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Savoie PH, Murez T, Fléchon A, Sèbe P, Rocher L, Camparo P, Morel-Journel N, Ferretti L, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU — Actualisation 2018—2020 : tumeur de la surrénale French ccAFU guidelines — Update 2018—2020: Adrenal cancer. Prog Urol 2018; 28:S175-S193. [PMID: 30473001 DOI: 10.1016/j.purol.2018.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.011.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the doi:10.1016/j.purol.2019.01.011.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- P-H Savoie
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800, Toulon cedex 09, France.
| | - T Murez
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie et transplantation rénale, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier cedex 5, France
| | - A Fléchon
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69008, Lyon, France
| | - P Sèbe
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, groupe hospitalier Diaconesses Croix Saint Simon, 125, rue d'Avron, 75020, Paris, France
| | - L Rocher
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service de radiologie, HU Paris Sud, site Kremlin-Bicêtre, AP-HP, 94270, Le Kremlin-Bicêtre, France
| | - P Camparo
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Centre de pathologie, 51, rue de Jeanne-D'Arc, 80000, Amiens, France
| | - N Morel-Journel
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, centre hospitalier Lyon Sud (Pierre Bénite), HCL groupement hospitalier du Sud, 69495, Pierre Bénite cedex, France
| | - L Ferretti
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, MSP de Bordeaux-Bagatelle, 203, route de Toulouse, BP 50048, 33401, Talence cedex, France
| | - A Méjean
- Service d'urologie, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800, Toulon cedex 09, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015, Paris, France
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Kimura N, Takekoshi K, Naruse M. Risk Stratification on Pheochromocytoma and Paraganglioma from Laboratory and Clinical Medicine. J Clin Med 2018; 7:jcm7090242. [PMID: 30150569 PMCID: PMC6162838 DOI: 10.3390/jcm7090242] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 12/13/2022] Open
Abstract
Pheochromocytoma (PCC) and sympathetic paraganglioma (PGL) are rare neuroendocrine tumors characterized by catecholamine production in the adrenal medulla and extra-adrenal paraganglia. PCC and PGL (PPGL) with metastasis was termed malignant PPGL. However, the distinction between “benign” and “malignant” PPGLs has been debated. Currently, all PPGLs are believed to have some metastatic potential and are assigned malignant tumors (ICD-O/3) by the WHO Classification of Endocrine Organs (2017, 4th edition). Therefore, the previous categories benign and malignant PPGL have been eliminated in favor of risk stratification approach. The Grading of Adrenal Pheochromocytoma and Paraganglioma (GAPP) is a tool for risk stratification for predicting metastasis and the prognosis of patients. At least 30% of PPGLs are hereditary, with 20 genes identified and genotype-phenotype correlations clarified. Of these genes, VHL, RET and NF1 have been well investigated and are the primary cause of bilateral PCC. In addition, mutation of succinate dehydrogenase gene subunits SDHB and SDHD are strongly correlated with extra-adrenal location, younger age, multiple tumors, metastasis and poor prognosis. Disease stratification by catecholamine phenotype and molecular profiling correlates with histological grading by GAPP. PPGLs should be understood comprehensively based on clinical, biochemical, molecular and pathological data for patient care. A flow chart for pathological diagnosis is included.
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Affiliation(s)
- Noriko Kimura
- Department of Clinical Research Pathology Division, Department of Diagnostic Pathology, National Hospital Organization Hakodate Hospital, Hakodate 041-8512, Hokkaido, Japan.
| | - Kazuhiro Takekoshi
- Division of Sports Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan.
| | - Mitsuhide Naruse
- Department of Endocrinology, Metabolism and Hypertension, National Hospital Organization, Kyoto Medical Center, Kyoto 612-8555, Japan.
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53
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Buffet A, Burnichon N, Amar L, Gimenez-Roqueplo AP. Pheochromocytoma: When to search a germline defect? Presse Med 2018; 47:e109-e118. [DOI: 10.1016/j.lpm.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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54
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Cho YY, Kwak MK, Lee SE, Ahn SH, Kim H, Suh S, Kim BJ, Song KH, Koh JM, Kim JH, Lee SH. A clinical prediction model to estimate the metastatic potential of pheochromocytoma/paraganglioma: ASES score. Surgery 2018; 164:511-517. [PMID: 29929757 DOI: 10.1016/j.surg.2018.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Malignant pheochromocytoma and paraganglioma can be defined only after the development of metastases in nonchromaffin tissues. There is no single clinical parameter that is sufficiently reliable to predict metastatic potential, so our goal was to develop a prediction model based on multiple clinical parameters. METHODS The baseline age, size, extra-adrenal location, secretory type score was calculated in a retrospective cohort study comprising 333 patients with pheochromocytoma and paraganglioma. In each patient, each variable for age ≤35 years, tumor size ≥ 6.0 cm, extra-adrenal, and norepinephrine-secretory type was coded as 1 point (otherwise 0 point); these points were summed to yield age, size, extra-adrenal location, secretory type score. RESULTS Metastases occurred in 23 of 333 patients (6.9%). Metastatic pheochromocytoma and paraganglioma was associated with age ≤35 years (hazard ratio [HR] 2.74, 95% confidence interval [95% CI] 1.19-6.35), tumor size ≥6.0 cm (HR 2.43, 95% CI 1.06-5.56), extra-adrenal location (HR 2.73, 95% confidence interval 1.10-7.40), and tumor producing only norepinephrine (HR 2.96, 95% CI 1.30-6.76). The area under the curve of the age, size, extra-adrenal location, secretory type score was 0.735. There was a significant difference in metastasis-free survival between participants with age, size, extra-adrenal location, secretory type score ≥2 and score <2 (P < .0001 by the log rank test). The negative predictive value of this system was 96.5% for a cutoff point of 2. CONCLUSION We developed a new prediction model, the age, size, extra-adrenal location, secretory type score, based on multiple clinical parameters to assess the metastatic potential of pheochromocytoma and paraganglioma.
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Affiliation(s)
- Yoon Young Cho
- Division of Endocrinology and Metabolism, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea; Institute of Health Sciences, Jinju, Korea
| | - Mi Kyung Kwak
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Eun Lee
- Division of Endocrinology and Metabolism, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Hee Ahn
- Division of Endocrinology and Metabolism, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Hyeonmok Kim
- Division of Endocrinology and Metabolism, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sunghwan Suh
- Division of Endocrinology and Metabolism, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea and
| | - Beom-Jun Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee-Ho Song
- Division of Endocrinology and Metabolism, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hun Lee
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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55
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Cheung VKY, Gill AJ, Chou A. Old, New, and Emerging Immunohistochemical Markers in Pheochromocytoma and Paraganglioma. Endocr Pathol 2018; 29:169-175. [PMID: 29779206 DOI: 10.1007/s12022-018-9534-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The evolution of genetic research over the past two decades has greatly improved the understanding of pheochromocytomas and paragangliomas. It is now accepted that more than one third of pheochromocytoma and paragangliomas arise in the context of syndromic disease, usually hereditary. The genetic profile of these tumors also has important prognostic implications which may help guide treatment. Accompanying the changing molecular landscape is the development of new immunohistochemical markers. Initially used in assisting with diagnosis, immunohistochemical markers have now become an important adjunct to screening programs for inherited conditions and subsequently as prognostic markers. The accessibility and efficiency of immunohistochemistry bring pathologists to the forefront in triaging patients based on tumor genotype-phenotype. In this review, we provide an update on the role of immunohistochemistry in the diagnosis of pheochromocytomas and paragangliomas, as an adjunct to assessment for hereditary disease and finally as a potential tool to assist risk stratification.
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Affiliation(s)
- Veronica K Y Cheung
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, 2065, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, 2065, Australia.
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, 2065, Australia.
- University of Sydney, Sydney, NSW, 2006, Australia.
- Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Angela Chou
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, 2065, Australia.
- University of Sydney, Sydney, NSW, 2006, Australia.
- Department of Anatomical Pathology, SydPATH St Vincent's Hospital, Sydney, 2010, Australia.
- Department of Anatomical Pathology, SydPATH, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia.
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56
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Stenman A, Zedenius J, Juhlin CC. Over-diagnosis of potential malignant behavior in MEN 2A-associated pheochromocytomas using the PASS and GAPP algorithms. Langenbecks Arch Surg 2018; 403:785-790. [PMID: 29779047 PMCID: PMC6153590 DOI: 10.1007/s00423-018-1679-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/30/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Pheochromocytomas (PCCs) exhibit malignant potential, but current histological modalities for the proper detection of aggressive behavior are debated. The two most widespread algorithms are the "Pheochromocytoma of the Adrenal Gland Scaled Score" (PASS) and the "Grading System for Adrenal Pheochromocytoma and Paraganglioma" (GAPP), both which mostly rely on histological parameters to identify PCC patients at risk of disseminated disease. Since the algorithms are derived from studies using predominantly sporadic PCCs, little is known whether the PASS or GAPP scores can predict malignant potential in hereditary cases. METHODS PASS and GAPP were applied on 41 PCCs; 13 PCCs were diagnosed in ten multiple endocrine neoplasia type 2A (MEN 2A) patients carrying established germline RET proto-oncogene mutations, as well as 28 assumed sporadic PCCs. RESULTS Six out of thirteen MEN 2A tumors (46%) exhibited PASS scores ≥ 4, indicative of a potential for aggressive behavior. In addition, 7/13 tumors (54%) exhibited GAPP scores ≥ 3, indicative of a "moderately differentiated type" with risk of future recurrence. All MEN 2A PCCs with an elevated PASS score also displayed an elevated GAPP score. In contrast, 4/28 (14%) sporadic PCCs demonstrated PASS scores ≥ 4, and 9/28 (32%) displayed GAPP scores ≥ 3. Follow-up found all cases in the study are free of metastatic or recurrent disease. CONCLUSIONS We conclude that the PASS and GAPP scoring systems might be suboptimal for determining true malignant potential in PCCs with constitutional RET mutations and advocate restrictive use of these scores in MEN 2A cases until the results are reproduced in larger numbers.
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Affiliation(s)
- Adam Stenman
- Department of Oncology-Pathology, Karolinska Institutet, CCK, Karolinska University Hospital, R8:04, 171 76, Solna, Stockholm, Sweden.
| | - Jan Zedenius
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Breast, Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Carl Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, CCK, Karolinska University Hospital, R8:04, 171 76, Solna, Stockholm, Sweden. .,Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden.
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57
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Jawed I, Velarde M, Därr R, Wolf KI, Adams K, Venkatesan AM, Balasubramaniam S, Poruchynsky MS, Reynolds JC, Pacak K, Fojo T. Continued Tumor Reduction of Metastatic Pheochromocytoma/Paraganglioma Harboring Succinate Dehydrogenase Subunit B Mutations with Cyclical Chemotherapy. Cell Mol Neurobiol 2018; 38:1099-1106. [PMID: 29623478 DOI: 10.1007/s10571-018-0579-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/15/2018] [Indexed: 11/27/2022]
Abstract
Patients harboring germline mutations in the succinate dehydrogenase complex subunit B (SDHB) gene present with pheochromocytomas and paragangliomas (PPGL) that are more likely malignant and clinically aggressive. The combination chemotherapy cyclophosphamide, vincristine, and dacarbazine (CVD) was retrospectively evaluated in patients with SDHB-associated metastatic PPGL.Query Twelve metastatic PPGL patients harboring SDHB mutations/polymorphisms with undetectable SDHB immunostaining were treated with CVD. CVD therapy consisted of 750 mg/m2 cyclophosphamide with 1.4 mg/m2 vincristine on day 1 and 600 mg/m2 dacarbazine on days 1 and 2, every 21-28 days. Treatment outcome was determined by RECIST criteria as well as determination of response duration and progression-free and overall survivals. A median of 20.5 cycles (range 4-41) was administered. All patients had tumor reduction (12-100% by RECIST). Complete response was seen in two patients, while partial response was observed in 8. The median number of cycles to response was 5.5. Median duration of response was 478 days, with progression-free and overall survivals of 930 and 1190 days, respectively. Serial [18F]-fluorodeoxyglucose positron emission tomography and computed tomography imaging demonstrated continued incremental reduction in maximal standardized uptake values (SUVmax) values in 26/30 lesions. During treatment administration, the median SUV decreased from > 25 to < 6, indicating the efficacy of chemotherapy over a prolonged period of time. Prolonged therapy results in continued incremental tumor reduction, and is consistent with persistent drug sensitivity. CVD chemotherapy is recommended to be considered part of the initial management in patients with metastatic SDHB-related PPGL.
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Affiliation(s)
- Irfan Jawed
- Medical Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Margarita Velarde
- Medical Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Roland Därr
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Katherine I Wolf
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Karen Adams
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Aradhana M Venkatesan
- Section of Abdominal Imaging, Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sanjeeve Balasubramaniam
- Medical Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Marianne S Poruchynsky
- Medical Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - James C Reynolds
- Nuclear Medicine Division, Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 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.
| | - Tito Fojo
- Medical Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
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Lee SE, Oh E, Lee B, Kim YJ, Oh DY, Jung K, Choi JS, Kim J, Kim SJ, Yang JW, An J, Oh YL, Choi YL. Phenylethanolamine N-methyltransferase downregulation is associated with malignant pheochromocytoma/paraganglioma. Oncotarget 2018; 7:24141-53. [PMID: 27007161 PMCID: PMC5029690 DOI: 10.18632/oncotarget.8234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 02/10/2016] [Indexed: 12/17/2022] Open
Abstract
Malignant pheochromocytoma/paraganglioma (PCC/PGL) is defined by the presence of metastases at non-chromaffin sites, which makes it difficult to prospectively diagnose malignancy. Here, we performed array CGH (aCGH) and paired gene expression profiling of fresh, frozen PCC/PGL samples (n = 12), including three malignant tumors, to identify genes that distinguish benign from malignant tumors. Most PCC/PGL cases showed few copy number aberrations, regardless of malignancy status, but mRNA analysis revealed that 390 genes were differentially expressed in benign and malignant tumors. Expression of the enzyme, phenylethanolamine N-methyltransferase (PNMT), which catalyzes the methylation of norepinephrine to epinephrine, was significantly lower in malignant PCC/PGL as compared to benign samples. In 62 additional samples, we confirmed that PNMT mRNA and protein levels were decreased in malignant PCC/PGL using quantitative real-time polymerase chain reaction and immunohistochemistry. The present study demonstrates that PNMT downregulation correlates with malignancy in PCC/PGL and identifies PNMT as one of the most differentially expressed genes between malignant and benign tumors.
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Affiliation(s)
- Seung Eun Lee
- Department of Pathology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Ensel Oh
- Laboratory of Cancer Genomics and Molecular Pathology, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Boram Lee
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yu Jin Kim
- Laboratory of Cancer Genomics and Molecular Pathology, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo-Yi Oh
- Laboratory of Cancer Genomics and Molecular Pathology, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Kyungsoo Jung
- Laboratory of Cancer Genomics and Molecular Pathology, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Jong-Sun Choi
- The Center for Anti-Cancer Companion Diagnostics, School of Biological Science, Institutes of Entrepreneurial BioConvergence, Seoul National University, Seoul, Korea
| | - Junghan Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Joo Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Wook Yang
- Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jungsuk An
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea
| | - Young Lyun Oh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon La Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Laboratory of Cancer Genomics and Molecular Pathology, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
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59
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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.
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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
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Jimenez C. Treatment for Patients With Malignant Pheochromocytomas and Paragangliomas: A Perspective From the Hallmarks of Cancer. Front Endocrinol (Lausanne) 2018; 9:277. [PMID: 29892268 PMCID: PMC5985332 DOI: 10.3389/fendo.2018.00277] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/11/2018] [Indexed: 12/15/2022] Open
Abstract
Malignant pheochromocytomas and paragangliomas affect a very small percentage of the general population. A substantial number of these patients have a hereditary predisposition for the disease and consequently, bear the risk of developing these tumors throughout their entire lives. It is, however, unclear why some patients with no hereditary predisposition develop these tumors, which frequently share a similar molecular phenotype with their hereditary counterparts. Both hereditary and sporadic tumors usually appear at an early age, and affected people often die before reaching their expected lifespans. Unfortunately, there is currently no systemic therapy approved for patients with this orphan disease. Therefore, pheochromocytomas and paragangliomas are very challenging malignancies. The recognition of genetic and molecular abnormalities responsible for the development of these tumors as well as the identification of effective therapies for other malignancies that share a similar pathogenesis is leading to the development of exciting clinical trials. Tyrosine kinase inhibitors, radiopharmaceutical agents, and immunotherapy are currently under evaluation in prospective clinical trials. A phase 2 clinical trial of the highly specific metaiodobenzylguanidine, iobenguane 131I, has provided impressive results; this radiopharmaceutical agent may become the first approved systemic therapy for patients with malignant pheochromocytoma and paraganglioma by the United States Food and Drug Administration. Nevertheless, systemic therapies are still not able to cure the disease. This review will discuss the development of systemic therapeutic approaches using the hallmarks of cancer as a framework. This approach will help the reader to understand where research efforts currently stand and what the future for this difficult field may be.
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Abstract
Phaeochromocytomas and paragangliomas (PPGLs) are catecholamine-secreting neuroendocrine tumours characterised by high rates of heritability and genetic heterogeneity. Despite advances in the genetic diagnosis and improved understanding of the molecular aberrations underlying these tumours, predictive markers of malignancy remain scarce, limiting the outlook of patients with metastatic PPGL. The identification of robust predictive markers remains the most pressing challenge in PPGL management, so that the potential of targeted therapy to impact patient care can be fully realised.
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Affiliation(s)
- Marlo Nicolas
- University of Texas (UT) Health Cancer Center, San Antonio, TX, USA.,Department of Pathology, San Antonio, TX, USA
| | - Patricia Dahia
- University of Texas (UT) Health Cancer Center, San Antonio, TX, USA.,Division of Hematology and Medical Oncology, Department of Medicine, UT Health San Antonio, TX, 78229, USA
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Validation of pathological grading systems for predicting metastatic potential in pheochromocytoma and paraganglioma. PLoS One 2017; 12:e0187398. [PMID: 29117221 PMCID: PMC5678867 DOI: 10.1371/journal.pone.0187398] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/26/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The Grading system for Adrenal Pheochromocytoma and Paraganglioma (GAPP) was proposed for predicting the metastatic potential of pheochromocytoma and paraganglioma to overcome the limitations of the Pheochromocytoma of the Adrenal Scaled Score (PASS). However, to date, no study validating the GAPP has been conducted, and previous studies did not include mutations in the succinate dehydrogenase type B (SDHB) gene in the score calculation. In this retrospective cohort study, we validated the prediction ability of GAPP and assessed whether it would be improved by inclusion of the loss of SDHB immunohistochemical staining. METHODS We divided the tumors into non-metastatic and metastatic groups based on the presence of synchronous or metachronous metastases. The GAPP score and PASS at the initial operation were measured. Moreover, we combined some GAPP parameters with the immunohistochemical staining of SDHB to obtain a modified GAPP (M-GAPP) score. RESULTS Metastasis occurred in 15/72 (20.8%) patients, with a mean follow-up of 43.5 months. Loss of SDHB staining was more frequent (P = 0.044) in the metastatic group. The GAPP score (P = 0.006), PASS (P = 0.003), and M-GAPP score (P<0.001) were all higher in the metastatic group. Twelve of 40 (30.0%) moderately or poorly differentiated tumors, as defined by the GAPP score, and 12/34 (35.3%) tumors with a PASS ≥4 were metastatic. Conversely, 10/19 (52.6%) tumors with an M-GAPP score ≥3 were metastatic. The area under the curve of the M-GAPP score (0.822) was significantly higher than that of the GAPP (0.728) (P = 0.012), but similar to that of the PASS (0.753) (P = 0.411). The GAPP (P = 0.032) and M-GAPP scores (P = 0.040), but not PASS (P = 0.200), negatively correlated with metastasis-free survival. CONCLUSION The GAPP was validated, and M-GAPP, a combination of some GAPP parameters and loss of SDHB staining, might be useful for the prediction of the metastatic potential of pheochromocytoma and paraganglioma.
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63
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Davison AS, Jones DM, Ruthven S, Helliwell T, Shore SL. Clinical evaluation and treatment of phaeochromocytoma. Ann Clin Biochem 2017; 55:34-48. [DOI: 10.1177/0004563217739931] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Phaeochromocytoma and extra adrenal paraganglioma are rare neuroendocrine tumours and have the potential to secrete adrenaline, noradrenaline and dopamine causing a myriad of clinical symptoms. Prompt diagnosis is essential for clinicians and requires a multidisciplinary specialist approach for the clinical and laboratory investigation, diagnosis, treatment and follow-up of patients. This paper is an integrated review of the clinical and laboratory evaluation and treatment of patients suspected to have phaeochromocytoma or paraganglioma, highlighting recent developments and best practices from recent published clinical guidelines.
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Affiliation(s)
- Andrew S Davison
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Danielle M Jones
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Stuart Ruthven
- Department of Cellular Pathology, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Timothy Helliwell
- Department of Cellular Pathology, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Susannah L Shore
- Department of Endocrine Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
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Dhir M, Li W, Hogg ME, Bartlett DL, Carty SE, McCoy KL, Challinor SM, Yip L. Clinical Predictors of Malignancy in Patients with Pheochromocytoma and Paraganglioma. Ann Surg Oncol 2017; 24:3624-3630. [PMID: 28884434 DOI: 10.1245/s10434-017-6074-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Factors associated with malignancy in patients with pheochromocytoma (adrenal tumors, Pheo) and paraganglioma (extra-adrenal, PGL) are not well-defined and all patients require lifelong surveillance. The primary aim of our study was to determine genetic and clinical variables associated with malignancy in patients with Pheo/PGL. METHODS Single institution retrospective review was performed of all patients who underwent surgery (1/95-1/15) for Pheo/PGL. Malignancy was defined as histology-confirmed distant metastasis, lymph nodal involvement, or tumor bed recurrence. RESULTS A total of 157 Pheo/PGL patients (44 malignant, 113 benign) with mean follow-up of 87 months were included. Compared with patients with benign Pheo/PGL, patients with malignant Pheo/PGL were younger (median 42 vs 50 years, p = 0.014), had larger tumors (median 6.5 vs 4 cm, p < 0.001) and had PGL (63.6 vs 4.4%, p < 0.001). Genetic testing was performed in 60 patients and was positive in 38 (63%). Although positive genetic results were equally likely in malignant vs benign Pheo/PGL (76 vs 54%, p = 0.1), all 11 patients with germline SDHB mutations had malignant disease. In multivariable analysis, younger age, larger tumor size, and PGL were associated with malignancy (p < 0.05). Pheo patients with negative genetic testing and negative family history who developed metachronous metastases all had primary tumors ≥4 cm in size. CONCLUSIONS Patients who are young, have larger tumors, positive genetic testing (especially SDHB) or have PGL require long-term follow-up. Patients with negative genetic testing or family history and Pheo <4 cm have a lower risk of malignancy, and de-escalated long-term surveillance may be appropriate follow-up.
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Affiliation(s)
- Mashaal Dhir
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wei Li
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melissa E Hogg
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - David L Bartlett
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sally E Carty
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kelly L McCoy
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sue M Challinor
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Linwah Yip
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Ji XK, Zheng XW, Wu XL, Yu ZP, Shan YF, Zhang QY, Zeng QQ. Diagnosis and surgical treatment of retroperitoneal paraganglioma: A single-institution experience of 34 cases. Oncol Lett 2017; 14:2268-2280. [PMID: 28789448 PMCID: PMC5530091 DOI: 10.3892/ol.2017.6468] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 04/21/2017] [Indexed: 12/30/2022] Open
Abstract
The present study aimed at identifying the clinical, radiological and pathological characteristics of retroperitoneal paragangliomas, and determining the association between the tumor features and the prognosis of patients following surgery. A total of 34 patients with retroperitoneal paragangliomas, who underwent resection between November 1999 and December 2015, were included in the present retrospective study. The patients' demographics, clinical symptoms and signs, tumor functional status, surgical procedure, intraoperative results, tumor pathology, radiological results, and postoperative survival time were recorded and analyzed. Of the 34 patients, the most common type of presenting symptom was abdominal mass (46%), followed by hypertension (39%) and abdominal pain (32%). Functional tumors occurred in 20 patients (59%). Computed tomography (CT) and magnetic resonance imaging revealed soft-tissue masses, with marked enhancement in the arterial phase, indicative of retroperitoneal paragangliomas. The preoperative CT diagnostic accuracy rate between 2010 and 2015 was markedly improved, compared with that between 1999 and 2009. The tumors were primarily located close to the renal arteries and veins surrounding the abdominal aorta and inferior vena cava. With the exception of one malignant paraganglioma, the majority of paragangliomas were positive for chromogranin A, S-100 protein, vimentin and heat-shock protein 90, and exhibited decreased expression of Ki-67 antigen and insulin-like growth factor 2. All tumors were completely removed by surgery. Distant metastasis, but not tumor size, functional status and local invasion, was markedly associated with survival. The preoperative diagnostic accuracy rate of retroperitoneal paragangliomas may be improved by focusing on the predilection sites and CT characteristics. In addition, immunohistochemical markers were useful to determine tumor malignancy. Complete surgical resection was appropriate for all patients and postoperative survival time was identified to be associated with tumor metastasis.
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Affiliation(s)
- Xiao-Ke Ji
- Department of General Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Xiang-Wu Zheng
- Radiological Department, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Xiu-Lin Wu
- Department of Pathology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Zheng-Ping Yu
- Department of General Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yun-Feng Shan
- Department of General Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Qi-Yu Zhang
- Department of General Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Qi-Qiang Zeng
- Department of General Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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Pęczkowska M, Cwikla J, Kidd M, Lewczuk A, Kolasinska-Ćwikła A, Niec D, Michałowska I, Prejbisz A, Januszewicz A, Chiarelli J, Bodei L, Modlin I. The clinical utility of circulating neuroendocrine gene transcript analysis in well-differentiated paragangliomas and pheochromocytomas. Eur J Endocrinol 2017; 176:143-157. [PMID: 27913608 DOI: 10.1530/eje-16-0727] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/18/2016] [Accepted: 11/08/2016] [Indexed: 12/18/2022]
Abstract
CONTEXT Paragangliomas and pheochromocytomas (PPGLs) exhibit variable malignancy, which is difficult to determine by histopathology, amine measurements or tissue genetic analyses. OBJECTIVE To evaluate whether a 51-neuroendocrine gene blood analysis has clinical utility as a diagnostic and prognostic marker. DESIGN Prospective cohort study. Well-differentiated PPGLs (n = 32), metastatic (n = 4); SDHx mutation (n = 25); 12 biochemically active, Lanreotide treated (n = 4). Nine patients had multiple sampling. Age- and gender-matched controls and GEP-NETs (comparators). METHODS Circulating neuroendocrine tumor mRNA measured (qPCR) with multianalyte algorithmic analysis. Metabolic, epigenomic and proliferative genes as well as somatostatin receptor expression were assessed (averaged, normalized gene expression: mean ± s.e.m.). Amines were measured by HPLC and chromogranin A by ELISA. Analyses (2-tailed): Fisher's test, non-parametric (Mann-Whitney), receiver-operator curve (ROC) and multivariate analysis (MVA). All data are presented as mean ± s.e.m. RESULTS PPGL were NETest positive (100%). All exhibited higher scores than controls (55 ± 5% vs 8 ± 1%, P = 0.0001), similar to GEP-NETs (47 ± 5%). ROC analysis area under curve was 0.98 for differentiating PPGLs/controls (cut-off for normal: 26.7%). Mutation status was not directly linked to NETest. Genetic and molecular clustering was associated (P < 0.04) with NETest scores. Metastatic (80 ± 9%) and multicentric (64 ± 9%) disease had significantly (P < 0.04) higher scores than localized disease (43 ± 7%). Progressive disease (PD) had the highest scores (86 ± 2%) vs stable (SD, 41 ± 2%) (P < 0.0001). The area under the curve for PD from SD was 0.93 (cut-off for PD: 53%). Proliferation, epigenetic and somatostatin receptor gene expression was elevated (P < 0.03) in PD. Metabolic gene expression was decreased in SDHx mutations. Repeat NETest measurements defined clinical status in the 9 patients (6 SD and 3 PD). Amine measurement was non-informative. Multivariate analysis identified NETest >53% as an independent prognostic factor. CONCLUSION Circulating NET transcript analysis is positive (100% diagnostic) in well-differentiated PCC/PGL, scores were elevated in progressive disease irrespective of mutation or biochemical activity and elevated levels were prognostic.
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Affiliation(s)
| | - J Cwikla
- University of Warmia and MazuryThe Faculty of Medical Sciences, Olsztyn, Poland
| | - M Kidd
- Wren LaboratoriesBranford, Connecticut, USA
| | - A Lewczuk
- Medical University of GdanskGdansk, Poland
| | | | - D Niec
- Institute of CardiologyWarsaw, Poland
| | | | | | | | | | - L Bodei
- Memorial Sloan Kettering Cancer CenterNew York, USA
| | - I Modlin
- Yale University School of MedicineNew Haven, Connecticut, USA
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Galac S, Korpershoek E. Pheochromocytomas and paragangliomas in humans and dogs. Vet Comp Oncol 2017; 15:1158-1170. [DOI: 10.1111/vco.12291] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/04/2016] [Accepted: 10/22/2016] [Indexed: 12/18/2022]
Affiliation(s)
- S. Galac
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine; Utrecht University; Utrecht The Netherlands
| | - E. Korpershoek
- Department of Pathology, Erasmus Medical Center Cancer Institute; University Medical Center Rotterdam; Rotterdam The Netherlands
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Javid M, Callender GG, Baregamian N, Carling T. Pheochromocytomatosis Treated By Radio-Guided Surgery. AACE Clin Case Rep 2017. [DOI: 10.4158/ep151053.cr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Al-Omaishi L, Babin J, Corsetti RL. A Case of Malignant Pheochromocytoma Presenting 7 Years After the Initial Surgery. Ochsner J 2017; 17:128-131. [PMID: 28331462 PMCID: PMC5349626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Pheochromocytoma (PHEO) is a rare tumor of the adrenal medulla and sympathetic ganglion that produces the catecholamines norepinephrine and epinephrine. Traditionally, approximately 10% of PHEOs were thought to be malignant, but recent developments in PHEO research have noted that specific genetic mutations are associated with higher risk of metastatic spread. CASE REPORT We report the case of a 71-year-old female who presented with abdominal pain in September 2009 when she was 64 years old. Evaluation at that time revealed cholelithiasis and bilateral adrenal masses. Workup showed elevated free normetanephrines, and positron emission tomography-computed tomography demonstrated bilateral adrenal hypermetabolic lesions concerning for malignancy. She underwent open bilateral adrenalectomies and cholecystectomy. The right adrenal mass was identified as a PHEO with nonaggressive features and negative margins, and the left adrenal mass was an adrenal cortical adenoma without dysplasia. In April 2016, the patient was referred by her endocrinologist for elevated blood pressure and 16-lb weight loss. The patient reported weakness, headaches, hot flashes, cold sweats, and fatigue. Laboratory workup revealed elevated plasma free normetanephrine, and imaging showed a recurrence of the PHEO in both the right adrenal bed and the head of the right humerus. CONCLUSION Current predictors of PHEO recurrence failed to identify the original tumor as aggressive or likely to return as a metastatic lesion. Because of the rarity of these tumors, few consistent laboratory or radiologic predictors of malignancy based on initial presentation have been identified; predictors of malignancy in PHEO warrant further investigation.
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Affiliation(s)
- Larsa Al-Omaishi
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Jonathan Babin
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA
| | - Ralph L. Corsetti
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA
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Kim KY, Kim JH, Hong AR, Seong MW, Lee KE, Kim SJ, Kim SW, Shin CS, Kim SY. Disentangling of Malignancy from Benign Pheochromocytomas/Paragangliomas. PLoS One 2016; 11:e0168413. [PMID: 27992508 PMCID: PMC5161476 DOI: 10.1371/journal.pone.0168413] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/29/2016] [Indexed: 12/21/2022] Open
Abstract
Objective Many malignant tumors initially appear benign but subsequently exhibit extensive metastases. Early identification of malignant pheochromocytomas and paragangliomas (PPGLs) before metastasis is important for improved prognosis. However, there are no robust prognostic indices of recurrence and malignancy. The aim of this study was to identify the clinical and histopathological factors that predict malignant PPGLs. Design Retrospective follow-up study. Methods In this study, we included 223 patients with pathologically confirmed PPGLs who were treated between 2000 and 2015 at the Seoul National University Hospital in South Korea. Results Of these patients, 29 were diagnosed with malignancy, 12 of whom presented with metastatic lesions at the initial diagnosis while 17 developed metastases during follow-up. Nineteen patients with recurrent PPGLs consisted of ones with malignant PPGLs (n = 17) and multifocal PPGLs (n = 2) who had VHL and RET mutations. The mean age at presentation for malignant PPGLs was significantly younger than that for benign PPGLs (43.0 vs. 49.0 years, respectively; p = 0.023). Tumor size was not a distinguishing factor between malignant and benign PPGLs (5.0 vs. 4.5 cm, respectively; p = 0.316) nor did it predict recurrence. Of 119 patients with available pheochromocytoma of adrenal gland scaled score (PASS) data, those with malignant PPGLs presented PASS values ≥4. Of 12 parameters of PASS, necrosis, capsular invasion, vascular invasion, cellular monotony, high mitosis, atypical mitotic figures, and nuclear hyperchromasia were significant predictors of malignancy. Conclusions Tumor size did not predict malignancy or recurrence of PPGLs. PPGL patients with characteristic pathologic findings and PASS ≥4 or germline mutations require close follow-up.
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Affiliation(s)
- Kyong Young Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon-si, South Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail:
| | - A. Ram Hong
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seong Yeon Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon-si, South Korea
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Waingankar N, Bratslavsky G, Jimenez C, Russo P, Kutikov A. Pheochromocytoma in Urologic Practice. Eur Urol Focus 2016; 1:231-240. [PMID: 28078330 DOI: 10.1016/j.euf.2015.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
CONTEXT Pheochromocytoma is regularly encountered in urological practice and requires a thoughtful and careful clinical approach. OBJECTIVE To review clinical aspects of management of pheochromocytoma in urologic practice. EVIDENCE ACQUISITION A systematic review of English-language literature was performed through year 2015 using the Medline database. Manuscripts were selected with consensus of the coauthors and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. EVIDENCE SYNTHESIS Findings and recommendations of the evaluated manuscripts are discussed with an emphasis on the description of presentation, diagnosis, evaluation, and perioperative care. CONCLUSION In addition to surgical expertise, appropriate management of pheochromocytoma in urologic practice requires nuanced understanding of pathophysiology, genetics, and endocrinological principles. When skillfully managed, the vast majority of patients with pheochromocytoma should expect an excellent prognosis. PATIENT SUMMARY In this article we review the clinical approach to patients with pheochromocytoma, a tumor that stems from the innermost part of the adrenal gland and that often secretes excessive amounts of powerful hormones such as noradrenaline and adrenaline. Significant expertise is required to appropriately manage patients with these tumors. TAKE HOME MESSAGE In addition to surgical expertise, appropriate management of pheochromocytoma in urologic practice requires nuanced understanding of pathophysiology, genetics, and endocrinological principles. When skillfully managed, vast majority of patients with pheochromocytoma should expect an excellent prognosis.
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Affiliation(s)
| | | | - Camilo Jimenez
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul Russo
- Memorial Sloan Kettering Cancer Center, New York, New York
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Abstract
Although most adrenal tumors are not diagnostic dilemmas, there are cases that are challenging. This may be due to the tissue provided, for example fragmented tissue received in the setting of morcellation, or it may be due to inherently challenging histology, such as in cases with equivocal features of malignancy. Additionally, much has been learned about the molecular alterations of adrenal tumors, especially pheochromocytomas. Many of these alterations represent germline mutations with significant clinical implications for patients and their families. The aim of this review is to provide an overview of the most common adrenal tumors in adults so that pathologists can tackle these interesting tumors.
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Abstract
Adrenal gland diagnostics can pose significant challenges. In most academic and community practice settings, adrenal gland resections are encountered less frequently than other endocrine or genitourinary specimens, leading to less familiarity with evolving classifications and criteria. The unique dichotomy between cortical and medullary lesions reflects the developmental evolution of these functionally independent components. Adrenal cortical lesions at resection include hyperplasia, adenoma, and carcinoma, with some cases straddling the boundary between these distinct clinical classifications. The lack of immunohistochemical or molecular markers to definitively categorize these intermediate lesions enhances the diagnostic challenge. In addition, modified terminology for oncocytic and myxoid cortical lesions has been proposed. Medullary lesions are somewhat easier to categorize; however, the prediction of aggressive behavior in pheochromocytomas remains a challenge due to a lack of reliable prognostic biomarkers. Recent work by the Cancer Genome Atlas Project and other research groups has identified a limited subset of molecular and signaling pathway alterations in these 2 major neoplastic categories. Ongoing research to better define prognostic and predictive biomarkers in cortical and medullary lesions has the potential to enhance both pathologic diagnosis and patient therapy.
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Moriyama S, Takeshita H, Araki S, Tokairin T, Kagawa M, Chiba K, Adachi A, Noro A. Carcinoma-like nonfunctional pheochromocytoma in the right adrenal gland: A case report. Oncol Lett 2016; 12:1489-1492. [PMID: 27446458 DOI: 10.3892/ol.2016.4776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/12/2016] [Indexed: 11/05/2022] Open
Abstract
Evaluation of the malignant potential of a pheochromocytoma (PCC) remains controversial. PCC is regarded as a neuroendocrine tumor (NET), and the classification of NETs has gradually been defined over the last decade, particularly for gastroenteropancreatic NET. The present study describes a case of locally advanced, carcinoma-like, nonfunctional PCC, which may be regarded as neuroendocrine carcinoma (NEC) rather than a malignant PCC. A 72-year-old man was referred to Saitama Red Cross Hospital (Saitama, Japan), presenting with a 2-month history of right flank pain. Computed tomography revealed a right adrenal gland tumor, which measured 6.0 cm in diameter, invading the hilum of the right kidney, liver and inferior vena cava (IVC). Radical surgery was performed with en bloc resection of the right kidney, and adjacent parts of the liver and IVC. Immunohistochemical examination demonstrated that all of the resected tissues were positive for cytokeratin AE1/AE3, chromogranin A, synaptophysin, cluster of differentiation 56 and Ki-67, and the specimen had a Ki-67 index of 80%. A diagnosis of carcinoma-like PCC or NEC of the adrenal gland was confirmed. Reports of NEC of the adrenal gland are extremely rare in the literature, and classification of PCC as a NET has not yet been fully discussed. The present case may therefore contribute to the classification of NETs in the adrenal gland.
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Affiliation(s)
- Shingo Moriyama
- Department of Urology, Saitama Red Cross Hospital, Saitama 338-8553, Japan
| | - Hideki Takeshita
- Department of Urology, Saitama Red Cross Hospital, Saitama 338-8553, Japan
| | - Saori Araki
- Department of Urology, Saitama Red Cross Hospital, Saitama 338-8553, Japan
| | - Takuo Tokairin
- Department of Pathology, Saitama Red Cross Hospital, Saitama 338-8553, Japan
| | - Makoto Kagawa
- Department of Urology, Saitama Red Cross Hospital, Saitama 338-8553, Japan
| | - Koji Chiba
- Department of Urology, Saitama Red Cross Hospital, Saitama 338-8553, Japan
| | - Akiko Adachi
- Department of Pathology, Saitama Red Cross Hospital, Saitama 338-8553, Japan
| | - Akira Noro
- Department of Urology, Saitama Red Cross Hospital, Saitama 338-8553, Japan
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Li P, Zhao D. A rare case of retroperitoneal paraganglioma-case report and literature review. Transl Gastroenterol Hepatol 2016; 1:58. [PMID: 28138625 DOI: 10.21037/tgh.2016.06.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/07/2016] [Indexed: 12/14/2022] Open
Abstract
Paraganglioma is a rarely type of neuroendocrine neoplasm with the ability of neuropeptide and catecholamine secretion. Hypertension and sympathetic hyperactivity was the most common clinical presentation. And it is still a challenge to determine the biological behavior pathologically. Here, we reported a case of paraganglioma originated from retroperitoneal with the classical clinical presentation. Radical resection was performed successfully and malignant tendency was revealed in pathology. Meanwhile, literature review was conducted in order to figure out the diagnosis and prognosis.
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Affiliation(s)
- Peng Li
- Department of Abdominal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Dongbing Zhao
- Department of Abdominal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
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Plouin PF, Amar L, Dekkers OM, Fassnacht M, Gimenez-Roqueplo AP, Lenders JWM, Lussey-Lepoutre C, Steichen O. European Society of Endocrinology Clinical Practice Guideline for long-term follow-up of patients operated on for a phaeochromocytoma or a paraganglioma. Eur J Endocrinol 2016; 174:G1-G10. [PMID: 27048283 DOI: 10.1530/eje-16-0033] [Citation(s) in RCA: 276] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/19/2016] [Indexed: 11/08/2022]
Abstract
Phaeochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumours. Standard treatment is surgical resection. Following complete resection of the primary tumour, patients with PPGL are at risk of developing new tumoural events. The present guideline aims to propose standardised clinical care of long-term follow-up in patients operated on for a PPGL. The guideline has been developed by The European Society of Endocrinology and based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles. We performed a systematic review of the literature and analysed the European Network for the Study of Adrenal Tumours (ENS@T) database. The risk of new events persisted in the long term and was higher for patients with genetic or syndromic diseases. Follow-up in the published cohorts and in the ENS@T database was neither standardised nor exhaustive, resulting in a risk of follow-up bias and in low statistical power beyond 10 years after complete surgery. To inform patients and care providers in this context of low-quality evidence, the Guideline Working Group therefore prepared recommendations on the basis of expert consensus. Key recommendations are the following: we recommend that all patients with PPGL be considered for genetic testing; we recommend assaying plasma or urinary metanephrines every year to screen for local or metastatic recurrences or new tumours; and we suggest follow-up for at least 10 years in all patients operated on for a PPGL. High-risk patients (young patients and those with a genetic disease, a large tumour and/or a paraganglioma) should be offered lifelong annual follow-up.
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Affiliation(s)
- P F Plouin
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity
| | - L Amar
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity
| | - O M Dekkers
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity
| | - M Fassnacht
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity
| | - A P Gimenez-Roqueplo
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity
| | - J W M Lenders
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity
| | - C Lussey-Lepoutre
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France
| | - O Steichen
- Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyAssistance Publique-Hôpitaux de ParisHôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, FranceINSERMUMR 970, Paris-Cardiovascular Research Center, F-75015 Paris, FranceDepartment of Internal MedicineDivision of Vascular Medicine, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Internal Medicine IIIUniversity Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyAssistance Publique-Hôpitaux de ParisSorbonne Universités, UPMC University Paris 06, Tenon Hospital, Internal Medicine Department, F-75020 Paris, FranceINSERMUMR_S1142, F-75006 Paris, France Unité d'Hypertension ArtérielleHôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, F-75015 Paris, FranceFaculté de MédecineSorbonne Paris Cité, Université Paris-Descartes, F-75006 Paris, FranceDepartment of MedicineDivision of Endocrinology, and Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, DenmarkDepartment of Internal Medicine IDivision of Endocrinology and Diabetology, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity
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77
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Du Y, Huang Z, Wang L, Huang L, Cao P, He D, zhang Y, Wu D, Yang Z, Fan J. A novel diagnostic method of Raman spectroscopy for malignant pheochromocytoma/paraganglioma. RSC Adv 2016. [DOI: 10.1039/c6ra18312c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Raman spectroscopy, a potential tool in diagnosis of malignant pheochromocytoma/paraganglioma.
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Affiliation(s)
- Yiqing Du
- Department of Urology
- The First Affiliated Hospital of Medical College of Xi'an Jiaotong University
- Xi'an
- China
- Department of Urology
| | - Zhixin Huang
- Department of Urology
- The First Affiliated Hospital of Medical College of Xi'an Jiaotong University
- Xi'an
- China
| | - Lei Wang
- Department of Thoracic Surgery
- Tangdu Hospital
- The Fourth Military Medical University
- Xi'an
- China
| | - Liqing Huang
- Non-equilibrium Condensed Matter and Quantum Engineering Laboratory
- The Key Laboratory of Ministry of Education
- School of Science
- Xi'an Jiaotong University
- Xi'an
| | - Peilong Cao
- Department of Pathology
- The First Affiliated Hospital of Medical College of Xi'an Jiaotong University
- Xi'an
- China
| | - Dalin He
- Department of Urology
- The First Affiliated Hospital of Medical College of Xi'an Jiaotong University
- Xi'an
- China
| | - Yue zhang
- Department of Urology
- The First Affiliated Hospital of Medical College of Xi'an Jiaotong University
- Xi'an
- China
| | - Dapeng Wu
- Department of Urology
- The First Affiliated Hospital of Medical College of Xi'an Jiaotong University
- Xi'an
- China
| | - Zhishang Yang
- Department of Urology
- The First Affiliated Hospital of Medical College of Xi'an Jiaotong University
- Xi'an
- China
| | - Jinhai Fan
- Department of Urology
- The First Affiliated Hospital of Medical College of Xi'an Jiaotong University
- Xi'an
- China
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Abstract
Pheochromocytomas (PCCs) and paragangliomas (PGLs) are rare but unique neuroendocrine tumors. The hypersecretion of catecholamines from the tumors can be associated with high morbidity and mortality, even when tumors are benign. Up to 40% of PCCs/PGLs are associated with germline mutations in susceptibility genes. About one-quarter are malignant, defined by the presence of distant metastases. Treatment options for unresectable metastatic disease, including chemotherapy, (131)I-MIBG, and radiation, can offer limited tumor and hormone control, although none are curative. This article reviews the inherited genetics, diagnosis, and treatment of PCCs and PGLs.
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Affiliation(s)
- Lauren Fishbein
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 351 BRB II/III, 421 Curie Boulevard, Philadelphia, PA 19104, USA.
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79
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Choi YM, Sung TY, Kim WG, Lee JJ, Ryu JS, Kim TY, Kim WB, Hong SJ, Song DE, Shong YK. Clinical course and prognostic factors in patients with malignant pheochromocytoma and paraganglioma: A single institution experience. J Surg Oncol 2015; 112:815-21. [PMID: 26464058 DOI: 10.1002/jso.24063] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 09/27/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Malignant pheochromocytoma (PCC)/paraganglioma (PG) are rare neuroendocrine malignancies, and their clinical courses and prognoses are not well understood. This study aimed to evaluate prognostic factors associated with the survival of malignant PCC/PG. METHODS This retrospective study reviewed 299 patients with PCC and 46 with PG treated between 1997 and 2013 at our single tertiary hospital. Malignant PCC/PG was defined as the presence of distant metastasis or recurrence at sites where neuroendocrine tissue is normally not present. RESULTS Twenty-seven patients (9%) were confirmed with malignant PCC and six patients (13%) with malignant PG. Twenty-seven patients (82%) had distant metastases, nine patients (27%) presented with a metastasis at the initial diagnosis, whilst 24 patients (73%) were diagnosed with malignant PCC/PG during follow-up (median, 4.3 year). The median survival was 7.2 years, and the 5 year survival rate was 75.4%. Older age (>45 years), larger tumor size (>6 cm), synchronous metastasis, and absence of surgical excision were associated with poor survival by univariate analysis. By multivariate analysis, older age (HR = 4.3, P = 0.02) and synchronous metastasis (HR = 4.3, P = 0.01) were significantly associated with a poor prognosis. CONCLUSIONS Patients with malignant PCC/PG have diverse clinical courses. Poor survival was independently associated with older age and synchronous metastasis.
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Affiliation(s)
- Yun Mi Choi
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Jin Lee
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suck Joon Hong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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80
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Ezzat Abdel-Aziz T, Prete F, Conway G, Gaze M, Bomanji J, Bouloux P, Khoo B, Caplin M, Mushtaq I, Smart J, Kurzawinski TR. Phaeochromocytomas and paragangliomas: A difference in disease behaviour and clinical outcomes. J Surg Oncol 2015; 112:486-91. [PMID: 26337393 DOI: 10.1002/jso.24030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 08/18/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Phaeochromocytomas and paragangliomas arise from the same chromaffin cell, but evidence suggests they do not represent a single clinical entity. The aim of this study was to compare clinical presentations, outcomes of surgical and oncological treatments and survival in patients with phaeochromocytomas and paragangliomas. METHODS A retrospective review was undertaken of all patients treated for these conditions at our centre between 1983 and 2012. RESULTS One hundred and six patients (88 adults, 18 children) with phaeochromocytoma (n = 83) or paraganglioma (n = 23) were studied. Catecholamine symptoms and incidentalomas were the main presentations in phaeochromocytoma patients (67% and 17%) respectively, but in those with paragangliomas pain (39%) was more common (P < 0.001). More paragangliomas were malignant (14/23 vs 9/83, P < 0.0001), larger (9.17 ± 4.95 cm vs. 5.8 ± 3.44 cm, P = 0.001) and had a higher rate of conversion to open surgery (P = <0.01), more R2 resections, more postoperative complications and a longer hospital stay (P = 0.014). MIBG uptake in malignant paragangliomas was lower than in malignant phaeochromocytomas (36% vs. 100%, P = 0.002) and disease stabilisation was achieved in 29% and 86% of patients respectively. (90) Y-DOTA-octreotate had a 78% response rate in malignant paragangliomas. CONCLUSION The clinical differences between paragangliomas and phaeochromocytomas support the view that they should be considered as separate clinical entities.
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Affiliation(s)
- Tarek Ezzat Abdel-Aziz
- Centre for Endocrine Surgery, University College London Hospital and Great Ormond Street Hospital, London, UK.,Department of General Surgery, University of Alexandria, Egypt
| | - Francesco Prete
- Centre for Endocrine Surgery, University College London Hospital and Great Ormond Street Hospital, London, UK
| | - Gerard Conway
- Departments of Oncology, Endocrinology and Nuclear Medicine, University College London Hospital, London, UK
| | - Mark Gaze
- Departments of Oncology, Endocrinology and Nuclear Medicine, University College London Hospital, London, UK
| | - Jamshed Bomanji
- Departments of Oncology, Endocrinology and Nuclear Medicine, University College London Hospital, London, UK
| | - Pierre Bouloux
- Department of Endocrinology, Oncology and Neuroendocrine Unit, Royal Free Hospital, London, UK
| | - Bernard Khoo
- Department of Endocrinology, Oncology and Neuroendocrine Unit, Royal Free Hospital, London, UK
| | - Martyn Caplin
- Department of Endocrinology, Oncology and Neuroendocrine Unit, Royal Free Hospital, London, UK
| | - Imran Mushtaq
- Centre for Endocrine Surgery, University College London Hospital and Great Ormond Street Hospital, London, UK
| | - James Smart
- Centre for Endocrine Surgery, University College London Hospital and Great Ormond Street Hospital, London, UK
| | - Tom R Kurzawinski
- Centre for Endocrine Surgery, University College London Hospital and Great Ormond Street Hospital, London, UK
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Pheochromocytomas and Paragangliomas: An Update on Recent Molecular Genetic Advances and Criteria for Malignancy. Adv Anat Pathol 2015; 22:283-93. [PMID: 26262510 DOI: 10.1097/pap.0000000000000086] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pheochromocytomas are uncommon neuroendocrine tumors arising in the adrenal medulla, whereas paragangliomas arise from chromaffin cells in sympathetic and parasympathetic locations outside of the adrenal gland. Molecular genetic studies in the past few years have identified >10 genes involved in the pathogenesis of pheochromocytomas and paragangliomas, including RET oncogene, involved in the pathogenesis of multiple endocrine neoplasia (MEN) 2A and 2B, von Hippel-Lindau tumor-suppressor gene, neurofibromatosis type 1 gene, succinate dehydrogenase, THEM127, and several others. The presence of genetic alterations in some of these genes such as in MEN 2A and 2B can be used to diagnose these disorders clinically, and other mutations such as succinate dehydrogenase can be used in the pathologic prediction of benign and malignant pheochromocytomas and paragangliomas. Although it has been difficult to separate benign and malignant pheochromocytomas and paragangliomas, recent studies that may predict the behavior of these chromaffin-derived neoplasms have been reported. The Pheochromocytoma of the Adrenal Scale Score and the Grading system for Adrenal Pheochromocytoma and Paraganglioma scoring system are also discussed.
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82
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Angelousi A, Kassi E, Zografos G, Kaltsas G. Metastatic pheochromocytoma and paraganglioma. Eur J Clin Invest 2015; 45:986-97. [PMID: 26183460 DOI: 10.1111/eci.12495] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/04/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Metastatic pheochromocytomas (PCs) and paragangliomas (PGLs) are rare neuroendocrine tumours with a strong genetic background. DESIGN We searched the PubMed database through February 2015 to identify studies characterizing metastatic PCs/PGLs as well as currently established and evolving therapies. RESULTS Large size tumours (> 5 cm), PASS score > 6 and Ki-67 labelling index > 3% are the most robust indices of metastatic PCs/PGLs albeit with great variability. Germline succinate dehydrogenase complex, subunit B (SDHB) mutation constitutes the main reliable molecular predictor of malignancy. Plasma and urinary methoxytyramine are the biochemical markers characterizing metastatic PCs/PGLs along with evolving molecular markers such as miRNAs and SNAIL. Conventional imaging is used for tumour localization, whereas (18)F-FDG-PET for staging of metastatic PCs/PGLs especially those related to SDHB gene mutations. In addition, (68)Ga-DOTATATE PET/CT is emerging as a highly sensitive alternative. Surgery remains the gold standard treatment in reducing tumour bulk and/or controlling the clinical syndrome. Treatment with (131)I-MIBG or radiolabelled somatostatin analogues is considered for unresectable disease. Conventional chemotherapy is reserved for more advanced and refractory to other therapies disease although new schemes are currently evolving. Recent genetic studies have highlighted a number of pathways involved in PCs/PGLs pathogenesis directing towards the use of targeted therapies which have still to be validated in clinical practice. CONCLUSIONS Metastatic PCs/PGLs remain an orphan disease that is only curable by surgery. However, advances in genomic analyses have improved the pathogenesis of these tumours and may lead to effective and more personalized treatments in the near future.
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Affiliation(s)
- Anna Angelousi
- Department of Pathophysiology, Medical School, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evanthia Kassi
- Department of Biochemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Gregory Kaltsas
- Department of Pathophysiology, Medical School, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
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83
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Paragangliome fonctionnel abdominal : à propos d’un cas de découverte fortuite. Presse Med 2015; 44:944-8. [DOI: 10.1016/j.lpm.2015.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 05/21/2015] [Indexed: 11/19/2022] Open
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Tischler AS, deKrijger RR. 15 YEARS OF PARAGANGLIOMA: Pathology of pheochromocytoma and paraganglioma. Endocr Relat Cancer 2015; 22:T123-33. [PMID: 26136457 DOI: 10.1530/erc-15-0261] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2015] [Indexed: 01/17/2023]
Abstract
Pathologists using their routine diagnostic tools can contribute both to the care of patients with pheochromocytoma/paraganglioma and to understanding the pathobiology of the tumors. They can document details of tissue organization and cytology that are accessible only by microscopy and can characterize admixtures of cell types that are morphologically distinct or show differential expression of immunohistochemical markers. Current roles and challenges for pathologists include differential diagnosis, identifying clues to the presence of hereditary disease, and effective communication of pathology information for clinical and research purposes. Future roles will increasingly involve risk stratification, identification of actionable targets for personalized therapies, and aiding the interpretation of molecular tests by helping characterize genetic variants of unknown significance. It remains to be determined to what extent the need for pathology input will be overshadowed by the availability of genetic testing and other molecular analyses at ever-decreasing cost, together with very effective clinical paradigms for risk stratification and patient care.
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Affiliation(s)
- Arthur S Tischler
- Department of Pathology and Laboratory MedicineTufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Box 802, Boston, Massachusetts 02111, USADepartment of PathologyErasmus MC University Medical Center, Rotterdam, The NetherlandsDepartment of PathologyReinier de Graaf Hospital, Delft, The Netherlands
| | - Ronald R deKrijger
- Department of Pathology and Laboratory MedicineTufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Box 802, Boston, Massachusetts 02111, USADepartment of PathologyErasmus MC University Medical Center, Rotterdam, The NetherlandsDepartment of PathologyReinier de Graaf Hospital, Delft, The Netherlands Department of Pathology and Laboratory MedicineTufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Box 802, Boston, Massachusetts 02111, USADepartment of PathologyErasmus MC University Medical Center, Rotterdam, The NetherlandsDepartment of PathologyReinier de Graaf Hospital, Delft, The Netherlands
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85
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Vascular pattern analysis for the prediction of clinical behaviour in pheochromocytomas and paragangliomas. PLoS One 2015; 10:e0121361. [PMID: 25794004 PMCID: PMC4368716 DOI: 10.1371/journal.pone.0121361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/31/2015] [Indexed: 01/18/2023] Open
Abstract
Pheochromocytomas (PCCs) are neuroendocrine tumors arising from chromaffin cells of the adrenal medulla. Related tumors that arise from the paraganglia outside the adrenal medulla are called paragangliomas (PGLs). PCC/PGLs are usually benign, but approximately 17% of these tumors are malignant, as defined by the development of metastases. Currently, there are no generally accepted markers for identifying a primary PCC or PGL as malignant. In 2002, Favier et al. described the use of vascular architecture for the distinction between benign and malignant primary PCC/PGLs. The aim of this study was to validate the use of vascular pattern analysis as a test for malignancy in a large series of primary PCC/PGLs. Six independent observers scored a series of 184 genetically well-characterized PCCs and PGLs for the CD34 immunolabeled vascular pattern and these findings were correlated to the clinical outcome. Tumors were scored as malignant if an irregular vascular pattern was observed, including vascular arcs, parallels and networks, while tumors with a regular pattern of short straight capillaries were scored as benign. Mean sensitivity and specificity of vascular architecture, as a predictor of malignancy was 59.7% and 72.9%, respectively. There was significant agreement between the 6 observers (mean κ = 0.796). Mean sensitivity of vascular pattern analysis was higher in tumors >5 cm (63.2%) and in genotype cluster 2 tumors (100%). In conclusion, vascular pattern analysis cannot be used in a stand-alone manner as a prognostic tool for the distinction between benign and malignant PCC, but could be used as an indicator of malignancy and might be a useful tool in combination with other morphological characteristics.
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86
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Zografos GN, Perysinakis I, Kyrodimou E, Kassi E, Kaltsas G. Surgical treatment of potentially primary malignant adrenal tumors: an unresolved issue. Hormones (Athens) 2015; 14:47-58. [PMID: 25885103 DOI: 10.1007/bf03401380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although the great majority of incidentalomas are adrenocortical adenomas, a number of them, depending on the size and radiological characteristics of the lesions, will turn out to be carcinomas. These tumors may present as suspicious on initial evaluation and potentially malignant or malignant on histology. Adrenocortical carcinoma is a rare and aggressive malignancy with evolving diagnostic and therapeutic approaches. Laparoscopic surgery has become the gold standard for surgery of benign adrenal tumors. Despite the extensive experience gained in laparoscopic adrenalectomy, controversy still remains in the management of adrenal tumors with high suspicion or evidence of malignancy. The aim of this review is to update the existing information regarding the diagnostic approach and surgical management of suspicious and potentially malignant primary adrenal tumors.The interpretation of radiologic characteristics is a cornerstone in pre-operative assessment of large adrenal masses, since open surgery remains the preferred procedure when malignancy is suspected in large tumors with possible local invasion. Despite the improvement of imaging techniques, they lack sufficient accuracy to exclude primary malignancy in tumors from 4 cm to 10 cm in size. An initial laparoscopic approach can be used in this group of patients, but early conversion to open technique is mandatory if curative resection cannot be performed. Adrenal tumors >10 cm of malignant potential should be treated by the open approach from the start. Solitary adrenal metastasis from another primary malignancy is usually amenable to laparoscopic surgery. Patients with suspected adrenal cancer should be referred to tertiary centers that perform laparoscopic and open adrenal surgery with minimal morbidity and mortality.
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Affiliation(s)
- George N Zografos
- Third Department of Surgery, General Hospital "G. Gennimatas", Athens, Greece
| | - Iraklis Perysinakis
- Third Department of Surgery, General Hospital "G. Gennimatas", Athens, Greece
| | | | - Eva Kassi
- Department of Biochemistry, National University of Athens; Athens, Greece
| | - Gregory Kaltsas
- Department of Pathophysiology, National University of Athens; Athens, Greece
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87
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Ocal I, Avci A, Cakalagaoglu F, Can H. Lack of correlations among histopathological parameters, Ki-67 proliferation index and prognosis in pheochromocytoma patients. Asian Pac J Cancer Prev 2014; 15:1751-5. [PMID: 24641403 DOI: 10.7314/apjcp.2014.15.4.1751] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this study prognostic correlations of histopathologic parameters and the Ki-67 proliferation index and as well as the diagnostic value of immunohistochemical markers in pheochromocytomas were evaluated. MATERIALS AND METHODS A total of 22 patients diagnosed with a pheochromocytoma between 2000-2010 in Izmir Katip Celebi University Ataturk Training and Research Hospital were included. Diagnostic value of the PASS scoring system, and prognostic correlations of histopathologic parameters and Ki-67 proliferation index were investigated. SPSS for Windows 17.0 software was used for statistical analysis. RESULTS There was no statistically significant correlation between recurrence and clinicopathologic parameters or the PASS score (PASS>4). In addition, there were no statistically significant correlations between PASS score and clinicopathologic parameters, such as diameter (5 cm), weight (>100g), gender (female/male ratio) and age (25-45/45-55/>55). Besides, there were no significant correlation between diameter and clinicopathological parameters and also recurrence. However, there was a statistically significant correlation between Ki-67 proliferation index and capsule invasion (p=0.047). CONCLUSIONS Some but not most of the findings in our study were concordant with the literature. To clarify relationships, investigations with standard scoring systems which are not affected by subjective factors and feature appropriate histopathological criteria should be made on larger study groups.
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Affiliation(s)
- Irfan Ocal
- Departmant of Pathology, Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey E-mail :
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88
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Wachtel H, Cerullo I, Bartlett EK, Roses RE, Cohen DL, Kelz RR, Karakousis GC, Fraker DL. Clinicopathologic Characteristics of Incidentally Identified Pheochromocytoma. Ann Surg Oncol 2014; 22:132-8. [DOI: 10.1245/s10434-014-3933-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Indexed: 01/05/2023]
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Abstract
A promising grading system to predict metastasis in patients with phaeochromocytoma and paraganglioma assigns risk according to selected histological and other criteria. Such risk stratification might be useful for personalized management and screening programmes, as it could limit the costs of follow-up and reduce the risk of disseminated disease.
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Affiliation(s)
- Graeme Eisenhofer
- Institute of Clinical Chemistry & Laboratory Medicine and Department of Medicine III, University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Arthur S Tischler
- Department of Pathology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
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Kimura N, Takayanagi R, Takizawa N, Itagaki E, Katabami T, Kakoi N, Rakugi H, Ikeda Y, Tanabe A, Nigawara T, Ito S, Kimura I, Naruse M. Pathological grading for predicting metastasis in phaeochromocytoma and paraganglioma. Endocr Relat Cancer 2014; 21:405-14. [PMID: 24521857 DOI: 10.1530/erc-13-0494] [Citation(s) in RCA: 218] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Phaeochromocytomas (PHEO) and paragangliomas are rare catecholamine-producing tumours. Although 10-30% of these tumours metastasise, histopathological criteria to discriminate malignant from benign tumours have not been established; therefore, reliable histopathological markers predicting metastasis are urgently required. A total of 163 tumours, including 40 metastatic tumours, collected by the Phaeochromocytoma Study Group in Japan (PHEO-J) were analysed using a system called grading system for adrenal phaeochromocytoma and paraganglioma (GAPP). The tumours were scored based on GAPP criteria as follows: histological pattern, cellularity, comedo-type necrosis, capsular/vascular invasion, Ki67 labelling index and catecholamine type. All tumours were scored from 0 to 10 points and were graded as one of the three types: well-differentiated (WD, 0-2 points), moderately differentiated (MD, 3-6 points) and poorly differentiated (PD, 7-10 points). GAPP scores of the non-metastatic and metastatic groups were 2.08±0.17 and 5.33±0.43 (mean±s.e.m., P<0.001) respectively. There was a significant negative correlation between the GAPP score and the interval until metastasis (r=-0.438, P<0.01). The mean number of years until metastasis after the initial operation was 5.5±2.6 years. The study included 111 WD, 35 MD and 17 PD types. The five-year survival of these groups was 100, 66.8 and 22.4% respectively. In addition, negative immunoreactivity for succinate dehydrogenase gene subunit B (SDHB) was observed in 13 (8%) MD or PD tumours and ten of the 13 (77%) had metastases. Our data indicate that a combination of GAPP classification and SDHB immunohistochemistry might be useful for the prediction of metastasis in these tumours.
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91
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Abstract
The past 25 years have witnessed revolutionary changes in the care of patients with pheochromocytomas and extra-adrenal paragangliomas. Germline mutations of at least 13 genes are now associated with tumor development, a greater degree of hereditary susceptibility than for any other human neoplasm. Somatic mutations, either of the same genes or of several additional ones with closely related functions, are also increasingly recognized. Clinicians are now aware of the genetic implications of a pheochromocytoma or paraganglioma. All patients are therefore offered genetic testing and receive lifelong surveillance. Almost all of the mutated genes have well-described correlations with clinical and biochemical phenotypes. Tumors arising in patients with mutations of the SDHB gene have at least a 30 % chance of metastasizing and typically produce norepinephrine and/or dopamine. Assay of plasma-free metanephrines serves as a highly sensitive and specific biochemical screen for the presence of catecholamine-producing tumors, and the dopamine metabolite methoxytyramine serves as a useful marker for detecting minimally functional tumors or their metastases. New functional imaging techniques provide highly sensitive tumor localization. In addition to differential diagnosis, pathologists play new roles in helping to identify hereditary disease and guiding the sequence of genetic testing.
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Affiliation(s)
- Arthur S Tischler
- Department of Pathology, Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA,
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92
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Martins R, Bugalho MJ. Paragangliomas/Pheochromocytomas: clinically oriented genetic testing. Int J Endocrinol 2014; 2014:794187. [PMID: 24899893 PMCID: PMC4037125 DOI: 10.1155/2014/794187] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/15/2014] [Indexed: 02/07/2023] Open
Abstract
Paragangliomas are rare neuroendocrine tumors that arise in the sympathetic or parasympathetic nervous system. Sympathetic paragangliomas are mainly found in the adrenal medulla (designated pheochromocytomas) but may also have a thoracic, abdominal, or pelvic localization. Parasympathetic paragangliomas are generally located at the head or neck. Knowledge concerning the familial forms of paragangliomas has greatly improved in recent years. Additionally to the genes involved in the classical syndromic forms: VHL gene (von Hippel-Lindau), RET gene (Multiple Endocrine Neoplasia type 2), and NF1 gene (Neurofibromatosis type 1), 10 novel genes have so far been implicated in the occurrence of paragangliomas/pheochromocytomas: SDHA, SDHB, SDHC, SDHD, SDHAF2, TMEM127, MAX, EGLN1, HIF2A, and KIF1B. It is currently accepted that about 35% of the paragangliomas cases are due to germline mutations in one of these genes. Furthermore, somatic mutations of RET, VHL, NF1, MAX, HIF2A, and H-RAS can also be detected. The identification of the mutation responsible for the paraganglioma/pheochromocytoma phenotype in a patient may be crucial in determining the treatment and allowing specific follow-up guidelines, ultimately leading to a better prognosis. Herein, we summarize the most relevant aspects regarding the genetics and clinical aspects of the syndromic and nonsyndromic forms of pheochromocytoma/paraganglioma aiming to provide an algorithm for genetic testing.
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Affiliation(s)
- Rute Martins
- Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, 8005-139 Faro, Portugal
| | - Maria João Bugalho
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., 1099-023 Lisboa, Portugal
- Clínica Universitária de Endocrinologia, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal
- *Maria João Bugalho:
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Papathomas TG, de Krijger RR, Tischler AS. Paragangliomas: update on differential diagnostic considerations, composite tumors, and recent genetic developments. Semin Diagn Pathol 2013; 30:207-23. [PMID: 24144290 DOI: 10.1053/j.semdp.2013.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Recent developments in molecular genetics have expanded the spectrum of disorders associated with pheochromocytomas (PCCs) and extra-adrenal paragangliomas (PGLs) and have increased the roles of pathologists in helping to guide patient care. At least 30% of these tumors are now known to be hereditary, and germline mutations of at least 10 genes are known to cause the tumors to develop. Genotype-phenotype correlations have been identified, including differences in tumor distribution, catecholamine production, and risk of metastasis, and types of tumors not previously associated with PCC/PGL are now considered in the spectrum of hereditary disease. Important new findings are that mutations of succinate dehydrogenase genes SDHA, SDHB, SDHC, SDHD, and SDHAF2 (collectively "SDHx") are responsible for a large percentage of hereditary PCC/PGL and that SDHB mutations are strongly correlated with extra-adrenal tumor location, metastasis, and poor prognosis. Further, gastrointestinal stromal tumors and renal tumors are now associated with SDHx mutations. A PCC or PGL caused by any of the hereditary susceptibility genes can present as a solitary, apparently sporadic, tumor, and substantial numbers of patients presenting with apparently sporadic tumors harbor occult germline mutations of susceptibility genes. Current roles of pathologists are differential diagnosis of primary tumors and metastases, identification of clues to occult hereditary disease, and triaging of patients for optimal genetic testing by immunohistochemical staining of tumor tissue for the loss of SDHB and SDHA protein. Diagnostic pitfalls are posed by morphological variants of PCC/PGL, unusual anatomic sites of occurrence, and coexisting neuroendocrine tumors of other types in some hereditary syndromes. These pitfalls can be avoided by judicious use of appropriate immunohistochemical stains. Aside from loss of staining for SDHB, criteria for predicting risk of metastasis are still controversial, and "malignancy" is diagnosed only after metastases have occurred. All PCCs/PGLs are considered to pose some risk of metastasis, and long-term follow-up is advised.
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Affiliation(s)
- Thomas G Papathomas
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC-University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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94
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Contribution 2013 du CCAFU au référentiel INCa : Tumeurs malignes de la surrénale. Prog Urol 2013; 23 Suppl 2:S167-74. [DOI: 10.1016/s1166-7087(13)70054-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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95
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Stefanidis D, Goldfarb M, Kercher KW, Hope WW, Richardson W, Fanelli RD. SAGES guidelines for minimally invasive treatment of adrenal pathology. Surg Endosc 2013; 27:3960-80. [PMID: 24018761 DOI: 10.1007/s00464-013-3169-z] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 08/02/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Dimitrios Stefanidis
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, CMC Surgical Specialty Center, Suite 300, 1025 Morehead Medical Plaza, Charlotte, NC, 28204, USA,
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96
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Lowery AJ, Walsh S, McDermott EW, Prichard RS. Molecular and therapeutic advances in the diagnosis and management of malignant pheochromocytomas and paragangliomas. Oncologist 2013; 18:391-407. [PMID: 23576482 DOI: 10.1634/theoncologist.2012-0410] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Pheochromocytomas (PCCs) and paragangliomas (PGLs) are rare catecholamine-secreting tumors derived from chromaffin cells originating in the neural crest. These tumors represent a significant diagnostic and therapeutic challenge because the diagnosis of malignancy is frequently made in retrospect by the development of metastatic or recurrent disease. Complete surgical resection offers the only potential for cure; however, recurrence can occur even after apparently successful resection of the primary tumor. The prognosis for malignant disease is poor because traditional treatment modalities have been limited. The last decade has witnessed exciting discoveries in the study of PCCs and PGLs; advances in molecular genetics have uncovered hereditary and germline mutations of at least 10 genes that contribute to the development of these tumors, and increasing knowledge of genotype-phenotype interactions has facilitated more accurate determination of malignant potential. Elucidating the molecular mechanisms responsible for malignant transformation in these tumors has opened avenues of investigation into targeted therapeutics that show promising results. There have also been significant advances in functional and radiological imaging and in the surgical approach to adrenalectomy, which remains the mainstay of treatment for PCC. In this review, we discuss the currently available diagnostic and therapeutic options for patients with malignant PCCs and PGLs and detail the molecular rationale and clinical evidence for novel and emerging diagnostic and therapeutic strategies.
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Affiliation(s)
- Aoife J Lowery
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
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97
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Fishbein L, Orlowski R, Cohen D. Pheochromocytoma/Paraganglioma: Review of perioperative management of blood pressure and update on genetic mutations associated with pheochromocytoma. J Clin Hypertens (Greenwich) 2013; 15:428-34. [PMID: 23730992 DOI: 10.1111/jch.12084] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 02/04/2023]
Abstract
Pheochromocytomas and paragangliomas are rare tumors with high morbidity rates caused by excessive catecholamine secretion, even though the majority of tumors are benign. The use of perioperative blockade regimens, together with improved surgical techniques, has greatly impacted the perioperative morbidity associated with these tumors. The old dogma of the "tumor of tens" no longer holds true. For example, at least one third of all pheochromocytomas and paragangliomas are hereditary, with mutations in 1 of 10 well-characterized susceptibility genes, and one quarter of all tumors are malignant. This review focuses on the perioperative management of pheochromocytoma and paragangliomas and the clinical implications of the associated genetic mutations.
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Affiliation(s)
- Lauren Fishbein
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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98
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Fishbein L, Nathanson KL. Pheochromocytoma and paraganglioma: understanding the complexities of the genetic background. Cancer Genet 2012; 205:1-11. [PMID: 22429592 DOI: 10.1016/j.cancergen.2012.01.009] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 01/17/2012] [Accepted: 01/19/2012] [Indexed: 12/29/2022]
Abstract
Pheochromocytomas and paragangliomas (PCC/PGL) are tumors derived from the adrenal medulla or extra-adrenal ganglia, respectively. They are rare and often benign tumors that are associated with high morbidity and mortality due to mass effect and high circulating catecholamines. Although most PCCs and PGLs are thought to be sporadic, over one third are associated with 10 known susceptibility genes. Mutations in three genes causing well characterized tumor syndromes are associated with an increased risk of developing PCCs and PGLs, including VHL (von Hippel-Lindau disease), NF1 (Neurofibromatosis Type 1), and RET (Multiple Endocrine Neoplasia Type 2). Mutations in any of the succinate dehydrogenase (SDH) complex subunit genes (SDHA, SDHB, SDHC, SDHD) can lead to PCCs and PGLs with variable penetrance, as can mutations in the subunit cofactor, SDHAF2. Recently, two additional genes have been identified, TMEM127 and MAX. Although these tumors are rare in the general population, occurring in two to eight per million people, they are more commonly associated with an inherited mutation than any other cancer type. This review summarizes the known germline and somatic mutations leading to the development of PCC and PGL, as well as biochemical profiling for PCCs/PGLs and screening of mutation carriers.
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Affiliation(s)
- Lauren Fishbein
- Division of Endocrinology, Department of Medicine, Diabetes and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Guillemot J, Thouënnon E, Guérin M, Vallet-Erdtmann V, Ravni A, Montéro-Hadjadje M, Lefebvre H, Klein M, Muresan M, Seidah NG, Anouar Y, Yon L. Differential expression and processing of secretogranin II in relation to the status of pheochromocytoma: implications for the production of the tumoral marker EM66. J Mol Endocrinol 2012; 48:115-27. [PMID: 22217803 DOI: 10.1530/jme-11-0077] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We have previously demonstrated that measurement of tissue concentrations of the secretogranin II (SgII or SCG2 as listed in the HUGO database)-derived peptide EM66 may help to discriminate between benign and malignant pheochromocytomas and that EM66 represents a sensitive plasma marker of pheochromocytomas. Here, we investigated the gene expression and protein production of SgII in 13 normal adrenal glands, and 35 benign and 16 malignant pheochromocytomas with the goal to examine the molecular mechanisms leading to the marked variations in the expression of EM66 in tumoral chromaffin tissue. EM66 peptide levels were 16-fold higher in benign than in malignant pheochromocytomas and had an area under the receiver-operating characteristic curve of 0.95 for the distinction of benign and malignant tumors. Q-PCR experiments indicated that the SgII gene was significantly underexpressed in malignant tumors compared with benign tumors. Western blot analysis using antisera directed against SgII and SgII-derived fragments revealed lower SgII protein and SgII-processing products in malignant tumors. Western blot also showed that low p-cAMP-responsive element-binding (CREB) concentrations seemed to be associated with the malignant status. In addition, the prohormone convertase PC1 and PC2 genes and proteins were overexpressed in benign pheochromocytomas compared with malignant pheochromocytomas. Low concentrations of EM66 found in malignant tumors are associated with reduced expression and production of SgII and SgII-derived peptides that could be ascribed to a decrease in SgII gene transcription, probably linked to p-CREB down-regulation, and to lower PC levels. These findings highlight the mechanisms leading to lower concentrations of EM66 in malignant pheochromocytoma and strengthen the notion that this peptide is a suitable marker of this neuroendocrine tumor.
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Affiliation(s)
- J Guillemot
- Institut National de la Santé et de la Recherche Médicale Unité 982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Rouen University, Institute for Research and Innovation in Biomedicine, 76821 Mont-Saint-Aignan, France
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100
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Eisenhofer G, Tischler AS, de Krijger RR. Diagnostic tests and biomarkers for pheochromocytoma and extra-adrenal paraganglioma: from routine laboratory methods to disease stratification. Endocr Pathol 2012; 23:4-14. [PMID: 22180288 DOI: 10.1007/s12022-011-9188-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The laboratory workup of patients with pheochromocytoma and extra-adrenal paraganglioma (PPGLs) has traditionally focused on biochemical measurements of tumor secretory products or their metabolites, with ultimate diagnosis resting on routine histopathology and immunohistochemistry. While such testing remains important, the needs to distinguish potentially metastatic from benign tumors and to identify tumors with a hereditary basis have stimulated searches for additional means to stratify patients according to risk of metastasis or presence of a particular mutation. Biomarkers based on traditional biochemical tests, such as profiles of catecholamine metabolites and granin-derived peptides, provide utility for both purposes, while novel biomarkers are being identified by proteomic and transcriptomic studies, the latter including microRNA expression profiling. Histopathological scoring methods for predicting metastatic potential, such as the Pheochromocytoma of the Adrenal Gland Scaled Score (PASS), are limited by poor interobserver concordance, discrepant results between studies and incomplete knowledge of how scores relate to genotype. Immunohistochemical staining for succinate dehydrogenase (SDH) subunit B to triage patients for genetic testing of SDH subunit genes illustrates the growing importance of pathology as an adjunct to genetic testing for disease stratification. Although considerable effort has been expended on microarray-based platforms to identify biomarkers of malignancy, as yet, none of those proposed have been demonstrated to reliably discriminate malignant from benign disease any better than the PASS. Because of the heterogeneity of PPGLs and variable time between first appearance of tumors and identification of metastases, any prospective study to establish prognostic efficacy requires large numbers of patients and extended follow-up.
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Affiliation(s)
- Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine and Department of Medicine III, University of Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
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