151
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Crona J, Taïeb D, Pacak K. New Perspectives on Pheochromocytoma and Paraganglioma: Toward a Molecular Classification. Endocr Rev 2017; 38:489-515. [PMID: 28938417 PMCID: PMC5716829 DOI: 10.1210/er.2017-00062] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023]
Abstract
A molecular biology-based taxonomy has been proposed for pheochromocytoma and paraganglioma (PPGL). Data from the Cancer Genome Atlas revealed clinically relevant prognostic and predictive biomarkers and stratified PPGLs into three main clusters. Each subgroup has a distinct molecular-biochemical-imaging signature. Concurrently, new methods for biochemical analysis, functional imaging, and medical therapies have also become available. The research community now strives to match the cluster biomarkers with the best intervention. The concept of precision medicine has been long awaited and holds great promise for improved care. Here, we review the current and future PPGL classifications, with a focus on hereditary syndromes. We discuss the current strengths and shortcomings of precision medicine and suggest a condensed manual for diagnosis and treatment of both adult and pediatric patients with PPGL. Finally, we consider the future direction of this field, with a particular focus on how advanced molecular characterization of PPGL can improve a patient's outcome, including cures and, ultimately, disease prevention.
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Affiliation(s)
- Joakim Crona
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.,Department of Medical Sciences, Uppsala University, Sweden
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, European Center for Research in Medical Imaging, Aix Marseille Université, France
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
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152
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Hu H, Huang B, Zhao J, Yuan D, Yang Y, Xiong F. En Bloc Resection with Major Blood Vessel Reconstruction for Locally Invasive Retroperitoneal Paragangliomas: A 15-Year Experience with Literature Review. World J Surg 2017; 41:997-1004. [PMID: 27896404 DOI: 10.1007/s00268-016-3846-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Retroperitoneal paragangliomas (PGs) are a rare subgroup of neuroendocrine tumors that are commonly located alongside the abdominal aorta. Complete tumor resection is thought to be restricted in patients with major blood vessel involvement. However, no study has specifically focused on aggressive surgical treatment in such patients. We evaluated the value of en bloc resection with major blood vessel reconstruction for locally invasive retroperitoneal PGs. METHODS Twenty-nine patients with retroperitoneal PGs with major blood vessel involvement were included in this retrospective study. Survival was compared between patients who underwent en bloc resection with major blood vessel reconstruction and those who underwent medical treatment. Prognostic predictors were analyzed in patients who underwent en bloc resection with major blood vessel reconstruction. RESULTS All 11 patients who underwent medical treatment obtained a pathological diagnosis by computed tomography-guided percutaneous needle biopsy. All 18 patients who underwent en bloc resection with major blood vessel reconstruction achieved complete tumor resection. Overall survival was higher in patients who underwent complete tumor resection than in those who underwent medical treatment (p < 0.05). No perioperative mortality occurred in patients who underwent complete tumor resection. Patients with no metastasis, no organ invasion, R0 resection, a Ki-67 index of ≤3%, and a tumor diameter of ≤11.7 cm showed better tumor-free survival (p < 0.05). CONCLUSIONS En bloc resection with major blood vessel reconstruction can be successfully performed and provide satisfactory outcomes for patients with locally invasive retroperitoneal PGs. This technique may become a standard surgical strategy for properly selected patients.
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Affiliation(s)
- Hankui Hu
- Department of Vascular Surgery, West China Hospital of Sichuan University, Guoxue Road No. 37, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Guoxue Road No. 37, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital of Sichuan University, Guoxue Road No. 37, Wuhou District, Chengdu, 610041, Sichuan Province, China.
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital of Sichuan University, Guoxue Road No. 37, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Yi Yang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Guoxue Road No. 37, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Fei Xiong
- Department of Vascular Surgery, West China Hospital of Sichuan University, Guoxue Road No. 37, Wuhou District, Chengdu, 610041, Sichuan Province, China
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153
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Hamidi O, Young WF, Gruber L, Smestad J, Yan Q, Ponce OJ, Prokop L, Murad MH, Bancos I. Outcomes of patients with metastatic phaeochromocytoma and paraganglioma: A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2017; 87:440-450. [PMID: 28746746 PMCID: PMC5854189 DOI: 10.1111/cen.13434] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The outcomes of patients with metastatic phaeochromocytoma (PHEO) and paraganglioma (PGL) are unclear. We performed a systematic review and meta-analysis of baseline characteristics and mortality rates of patients with metastatic PHEO and PGL (PPGL). DESIGN Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Scopus, Web of Science, and references of key articles were searched from inception to 2016. PATIENTS Studies comprised ≥20 patients with metastatic PPGL and reported baseline characteristics and follow-up data. MEASUREMENTS Reviewers extracted standardized data and assessed risk of bias using a modified Newcastle-Ottawa tool. Random-effects meta-analysis was used to pool event rates across studies. RESULTS Twenty retrospective noncomparative studies reported on 1338 patients with metastatic PHEO (685/1296, 52.9%) and PGL (611/1296, 47.1%), diagnosed at a mean age of 43.9 ± 5.2 years. Mean follow-up was 6.3 ± 3.2 years. Of 532 patients with reported data, 40.4% had synchronous metastases. Five-year (7 studies, n = 738) and 10-year (2 studies, n = 55) mortality rates for patients with metastatic PPGL were 37% (95% CI, 24%-51%) and 29% (95% CI, 17%-42%), respectively. Higher mortality was associated with male sex (RR 1.50; 95% CI, 1.11-2.02) and synchronous metastases (RR 2.43; 95% CI, 1.01-5.85). CONCLUSIONS Available low-quality evidence from heterogeneous studies suggests low mortality rates of patients with metastatic PPGL. Male sex and synchronous metastases correlated with increased mortality. The outcomes of patients with metastatic PPGL have been inadequately assessed, indicating the need for carefully planned prospective studies.
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Affiliation(s)
- Oksana Hamidi
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - William F. Young
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Lucinda Gruber
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - John Smestad
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic, Rochester, MN, USA
| | - Qi Yan
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Oscar J. Ponce
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Larry Prokop
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
| | - M. Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA
- Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA
| | - Irina Bancos
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN, USA
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154
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Abstract
PURPOSE OF REVIEW The purpose of this manuscript is to review the progress in the field of therapeutics for malignant pheochromocytomas and sympathetic paraganglioma (MPPG) over the past 5 years. RECENT FINDINGS The manuscript will describe the clinical predictors of survivorship and their influence on the first TNM staging classification for pheochromocytomas and sympathetic paragangliomas, the treatment of hormonal complications, and the rationale that supports the resection of the primary tumor and metastases in patients with otherwise incurable disease. Therapeutic options for patients with bone metastasis to the spine will be presented. The manuscript will also review chemotherapy and propose a maintenance regimen with dacarbazine for patients initially treated with cyclophosphamide, vincristine, and dacarbazine. Finally, the manuscript will review preliminary results of several phase 2 clinical trials of novel radiopharmaceutical agents and tyrosine kinase inhibitors. MPPGs are very rare neuroendocrine tumors. MPPGs are usually characterized by a large tumor burden, excessive secretion of catecholamines, and decreased overall survival. Recent discoveries have enhanced our knowledge of the pathogenesis and phenotypes of MPPG. This knowledge is leading to a better understanding of the indications and limitations of the currently available localized and systemic therapies as well as the development of phase 2 clinical trials for novel medications.
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155
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Kaemmerer D, Sänger J, Arsenic R, D’Haese JG, Neumann J, Schmitt-Graeff A, Wirtz RM, Schulz S, Lupp A. Evaluation of somatostatin, CXCR4 chemokine and endothelin A receptor expression in a large set of paragangliomas. Oncotarget 2017; 8:89958-89969. [PMID: 29163802 PMCID: PMC5685723 DOI: 10.18632/oncotarget.21194] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/17/2017] [Indexed: 12/11/2022] Open
Abstract
Paragangliomas are predominantly benign tumors, but in some cases invasive growth and also metastasis are observed. Given the limited number of nonsurgical treatment options, novel target structures for diagnostics and therapy of this tumor entity are urgently needed. In the present study, expression of all five somatostatin receptor (SST) subtypes, chemokine receptor CXCR4 and endothelin receptor type A (ETA) was assessed by means of immunohistochemistry in a total of 66 paraffin-embedded paraganglioma samples from 55 patients. The stainings were rated by means of the Immunoreactive Score and correlated to clinical data and to succinate dehydrogenase subunit B (SDHB) expression. SST2A was by far the most prominent receptor in the paragangliomas investigated. It was present in 89% of the tumors at a high intensity, followed by SST5, SST3, SST1 and SST4, which were detected in 47%, 35%, 35% and 13% of the samples, respectively. SDHB positive tumors exhibited significantly higher SST2A and SST3 expression as compared to SDHB negative cases. There was no correlation between SST and Ki-67 expression or grading of the tumors and no difference in SST expression between primary tumors and metastases. Cell surface expression of CXCR4 and ETA was detected only in few samples. On tumor capillaries, however, exceptionally strong staining for these two receptors was noticed in the vast majority of the tumors. In conclusion, paragangliomas are well suited for SST2A-based diagnostics and treatment modalities. An indirect targeting of these highly vascularized tumors via CXCR4 or ETA may also represent a promising future strategy.
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Affiliation(s)
- Daniel Kaemmerer
- Department of General and Visceral Surgery, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Jörg Sänger
- Laboratory of Pathology and Cytology Bad Berka, Bad Berka, Germany
| | - Ruza Arsenic
- Institute of Pathology, Charité University Hospital Berlin, Berlin, Germany
| | - Jan G. D’Haese
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Munich, Germany
| | - Jens Neumann
- Department of Pathology, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | | | - Stefan Schulz
- Institute of Pharmacology and Toxicology, Jena University Hospital, Jena, Germany
| | - Amelie Lupp
- Institute of Pharmacology and Toxicology, Jena University Hospital, Jena, Germany
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156
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Eijkelenkamp K, Osinga TE, de Jong MM, Sluiter WJ, Dullaart RPF, Links TP, Kerstens MN, van der Horst-Schrivers ANA. Calculating the optimal surveillance for head and neck paraganglioma in SDHB-mutation carriers. Fam Cancer 2017; 16:123-130. [PMID: 27573198 PMCID: PMC5243881 DOI: 10.1007/s10689-016-9923-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Germline mutations of the gene encoding succinate dehydrogenase subunit B (SDHB) predispose to head-and-neck-paraganglioma (HNPGL), sympathetic PGL, pheochromocytoma and renal cell carcinoma for which regular surveillance is required. SDHB-associated tumors harbor germline and somatic mutations, consistent with Knudson’s two-hit hypothesis. To assess the penetrance and optimal surveillance for different manifestations of SDHB mutation carriers. This study included all SDHB mutation carriers who were followed at the Department of Endocrinology at the University Medical Center of Groningen. Kaplan–Meier curves were used to assess the penetrance. Poisson process was used to assess the optimal age to start surveillance and intervals. Ninety-one SDHB-mutation carriers (38 men and 53 women) were included. Twenty-seven mutation carriers (30 %) had manifestations, with an overall penetrance 35 % at the age of 60 years. We calculated that optimal surveillance for HNPGL could start from an age of 27 years with an interval of 3.2 years. This study underscores the relatively low penetrance of disease in SDHB mutation carriers. Use of the Poisson approach provides a more accurate estimation of the age to initiate surveillance and length of intervals for HNPGL. These results may give rise to reconsider the current guidelines regarding the screening of these mutation carriers.
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Affiliation(s)
- Karin Eijkelenkamp
- Department of Endocrinology and Metabolic Diseases, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Thamara E Osinga
- Department of Endocrinology and Metabolic Diseases, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Mirjam M de Jong
- Department of Clinical Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wim J Sluiter
- Department of Endocrinology and Metabolic Diseases, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Robin P F Dullaart
- Department of Endocrinology and Metabolic Diseases, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Thera P Links
- Department of Endocrinology and Metabolic Diseases, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Michiel N Kerstens
- Department of Endocrinology and Metabolic Diseases, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Anouk N A van der Horst-Schrivers
- Department of Endocrinology and Metabolic Diseases, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
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157
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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: 23] [Impact Index Per Article: 3.3] [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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158
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Oldani A, Boldorini R, Spina P, Gentilli S. A rare case of Calot’s triangle paraganglioma. Eur Surg 2017. [DOI: 10.1007/s10353-017-0488-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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159
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Hamidi O, Young WF, Iñiguez-Ariza NM, Kittah NE, Gruber L, Bancos C, Tamhane S, Bancos I. Malignant Pheochromocytoma and Paraganglioma: 272 Patients Over 55 Years. J Clin Endocrinol Metab 2017; 102:3296-3305. [PMID: 28605453 PMCID: PMC5587061 DOI: 10.1210/jc.2017-00992] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/06/2017] [Indexed: 02/06/2023]
Abstract
CONTEXT Malignant pheochromocytoma (PHEO) and paraganglioma (PGL) are rare and knowledge of the natural history is limited. OBJECTIVE We aimed to describe baseline characteristics and outcomes of patients with malignant PHEO and PGL (PPGL) and to identify predictors of shorter survival. DESIGN Retrospective review of patients with malignant PPGL evaluated from 1960 to 2016. SETTING Referral center. PATIENTS The group comprised 272 patients. MAIN OUTCOME MEASURES Baseline description, survival outcomes, and predictors of shorter survival were evaluated in patients with rapidly progressive (n = 29) and indolent disease (n = 188). RESULTS Malignant PPGL was diagnosed at a median age of 39 years (range, 7 to 83 years), with synchronous metastases in 96 (35%) patients. In 176 (65%) patients, metastases developed at a median of 5.5 years (range, 0.3 to 53.4 years) from the initial diagnosis. Median follow-up was 8.2 years (range, 0.01 to 54.1 years). Median overall and disease-specific survivals were 24.6 and 33.7 years, respectively. Shorter survival correlated with male sex (P = 0.014), older age at the time of primary tumor (P = 0.0011), synchronous metastases (P < 0.0001), larger primary tumor size (P = 0.0039), elevated dopamine (P = 0.0195), and not undergoing primary tumor resection (P < 0.0001). There was no difference in the type of primary tumor or presence of SDHB mutation. CONCLUSIONS The clinical course of patients with malignant PPGL is remarkably variable. Rapid disease progression is associated with male sex, older age at diagnosis, synchronous metastases, larger tumor size, elevated dopamine, and not undergoing resection of primary tumor. An individualized approach to patients with metastatic PPGL is warranted.
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Affiliation(s)
- Oksana Hamidi
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
| | - William F. Young
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
| | | | - Nana Esi Kittah
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
| | - Lucinda Gruber
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Cristian Bancos
- Division of IT Services, Mayo Clinic, Rochester, Minnesota 55905
| | - Shrikant Tamhane
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
| | - Irina Bancos
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
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160
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Milione M, Maisonneuve P, Pellegrinelli A, Pusceddu S, Centonze G, Dominoni F, Brambilla C, Rubino M, Faggiano A, Buzzoni R, Concas L, Giacomelli L, Coppa J, Mazzaferro V, de Braud F. Loss of succinate dehydrogenase subunit B (SDHB) as a prognostic factor in advanced ileal well-differentiated neuroendocrine tumors. Endocrine 2017; 57:512-517. [PMID: 27905048 DOI: 10.1007/s12020-016-1180-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/10/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE Abnormal expression of succinate dehydrogenase, (SDH), in particular of the B subunit (SDHB), is implicated in the pathogenesis of neuroendocrine tumors. This study evaluates the distribution of SDHB in WHO grading G1 and G2 intestinal, well-differentiated neuroendocrine tumors and corresponding lymph node or liver metastases. METHODS We collected ileal well-differentiated neuroendocrine tumors specimens from consecutive patients with prior primary resection and distant synchronous or metachronous liver metastases. We obtained 195 specimens from primary tumors (n = 106) and metastases (n = 89). The expression (E) of SDHB and the immunostaining intensity (I) were evaluated semiquantitatively and combined into a single score. SDHB score was evaluated in primitive tumor and metastatic specimens. RESULTS SDHB was found in all tumor cells. Mean SDHB expression was 72.7 % ± 17.1 % in primitive specimens and 27.9 % ± 24.6 % in metastatic specimens (p < 0.0001). SDH intensity was higher in primitive specimens (p < 0.0001). SDHB score was 9-12 in 96 specimens of the primitive group and 2 metastatic specimens (p < 0.0001). None of the analyzed parameters was predictive of overall survival in the primitive subset. In the metastatic subset, loss of SDHB expression, intensity, and score were prognostic factors for survival. Lower expression and intensity of SDHB in metastatic lesions were associated with longer overall survival. When combining SDHB score and Ki-67 % in the metastatic subset, a lower SDHB score was associated with prolonged overall survival, independently from Ki-67 %. CONCLUSIONS SDHB score was different in primitive and metastatic specimens. The combination of SDHB score and Ki-67 % was a stronger predictor of overall survival than Ki-67 % alone. This stratification might help predict survival.
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Affiliation(s)
- Massimo Milione
- 1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS, Milan, Italy.
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of oncology (IEO), Milan, Italy
| | - Alessio Pellegrinelli
- 1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS, Milan, Italy
| | - Sara Pusceddu
- Departement of Medical Oncology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Giovanni Centonze
- 1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS, Milan, Italy
| | - Francesca Dominoni
- 1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS, Milan, Italy
| | - Cecilia Brambilla
- 1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS, Milan, Italy
| | - Manila Rubino
- Istituto Nazionale per lo studio e la cura dei tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - Antongiulio Faggiano
- Istituto Nazionale per lo studio e la cura dei tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - Roberto Buzzoni
- Departement of Medical Oncology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Laura Concas
- Departement of Medical Oncology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | | | - Jorgelina Coppa
- Department of Surgery, G.I. Surgery and Liver Transplantation, Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy
| | - Vincenzo Mazzaferro
- Department of Surgery, G.I. Surgery and Liver Transplantation, Istituto Nazionale Tumori (National Cancer Institute), Milan, Italy
| | - Filippo de Braud
- Departement of Medical Oncology, IRCCS Foundation National Cancer Institute, Milan, Italy
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161
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Chew WHW, Courtney E, Lim KH, Li ST, Chen Y, Tan MH, Chung A, Khoo J, Loh A, Soh SY, Iyer P, Loh LM, Ngeow J. Clinical management of pheochromocytoma and paraganglioma in Singapore: missed opportunities for genetic testing. Mol Genet Genomic Med 2017; 5:602-607. [PMID: 28944243 PMCID: PMC5606879 DOI: 10.1002/mgg3.313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/05/2017] [Accepted: 06/09/2017] [Indexed: 01/28/2023] Open
Abstract
Background Pheochromocytomas and paragangliomas (PPGLs) are neuroendocrine tumors of the adrenal glands and paraganglia, occurring sporadically or as a range of hereditary tumor syndromes. About 30% of PPGLs are attributed to germline mutations. Clinical presentation, including localization, malignant potential, and age of onset, varies depending on the genetic background. Genetic testing for PPGLs is not well studied in Southeast Asia. We reviewed clinical management of PPGLs in Singapore, highlighting current gaps in clinical practice. Methods Medical records of patients with PPGLs between 2005 and 2016 were reviewed. Diagnosis was confirmed histologically and stratified into sporadic or familial/syndromic (FS). Results Twenty‐seven (21.8%) patients were referred to the Cancer Genetics Service (CGS). FS PPGLs (18.5%) and extra‐adrenal PPGLs (58.1%) incidences were higher than previous studies. Referrals were lower for sporadic PPGLs compared to FS PPGLs (3.7% vs. 100%). Referrals were highest at diagnosis age <20 years old (80%) and decreased with increasing age; ≥20–<40 years old (32.1%), ≥40–<60 years old (10.6%). Genetic testing was taken up in 12/27 (44.4%) patients of which 7/12 (58.3%, 3 SDHB, 2 SDHD, 2 VHL) had germline mutations. Conclusion Opportunities for genetic testing are frequently missed due to low referral rates in patients with apparently sporadic PPGLs, particularly between ages 20‐60.
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Affiliation(s)
- Winston Hong Wern Chew
- Cancer Genetics ServiceDivision of Medical OncologyNational Cancer Centre SingaporeSingapore City169610Singapore
| | - Eliza Courtney
- Cancer Genetics ServiceDivision of Medical OncologyNational Cancer Centre SingaporeSingapore City169610Singapore
| | - Kok Hing Lim
- Department of PathologySingapore General HospitalSingapore City169610Singapore
| | - Shao Tzu Li
- Cancer Genetics ServiceDivision of Medical OncologyNational Cancer Centre SingaporeSingapore City169610Singapore
| | - Yanni Chen
- Cancer Genetics ServiceDivision of Medical OncologyNational Cancer Centre SingaporeSingapore City169610Singapore
| | - Min Han Tan
- Cancer Genetics ServiceDivision of Medical OncologyNational Cancer Centre SingaporeSingapore City169610Singapore
| | - Alexander Chung
- Division of SurgerySingapore General HospitalSingapore City169610Singapore
| | - Joan Khoo
- Department of EndocrinologyChangi General HospitalSingapore City529889Singapore
| | - Amos Loh
- Department of Paediatrics SurgeryKK Women's and Children's HospitalSingapore City229899Singapore
| | - Shui Yen Soh
- Division of PaediatricsKK Women's and Children's HospitalSingapore City229899Singapore
| | - Prasad Iyer
- Department of Paediatric SubspecialtiesHaematology-Oncology ServiceKK Women's and Children's HospitalSingapore City229899Singapore
| | - Lih Ming Loh
- Department of EndocrinologySingapore General HospitalSingapore City169610Singapore
| | - Joanne Ngeow
- Cancer Genetics ServiceDivision of Medical OncologyNational Cancer Centre SingaporeSingapore City169610Singapore
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Roman-Gonzalez A, Jimenez C. Malignant pheochromocytoma-paraganglioma: pathogenesis, TNM staging, and current clinical trials. Curr Opin Endocrinol Diabetes Obes 2017; 24:174-183. [PMID: 28234804 DOI: 10.1097/med.0000000000000330] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Pheochromocytomas and paragangliomas (PPGs) are rare neuroendocrine tumors. Over the last 15 years, substantial progress has been made toward understanding the clinical aspects and molecular origins of this disease. Nevertheless, predicting and managing malignancy remains the biggest challenge in clinical practice. The natural history of patients with malignant PPGs has not yet been described, and their prognosis varies. Currently, the diagnosis of malignant PPGs relies on the presence of metastases, by which time the disease is usually advanced. Better understanding of the clinical and molecular characteristics of patients with malignant PPGs has spurred several prospective clinical trials. RECENT FINDINGS Several molecular targeted therapies, a novel radiopharmaceutical medication that targets the catecholamine transporter, and immunotherapy are under evaluation for the treatment of patients with malignant PPGs. Furthermore, the identification of clinical predictors of malignancy and survival has led to the first TNM staging classification for PPGs. SUMMARY Prospective clinical trials are providing patients with therapeutic options beyond systemic chemotherapy. The knowledge derived from these trials and from the evaluation of the TNM staging in clinical practice will help to clarify how to most effectively treat malignant PPGs.
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Affiliation(s)
- Alejandro Roman-Gonzalez
- aDepartment of Endocrinology, Hospital Universitario San Vicente Fundacion-Universidad de Antioquia, Medellín, Colombia bDepartment of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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163
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Currás-Freixes M, Piñeiro-Yañez E, Montero-Conde C, Apellániz-Ruiz M, Calsina B, Mancikova V, Remacha L, Richter S, Ercolino T, Rogowski-Lehmann N, Deutschbein T, Calatayud M, Guadalix S, Álvarez-Escolá C, Lamas C, Aller J, Sastre-Marcos J, Lázaro C, Galofré JC, Patiño-García A, Meoro-Avilés A, Balmaña-Gelpi J, De Miguel-Novoa P, Balbín M, Matías-Guiu X, Letón R, Inglada-Pérez L, Torres-Pérez R, Roldán-Romero JM, Rodríguez-Antona C, Fliedner SMJ, Opocher G, Pacak K, Korpershoek E, de Krijger RR, Vroonen L, Mannelli M, Fassnacht M, Beuschlein F, Eisenhofer G, Cascón A, Al-Shahrour F, Robledo M. PheoSeq: A Targeted Next-Generation Sequencing Assay for Pheochromocytoma and Paraganglioma Diagnostics. J Mol Diagn 2017; 19:575-588. [PMID: 28552549 DOI: 10.1016/j.jmoldx.2017.04.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/07/2017] [Indexed: 12/26/2022] Open
Abstract
Genetic diagnosis is recommended for all pheochromocytoma and paraganglioma (PPGL) cases, as driver mutations are identified in approximately 80% of the cases. As the list of related genes expands, genetic diagnosis becomes more time-consuming, and targeted next-generation sequencing (NGS) has emerged as a cost-effective tool. This study aimed to optimize targeted NGS in PPGL genetic diagnostics. A workflow based on two customized targeted NGS assays was validated to study the 18 main PPGL genes in germline and frozen tumor DNA, with one of them specifically directed toward formalin-fixed paraffin-embedded tissue. The series involved 453 unrelated PPGL patients, of whom 30 had known mutations and were used as controls. Partial screening using Sanger had been performed in 275 patients. NGS results were complemented with the study of gross deletions. NGS assay showed a sensitivity ≥99.4%, regardless of DNA source. We identified 45 variants of unknown significance and 89 pathogenic mutations, the latter being germline in 29 (7.2%) and somatic in 58 (31.7%) of the 183 tumors studied. In 37 patients previously studied by Sanger sequencing, the causal mutation could be identified. We demonstrated that both assays are an efficient and accurate alternative to conventional sequencing. Their application facilitates the study of minor PPGL genes, and enables genetic diagnoses in patients with incongruent or missing clinical data, who would otherwise be missed.
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Affiliation(s)
- Maria Currás-Freixes
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Elena Piñeiro-Yañez
- Translational Bioinformatics Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - Cristina Montero-Conde
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - María Apellániz-Ruiz
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Bruna Calsina
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Veronika Mancikova
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Laura Remacha
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Susan Richter
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universitat Dresden, Dresden, Germany
| | - Tonino Ercolino
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence and Istituto Toscano Tumori, Florence, Italy
| | - Natalie Rogowski-Lehmann
- Department of Internal Medicine IV Campus Innenstadt, University-Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - María Calatayud
- Department of Endocrinology and Nutrition Service, University Hospital 12 de Octubre, Madrid, Spain
| | - Sonsoles Guadalix
- Department of Endocrinology and Nutrition Service, University Hospital 12 de Octubre, Madrid, Spain
| | | | - Cristina Lamas
- Department of Endocrinology, Albacete University Hospital Complex, Albacete, Spain
| | - Javier Aller
- Department of Endocrinology, University Hospital Puerta de Hierro, Madrid, Spain
| | - Julia Sastre-Marcos
- Department of Endocrinology, Virgen de la Salud Hospital-Toledo Hospital Complex, Toledo, Spain
| | - Conxi Lázaro
- Molecular Diagnostics Units of the Hereditary Cancer Program at the Catalan Institute of Oncology, Barcelona, Spain
| | - Juan C Galofré
- Department of Endocrinology, University of Navarra Clinic, Navarra, Spain
| | - Ana Patiño-García
- Department of Pediatrics and Clinical Genetics Unit, University of Navarra Clinic, Navarra, Spain
| | | | - Judith Balmaña-Gelpi
- High Risk and Cancer Prevention Group, Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Milagros Balbín
- Department of Molecular Oncology, Central University Hospital of Asturias and University Institute of Oncology of Asturias, University of Oviedo, Oviedo, Spain
| | - Xavier Matías-Guiu
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, IRBLLEIDA, Lleida, Spain; Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Rocío Letón
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Lucía Inglada-Pérez
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain; Biomedical Research Networking Center on Rare Diseases (CIBERER), Madrid, Spain
| | - Rafael Torres-Pérez
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Juan M Roldán-Romero
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - Cristina Rodríguez-Antona
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain; Biomedical Research Networking Center on Rare Diseases (CIBERER), Madrid, Spain
| | - Stephanie M J Fliedner
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Giuseppe Opocher
- Department of Endocrinology, Department of Medical and Surgical Sciences University of Padova, Padova, Italy
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
| | - Esther Korpershoek
- Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ronald R de Krijger
- Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Pathology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Laurent Vroonen
- Department of Endocrinology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Massimo Mannelli
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence and Istituto Toscano Tumori, Florence, Italy
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Felix Beuschlein
- Department of Internal Medicine IV Campus Innenstadt, University-Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universitat Dresden, Dresden, Germany; Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Alberto Cascón
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain; Biomedical Research Networking Center on Rare Diseases (CIBERER), Madrid, Spain
| | - Fátima Al-Shahrour
- Translational Bioinformatics Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre, Madrid, Spain; Biomedical Research Networking Center on Rare Diseases (CIBERER), Madrid, Spain.
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164
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Lussey-Lepoutre C, Buffet A, Gimenez-Roqueplo AP, Favier J. Mitochondrial Deficiencies in the Predisposition to Paraganglioma. Metabolites 2017; 7:metabo7020017. [PMID: 28471419 PMCID: PMC5487988 DOI: 10.3390/metabo7020017] [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: 03/30/2017] [Revised: 04/27/2017] [Accepted: 04/30/2017] [Indexed: 01/03/2023] Open
Abstract
Paragangliomas and pheochromocytomas are rare neuroendocrine tumours with a very strong genetic component. It is estimated that around 40% of all cases are caused by a germline mutation in one of the 13 predisposing genes identified so far. Half of these inherited cases are intriguingly caused by mutations in genes encoding tricarboxylic acid enzymes, namely SDHA, SDHB, SDHC, SDHD, and SDHAF2 genes, encoding succinate dehydrogenase and its assembly protein, FH encoding fumarate hydratase, and MDH2 encoding malate dehydrogenase. These mutations may also predispose to other type of cancers, such as renal cancer, leiomyomas, or gastro-intestinal stromal tumours. SDH, which is also the complex II of the oxidative respiratory chain, was the first mitochondrial enzyme to be identified having tumour suppressor functions, demonstrating that 80 years after his initial proposal, Otto Warburg may have actually been right when he hypothesized that low mitochondrial respiration was the origin of cancer. This review reports the current view on how such metabolic deficiencies may lead to cancer predisposition and shows that the recent data may lead to the development of innovative therapeutic strategies and establish precision medicine approaches for the management of patients affected by these rare diseases.
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Affiliation(s)
- Charlotte Lussey-Lepoutre
- INSERM UMR970, Paris-Cardiovascular Research Center at HEGP, F-75015 Paris, France.
- Equipe Labellisée Ligue contre le Cancer, F-75015 Paris, France.
- Faculté de Médecine, Université Pierre et Marie Curie, F-75006 Paris, France.
| | - Alexandre Buffet
- INSERM UMR970, Paris-Cardiovascular Research Center at HEGP, F-75015 Paris, France.
- Equipe Labellisée Ligue contre le Cancer, F-75015 Paris, France.
- Faculté de Médecine, Sorbonne Paris Cité, Paris Descartes, F-75006 Paris, France.
| | - Anne-Paule Gimenez-Roqueplo
- INSERM UMR970, Paris-Cardiovascular Research Center at HEGP, F-75015 Paris, France.
- Equipe Labellisée Ligue contre le Cancer, F-75015 Paris, France.
- Faculté de Médecine, Sorbonne Paris Cité, Paris Descartes, F-75006 Paris, France.
- APHP, Hôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, France.
| | - Judith Favier
- INSERM UMR970, Paris-Cardiovascular Research Center at HEGP, F-75015 Paris, France.
- Equipe Labellisée Ligue contre le Cancer, F-75015 Paris, France.
- Faculté de Médecine, Sorbonne Paris Cité, Paris Descartes, F-75006 Paris, France.
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165
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Jochmanova I, Wolf KI, King KS, Nambuba J, Wesley R, Martucci V, Raygada M, Adams KT, Prodanov T, Fojo AT, Lazurova I, Pacak K. SDHB-related pheochromocytoma and paraganglioma penetrance and genotype-phenotype correlations. J Cancer Res Clin Oncol 2017; 143:1421-1435. [PMID: 28374168 DOI: 10.1007/s00432-017-2397-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/14/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Succinate dehydrogenase subunit B (SDHB) gene mutations are associated with an aggressive clinical disease course of pheochromocytoma/paraganglioma (PHEO/PGL). Limited information is available concerning PHEO/PGL penetrance among SDHB mutation carriers with regards to primary tumor location, specific mutation type, and gender. We assessed PHEO/PGL penetrance in SDHB mutation carriers and described the clinical presentation and disease course. METHODS Asymptomatic relatives (N = 611) of 103 index patients were tested for SDHB mutations. Mutation carriers (N = 328) were offered PHEO/PGL screening, of which 241 participated and were included in penetrance analysis. For additional disease outcome analysis, the 103 index patients and 40 screened individuals who developed PHEO/PGL were included. Clinical data were collected between October 2004 and June 2016. RESULTS Forty (16.60%) of the 241 screened individuals developed PHEO/PGL during the study. The penetrance estimate in this population was 49.80% (95% CI 29-74.9) at 85 years. A significantly higher age-related penetrance of disease was observed in males compared to females, with 50% penetrance achieved at age 74 vs. not reached. Age-related penetrance analysis demonstrated 4 mutations (Ile127Ser, IVS1+1G>T, Exon 1 deletion, Arg90X) presenting with a slower rate of disease development (50% penetrance ages, respectively: not achieved, 70, 63, 61 years) compared to Arg46X and Val140Phe mutations (50% penetrance at 38 years). CONCLUSIONS Here, we found a higher estimated penetrance compared to several other studies, and a striking difference in age-related penetrance between male and female SDHB mutation carriers with no association between mutation and gender or tumor location.
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Affiliation(s)
- Ivana Jochmanova
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, 1E-3140, Bethesda, MD, 20892-1109, USA.,1st Department of Internal Medicine, Medical Faculty of P. J. Šafárik University in Košice, Trieda SNP 1, 04011, Košice, Slovakia
| | - Katherine I Wolf
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, 1E-3140, Bethesda, MD, 20892-1109, USA
| | - Kathryn S King
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, 1E-3140, Bethesda, MD, 20892-1109, USA
| | - Joan Nambuba
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, 1E-3140, Bethesda, MD, 20892-1109, USA
| | - Robert Wesley
- Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Victoria Martucci
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, 1E-3140, Bethesda, MD, 20892-1109, USA
| | - Margarita Raygada
- Section on Developmental Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Karen T Adams
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, 1E-3140, Bethesda, MD, 20892-1109, USA
| | - Tamara Prodanov
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, 1E-3140, Bethesda, MD, 20892-1109, USA
| | - Antonio Tito Fojo
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Ivica Lazurova
- 1st Department of Internal Medicine, Medical Faculty of P. J. Šafárik University in Košice, Trieda SNP 1, 04011, Košice, Slovakia
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, 1E-3140, Bethesda, MD, 20892-1109, USA.
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166
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Backman S, Maharjan R, Falk-Delgado A, Crona J, Cupisti K, Stålberg P, Hellman P, Björklund P. Global DNA Methylation Analysis Identifies Two Discrete clusters of Pheochromocytoma with Distinct Genomic and Genetic Alterations. Sci Rep 2017; 7:44943. [PMID: 28327598 PMCID: PMC5361146 DOI: 10.1038/srep44943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/14/2017] [Indexed: 02/07/2023] Open
Abstract
Pheochromocytomas and paragangliomas (PPGLs) are rare and frequently heritable neural-crest derived tumours arising from the adrenal medulla or extra-adrenal chromaffin cells respectively. The majority of PPGL tumours are benign and do not recur with distant metastases. However, a sizeable fraction of these tumours secrete vasoactive catecholamines into the circulation causing a variety of symptoms including hypertension, palpitations and diaphoresis. The genetic landscape of PPGL has been well characterized and more than a dozen genes have been described as recurrently mutated. Recent studies of DNA-methylation have revealed distinct clusters of PPGL that share DNA methylation patterns and driver mutations, as well as identified potential biomarkers for malignancy. However, these findings have not been adequately validated in independent cohorts. In this study we use an array-based genome-wide approach to study the methylome of 39 PPGL and 4 normal adrenal medullae. We identified two distinct clusters of tumours characterized by different methylation patterns and different driver mutations. Moreover, we identify genes that are differentially methylated between tumour subcategories, and between tumours and normal tissue.
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Affiliation(s)
- Samuel Backman
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Rajani Maharjan
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Joakim Crona
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Kenko Cupisti
- Department of Surgery, Marien-Hospital, Euskirchen, Germany
| | - Peter Stålberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Per Hellman
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Peyman Björklund
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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167
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Ellis CL, Harik LR, Cohen C, Osunkoya AO. Biomarker, Molecular, and Technologic Advances in Urologic Pathology, Oncology, and Imaging. Arch Pathol Lab Med 2017; 141:499-516. [PMID: 28157406 DOI: 10.5858/arpa.2016-0263-sa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Urologic pathology is evolving rapidly. Emerging trends include the expanded diagnostic utility of biomarkers and molecular testing, as well as adapting to the plethora of technical advances occurring in genitourinary oncology, surgical practice, and imaging. We illustrate those trends by highlighting our approach to the diagnostic workup of a few selected disease entities that pathologists may encounter, including newly recognized subtypes of renal cell carcinoma, pheochromocytoma, and prostate cancer, some of which harbor a distinctive chromosomal translocation, gene loss, or mutation. We illustrate applications of immunohistochemistry for differential diagnosis of needle core renal biopsies, intraductal carcinoma of the prostate, and amyloidosis and cite encouraging results from early studies using targeted gene expression panels to predict recurrence after prostate cancer surgery. At our institution, pathologists are working closely with urologic surgeons and interventional radiologists to explore the use of intraoperative frozen sections for margins and nerve sparing during robotic prostatectomy, to pioneer minimally invasive videoscopic inguinal lymphadenectomy, and to refine image-guided needle core biopsies and cryotherapy of prostate cancer as well as blue-light/fluorescence cystoscopy. This collaborative, multidisciplinary approach enhances clinical management and research, and optimizes the care of patients with urologic disorders.
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Affiliation(s)
| | | | | | - Adeboye O Osunkoya
- From the Departments of Pathology (Drs Ellis, Harik, Cohen, and Osunkoya), Urology (Dr Osunkoya), and the Winship Cancer Institute (Dr Osunkoya), Emory University School of Medicine, Atlanta, Georgia; and the Department of Pathology, Veterans Affairs Medical Center, Atlanta, Georgia (Dr Osunkoya)
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168
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Srirangalingam U, Banerjee A, Patki P, Peters J, George E, Chew SL, Kumar VA, Korbonits M, Waterhouse M, Druce MR, Sahdev A, Drake WM, Akker SA. Succinate Dehydrogenase B (SDHB)-Associated Bladder Paragangliomas. Clin Genitourin Cancer 2017; 15:e131-e136. [DOI: 10.1016/j.clgc.2016.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/11/2016] [Indexed: 11/15/2022]
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169
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Controlling Tumor Progression with Cyclophosphamide, Vincristine, and Dacarbazine Treatment Improves Survival in Patients with Metastatic and Unresectable Malignant Pheochromocytomas/Paragangliomas. Discov Oncol 2017; 8:108-118. [DOI: 10.1007/s12672-017-0284-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/11/2017] [Indexed: 01/01/2023] Open
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170
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Tosev G, Mendler M, Bergmann F, Klein T, Pahernik SA, Hadaschik BA, Hohenfellner M. Paraganglioma of the Seminal Vesicle Case Report and Review of the Literature. J Endourol Case Rep 2017; 2:227-231. [PMID: 28078324 PMCID: PMC5177995 DOI: 10.1089/cren.2016.0119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: The present case report describes an extremely rare case of a norepinephrine secreting extraadrenal paraganglioma (PGL) located in the seminal vesicle. Case Presentation: A 36-year-old patient had signs of intermittent hypertensive derailments, bradycardia, increased norepinephrine excretion in 24-hour urine, an increased metanephrine plasma concentration, and a positive clonidine suppression test. A suspicious mass was detected in an (18)F-DOPA-PET/CT-scan in the left seminal vesicle. Following adrenergic blockade, a robotically assisted laparoscopic left vesiculectomy with negative soft tissue surgical margins was performed. The patient sustained a couple of few months of voiding difficulties of the lower urinary tract and obstruction of the left upper urinary tract after the surgery, which resolved spontaneously with home medical treatment. Two years after the initial treatment, the patient relapsed, which was confirmed by endocrinologic follow-up tests with increased urine catecholamine, a positive clonidine suppression test, as well as an elevated blood pressure. Staging with (18)F-DOPA-PET/CT-scan confirmed the diagnosis of a recurrent PGL. This was followed by subsequent open surgical removal of the suspicious lesion in the seminal fossa. The patient is still recurrence free 15 months after the second surgery. Complications after the second surgery included an intermittent paresthesia of the left leg lasting 3 to 4 months. No other urologic symptoms such as voiding or erectile dysfunction occurred. Conclusion: DaVinci-assisted laparoscopic vesiculectomy is a viable procedure to treat such cases providing satisfactory results. Relevant for clinical practice are the regular and lifelong follow-up examinations to detect recurrences.
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Affiliation(s)
- Georgi Tosev
- Department of Urology, University of Heidelberg , Heidelberg, Germany
| | - Michael Mendler
- Department of Medicine 1 and Clinical Chemistry, University of Heidelberg , Heidelberg, Germany
| | - Frank Bergmann
- Department of Pathology, University of Heidelberg , Heidelberg, Germany
| | - Tilman Klein
- Department of Urology, University of Heidelberg , Heidelberg, Germany
| | - Sascha A Pahernik
- Department of Urology, University of Heidelberg , Heidelberg, Germany
| | - Boris A Hadaschik
- Department of Urology, University of Heidelberg , Heidelberg, Germany
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171
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Strajina V, Dy BM, Farley DR, Richards ML, McKenzie TJ, Bible KC, Que FG, Nagorney DM, Young WF, Thompson GB. Surgical Treatment of Malignant Pheochromocytoma and Paraganglioma: Retrospective Case Series. Ann Surg Oncol 2017; 24:1546-1550. [PMID: 28058556 DOI: 10.1245/s10434-016-5739-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Pheochromocytoma and paraganglioma (PPGL) are rare neoplasms; about 10% are malignant. Literature regarding possible benefit from resection is extremely limited. METHODS A 20 year review of all patients undergoing surgery for malignant PPGL at the Mayo Clinic Rochester Campus between 1994 and June 2014 was performed. RESULTS We identified 34 patients undergoing surgery for malignant PPGL. Median follow up was 6 and 5 years survival was 90% (median 11 years). Complete resection (R0) was achieved in 14 patients (41%). Median disease-free survival was 4.6 years for patients with R0 resection (up to 12 years). Only eight patients (23%) were disease-free on last follow up. Elevated preoperative fractionated metanephrines or catecholamines were documented in 23 patients (68%); these normalized in 13 of 23 patients (56%) postoperatively-with symptom relief in 15 of 18 preoperatively symptomatic patients (79%). Among 23 patients with hormone-producing tumors, significant reduction in number of antihypertensive medications was also noted postoperatively; 11 patients have remained off all antihypertensives, 6 required 1 medication, 1 required 2, while 5 required full blockade with phenoxybenzamine and a beta-adrenergic blocker. CONCLUSION Surgery plays a significant role in the management of selected malignant PPGL. Resection can be effective in normalizing or significantly reducing levels of catecholamines and metanephrines, and can improve hormone-related symptoms and hypertension. Surgical resection, either complete or incomplete, is associated with durable survival despite a high rate of tumor recurrence.
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Affiliation(s)
| | - Benzon M Dy
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Keith C Bible
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - William F Young
- Division of Endocrinology, Metabolism, Nutrition and Diabetes, Mayo Clinic, Rochester, MN, USA
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172
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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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173
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SDHB mutation status and tumor size but not tumor grade are important predictors of clinical outcome in pheochromocytoma and abdominal paraganglioma. Surgery 2016; 161:230-239. [PMID: 27839933 DOI: 10.1016/j.surg.2016.05.050] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/25/2016] [Accepted: 05/05/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND A staging/prognostic system has long been desired to better categorize pheochromocytoma/paraganglioma which can be very aggressive in the setting of SDHB mutations. METHODS A retrospective analysis was conducted of clinical characteristics and outcomes including results of genetic testing, tumor recurrence/metastasis, Ki67/MIB1% staining, and tumor mitotic index in patients with pheochromocytoma/paraganglioma. RESULTS Patients with SDHB mutation presented at younger age (33.0 years old vs 49.6 years old, P < .001), had increased local recurrence and distant metastases (47.6% vs 9.1%, P < .001, and 56.3% vs 9.1%, P < .001, respectively), and lesser median disease-free interval (89.8 months, 95% confidence interval 36.0-96.4 vs not reached, P < .001). SDHB mutation, greatest tumor diameter, and open operative resection were associated with a greater rate of local recurrence and distant metastases (P < .006 each). SDHB mutation and tumor diameter were independent risk factors for local recurrence (P ≤ .04 each) and metastases. Ki67% and mitotic index were not associated with SDHB mutation (P ≥ .09 each), local recurrence (P = .48, P = .066, respectively), metastases (P ≥ .22 each), or disease-free interval (P ≥ .19 each). CONCLUSION SDHB status and primary tumor size are more predictive of patient outcome than Ki67% or mitotic index and should be part of any clinically relevant, prognostic scoring system.
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174
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Khadilkar K, Sarathi V, Kasaliwal R, Pandit R, Goroshi M, Malhotra G, Dalvi A, Bakshi G, Bhansali A, Rajput R, Shivane V, Lila A, Bandgar T, Shah NS. Predictors of malignancy in patients with pheochromocytomas/paragangliomas: Asian Indian experience. Endocr Connect 2016; 5:89-97. [PMID: 27852633 PMCID: PMC5314950 DOI: 10.1530/ec-16-0086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/16/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Malignant transformation of pheochromocytomas/paragangliomas (PCC/PGL) is a rare occurrence, and predictive factors for the same are not well understood. This study aims to identify the predictors of malignancy in patients with PCC/PGL. MATERIALS AND METHODS We performed a retrospective analysis of 142 patients with either PCC or PGL registered at our institute between 2000 and 2015. Records were evaluated for clinical parameters like age, gender, familial/syndromic presentation, symptomatic presentation, biochemistry, size, number and location of tumours and presence of metastases and mode of its diagnosis. RESULTS Twenty patients were found to have metastases; 13 had metastases at diagnosis and seven during follow-up. Metastases were detected by radiology (CT-neck to pelvis) in 11/20 patients (5/13 synchronous and 6/7 metachronous), 131I-metaiodobenzylguanidine in five (2/12 synchronous and 3/6 metachronous) patients and 18F-flurodeoxyglucose PET/CT in 15 (12/12 synchronous and 3/3 metachronous) patients. Malignant tumours were significantly larger than benign tumours (8.3 ± 4.1 cm, range: 3-22 cm vs 5.7 ± 2.3 cm, range: 2-14 cm, P = 0.0001) and less frequently metanephrine secreting. On linear regression analysis, tumour size and lack of metanephrine secretion were the independent predictors of malignancy. CONCLUSIONS Patients with primary tumour size >5.7 cm and lack of metanephrine secretory status should be evaluated for possible malignancy not only at diagnosis but also in the postoperative period. As compared to CT and 131I-MIBG scan, 18F-flurodeoxyglucose PET/CT analyses are better (sensitivity: 100%) for the diagnosis of metastases in our study.
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Affiliation(s)
- Kranti Khadilkar
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India
| | - Vijaya Sarathi
- Department of EndocrinologyVydehi Institute of Medical Sciences and Research Center, Bangalore, India
| | - Rajeev Kasaliwal
- Department of EndocrinologyMahatma Gandhi Hospital and Medical College, Jaipur, India
| | - Reshma Pandit
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India
| | - Manjunath Goroshi
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India
| | - Gaurav Malhotra
- Radiation Medicine CentreBhabha Atomic Research Centre, Mumbai, India
| | - Abhay Dalvi
- Department of General SurgerySeth G S Medical College and KEM Hospital, Mumbai, India
| | - Ganesh Bakshi
- Department of Uro-oncologyTata Memorial Hospital, Mumbai, India
| | - Anil Bhansali
- Department of EndocrinologyPostgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Rajesh Rajput
- Department of EndocrinologyPt. B.D. Sharma PGIMS, Rohtak, India
| | - Vyankatesh Shivane
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India
| | - Anurag Lila
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India
| | - Tushar Bandgar
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India
| | - Nalini S Shah
- Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India
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175
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Loriot C, Domingues M, Berger A, Menara M, Ruel M, Morin A, Castro-Vega LJ, Letouzé É, Martinelli C, Bemelmans AP, Larue L, Gimenez-Roqueplo AP, Favier J. Deciphering the molecular basis of invasiveness in Sdhb-deficient cells. Oncotarget 2016; 6:32955-65. [PMID: 26460615 PMCID: PMC4741742 DOI: 10.18632/oncotarget.5106] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/25/2015] [Indexed: 12/15/2022] Open
Abstract
Metastatic pheochromocytomas and paragangliomas (PPGL) are malignant neuroendocrine tumors frequently associated with germline mutations in the SDHB gene. SDHB-mutated PPGL display a hypermethylator phenotype associated with hallmarks of epithelial-to-mesenchymal transition (EMT). In the present study, we report the characterization of a unique model of Sdhb knockout in mouse chromaffin cells. Sdhb deficient cells exhibit a metastatic phenotype as highlighted by increased individual cell migration (characterized by faster motility and increased persistence) as well as high invasive and adhesion abilities. This phenotype is associated with the modulation of Twist1, Twist2, Tcf3, Snai1, N-cadherin or Krt19 expression, reflecting an EMT-like reprogramming of cells. Krt19 is epigenetically silenced in Sdhb-deficient cells and re-expressed after treatment by the demethylating agent decitabine. Krt19 rescue by lentiviral transduction in Sdhb-deficient cells and Krt19 inhibition by RNA interference in wild-type cells were performed. Both studies revealed the involvement of KRT19 in the invasive phenotype by modulating collective and individual migration and cell/extra-cellular matrix adhesion properties. These findings underline the role of hypermethylation and EMT in the in vitro acquisition of metastatic properties, following SDHB loss of function.
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Affiliation(s)
- Céline Loriot
- INSERM, UMR970, Paris Cardiovascular Research Centre, F-75015 Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France
| | - Mélanie Domingues
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France.,INSERM, U1021, CNRS UMR3347, Institut Curie, F-91405 Orsay, France
| | - Adeline Berger
- INSERM, U968, Institut de la vision, F-75012 Paris, France.,Université Pierre et Marie Curie Paris 06, F-75005 Paris, France
| | - Mélanie Menara
- INSERM, UMR970, Paris Cardiovascular Research Centre, F-75015 Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France
| | - Maëva Ruel
- INSERM, UMR970, Paris Cardiovascular Research Centre, F-75015 Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France
| | - Aurélie Morin
- INSERM, UMR970, Paris Cardiovascular Research Centre, F-75015 Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France
| | - Luis-Jaime Castro-Vega
- INSERM, UMR970, Paris Cardiovascular Research Centre, F-75015 Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France
| | - Éric Letouzé
- Programme Cartes d'Identité des Tumeurs, Ligue Nationale Contre Le Cancer, F-75013 Paris, France
| | - Cosimo Martinelli
- INSERM, UMR970, Paris Cardiovascular Research Centre, F-75015 Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France
| | - Alexis-Pierre Bemelmans
- CEA, DSV, I2BM, Molecular Imaging Research Center (MIRCen), F-92265 Fontenay-aux-Roses, France.,CNRS, CEA URA 2210, F-92265 Fontenay-aux-Roses, France
| | - Lionel Larue
- INSERM, U1021, CNRS UMR3347, Institut Curie, F-91405 Orsay, France
| | - Anne-Paule Gimenez-Roqueplo
- INSERM, UMR970, Paris Cardiovascular Research Centre, F-75015 Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, France.,Rare Adrenal Cancer Network-Cortico Médullosurrénale Tumeurs Endocrines, Institut National du Cancer, F-75014 Paris, France
| | - Judith Favier
- INSERM, UMR970, Paris Cardiovascular Research Centre, F-75015 Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France
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176
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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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177
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Ibrahim R, Ammori MB, Yianni J, Grainger A, Rowe J, Radatz M. Gamma Knife radiosurgery for glomus jugulare tumors: a single-center series of 75 cases. J Neurosurg 2016; 126:1488-1497. [PMID: 27392265 DOI: 10.3171/2016.4.jns152667] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Glomus jugulare tumors are rare indolent tumors that frequently involve the lower cranial nerves (CNs). Complete resection can be difficult and associated with lower CN injury. Gamma Knife radiosurgery (GKRS) has established its role as a noninvasive alternative treatment option for these often formidable lesions. The authors aimed to review their experience at the National Centre for Stereotactic Radiosurgery, Sheffield, United Kingdom, specifically the long-term tumor control rate and complications of GKRS for these lesions. METHODS Clinical and radiological data were retrospectively reviewed for patients treated between March 1994 and December 2010. Data were available for 75 patients harboring 76 tumors. The tumors in 3 patients were treated in 2 stages. Familial and/or hereditary history was noted in 12 patients, 2 of whom had catecholamine-secreting and/or active tumors. Gamma Knife radiosurgery was the primary treatment modality in 47 patients (63%). The median age at the time of treatment was 55 years. The median tumor volume was 7 cm3, and the median radiosurgical dose to the tumor margin was 18 Gy (range 12-25 Gy). The median duration of radiological follow-up was 51.5 months (range 12-230 months), and the median clinical follow-up was 38.5 months (range 6-223 months). RESULTS The overall tumor control rate was 93.4% with low CN morbidity. Improvement of preexisting deficits was noted in 15 patients (20%). A stationary clinical course and no progression of symptoms were noted in 48 patients (64%). Twelve patients (16%) had new symptoms or progression of their preexisting symptoms. The Kaplan-Meier actuarial tumor control rate was 92.2% at 5 years and 86.3% at 10 years. CONCLUSIONS Gamma Knife radiosurgery offers a risk-versus-benefit treatment option with very low CN morbidity and stable long-term results.
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Affiliation(s)
- Ramez Ibrahim
- National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and
| | | | - John Yianni
- National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and
| | - Alison Grainger
- National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and
| | - Jeremy Rowe
- National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and
| | - Matthias Radatz
- National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield; and
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178
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Total 18F-FDG PET/CT Metabolic Tumor Volume Is Associated With Postoperative Biochemical Response in Patients With Metastatic Pheochromocytomas and Paragangliomas. Ann Surg 2016; 263:582-7. [PMID: 25405562 DOI: 10.1097/sla.0000000000001018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this pilot study was to determine if metabolic tumor volume (MTV) and total lesion glycolysis (TLG) could serve as predictors of biochemical remission and pharmacotherapy-free interval in patients with metastatic pheochromocytomas (PCCs) and paragangliomas (PGLs). BACKGROUND Patients with metastatic PCCs/PGLs have a high rate of biochemical recurrence, which can be associated with increased cardiovascular morbidity. Predictors of biochemical response are needed to guide and select patients who may benefit from therapy. METHODS Whole body MTV and TLG was calculated from preoperative 18F-FDG PET/CT scans and analyzed as marker of biochemical response and pharmacotherapy-free interval. RESULTS Seventeen patients underwent a total of 19 procedures, with a median follow-up time of 26.4 months. Whole body MTV of patients with biochemical recurrence (n = 13, mean 73.8 mL) was higher than those who had a biochemical response (n = 6, mean 14.7 mL, P = 0.05). Patients with low MTV (<37.2 mL) had an improved durable partial biochemical response (P < 0.05), and a statistical trend for complete biochemical remission (P = 0.07) and pharmacotherapy-free interval (P = 0.06). In 8 patients with metastatic disease outside the abdomen, 4 patients had less than 35% of their disease burden outside the abdomen and these patients had a more durable partial biochemical response compared to patients with greater than 35% of their disease burden outside the abdomen (P < 0.05). CONCLUSIONS Whole body MTV and TLG represents novel and valuable predictors of biochemical response for patients with metastatic PCCs and PGLs. A larger prospective study should be performed to validate these findings.
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179
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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: 292] [Impact Index Per Article: 36.5] [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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Wigerup C, Påhlman S, Bexell D. Therapeutic targeting of hypoxia and hypoxia-inducible factors in cancer. Pharmacol Ther 2016; 164:152-69. [PMID: 27139518 DOI: 10.1016/j.pharmthera.2016.04.009] [Citation(s) in RCA: 450] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Insufficient tissue oxygenation, or hypoxia, contributes to tumor aggressiveness and has a profound impact on clinical outcomes in cancer patients. At decreased oxygen tensions, hypoxia-inducible factors (HIFs) 1 and 2 are stabilized and mediate a hypoxic response, primarily by acting as transcription factors. HIFs exert differential effects on tumor growth and affect important cancer hallmarks including cell proliferation, apoptosis, differentiation, vascularization/angiogenesis, genetic instability, tumor metabolism, tumor immune responses, and invasion and metastasis. As a consequence, HIFs mediate resistance to chemo- and radiotherapy and are associated with poor prognosis in cancer patients. Intriguingly, perivascular tumor cells can also express HIF-2α, thereby forming a "pseudohypoxic" phenotype that further contributes to tumor aggressiveness. Therefore, therapeutic targeting of HIFs in cancer has the potential to improve treatment efficacy. Different strategies to target hypoxic cancer cells and/or HIFs include hypoxia-activated prodrugs and inhibition of HIF dimerization, mRNA or protein expression, DNA binding capacity, and transcriptional activity. Here we review the functions of HIFs in the progression and treatment of malignant solid tumors. We also highlight how HIFs may be targeted to improve the management of patients with therapy-resistant and metastatic cancer.
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Affiliation(s)
- Caroline Wigerup
- Translational Cancer Research, Medicon Village 404:C3, Lund University, Lund, Sweden
| | - Sven Påhlman
- Translational Cancer Research, Medicon Village 404:C3, Lund University, Lund, Sweden.
| | - Daniel Bexell
- Translational Cancer Research, Medicon Village 404:C3, Lund University, Lund, Sweden
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Henegan JC, Gomez CR. Heritable Cancer Syndromes Related to the Hypoxia Pathway. Front Oncol 2016; 6:68. [PMID: 27047799 PMCID: PMC4801850 DOI: 10.3389/fonc.2016.00068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/08/2016] [Indexed: 01/09/2023] Open
Abstract
Families of tumor-suppressor genes, such as those involved in homologous recombination or mismatch repair, contain individual genes implicated in hereditary cancer syndromes. Collectively, such groupings establish that inactivating germline changes in genes within pathways related to genomic repair can promote carcinogenesis. The hypoxia pathway, whose activation is associated with aggressive and resistant sporadic tumors, is another pathway in which tumor-suppressor genes have been identified. von Hippel–Lindau disease, some of the hereditary paraganglioma–pheochromocytoma (PGL/PCC) syndromes, and the syndrome of hereditary leiomyomatosis and renal cell carcinoma are heritable conditions associated with genes involved or associated with the hypoxia pathway. This review links these heritable cancer syndromes to the hypoxia pathway while also comparing the relative aggression and treatment resistance of syndrome-associated tumors to similar, sporadic tumors. The reader will become aware of shared phenotypes (e.g., PGL/PCC, renal cell carcinoma) among these three hypoxia-pathway-associated heritable cancer syndromes as well as the known associations of tumor aggressiveness and treatment resistance within these pathways.
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Affiliation(s)
- John Clark Henegan
- Division of Hematology/Oncology, Department of Medicine, University of Mississippi Medical Center , Jackson, MS , USA
| | - Christian R Gomez
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA; Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA; Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
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Ullrich M, Bergmann R, Peitzsch M, Zenker EF, Cartellieri M, Bachmann M, Ehrhart-Bornstein M, Block NL, Schally AV, Eisenhofer G, Bornstein SR, Pietzsch J, Ziegler CG. Multimodal Somatostatin Receptor Theranostics Using [(64)Cu]Cu-/[(177)Lu]Lu-DOTA-(Tyr(3))octreotate and AN-238 in a Mouse Pheochromocytoma Model. Theranostics 2016; 6:650-65. [PMID: 27022413 PMCID: PMC4805660 DOI: 10.7150/thno.14479] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/10/2016] [Indexed: 12/17/2022] Open
Abstract
Pheochromocytomas and extra-adrenal paragangliomas (PHEO/PGLs) are rare catecholamine-producing chromaffin cell tumors. For metastatic disease, no effective therapy is available. Overexpression of somatostatin type 2 receptors (SSTR2) in PHEO/PGLs promotes interest in applying therapies using somatostatin analogs linked to radionuclides and/or cytotoxic compounds, such as [177Lu]Lu-DOTA-(Tyr3)octreotate (DOTATATE) and AN-238. Systematic evaluation of such therapies for the treatment of PHEO/PGLs requires sophisticated animal models. In this study, the mouse pheochromocytoma (MPC)-mCherry allograft model showed high tumor densities of murine SSTR2 (mSSTR2) and high tumor uptake of [64Cu]Cu-DOTATATE. Using tumor sections, we assessed mSSTR2-specific binding of DOTATATE, AN-238, and somatostatin-14. Therapeutic studies showed substantial reduction of tumor growth and tumor-related renal monoamine excretion in tumor-bearing mice after treatment with [177Lu]Lu-DOTATATE compared to AN-238 and doxorubicin. Analyses did not show agonist-dependent receptor downregulation after single mSSTR2-targeting therapies. This study demonstrates that the MPC-mCherry model is a uniquely powerful tool for the preclinical evaluation of SSTR2-targeting theranostic applications in vivo. Our findings highlight the therapeutic potential of somatostatin analogs, especially of [177Lu]Lu-DOTATATE, for the treatment of metastatic PHEO/PGLs. Repeated treatment cycles, fractionated combinations of SSTR2-targeting radionuclide and cytotoxic therapies, and other adjuvant compounds addressing additional mechanisms may further enhance therapeutic outcome.
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Turkova H, Prodanov T, Maly M, Martucci V, Adams K, Widimsky J, Chen CC, Ling A, Kebebew E, Stratakis CA, Fojo T, Pacak K. CHARACTERISTICS AND OUTCOMES OF METASTATIC SDHB AND SPORADIC PHEOCHROMOCYTOMA/PARAGANGLIOMA: AN NATIONAL INSTITUTES OF HEALTH STUDY. Endocr Pract 2016; 22:302-14. [PMID: 26523625 PMCID: PMC7473461 DOI: 10.4158/ep15725.or] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Overall about 10 to 20% of pheochromocytomas/paragangliomas (PHEOs/PGLs) are metastatic, with higher metastatic potential observed in succinate dehydrogenase subunit B/fumarate hydratase (SDHB/FH)-related tumors. Due to the improved availability of biochemical and genetic testing and the frequent use of anatomical/functional imaging, there is currently a higher detection rate of metastatic PHEO/PGL. METHODS A retrospective analysis of 132 patients (27 children, 105 adults) with metastatic PHEO/PGL diagnosed and treated from 2000 to 2014 was conducted. RESULTS Seventy-seven (58%) males and 55 (42%) females were included; 39 (30%) have died, with no sex preference. Seventy-three (55%) patients had SDHB mutations; 59 (45%) patients had apparently sporadic tumors (AST). SDHB patients had an average age at primary tumor diagnosis of 31 ± 16 years compared to 40 ± 15 years in AST patients (P<.001). The average metastatic interval (MI) decreased with increasing age in both SDHB and AST patients (P = .013 for both). Only 16% of all primary tumors were smaller than 4.5 cm. Eleven percent of patients had biochemically silent disease, more with SDHB. Of SDHB patients, 23% had metastatic tumors at first diagnosis, compared to 15% of AST patients. Five- and 10-year survival rates were significantly better for metastatic AST than SDHB patients (P = .01). Overall survival was significantly different between children and adults (P = .037); this was mostly attributed to the SDHB patients, in whom children had statistically significantly longer survival than adults (P = .006). The deceased patients all died due to the PHEO/PGL and mainly had noradrenergic phenotypes. CONCLUSION In children, metastatic PHEOs/PGLs are mainly due to SDHB mutations; in adults they are equally distributed between in SDHB mutations and AST, with better 5- and 10-year survival rates for ASTs. In SDHB patients, children survive longer than adults. Primary metastatic tumors, most presenting as noradrenergic PGLs, are larger than 4.5 cm in >80% of patients. The frequency of metastatic tumors from primary AST increases with age, including a decreased MI compared to SDHB tumors. These results support several recommendations that are summarized in the Discussion.
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Affiliation(s)
- Hana Turkova
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Oncology Department of General Faculty Hospital, Prague, Czech Republic
| | - Tamara Prodanov
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Marek Maly
- National Institute of Public Health, Department of Biostatistics and Informatics, Prague, Czech Republic
| | - Victoria Martucci
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Karen Adams
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Jiri Widimsky
- 1st Medical Faculty of Charles University and 3rd Department of Internal Medicine of the General Faculty Hospital, Prague, Czech Republic
| | - Clara C. Chen
- Department of Nuclear Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Alexander Ling
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Electron Kebebew
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Constantine A. Stratakis
- Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Tito Fojo
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Karel Pacak
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Olson SW, Yoon S, Baker T, Prince LK, Oliver D, Abbott KC. Longitudinal plasma metanephrines preceding pheochromocytoma diagnosis: a retrospective case-control serum repository study. Eur J Endocrinol 2016; 174:289-95. [PMID: 26671972 DOI: 10.1530/eje-15-0651] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 12/15/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Plasma metanephrines (PMN) are highly sensitive for diagnosis of pheochromocytoma, but the natural history of PMN before pheochromocytoma diagnosis has not been previously described. The aim of the study was to compare the progression of PMN before pheochromocytoma diagnosis to matched healthy and essential hypertension disease controls. DESIGN A retrospective case-control Department of Defense Serum Repository (DoDSR) study. METHODS We performed a DoDSR study that compared three longitudinal pre-diagnostic PMN for 30 biopsy-proven pheochromocytoma cases to three longitudinal PMN for age, sex, race, and age of serum sample matched healthy and essential hypertension disease controls. Predominant metanephrine (MN) or normetanephrine (NMN) production was identified for each case and converted to a percentage of the upper limit of normal to allow analysis of all cases together. PMN were measured by Quest Diagnostics. RESULTS The predominant plasma metanephrine (PPM) was >100 and 300% of the upper limit of normal a median of 6.6 and 4.1 years before diagnosis respectively. A greater percentage of pheochromocytoma patients had a PPM >100 and >300% of the upper limit of normal compared with combined healthy and essential hypertension disease controls <2, 2-8, and >8 years prior to diagnosis. For patients with a baseline PPM 90-300% of the upper limit of normal, a 25% rate of rise per year was 100% specific for pheochromocytoma. CONCLUSIONS PPMs elevate years before diagnosis which suggests that delayed diagnoses are common. For mild PMN elevations, follow-up longitudinal PMN trends may provide a highly specific and economical diagnostic tool.
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Affiliation(s)
| | | | - T Baker
- Department of NephrologyWalter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, Maryland 20889, USADepartment Chief, Joint Pathology Center606 Stephen Sitter Avenue, Silver Spring, Maryland 20910, USAThe National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)Bethesda, Maryland 20892, USA
| | | | | | - K C Abbott
- Department of NephrologyWalter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, Maryland 20889, USADepartment Chief, Joint Pathology Center606 Stephen Sitter Avenue, Silver Spring, Maryland 20910, USAThe National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)Bethesda, Maryland 20892, USA
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Lepoutre-Lussey C, Thibault C, Buffet A, Morin A, Badoual C, Bénit P, Rustin P, Ottolenghi C, Janin M, Castro-Vega LJ, Trapman J, Gimenez-Roqueplo AP, Favier J. From Nf1 to Sdhb knockout: Successes and failures in the quest for animal models of pheochromocytoma. Mol Cell Endocrinol 2016; 421:40-8. [PMID: 26123588 DOI: 10.1016/j.mce.2015.06.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/02/2015] [Accepted: 06/02/2015] [Indexed: 01/19/2023]
Abstract
Pheochromocytomas and paragangliomas (PPGL) are rare neuroendocrine tumors characterized by a high frequency of hereditary forms. Based on transcriptome classification, PPGL can be classified in two different clusters. Cluster 1 tumors are caused by mutations in SDHx, VHL and FH genes and are characterized by a pseudohypoxic signature. Cluster 2 PPGL carry mutations in RET, NF1, MAX or TMEM127 genes and display an activation of the MAPK and mTOR signaling pathways. Many genetically engineered and allografted mouse models have been generated these past 30 years to investigate the mechanisms of PPGL tumorigenesis and test new therapeutic strategies. Among them, only Cluster 2-related models have been successful while no Cluster 1-related knockout mouse was so far reported to develop a PPGL. In this review, we present an overview of existing, successful or not, PPGL models, and a description of our own experience on the quest of Sdhb knockout mouse models of PPGL.
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Affiliation(s)
- Charlotte Lepoutre-Lussey
- INSERM, UMR970, Paris-Cardiovascular Research Center, F-75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France
| | - Constance Thibault
- INSERM, UMR970, Paris-Cardiovascular Research Center, F-75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France
| | - Alexandre Buffet
- INSERM, UMR970, Paris-Cardiovascular Research Center, F-75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France
| | - Aurélie Morin
- INSERM, UMR970, Paris-Cardiovascular Research Center, F-75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France
| | - Cécile Badoual
- INSERM, UMR970, Paris-Cardiovascular Research Center, F-75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d'anatomo-pathologie, F-75015 Paris, France
| | - Paule Bénit
- INSERM, UMR1141, Hôpital Robert Debré, F-75019 Paris, France; Université Paris 7, Faculté de Médecine Denis Diderot, Paris, France
| | - Pierre Rustin
- INSERM, UMR1141, Hôpital Robert Debré, F-75019 Paris, France; Université Paris 7, Faculté de Médecine Denis Diderot, Paris, France
| | - Chris Ottolenghi
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France; Metabolic Biochemistry, Hôpital Necker-Enfants Malades, Paris, France; INSERM, Unit 1124, Paris, France
| | - Maxime Janin
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France; Metabolic Biochemistry, Hôpital Necker-Enfants Malades, Paris, France; INSERM, Unit 1124, Paris, France
| | - Luis-Jaime Castro-Vega
- INSERM, UMR970, Paris-Cardiovascular Research Center, F-75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France
| | - Jan Trapman
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Anne-Paule Gimenez-Roqueplo
- INSERM, UMR970, Paris-Cardiovascular Research Center, F-75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, F-75015 Paris, France
| | - Judith Favier
- INSERM, UMR970, Paris-Cardiovascular Research Center, F-75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75006 Paris, France.
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Saxena N, Maio N, Crooks DR, Ricketts CJ, Yang Y, Wei MH, Fan TWM, Lane AN, Sourbier C, Singh A, Killian JK, Meltzer PS, Vocke CD, Rouault TA, Linehan WM. SDHB-Deficient Cancers: The Role of Mutations That Impair Iron Sulfur Cluster Delivery. J Natl Cancer Inst 2016; 108:djv287. [PMID: 26719882 DOI: 10.1093/jnci/djv287] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Mutations in the Fe-S cluster-containing SDHB subunit of succinate dehydrogenase cause familial cancer syndromes. Recently the tripeptide motif L(I)YR was identified in the Fe-S recipient protein SDHB, to which the cochaperone HSC20 binds. METHODS In order to characterize the metabolic basis of SDH-deficient cancers we performed stable isotope-resolved metabolomics in a novel SDHB-deficient renal cell carcinoma cell line and conducted bioinformatics and biochemical screening to analyze Fe-S cluster acquisition and assembly of SDH in the presence of other cancer-causing SDHB mutations. RESULTS We found that the SDHBR46Q mutation in UOK269 cells disrupted binding of HSC20, causing rapid degradation of SDHB. In the absence of SDHB, respiration was undetectable in UOK269 cells, succinate was elevated to 351.4 ± 63.2 nmol/mg cellular protein, and glutamine became the main source of TCA cycle metabolites through reductive carboxylation.Furthermore, HIF1α, but not HIF2α, increased markedly and the cells showed a strong DNA CpG island methylatorphenotype (CIMP). Biochemical and bioinformatic screening revealed that 37% of disease-causing missense mutations in SDHB were located in either the L(I)YR Fe-S transfer motifs or in the 11 Fe-S cluster-ligating cysteines. CONCLUSIONS These findings provide a conceptual framework for understanding how particular mutations disproportionately cause the loss of SDH activity, resulting in accumulation of succinate and metabolic remodeling in SDHB cancer syndromes.
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Minnetti M, Grossman A. Somatic and germline mutations in NETs: Implications for their diagnosis and management. Best Pract Res Clin Endocrinol Metab 2016; 30:115-27. [PMID: 26971848 DOI: 10.1016/j.beem.2015.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
It is now understood that specific somatic and germline mutations may lead to the development of the neuroendocrine tumours (NETs). NETs usually occur as sporadic isolated tumours, although they also may present as part of complex familial endocrine cancer syndromes, such as multiple endocrine neoplasia type 1 (MEN1) and type 2 (MEN2), Von Hippel-Lindau (VHL) and neurofibromatosis syndromes, tuberous sclerosis, Carney triad and dyad, Reed syndrome and polycythaemia-paraganglioma syndromes. Only in MEN2 syndrome is there a specific genotype-phenotype correlation, although in both sporadic and syndromic NETs some gene mutations are associated with specific clinico-pathological features and prognosis. There have been several advances in our understanding of the NETs leading to earlier detection and targeted therapeutic treatment, but given the poor prognosis associated with metastatic NETs, it will be necessary to find new biomarkers for the prediction of malignant potential and to find novel therapeutic targets for NETs.
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Affiliation(s)
- Marianna Minnetti
- Dept. of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Dept. of Medicine, University of Oxford, UK
| | - Ashley Grossman
- Dept. of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Dept. of Medicine, University of Oxford, UK.
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190
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Loss of succinate dehydrogenase activity results in dependency on pyruvate carboxylation for cellular anabolism. Nat Commun 2015; 6:8784. [PMID: 26522426 DOI: 10.1038/ncomms9784] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/02/2015] [Indexed: 12/21/2022] Open
Abstract
The tricarboxylic acid (TCA) cycle is a central metabolic pathway responsible for supplying reducing potential for oxidative phosphorylation and anabolic substrates for cell growth, repair and proliferation. As such it thought to be essential for cell proliferation and tissue homeostasis. However, since the initial report of an inactivating mutation in the TCA cycle enzyme complex, succinate dehydrogenase (SDH) in paraganglioma (PGL), it has become clear that some cells and tissues are not only able to survive with a truncated TCA cycle, but that they are also able of supporting proliferative phenotype observed in tumours. Here, we show that loss of SDH activity leads to changes in the metabolism of non-essential amino acids. In particular, we demonstrate that pyruvate carboxylase is essential to re-supply the depleted pool of aspartate in SDH-deficient cells. Our results demonstrate that the loss of SDH reduces the metabolic plasticity of cells, suggesting vulnerabilities that can be targeted therapeutically.
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Schovanek J, Bullova P, Tayem Y, Giubellino A, Wesley R, Lendvai N, Nölting S, Kopacek J, Frysak Z, Pommier Y, Kummar S, Pacak K. Inhibitory Effect of the Noncamptothecin Topoisomerase I Inhibitor LMP-400 on Female Mice Models and Human Pheochromocytoma Cells. Endocrinology 2015; 156:4094-104. [PMID: 26267380 PMCID: PMC4606751 DOI: 10.1210/en.2015-1476] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Metastatic pheochromocytoma continues to be an incurable disease, and treatment with conventional cytotoxic chemotherapy offers limited efficacy. In the present study, we evaluated a novel topoisomerase I inhibitor, LMP-400, as a potential treatment for this devastating disease. We found a high expression of topoisomerase I in human metastatic pheochromocytoma, providing a basis for the evaluation of a topoisomerase 1 inhibitor as a therapeutic strategy. LMP-400 inhibited the cell growth of established mouse pheochromocytoma cell lines and primary human tumor tissue cultures. In a study performed in athymic female mice, LMP-400 demonstrated a significant inhibitory effect on tumor growth with two drug administration regimens. Furthermore, low doses of LMP-400 decreased the protein levels of hypoxia-inducible factor 1 (HIF-1α), one of a family of factors studied as potential metastatic drivers in these tumors. The HIF-1α decrease resulted in changes in the mRNA levels of HIF-1 transcriptional targets. In vitro, LMP-400 showed an increase in the growth-inhibitory effects in combination with other chemotherapeutic drugs that are currently used for the treatment of pheochromocytoma. We conclude that LMP-400 has promising antitumor activity in preclinical models of metastatic pheochromocytoma and its use should be considered in future clinical trials.
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MESH Headings
- Adrenal Gland Neoplasms/drug therapy
- Adrenal Gland Neoplasms/enzymology
- Adrenal Gland Neoplasms/pathology
- Animals
- Antineoplastic Agents/pharmacology
- Benzodioxoles/administration & dosage
- Benzodioxoles/pharmacology
- Blotting, Western
- Cell Hypoxia
- Cell Line, Tumor
- Cell Proliferation/drug effects
- DNA Topoisomerases, Type I/metabolism
- Disease Models, Animal
- Dose-Response Relationship, Drug
- Drug Synergism
- Female
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Hypoxia-Inducible Factor 1, alpha Subunit/genetics
- Hypoxia-Inducible Factor 1, alpha Subunit/metabolism
- Isoquinolines/administration & dosage
- Isoquinolines/pharmacology
- Liver Neoplasms/drug therapy
- Liver Neoplasms/enzymology
- Liver Neoplasms/secondary
- Lung Neoplasms/drug therapy
- Lung Neoplasms/enzymology
- Lung Neoplasms/secondary
- Mice, Nude
- PC12 Cells
- Pheochromocytoma/drug therapy
- Pheochromocytoma/enzymology
- Pheochromocytoma/pathology
- Rats
- Reverse Transcriptase Polymerase Chain Reaction
- Topoisomerase I Inhibitors/administration & dosage
- Topoisomerase I Inhibitors/pharmacology
- Tumor Cells, Cultured
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Affiliation(s)
- Jan Schovanek
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Petra Bullova
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Yasin Tayem
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Alessio Giubellino
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Robert Wesley
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Nikoletta Lendvai
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Svenja Nölting
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Juraj Kopacek
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Zdenek Frysak
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Yves Pommier
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Shivaani Kummar
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
| | - Karel Pacak
- Program in Reproductive and Adult Endocrinology (J.S., P.B., Y.T., A.G., N.L., S.N., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Warren G. Magnuson Clinical Center (R.W.), and National Cancer Institute (Y.P., S.K.), National Institutes of Health, Bethesda, Maryland 20892-1109; Department of Internal Medicine III-Nephrology, Rheumatology, and Endocrinology (J.S., Z.F.), Faculty of Medicine and Dentistry, Palacky University, 771 47 Olomouc, Czech Republic; Department of Molecular Medicine (P.B., J.K.), Institute of Virology, Slovak Academy of Sciences, 845 05 Bratislava, Slovak Republic; and Department of Internal Medicine II (S.N.), Campus Grosshadern, University-Hospital of the Ludwig-Maximilians-University of Munich, 80539 Munich, Germany
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Lussey-Lepoutre C, Bellucci A, Morin A, Buffet A, Amar L, Janin M, Ottolenghi C, Zinzindohoué F, Autret G, Burnichon N, Robidel E, Banting B, Fontaine S, Cuenod CA, Benit P, Rustin P, Halimi P, Fournier L, Gimenez-Roqueplo AP, Favier J, Tavitian B. In Vivo Detection of Succinate by Magnetic Resonance Spectroscopy as a Hallmark of SDHx Mutations in Paraganglioma. Clin Cancer Res 2015; 22:1120-9. [PMID: 26490314 DOI: 10.1158/1078-0432.ccr-15-1576] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/06/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Germline mutations in genes encoding mitochondrial succinate dehydrogenase (SDH) are found in patients with paragangliomas, pheochromocytomas, gastrointestinal stromal tumors, and renal cancers. SDH inactivation leads to a massive accumulation of succinate, acting as an oncometabolite and which levels, assessed on surgically resected tissue are a highly specific biomarker of SDHx-mutated tumors. The aim of this study was to address the feasibility of detecting succinate in vivo by magnetic resonance spectroscopy. EXPERIMENTAL DESIGN A pulsed proton magnetic resonance spectroscopy ((1)H-MRS) sequence was developed, optimized, and applied to image nude mice grafted with Sdhb(-/-) or wild-type chromaffin cells. The method was then applied to patients with paraganglioma carrying (n = 5) or not (n = 4) an SDHx gene mutation. Following surgery, succinate was measured using gas chromatography/mass spectrometry, and SDH protein expression was assessed by immunohistochemistry in resected tumors. RESULTS A succinate peak was observed at 2.44 ppm by (1)H-MRS in all Sdhb(-/-)-derived tumors in mice and in all paragangliomas of patients carrying an SDHx gene mutation, but neither in wild-type mouse tumors nor in patients exempt of SDHx mutation. In one patient, (1)H-MRS results led to the identification of an unsuspected SDHA gene mutation. In another case, it helped define the pathogenicity of a variant of unknown significance in the SDHB gene. CONCLUSIONS Detection of succinate by (1)H-MRS is a highly specific and sensitive hallmark of SDHx mutations. This noninvasive approach is a simple and robust method allowing in vivo detection of the major biomarker of SDHx-mutated tumors.
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Affiliation(s)
- Charlotte Lussey-Lepoutre
- INSERM, UMR970, Paris Cardiovascular Research Center, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Alexandre Bellucci
- INSERM, UMR970, Paris Cardiovascular Research Center, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Aurélie Morin
- INSERM, UMR970, Paris Cardiovascular Research Center, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Alexandre Buffet
- INSERM, UMR970, Paris Cardiovascular Research Center, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Laurence Amar
- INSERM, UMR970, Paris Cardiovascular Research Center, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d'hypertension artérielle et médecine vasculaire, Paris, France
| | - Maxime Janin
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Laboratoire de Biochimie Métabolique, Paris, France. INSERM, U1124, Paris, France
| | - Chris Ottolenghi
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Laboratoire de Biochimie Métabolique, Paris, France. INSERM, U1124, Paris, France
| | - Franck Zinzindohoué
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Chirurgie Digestive, Paris, France
| | - Gwennhael Autret
- INSERM, UMR970, Paris Cardiovascular Research Center, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Nelly Burnichon
- INSERM, UMR970, Paris Cardiovascular Research Center, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France
| | - Estelle Robidel
- INSERM, UMR970, Paris Cardiovascular Research Center, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Benjamin Banting
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Radiologie, Paris, France
| | - Sébastien Fontaine
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Radiologie, Paris, France
| | - Charles-André Cuenod
- INSERM, UMR970, Paris Cardiovascular Research Center, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Radiologie, Paris, France
| | - Paule Benit
- INSERM, UMR1141, Hôpital Robert Debré, Paris, France. Université Paris 7, Faculté de Médecine Denis Diderot, Paris, France
| | - Pierre Rustin
- INSERM, UMR1141, Hôpital Robert Debré, Paris, France. Université Paris 7, Faculté de Médecine Denis Diderot, Paris, France
| | - Philippe Halimi
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Radiologie, Paris, France
| | - Laure Fournier
- INSERM, UMR970, Paris Cardiovascular Research Center, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Radiologie, Paris, France
| | - Anne-Paule Gimenez-Roqueplo
- INSERM, UMR970, Paris Cardiovascular Research Center, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France
| | - Judith Favier
- INSERM, UMR970, Paris Cardiovascular Research Center, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.
| | - Bertrand Tavitian
- INSERM, UMR970, Paris Cardiovascular Research Center, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Radiologie, Paris, France
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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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194
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Blanchet EM, Taieb D, Millo C, Martucci V, Chen CC, Merino M, Herscovitch P, Pacak K. 18F-FLT PET/CT in the Evaluation of Pheochromocytomas and Paragangliomas: A Pilot Study. J Nucl Med 2015; 56:1849-54. [PMID: 26359261 DOI: 10.2967/jnumed.115.159061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/23/2015] [Indexed: 12/26/2022] Open
Abstract
UNLABELLED (18)F-FDG PET/CT has been proven to be a highly sensitive method for pheochromocytomas/paragangliomas (PHEOs/PGLs) associated with succinate dehydrogenase (SDH) mutations. This finding has been attributed to altered tumor cell metabolism resulting from these mutations and does not provide additional prognostic information to genotype. Therefore, identification of new biomarkers for aggressiveness is needed. A high Ki-67 index was proposed to be an additional prognostic factor. This pilot study aimed to evaluate 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) PET/CT, a PET proliferation tracer, as a potential imaging agent in a series of 12 PHEO/PGL patients with different genetic backgrounds, to compare (18)F-FLT uptake with (18)F-FDG PET/CT, and to evaluate classic factors of aggressiveness. METHODS Twelve patients (7 metastatic and 5 nonmetastatic) were prospectively evaluated with (18)F-FDG and (18)F-FLT and followed for at least 2 y after the initial imaging work-up. Uptake was assessed at a lesion level, visually and quantitatively by maximum standardized uptake values (SUVmax) for both tracers. (18)F-FLT uptake was compared with risk factors known to be linked with a poor prognosis in PGLs (SDHB-mutated status, lesion size, dopaminergic phenotype) and with (18)F-FDG uptake. RESULTS In 12 patients, 77 lesions were assessed. All lesions had low (18)F-FLT uptake (median SUVmax, 2.25; range, 0.7-4.5). There was no apparent superiority of (18)F-FLT uptake in progressive lesions, and most of the lesions showed a mismatch, with high (18)F-FDG uptake (median SUVmax, 10.8; range, 1.1-79.0) contrasting with low (18)F-FLT uptake. CONCLUSION This study suggests that PHEOs/PGLs-even those that progress-do not exhibit intense (18)F-FLT uptake. It provides the first in vivo demonstration that proliferation may not be a major determinant of (18)F-FDG uptake in these tumors. These findings provide new insight into the biologic behavior of PGL and suggest that antiproliferative agents may be suboptimal for treatment of these tumors.
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Affiliation(s)
- Elise M Blanchet
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, Maryland
| | - David Taieb
- La Timone University Hospital, European Center for Research in Medical Imaging, Aix-Marseille University, Marseille, France
| | - Corina Millo
- Positron Emission Tomography Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Victoria Martucci
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, Maryland
| | - Clara C Chen
- Nuclear Medicine Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland; and
| | - Maria Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter Herscovitch
- Positron Emission Tomography Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Karel Pacak
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, Maryland
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195
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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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196
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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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197
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Baysal BE, Maher ER. 15 YEARS OF PARAGANGLIOMA: Genetics and mechanism of pheochromocytoma-paraganglioma syndromes characterized by germline SDHB and SDHD mutations. Endocr Relat Cancer 2015; 22:T71-82. [PMID: 26113606 DOI: 10.1530/erc-15-0226] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2015] [Indexed: 12/29/2022]
Abstract
Pheochromocytomas and paragangliomas (PPGL) are rare neuroendocrine neoplasms that derive from small paraganglionic tissues which are located from skull base to the pelvic floor. Genetic predisposition plays an important role in development of PPGLs. Since the discovery of first mutations in the succinate dehydrogenase D (SDHD) gene, which encodes the smallest subunit of mitochondrial complex II (SDH), genetic studies have revealed a major role for mutations in SDH subunit genes, primarily in SDHB and SDHD, in predisposition to both familial and non-familial PPGLs. SDH-mutated PPGLs show robust expression of hypoxia induced genes, and genomic and histone hypermethylation. These effects occur in part through succinate-mediated inhibition of α-ketoglutarate-dependent dioxygenases. However, details of mechanisms by which SDH mutations activate hypoxic pathways and trigger subsequent neoplastic transformation remain poorly understood. Here, we present a brief review of the genetic and mechanistic aspects of SDH-mutated PPGLs.
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Affiliation(s)
- Bora E Baysal
- Department of PathologyRoswell Park Cancer Institute, Buffalo, New York 14263, USADepartment of Medical GeneticsCambridge NIHR Biomedical Research Centre, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Eamonn R Maher
- Department of PathologyRoswell Park Cancer Institute, Buffalo, New York 14263, USADepartment of Medical GeneticsCambridge NIHR Biomedical Research Centre, University of Cambridge, Cambridge CB2 0QQ, UK
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198
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Kimura N. A pathologist's view: molecular profiles for diagnosing pheochromocytomas and paragangliomas. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2015. [DOI: 10.2217/ije.15.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pheochromocytomas (PCC) and paragangliomas (PGL) are catecholamine (CA)-producing tumors classified into well (WD)-, moderately (MD)- or poorly differentiated (PD) types by the Grading of Adrenal Pheochromocytoma and Paraganglioma (GAPP). Seventy percent of PCCs/PGLs are WD type with 4% metastasis, the rest are MD with 60% and PD are with 88% metastasis. Thus, PCCs/PGLs can also be classified as low-grade (WD type), intermediate grade (MD type) and high-grade malignancies (PD types). MD/PD types are with 70% metastasis. Thus, PCCs/PGLs can also be classified as low-grade (WD type) and high-grade malignancies (MD/PD types) using GAPP. Hereditary PCCs/PGLs have been previously classified into cluster 1 or cluster 2 based on genetic mutations involved and types of catecholamine produced by the tumors. GAPP revealed that tumors in cluster 1 and cluster 2 correspond to MD type and WD type, respectively. Susceptible genes for high-grade malignancy (PD type) are currently unknown.
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Affiliation(s)
- Noriko Kimura
- Department of Clinical Research, Pathology Division, National Hospital Organization Hakodate Hospital, Hakodate, Japan
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199
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Benn DE, Robinson BG, Clifton-Bligh RJ. 15 YEARS OF PARAGANGLIOMA: Clinical manifestations of paraganglioma syndromes types 1-5. Endocr Relat Cancer 2015; 22:T91-103. [PMID: 26273102 PMCID: PMC4532956 DOI: 10.1530/erc-15-0268] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The paraganglioma (PGL) syndromes types 1-5 are autosomal dominant disorders characterized by familial predisposition to PGLs, phaeochromocytomas (PCs), renal cell cancers, gastrointestinal stromal tumours and, rarely, pituitary adenomas. Each syndrome is associated with mutation in a gene encoding a particular subunit (or assembly factor) of succinate dehydrogenase (SDHx). The clinical manifestations of these syndromes are protean: patients may present with features of catecholamine excess (including the classic triad of headache, sweating and palpitations), or with symptoms from local tumour mass, or increasingly as an incidental finding on imaging performed for some other purpose. As genetic testing for these syndromes becomes more widespread, presymptomatic diagnosis is also possible, although penetrance of disease in these syndromes is highly variable and tumour development does not clearly follow a predetermined pattern. PGL1 syndrome (SDHD) and PGL2 syndrome (SDHAF2) are notable for high frequency of multifocal tumour development and for parent-of-origin inheritance: disease is almost only ever manifest in subjects inheriting the defective allele from their father. PGL4 syndrome (SDHB) is notable for an increased risk of malignant PGL or PC. PGL3 syndrome (SDHC) and PGL5 syndrome (SDHA) are less common and appear to be associated with lower penetrance of tumour development. Although these syndromes are all associated with SDH deficiency, few genotype-phenotype relationships have yet been established, and indeed it is remarkable that such divergent phenotypes can arise from disruption of a common molecular pathway. This article reviews the clinical presentations of these syndromes, including their component tumours and underlying genetic basis.
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Affiliation(s)
- Diana E Benn
- Cancer GeneticsKolling Institute, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales 2065, Australia
| | - Bruce G Robinson
- Cancer GeneticsKolling Institute, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales 2065, Australia
| | - Roderick J Clifton-Bligh
- Cancer GeneticsKolling Institute, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales 2065, Australia
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Álvarez-Morujo RJGO, Ruiz MÁA, Serafini DP, Delgado IL, Friedlander E, Yurrita BS. Management of multicentric paragangliomas: Review of 24 patients with 60 tumors. Head Neck 2015; 38:267-76. [PMID: 26079175 DOI: 10.1002/hed.23894] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to reflect our experience in the management of multicentric head and neck paragangliomas, including genetic study and counseling, diagnostic tools, types of treatment, and the need for monitoring. METHODS A retrospective review of 24 patients with multicentric paraganglioma, including a total of 60 paragangliomas: 37 carotid body tumors, 13 jugulotympanic paragangliomas, and 10 vagal paragangliomas. RESULTS A total of 26 surgical procedures were performed, including the resection of 36 paragangliomas. Four tumors were pending surgery at the time of this review. Radiotherapy was administered in 7 patients with 9 tumors. A "wait-and-scan" policy with periodic MRI imaging tests was instituted for 9 patients with 12 paragangliomas. CONCLUSION The knowledge of the different modalities of management is especially relevant in patients with multicentric paragangliomas. In every case, benefits and potential risks of all treatment options may be taken into consideration for every individual patient.
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Affiliation(s)
| | | | - Daniel Poletti Serafini
- Ear, Nose, and Throat Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Irene López Delgado
- Ear, Nose, and Throat Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eviatar Friedlander
- Ear, Nose, and Throat Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Bartolomé Scola Yurrita
- Ear, Nose, and Throat Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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