC) and paraganglioma (PGL) is increasingly being studied; however, Asian Indian data on this aspect are scarce. OBJECTIVE To study the prevalence of germline mutations and genotype-phenotype correlation in Asian Indian PCC/PGL patients. DESIGN In this study, 150 index patients (M:F, 73:77) with PCC/PGL were evaluated. Phenotypic data were collected. Germline mutations in five susceptibility genes (RET, VHL, SDHB, SDHD and SDHC) were tested by sequencing and NF1 was diagnosed according to phenotype. RESULT Of the total population, 49 (32.7%) PCC/PGL patients had germline mutations (VHL: 23 (15.3%), RET: 13 (8.7%), SDHB: 9 (6%), SDHD: 2 (1.3%) and NF1: 2 (1.3%)). Amongst the 30 patients with familial and/or syndromic presentation, all had germline mutations (VHL: 14 (46.7%), RET: 13 (43.3%), SDHB: 1 (3.3%) and NF1: 2 (6.7%)). Out of 120 patients with apparently sporadic presentation, 19 (15.8%) had a germline mutation (VHL: 9 (7.5%), SDHB: 8 (6.7%) and SDHD: 2 (1.7%)). Mutation carriers were younger (29.9 ± 14.5 years vs 36.8 ± 14.9; P = 0.01) and had a higher prevalence of bilateral PCC (26.5% vs 2.9%, P < 0.001) and multifocal tumours (12.2% vs 0.96%, P = 0.06). Based on syndromic features, metastasis, location and number of tumours, around 96% mutations in our cohort could be detected by appropriately selected single gene testing. CONCLUSION Asian Indians with PCC/PGL differ from Western cohorts in having preponderance of VHL mutations in multifocal tumours and apparently sporadic unilateral PCC. Syndromic presentation, metastasis, location and number of PCC/PGL can be effectively used for guiding genetic prioritisation.
Collapse
Affiliation(s)
- Reshma Pandit
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Kranti Khadilkar
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Vijaya Sarathi
- Department of EndocrinologyVydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Rajeev Kasaliwal
- Department of EndocrinologyMahatma Gandhi Hospital and Medical College, Jaipur, Rajasthan, India
| | - Manjunath Goroshi
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Shruti Khare
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sandhya Nair
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Vijaya Raghavan
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | | | - Gwendolyn Fernandes
- PathologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Pragati Sathe
- PathologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Amey Rojekar
- PathologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Gaurav Malhotra
- Radiation Medicine CentreBhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Ganesh Bakshi
- Department of Uro-oncologyTata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gagan Prakash
- Department of Uro-oncologyTata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anil Bhansali
- Department of EndocrinologyPostgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Rama Walia
- Department of EndocrinologyPostgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sadishkumar Kamalanathan
- Department of EndocrinologyJawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Jayaprakash Sahoo
- Department of EndocrinologyJawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Ankush Desai
- Endocrine UnitDepartment of Medicine, Goa Medical College, Bambolim, Goa, India
| | - Nikhil Bhagwat
- Department of EndocrinologyTopiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Prashanth Mappa
- Department of MedicineKannur Medical College and Hospital, Kannur, Kerala, India
| | - Rajesh Rajput
- Department of EndocrinologyPt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Sudha Rao Chandrashekhar
- Division of Pediatric EndocrinologyBai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Vyankatesh Shivane
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Padma Menon
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Anurag Lila
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Tushar Bandgar
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nalini Shah
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
80
|
Roche O, Deguiz ML, Tiana M, Galiana-Ribote C, Martinez-Alcazar D, Rey-Serra C, Ranz-Ribeiro B, Casitas R, Galera R, Fernández-Navarro I, Sánchez-Cuéllar S, Bernard V, Ancochea J, Wasserman WW, García-Rio F, Jimenez B, Del Peso L. Identification of non-coding genetic variants in samples from hypoxemic respiratory disease patients that affect the transcriptional response to hypoxia. Nucleic Acids Res 2016; 44:9315-9330. [PMID: 27625398 PMCID: PMC5100585 DOI: 10.1093/nar/gkw811] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/02/2016] [Indexed: 12/11/2022] Open
Abstract
A wide range of diseases course with an unbalance between the consumption of oxygen by tissues and its supply. This situation triggers a transcriptional response, mediated by the hypoxia inducible factors (HIFs), that aims to restore oxygen homeostasis. Little is known about the inter-individual variation in this response and its role in the progression of disease. Herein, we sought to identify common genetic variants mapping to hypoxia response elements (HREs) and characterize their effect on transcription. To this end, we constructed a list of genome-wide HIF-binding regions from publicly available experimental datasets and studied the genetic variability in these regions by targeted re-sequencing of genomic samples from 96 chronic obstructive pulmonary disease and 144 obstructive sleep apnea patients. This study identified 14 frequent variants disrupting potential HREs. The analysis of the genomic regions containing these variants by means of reporter assays revealed that variants rs1009329, rs6593210 and rs150921338 impaired the transcriptional response to hypoxia. Finally, using genome editing we confirmed the functional role of rs6593210 in the transcriptional regulation of EGFR. In summary, we found that inter-individual variability in non-coding regions affect the response to hypoxia and could potentially impact on the progression of pulmonary diseases.
Collapse
Affiliation(s)
- Olga Roche
- Departamento de Bioquímica, Universidad Autónoma de Madrid (UAM) and Instituto de Investigaciones Biomédicas 'Alberto Sols' (CSIC-UAM), 28029 Madrid, Spain.,IdiPaz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz, 28029 Madrid, Spain.,Unidad de Medicina Molecular, laboratorio de Oncología, CRIB. Universidad de Castilla-La Mancha, 02006, Albacete, Spain
| | - María Laura Deguiz
- Departamento de Bioquímica, Universidad Autónoma de Madrid (UAM) and Instituto de Investigaciones Biomédicas 'Alberto Sols' (CSIC-UAM), 28029 Madrid, Spain.,IdiPaz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz, 28029 Madrid, Spain
| | - María Tiana
- Departamento de Bioquímica, Universidad Autónoma de Madrid (UAM) and Instituto de Investigaciones Biomédicas 'Alberto Sols' (CSIC-UAM), 28029 Madrid, Spain.,IdiPaz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz, 28029 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Clara Galiana-Ribote
- Departamento de Bioquímica, Universidad Autónoma de Madrid (UAM) and Instituto de Investigaciones Biomédicas 'Alberto Sols' (CSIC-UAM), 28029 Madrid, Spain
| | - Daniel Martinez-Alcazar
- Departamento de Bioquímica, Universidad Autónoma de Madrid (UAM) and Instituto de Investigaciones Biomédicas 'Alberto Sols' (CSIC-UAM), 28029 Madrid, Spain
| | - Carlos Rey-Serra
- Departamento de Bioquímica, Universidad Autónoma de Madrid (UAM) and Instituto de Investigaciones Biomédicas 'Alberto Sols' (CSIC-UAM), 28029 Madrid, Spain
| | - Beatriz Ranz-Ribeiro
- Departamento de Bioquímica, Universidad Autónoma de Madrid (UAM) and Instituto de Investigaciones Biomédicas 'Alberto Sols' (CSIC-UAM), 28029 Madrid, Spain
| | - Raquel Casitas
- IdiPaz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz, 28029 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain.,Hospital Universitario La Paz, IdiPAZ, Servicio de Neumología, 28029 Madrid, Spain
| | - Raúl Galera
- IdiPaz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz, 28029 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain.,Hospital Universitario La Paz, IdiPAZ, Servicio de Neumología, 28029 Madrid, Spain
| | - Isabel Fernández-Navarro
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain.,Hospital Universitario La Paz, IdiPAZ, Servicio de Neumología, 28029 Madrid, Spain
| | - Silvia Sánchez-Cuéllar
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain.,Servicio de Neumología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del hospital de La Princesa, 28006 Madrid, Spain
| | - Virginie Bernard
- Departamento de Medicina, Universidad Autónoma de Madrid (UAM) 28029 Madrid, Spain
| | - Julio Ancochea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain.,Servicio de Neumología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del hospital de La Princesa, 28006 Madrid, Spain.,Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia Vancouver, British Columbia V5Z 4H4, Canada
| | - Wyeth W Wasserman
- Departamento de Medicina, Universidad Autónoma de Madrid (UAM) 28029 Madrid, Spain
| | - Francisco García-Rio
- IdiPaz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz, 28029 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain.,Hospital Universitario La Paz, IdiPAZ, Servicio de Neumología, 28029 Madrid, Spain.,Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia Vancouver, British Columbia V5Z 4H4, Canada
| | - Benilde Jimenez
- Departamento de Bioquímica, Universidad Autónoma de Madrid (UAM) and Instituto de Investigaciones Biomédicas 'Alberto Sols' (CSIC-UAM), 28029 Madrid, Spain.,IdiPaz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz, 28029 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Luis Del Peso
- Departamento de Bioquímica, Universidad Autónoma de Madrid (UAM) and Instituto de Investigaciones Biomédicas 'Alberto Sols' (CSIC-UAM), 28029 Madrid, Spain .,IdiPaz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz, 28029 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| |
Collapse
|
81
|
Abstract
About 30% of phaeochromocytomas or paragangliomas are genetic. Whilst some individuals will have clinical features or a family history of inherited cancer syndrome such as neurofibromatosis type 1 (NF1) or multiple endocrine neoplasia 2 (MEN2), the majority will present as an isolated case. To date, 14 genes have been described in which pathogenic mutations have been demonstrated to cause paraganglioma or phaeochromocytoma . Many cases with a pathogenic mutation may be at risk of developing further tumours. Therefore, identification of genetic cases is important in the long-term management of these individuals, ensuring that they are entered into a surveillance programme. Mutation testing also facilitates cascade testing within the family, allowing identification of other at-risk individuals. Many algorithms have been described to facilitate cost-effective genetic testing sequentially of these genes, with phenotypically driven pathways. New genetic technologies including next-generation sequencing and whole-exome sequencing will allow much quicker, cheaper and extensive testing of individuals in whom a genetic aetiology is suspected.
Collapse
|
82
|
Crona J, Skogseid B. GEP- NETS UPDATE: Genetics of neuroendocrine tumors. Eur J Endocrinol 2016; 174:R275-90. [PMID: 27165966 DOI: 10.1530/eje-15-0972] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/21/2015] [Indexed: 12/12/2022]
Abstract
Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms, arising from neuroendocrine cells that are dispersed throughout the body. Around 20% of NETs occur in the context of a genetic syndrome. Today there are at least ten recognized NET syndromes. This includes the classical syndromes: multiple endocrine neoplasias types 1 and 2, and von Hippel-Lindau and neurofibromatosis type 1. Additional susceptibility genes associated with a smaller fraction of NETs have also been identified. Recognizing genetic susceptibility has proved essential both to provide genetic counseling and to give the best preventive care. In this review we will also discuss the knowledge of somatic genetic alterations in NETs. At least 24 genes have been implicated as drivers of neuroendocrine tumorigenesis, and the overall rates of genomic instability are relatively low. Genetic intra-tumoral, as well as inter-tumoral heterogeneity in the same patient, have also been identified. Together these data point towards the common pathways in NET evolution, separating early from late disease drivers. Although knowledge of specific mutations in NETs has limited impact on actual patient management, we predict that in the near future genomic profiling of tumors will be included in the clinical arsenal for diagnostics, prognostics and therapeutic decisions.
Collapse
Affiliation(s)
- Joakim Crona
- Department of Medical SciencesUppsala University, Rudbecklaboratoriet, Dag hammarskjölds väg 20, 75185 Uppsala, Sweden
| | - Britt Skogseid
- Department of Medical SciencesUppsala University, Rudbecklaboratoriet, Dag hammarskjölds väg 20, 75185 Uppsala, Sweden
| |
Collapse
|
83
|
Comino-Méndez I, Tejera ÁM, Currás-Freixes M, Remacha L, Gonzalvo P, Tonda R, Letón R, Blasco MA, Robledo M, Cascón A. ATRX driver mutation in a composite malignant pheochromocytoma. Cancer Genet 2016; 209:272-7. [PMID: 27209355 DOI: 10.1016/j.cancergen.2016.04.058] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/01/2016] [Accepted: 04/23/2016] [Indexed: 12/19/2022]
Abstract
Pheochromocytomas (PCCs) and paragangliomas (PGLs) are tumors arising from the adrenal medulla and sympathetic/parasympathetic paraganglia, respectively. Approximately 40% of PCCs/PGLs are due to germline mutations in one of 16 susceptibility genes, and a further 30% are due to somatic alterations in 5 main genes. Recently, somatic ATRX mutations have been found in succinate dehydrogenase (SDH)-associated hereditary PCCs/PGLs. In the present study we applied whole-exome sequencing to the germline and tumor DNA of a patient with metastatic composite PCC and no alterations in known PCC/PGL susceptibility genes. A somatic loss-of-function mutation affecting ATRX was identified in tumor DNA. Transcriptional profiling analysis classified the tumor within cluster 2 of PCCs/PGLs (without SDH gene mutations) and identified downregulation of genes involved in neuronal development and homeostasis (NLGN4, CD99 and CSF2RA) as well as upregulation of Drosha, an important gene involved in miRNA and rRNA processing. CpG island methylator phenotype typical of SDH gene-mutated tumors was ruled out, and SNP array data revealed a unique profile of gains and losses. Finally, we demonstrated the presence of alternative lengthening of telomeres in the tumor, probably associated with the failure of ATRX functions. In conclusion, somatic variants affecting ATRX may play a driver role in sporadic PCC/PGL.
Collapse
Affiliation(s)
- Iñaki Comino-Méndez
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Águeda M Tejera
- Telomeres and Telomerase Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - María Currás-Freixes
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Laura Remacha
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Pablo Gonzalvo
- Department of Anatomical Pathology, Cabueñes Hospital, Gijón, Spain
| | - Raúl Tonda
- CNAG-CRG, Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Rocío Letón
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - María A Blasco
- Telomeres and Telomerase Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Alberto Cascón
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain.
| |
Collapse
|
84
|
Pan J, Bishop T, Ratcliffe PJ, Yeger H, Cutz E. Hyperplasia and hypertrophy of pulmonary neuroepithelial bodies, presumed airway hypoxia sensors, in hypoxia-inducible factor prolyl hydroxylase-deficient mice. HYPOXIA (AUCKLAND, N.Z.) 2016; 4:69-80. [PMID: 27800509 PMCID: PMC5085281 DOI: 10.2147/hp.s103957] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pulmonary neuroepithelial bodies (NEBs), presumed polymodal airway sensors, consist of innervated clusters of amine (serotonin) and peptide-producing cells. While NEB responses to acute hypoxia are mediated by a membrane-bound O2 sensor complex, responses to sustained and/or chronic hypoxia involve a prolyl hydroxylase (PHD)-hypoxia-inducible factor-dependent mechanism. We have previously reported hyperplasia of NEBs in the lungs of Phd1-/- mice associated with enhanced serotonin secretion. Here we use a novel multilabel immunofluorescence method to assess NEB distribution, frequency, and size, together with the number and size of NEB cell nuclei, and to colocalize multiple cytoplasmic and nuclear epitopes in the lungs of Phd1-/-, Phd2+/-, and Phd3-/- mice and compare them with wild-type controls. To define the mechanisms of NEB cell hyperplasia, we used antibodies against Mash1 and Prox1 (neurogenic genes involved in NEB cell differentiation/maturation), hypoxia-inducible factor-1alpha, and the cell proliferation marker Ki67. Morphometric analysis of (% total lung area) immunostaining for synaptophysin (% synaptophysin), a cytoplasmic marker of NEB cells, was significantly increased in Phd1-/- and Phd3-/- mice compared to wild-type mice. In addition, NEB size and the number and size of NEB nuclei were also significantly increased, indicating that deficiency of Phds is associated with striking hyperplasia and hypertrophy of NEBs. In Phd2+/- mice, while mean % synaptophysin was comparable to wild-type controls, the NEB size was moderately increased, suggesting an effect even in heterozygotes. NEBs in all Phd-deficient mice showed increased expression of Mash1, Prox1, Ki67, and hypoxia-inducible factor-1alpha, in keeping with enhanced differentiation from precursor cells and a minor component of cell proliferation. Since the loss of PHD activity mimics chronic hypoxia, our data provide critical information on the potential role of PHDs in the pathobiology and mechanisms of NEB cell hyperplasia that is relevant to a number of pediatric lung disorders.
Collapse
Affiliation(s)
- Jie Pan
- Division of Pathology, Department of Pediatric Laboratory Medicine, The Research Institute, The Hospital for Sick Children
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Tammie Bishop
- Nuffield Department of Medicine, Henry Wellcome Building for Molecular Physiology, University of Oxford, Oxford, UK
| | - Peter J Ratcliffe
- Nuffield Department of Medicine, Henry Wellcome Building for Molecular Physiology, University of Oxford, Oxford, UK
| | - Herman Yeger
- Division of Pathology, Department of Pediatric Laboratory Medicine, The Research Institute, The Hospital for Sick Children
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Ernest Cutz
- Division of Pathology, Department of Pediatric Laboratory Medicine, The Research Institute, The Hospital for Sick Children
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
85
|
Pillai S, Gopalan V, Smith RA, Lam AKY. Updates on the genetics and the clinical impacts on phaeochromocytoma and paraganglioma in the new era. Crit Rev Oncol Hematol 2016; 100:190-208. [DOI: 10.1016/j.critrevonc.2016.01.022] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 11/13/2015] [Accepted: 01/20/2016] [Indexed: 12/18/2022] Open
|
86
|
Erythrocytosis due to PHD2 Mutations: A Review of Clinical Presentation, Diagnosis, and Genetics. Case Rep Hematol 2016; 2016:6373706. [PMID: 27034858 PMCID: PMC4789426 DOI: 10.1155/2016/6373706] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 12/17/2022] Open
Abstract
The association of mutations in the PHD2 protein of the hypoxia-sensing pathway and erythrocytosis has only been established in the last decade. Here we report the case of a novel PHD2 gene mutation in a patient with erythrocytosis and summarize all reported cases to date. Case Report. A 55-year-old man presented with dyspnea and a previous diagnosis of idiopathic erythrocytosis. PHD gene sequencing revealed a mutation on exon 2. The mutation was recognized as p.(Trp334⁎) (c. 1001G>A) resulting in a truncation of a highly conserved amino acid residue in catalytic domain. A diagnosis of erythrocytosis secondary to mutant PHD2 gene was made. Conclusions. Our findings indicate that with PHD2 mutations there is moderate erythrocytosis and erythropoietin (Epo) levels are generally low to normal. Two patients with PHD2 substitution mutations were found to have paraganglioma and one of these patients had a concurrent pheochromocytoma. In addition, one mutation was associated with sagittal sinus thrombosis. Given the severity of some of the clinical features of these mutations, we conclude that clinical guidelines should include the PHD2 mutation in the idiopathic erythrocytosis workup.
Collapse
|
87
|
Minnetti M, Grossman A. Somatic and germline mutations in NETs: Implications for their diagnosis and management. Best Pract Res Clin Endocrinol Metab 2016; 30:115-27. [PMID: 26971848 DOI: 10.1016/j.beem.2015.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
It is now understood that specific somatic and germline mutations may lead to the development of the neuroendocrine tumours (NETs). NETs usually occur as sporadic isolated tumours, although they also may present as part of complex familial endocrine cancer syndromes, such as multiple endocrine neoplasia type 1 (MEN1) and type 2 (MEN2), Von Hippel-Lindau (VHL) and neurofibromatosis syndromes, tuberous sclerosis, Carney triad and dyad, Reed syndrome and polycythaemia-paraganglioma syndromes. Only in MEN2 syndrome is there a specific genotype-phenotype correlation, although in both sporadic and syndromic NETs some gene mutations are associated with specific clinico-pathological features and prognosis. There have been several advances in our understanding of the NETs leading to earlier detection and targeted therapeutic treatment, but given the poor prognosis associated with metastatic NETs, it will be necessary to find new biomarkers for the prediction of malignant potential and to find novel therapeutic targets for NETs.
Collapse
Affiliation(s)
- Marianna Minnetti
- Dept. of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Dept. of Medicine, University of Oxford, UK
| | - Ashley Grossman
- Dept. of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Dept. of Medicine, University of Oxford, UK.
| |
Collapse
|
88
|
Maxwell PH, Eckardt KU. HIF prolyl hydroxylase inhibitors for the treatment of renal anaemia and beyond. Nat Rev Nephrol 2015; 12:157-68. [DOI: 10.1038/nrneph.2015.193] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
89
|
Abstract
Hydroxylation is an emerging modification generally catalyzed by a family of ∼70 enzymes that are dependent on oxygen, Fe(II), ascorbate, and the Kreb's cycle intermediate 2-oxoglutarate (2OG). These "2OG oxygenases" sit at the intersection of nutrient availability and metabolism where they have the potential to regulate gene expression and growth in response to changes in co-factor abundance. Characterized 2OG oxygenases regulate fundamental cellular processes by catalyzing the hydroxylation or demethylation (via hydroxylation) of DNA, RNA, or protein. As such they have been implicated in various syndromes and diseases, but particularly cancer. In this review we discuss the emerging role of 2OG oxygenases in gene expression control, examine the regulation of these unique enzymes by nutrient availability and metabolic intermediates, and describe these properties in relation to the expanding role of these enzymes in cancer.
Collapse
|
90
|
Recommendations for somatic and germline genetic testing of single pheochromocytoma and paraganglioma based on findings from a series of 329 patients. J Med Genet 2015; 52:647-56. [DOI: 10.1136/jmedgenet-2015-103218] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/18/2015] [Indexed: 01/21/2023]
|
91
|
Jochmanová I, Zhuang Z, Pacak K. Pheochromocytoma: Gasping for Air. Discov Oncol 2015; 6:191-205. [PMID: 26138106 DOI: 10.1007/s12672-015-0231-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/19/2015] [Indexed: 02/06/2023] Open
Abstract
There has been increasing evidence that pseudohypoxia--a phenomenon that we refer to as "gasping for air"--along with mitochondrial enzyme dysregulation play a crucial role in tumorigenesis, particularly in several hereditary pheochromocytomas (PHEOs) and paragangliomas (PGLs). Alterations in key tricarboxylic acids (TCA) cycle enzymes (SDH, FH, MDH2) have been shown to induce pseudohypoxia via activation of the hypoxia-inducible transcription factor (HIF) signaling pathway that is involved in tumorigenesis, invasiveness, and metastatic spread, including an association with resistance to various cancer therapies and worse prognosis. This review outlines the ongoing story of the pathogenesis of hereditary PHEOs/PGLs, showing the unique and most updated evidence of TCA cycle dysregulation that is tightly linked to hypoxia signaling.
Collapse
Affiliation(s)
- Ivana Jochmanová
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver NICHD, National Institutes of Health, Building 10, CRC, 1-East, Room 1E-3140, 10 Center Drive, MSC-1109, Bethesda, MD, 20892-1109, USA.,1st Department of Internal Medicine, Medical Faculty, P. J. Šafárik University in Košice, Trieda SNP 1, 04011, Košice, Slovakia
| | - Zhengping Zhuang
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Karel Pacak
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver NICHD, National Institutes of Health, Building 10, CRC, 1-East, Room 1E-3140, 10 Center Drive, MSC-1109, Bethesda, MD, 20892-1109, USA.
| |
Collapse
|
92
|
SDHB/SDHA immunohistochemistry in pheochromocytomas and paragangliomas: a multicenter interobserver variation analysis using virtual microscopy: a Multinational Study of the European Network for the Study of Adrenal Tumors (ENS@T). Mod Pathol 2015; 28:807-21. [PMID: 25720320 DOI: 10.1038/modpathol.2015.41] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 01/10/2015] [Accepted: 01/10/2015] [Indexed: 12/13/2022]
Abstract
Despite the established role of SDHB/SDHA immunohistochemistry as a valuable tool to identify patients at risk for familial succinate dehydrogenase-related pheochromocytoma/paraganglioma syndromes, the reproducibility of the assessment methods has not as yet been determined. The aim of this study was to investigate interobserver variability among seven expert endocrine pathologists using a web-based virtual microscopy approach in a large multicenter pheochromocytoma/paraganglioma cohort (n=351): (1) 73 SDH mutated, (2) 105 non-SDH mutated, (3) 128 samples without identified SDH-x mutations, and (4) 45 with incomplete SDH molecular genetic analysis. Substantial agreement among all the reviewers was observed either with a two-tiered classification (SDHB κ=0.7338; SDHA κ=0.6707) or a three-tiered classification approach (SDHB κ=0.6543; SDHA κ=0.7516). Consensus was achieved in 315 cases (89.74%) for SDHB immunohistochemistry and in 348 cases (99.15%) for SDHA immunohistochemistry. Among the concordant cases, 62 of 69 (~90%) SDHB-/C-/D-/AF2-mutated cases displayed SDHB immunonegativity and SDHA immunopositivity, 3 of 4 (75%) with SDHA mutations showed loss of SDHA/SDHB protein expression, whereas 98 of 105 (93%) non-SDH-x-mutated counterparts demonstrated retention of SDHA/SDHB protein expression. Two SDHD-mutated extra-adrenal paragangliomas were scored as SDHB immunopositive, whereas 9 of 128 (7%) tumors without identified SDH-x mutations, 6 of 37 (~16%) VHL-mutated, as well as 1 of 21 (~5%) NF1-mutated tumors were evaluated as SDHB immunonegative. Although 14 out of those 16 SDHB-immunonegative cases were nonmetastatic, an overall significant correlation between SDHB immunonegativity and malignancy was observed (P=0.00019). We conclude that SDHB/SDHA immunohistochemistry is a reliable tool to identify patients with SDH-x mutations with an additional value in the assessment of genetic variants of unknown significance. If SDH molecular genetic analysis fails to detect a mutation in SDHB-immunonegative tumor, SDHC promoter methylation and/or VHL/NF1 testing with the use of targeted next-generation sequencing is advisable.
Collapse
|
93
|
Rethinking pheochromocytomas and paragangliomas from a genomic perspective. Oncogene 2015; 35:1080-9. [DOI: 10.1038/onc.2015.172] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 12/12/2022]
|
94
|
von Dobschuetz E, Leijon H, Schalin-Jäntti C, Schiavi F, Brauckhoff M, Peczkowska M, Spiazzi G, Demattè S, Cecchini ME, Sartorato P, Krajewska J, Hasse-Lazar K, Roszkowska-Purska K, Taschin E, Malinoc A, Akslen LA, Arola J, Lange D, Fassina A, Pennelli G, Barbareschi M, Luettges J, Prejbisz A, Januszewicz A, Strate T, Bausch B, Castinetti F, Jarzab B, Opocher G, Eng C, Neumann HPH. A registry-based study of thyroid paraganglioma: histological and genetic characteristics. Endocr Relat Cancer 2015; 22:191-204. [PMID: 25595276 DOI: 10.1530/erc-14-0558] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The precise diagnosis of thyroid neoplasias will guide surgical management. Primary thyroid paraganglioma has been rarely reported. Data on prevalence, immunohistochemistry (IHC), and molecular genetics in a systematic series of such patients are pending. We performed a multinational population-based study on thyroid paraganglioma and analyzed prevalence, IHC, and molecular genetics. Patients with thyroid paraganglioma were recruited from the European-American-Head-and-Neck-Paraganglioma-Registry. Demographic and clinical data were registered. Histopathology and IHC were re-investigated. All patients with thyroid paraganglioma underwent molecular genetic analyses of the SDHA, SDHB, SDHC, SDHD, SDHAF2, VHL, RET, TMEM127, and MAX genes. Analyses included Sanger sequencing and multiplex ligation-dependent probe amplification (MLPA) for detection of large rearrangements. Of 947 registrants, eight candidates were initially identified. After immunohistochemical analyses of these eight subjects, 5 (0.5%) were confirmed to have thyroid paraganglioma. IHC was positive for chromogranin, synaptophysin, and S-100 and negative for calcitonin in all five thyroid paragangliomas, whereas the three excluded candidate tumors stained positive for pan-cytokeratin, a marker excluding endocrine tumors. Germline variants, probably representing mutations, were found in four of the five confirmed thyroid paraganglioma cases, two each in SDHA and SDHB, whereas the excluded cases had no mutations in the tested genes. Thyroid paraganglioma is a finite entity, which must be differentiated from medullary thyroid carcinoma, because medical, surgical, and genetic management for each is different. Notably, approximately 80% of thyroid paragangliomas are associated with germline variants, with implications for additional tumors and a potential risk for the family. As opposed to sporadic tumors, surgical management and extent of resection are different for heritable tumors, each guided by the precise gene involved.
Collapse
Affiliation(s)
- Ernst von Dobschuetz
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Helena Leijon
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Camilla Schalin-Jäntti
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Francesca Schiavi
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Michael Brauckhoff
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Mariola Peczkowska
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Giovanna Spiazzi
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Serena Demattè
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Maria Enrica Cecchini
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Paola Sartorato
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Jolanta Krajewska
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Kornelia Hasse-Lazar
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Katarzyna Roszkowska-Purska
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Elisa Taschin
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Angelica Malinoc
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Lars A Akslen
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Johanna Arola
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Dariusz Lange
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Ambrogio Fassina
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Gianmaria Pennelli
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Mattia Barbareschi
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Jutta Luettges
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Aleksander Prejbisz
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Andrzej Januszewicz
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Tim Strate
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Birke Bausch
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Frederic Castinetti
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Barbara Jarzab
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Giuseppe Opocher
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Charis Eng
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| | - Hartmut P H Neumann
- Section of Endocrine SurgeryDepartment of General, Visceral and Thoracic Surgery, Krankenhaus Reinbek, St. Adolf Stift, Academic Teaching Hospital University of Hamburg, Reinbek, GermanyDepartment of PathologyHelsinki University Central Hospital and University of Helsinki, Helsinki, FinlandDivision of EndocrinologyDepartment of Medicine, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFamilial Cancer Clinic and Onco-EndocrinologyVeneto Institute of Oncology, IRCCS, Padova, ItalyDepartment of Endocrine SurgeryUniversity of Bergen, Bergen, NorwayDepartment of HypertensionInstitute of Cardiology, Warsaw, PolandEndocrinologyDiabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, ItalyUnits of Internal MedicineSanta Chiara General Hospital, Trento, ItalyDepartment of Internal MedicineGeneral Hospital, Montebelluna, Treviso, ItalyDepartment of Nuclear Medicine and Endocrine OncologyMaria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandDepartment of Pathology and Laboratory DiagnosticsSkłodowska-Curie Memorial Institute of Oncology, Warsaw, PolandSection for Preventive MedicineDepartment of Nephrology and General Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, GermanySection for PathologyDepartment of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, NorwayDepartment of Tumor PathologyM.Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, PolandSurgical Pathology and Cytopathology UnitDepartment of Medicine, DIMED, University of Padova, Padova, ItalyDepartment of PathologySanta Chiara Regional Hospital, Trento, ItalyDepartment of PathologyMarienkrankenhaus, Hamburg, GermanyDepartment of GastroenterologyAlbert-Ludwigs-University of Freiburg, Freiburg, GermanyDepartment of EndocrinologyLa Timone Hospital, Hopitaux de Marseille
| |
Collapse
|
95
|
Hernandez KG, Ezzat S, Morel CF, Swallow C, Otremba M, Dickson BC, Asa SL, Mete O. Familial pheochromocytoma and renal cell carcinoma syndrome: TMEM127 as a novel candidate gene for the association. Virchows Arch 2015; 466:727-32. [DOI: 10.1007/s00428-015-1755-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 02/21/2015] [Accepted: 03/09/2015] [Indexed: 12/30/2022]
|