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Tyagi S, Kumar KC, Saluja K. How 'eye' helped in von Hippel-Lindau syndrome. Eur J Ophthalmol 2023; 33:NP5-NP9. [PMID: 34308676 DOI: 10.1177/11206721211035632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Von Hippel-Lindau syndrome is a rare autosomal dominantly inherited multisystemic oncologic syndrome, presenting predominantly with angiomatosis in embryologically similar neurologic tissue such as retina, cerebellum and adrenals. Retinal hemangioblastomas are the hallmark ophthalmic finding. In this case report, we describe the importance of timely diagnosis, thorough systemic examination and treatment of bilaterally asymmetrical retinal hemangioblastomas in a young adult male. CASE PRESENTATION A 31-year-old male presented with painless diminution of vision in both eyes, associated with eyestrain and headache. Multiple asymmetric retinal lesions and dilated feeder vessels were noted on ophthalmoscopic examination and confirmed by fluorescein angiography to be retinal hemangioblastomas. Comprehensive systemic examination revealed cerebellar hemangioblastomas and multiple pancreatic and renal cysts. Treatment of retinal lesions was done by combination therapy of argon laser photocoagulation and cryopexy, which lead to a good visual outcome. Subsequently, neurosurgical resection of cerebellar hemangioblastoma proved to be lifesaving for the patient. CONCLUSION RHBs are the earliest, easiest and the most frequently detected manifestation of VHL. Identification of ocular manifestations play a pivotal role in early diagnosis and timely intervention in VHL syndrome, thereby significantly reducing associated morbidity and mortality. Therefore, an ophthalmologist's role is crucial in the management of these potentially deadly tumours.
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Affiliation(s)
- Swati Tyagi
- Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | | | - Komal Saluja
- Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
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2
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Otero-Marquez O, Chui TY, Pinhas A, Castanos Toral MV, Zhou DB, Migacz J, Rosen RB. 3-D OCT angiographic evidence of Anti-VEGF therapeutic effects on retinal capillary hemangioma. Am J Ophthalmol Case Rep 2022; 25:101394. [PMID: 35198818 PMCID: PMC8842027 DOI: 10.1016/j.ajoc.2022.101394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To report the impact of intravitreal anti–vascular endothelial growth factor (VEGF) therapy on a retinal capillary hemangioma (RCH) using clinical OCT angiography (OCT-A) in addition to standard imaging modalities. Observations A 25-year-old male patient with Von Hippel-Lindau (VHL) disease presented with a history of bilateral RCH. No view was present in the right eye. Examination of the left eye revealed six peripheral RCH, the smallest of which was temporal to the macula with active exudation. This RCH was thought to be the source of cystoid macular edema (CME) involving the fovea, and therefore, the source of vision decline. 11 injections of 1.25mg of Bevacizumab EA across 14-month was given. Comparison of the pre- and post-treatment OCT-A at the temporal RCH showed a reduction of CME and regression of RCH. Conclusion Anti-VEGF therapy appeared to stabilize the visual acuity and produce partial regression of RCH. It offers a safe option when visual acuity is threatened. OCT and OCT-A have the ability to document the impact of antiangiogenic therapy on RCH. 3D renderings of OCT-A offer enhanced sensitivity to recognition of structural and functional changes of RCH which may prove useful for monitoring treatment response.
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Affiliation(s)
- Oscar Otero-Marquez
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Toco Yp Chui
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander Pinhas
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | | | - Davis B Zhou
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Justin Migacz
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Richard B Rosen
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kumari N, Das S, Bhaduri A, Gandhi A. Retinal Hemangioblastoma with Extraocular Extension: Report of Three Cases. Ocul Oncol Pathol 2021; 7:177-181. [PMID: 34307328 PMCID: PMC8280437 DOI: 10.1159/000512173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/08/2020] [Indexed: 11/19/2022] Open
Abstract
Retinal hemangioblastoma (RH) is the earliest and most common clinical manifestation in Von Hippel-Lindau (VHL) disease. RH can also present in isolation without any evidence of VHL. Clinical course of RH can be stationary or progress to exudation and chronic retinal detachment requiring surgical intervention. We report 3 cases of aggressive RH with extraocular extension in young males causing painful blind eye requiring enucleation. Two of our cases were bilateral involvement and had systemic manifestations of VHL. The third patient had unilateral involvement with no systemic evidence of VHL. This manifestation of RH is rarely reported. Two of our patients with VHL had early manifestations of RH and had undergone multiple cryotherapy sessions as well as retinal detachment surgery for exudative retinal detachment. This differential should be considered in vascular lesion arising from intraocular structures especially in diagnosed patients of VHL. The cases also highlight the aggressive behaviour and long-term progression of RH in some patients despite early treatment.
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Affiliation(s)
- Namita Kumari
- Oculoplasty and Ocular Oncology Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Sima Das
- Oculoplasty and Ocular Oncology Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Anirban Bhaduri
- Oculoplasty and Ocular Oncology Services, Susrut Eye Foundation and Research Institute, Kolkata, India
| | - Arpan Gandhi
- Laboratory Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
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Khan HA, Shahzad MA, Iqbal F, Awan MA, Khan QA, Saatci AO, Abbass A, Hussain F, Hussain SA, Ali A, Ali W. Ophthalmological Aspects of von-Hippel-Lindau Syndrome. Semin Ophthalmol 2021; 36:531-540. [PMID: 33780299 DOI: 10.1080/08820538.2021.1897851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: von Hippel-Lindau (VHL) syndrome is a multisystem neoplastic disorder involving eyes, central nervous system, kidneys, spine, and other tissues. A retinal capillary hemangioma (RCH) is the earliest manifestation of the VHL disease in most cases.Areas covered:This paper aims to provide an up-to-date review of the current literature about von Hippel-Lindau syndrome. Molecular background, systemic and ocular features of the diseases as well as the utility of newer imaging modalities in diagnosis and monitoring of ocular VHL disease have been described. Besides, we have discussed newer treatment modalities and therapeutic targets.Conclusion: Modern imaging technologies like optical coherence tomography and optical coherence tomography angiography are tools of the trade, in making an appropriate diagnosis and monitoring disease activity and response to treatment. Peripheral RCH may be treated using laser photocoagulation in tumors up to 3000 µm. Vascular endothelial growth factor suppression can help in reducing tumor activity and stabilize the tumor size; however, it does not regress the RCH.
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Affiliation(s)
- Hashim Ali Khan
- Ophthalmology department, SEHHAT Foundation Hospital, Danyore, Gilgit, Pakistan.,School of Optometry & Department of Ophthalmology, The University of Faisalabad, Faisalabad, Pakistan
| | | | - Fatima Iqbal
- School of Optometry & Department of Ophthalmology, The University of Faisalabad, Faisalabad, Pakistan.,School of Optometry and Vision Science - University of New South Wale, Sydney, Australia
| | - Muhammad Amer Awan
- Ophthalmology department, Shifa College of Medicine, Islamabad, Pakistan
| | - Qaim Ali Khan
- Ophthalmology department, Punch Medical College, AJK, Pakistan
| | | | - Ahmed Abbass
- Ophthalmology department, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Fazil Hussain
- Department of General Medicine PHQ Hospital, Gilgit, Pakistan
| | - Syed Arif Hussain
- Neurosurgery department, Pakistan Institute of Medical Science (PIMS), Islamabad, Pakistan
| | - Atif Ali
- Department of Acute Medicine, Luton & Dunstable Hospital, Luton, UK
| | - Wajahat Ali
- Department of Internal Medicine, King's Mill Hospital, Sutton-in-Ashfield, Nottinghamshire, UK
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Abstract
PURPOSE To provide an update summarizing the biologic pathways governing von Hippel-Lindau (VHL) disease pathogenesis and to provide an overview of systemic manifestations as well as screening recommendations. METHODS A PubMed search of the English language literature was reviewed using the following search terms: von Hippel-Lindau, von Hippel-Lindau disease, and VHL. Of 6,696 publications, the most current and pertinent information related to the pathogenesis and systemic aspects of VHL disease were included in this review. RESULTS von Hippel-Lindau disease is one of the most frequently occurring multisystem familial cancer syndromes. The disease results from germline mutation in the VHL tumor suppressor gene on the short arm of chromosome 3. Mutation in the VHL gene affects multiple cellular processes including transcriptional regulation, extracellular matrix formation, apoptosis, and, in particular, the cellular adaptive response to hypoxia. As a result, there is widespread development of vascular tumors affecting the retina, brain, and spine, as well as a spectrum of benign and malignant tumors and/or cysts in visceral organs. CONCLUSION The ophthalmologist plays a key role in VHL disease diagnosis, as retinal hemangioblastoma is frequently the first disease manifestation. Screening guidelines for individuals with known VHL disease, and those at risk of VHL disease, help to ensure early detection of potentially vision-threatening and life-threatening disease.
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6
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Kumar P, Ravani R, Agarwal S, Dhanda S, Kumar V. Insights into retinal hemangioblastoma using ultra widefield imaging. Indian J Ophthalmol 2020; 67:2029-2034. [PMID: 31755444 PMCID: PMC6896565 DOI: 10.4103/ijo.ijo_802_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose: Retinal hemangioblastomas (RHs) are characteristic of von Hippel-Lindau (VHL) disease. Early diagnosis of retinal lesions may aid in systemic diagnosis. Early identification of VHL is life-saving and also prevents vision loss. Fundus fluorescein angiography (FFA) is a useful tool in the diagnosis and management of RHs. The aim of this study is to report FFA features of RH using ultra-widefield (UWF) imaging. Methods: A retrospective cross-sectional study of consecutive patients of RH who underwent UWF FFA at a tertiary eye care center. Images were analyzed and assessed by authors. The main outcome measures were (a) the number and size of RH in each eye and (b) vascular characteristics of the retina. UWF-FFA characteristics in each eye were tabulated. The number of clock hours involved by these characteristics and their correlation with the number and size of RH were analyzed. Results: The study evaluated 24 eyes of 13 patients. The mean age was 28.4 years. The median number of RHs in an eye was 3.5 (range 1–16), and the size of RHs varied from 0.1 to 4 disc diameters. Novel UWF-FFA findings noted in this study were the presence of abnormal capillary network in 22 of 24 eyes (91.7%), capillary leakage in 15 of 24 eyes (62.5%), and capillary telangiectasia in 7 of 24 eyes (29.2%). In addition, feeder arterioles and venules showed bulbous projections in 8 of 24 eyes (33.3%). Conclusion: The UWF-FFA characteristics of RH, which have not been described before, were identified. These add to our understanding of the pathogenesis of the disease and may pave the way for future therapeutic targets.
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Affiliation(s)
- Pradeep Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Raghav Ravani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Dhanda
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Wei R, Ren X, Kong H, Lv Z, Chen Y, Tang Y, Wang Y, Xiao L, Yu T, Hacibekiroglu S, Liang C, Nagy A, Bremner R, Chen D. Rb1/Rbl1/Vhl loss induces mouse subretinal angiomatous proliferation and hemangioblastoma. JCI Insight 2019; 4:127889. [PMID: 31613797 DOI: 10.1172/jci.insight.127889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/10/2019] [Indexed: 02/05/2023] Open
Abstract
Von Hippel-Lindau (Vhl) protein inhibits hypoxia-inducible factor (Hif), yet its deletion in murine retina does not cause the extensive angiogenesis expected with Hif induction. The mechanism is unclear. Here we show that retinoblastoma tumor suppressor (Rb1) constrains expression of Hif target genes in the Vhl-/- retina. Deleting Rb1 induced extensive retinal neovascularization and autophagic ablation of photoreceptors in the Vhl-/- retina. RNA-sequencing, ChIP, and reporter assays showed Rb1 recruitment to and repression of certain Hif target genes. Activating Rb1 by deleting cyclin D1 induced a partial defect in the retinal superficial vascular plexus. Unexpectedly, removing Vhl suppressed retinoblastoma formation in murine Rb1/Rbl1-deficient retina but generated subretinal vascular growths resembling retinal angiomatous proliferation (RAP) and retinal capillary hemangioblastoma (RCH). Most stromal cells in the RAP/RCH-like lesions were Sox9+, suggesting a Müller glia origin, and expressed Lgals3, a marker of human brain hemangioblastoma. Thus, the Rb family limit Hif target gene expression in the Vhl-/- retina, and removing this inhibitory signal generates new models for RAP and RCH.
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Affiliation(s)
- Ran Wei
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, and.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Ren
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, and.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongyu Kong
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, and.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongping Lv
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, and.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Yongjiang Chen
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, and Departments of Ophthalmology and Visual Science, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Yunjing Tang
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, and.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Yujiao Wang
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, and.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Lirong Xiao
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, and
| | - Tao Yu
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Sabiha Hacibekiroglu
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Chen Liang
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, and
| | - Andras Nagy
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Rod Bremner
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, and Departments of Ophthalmology and Visual Science, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Danian Chen
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, and.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, and Departments of Ophthalmology and Visual Science, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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8
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McGrath LA, Mudhar HS, Salvi SM. Hemangioblastoma of the optic nerve. Surv Ophthalmol 2019; 64:175-184. [DOI: 10.1016/j.survophthal.2018.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/27/2018] [Accepted: 10/01/2018] [Indexed: 11/27/2022]
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9
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Albiñana V, Escribano RMJ, Soler I, Padial LR, Recio-Poveda L, Villar Gómez de Las Heras K, Botella LM. Repurposing propranolol as a drug for the treatment of retinal haemangioblastomas in von Hippel-Lindau disease. Orphanet J Rare Dis 2017; 12:122. [PMID: 28662711 PMCID: PMC5492903 DOI: 10.1186/s13023-017-0664-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/09/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Von Hippel-Lindau (VHL) disease is a rare oncological disease with an incidence of 1:36,000, and is characterized by the growth of different types of tumours. Haemangioblastomas in the central nervous system (CNS) and retina, renal carcinoma and pheochromocytomas are the most common tumours. The absence of treatment for VHL leads to the need of repeated surgeries as the only option for these patients. Targeting VHL-derived tumours with drugs with reduced side effects is urgent to avoid repeated CNS surgeries. Recent reports have demonstrated that propranolol, a β-blocker used for the treatment of hypertension and other cardiac and neurological diseases, is the best option for infantile hemangioma (IH). Propranolol could be an efficient treatment to control haemangioblastoma growth in VHL disease given its antiangiogenic effects that were recently demonstrated by us. The main objective of the present study was the assessment of the efficacy and safety of propranolol on retinal haemangioblastoma in von Hippel-Lindau disease (VHL). METHODS 7 VHL patients, from different regions of Spain, affected from juxtapapillary or peripheral haemangioblastomas were administered 120 mg propranolol daily. Patients were evaluated every 3 months for 12 months, at Virgen de la Salud Hospital (Toledo). The patients had juxtapapillary or peripheral haemangioblastomas but had refused standard treatments. RESULTS Propranolol was initiated with a progressive increase up to a final dose of 120 mg daily. All tumours remained stable, and no new tumours appeared. The reabsorption of retinal exudation was noted in the two patients having exudates. No adverse effects were recorded. VEGF and miRNA 210 levels were monitored in the plasma of patients as possible biomarkers of VHL. These levels decreased in all cases from the first month of treatment. CONCLUSIONS Although more studies are necessary, the results of this work suggest that propranolol is a drug to be considered in the treatment of VHL patients with retinal haemangioblastomas. VEGF and miRNA 210 could be used as biomarkers of the VHL disease activity. TRIAL REGISTRATION The study has a clinical trial design and was registered at EU Clinical Trials Register and Spanish Clinical Studies Registry, EudraCT Number: 2014-003671-30 . Registered 2 September 2014.
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Affiliation(s)
- Virginia Albiñana
- Centro de Investigaciones Biológicas, CSIC, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | | | - Isabel Soler
- Hospital Virgen de la Salud (SESCAM), Toledo, Spain
| | | | | | | | - Luisa María Botella
- Centro de Investigaciones Biológicas, CSIC, Madrid, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain.
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Şahin Atik S, Solmaz AE, Öztaş Z, Eğrilmez ED, Uğurlu Ş, Atik T, Afrashi F. Von Hippel-Lindau Disease: The Importance of Retinal Hemangioblastomas in Diagnosis. Turk J Ophthalmol 2017. [PMID: 28630796 PMCID: PMC5468534 DOI: 10.4274/tjo.90912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Von Hippel-Lindau (VHL) disease is a familial cancer syndrome characterized by benign or malignant tumors which may involve more than one system. Retinal hemangioblastomas are usually the initial manifestation of VHL disease and can cause vision loss. A 32-year-old man presented to our clinic with vision loss in the left eye for 2 months. He had a history of cerebral hemangioblastoma operation. Family history showed that his mother had unilateral vision loss and died because of renal cell carcinoma. Ophthalmologic examination revealed multiple retinal hemangioblastomas in both eyes. VHL gene sequencing was performed and heterozygous p.R161X mutation was detected. His sister and daughter were also found to have the same variant. A treatment and follow-up plan was initiated for the patient and affected family members. Considering VHL disease in the differential diagnosis of retinal hemangioblastomas has a very important role in the early detection of life-threatening tumors in these patients.
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Affiliation(s)
- Sevinç Şahin Atik
- Katip Çelebi University Atatürk Training and Research Hospital, Ophthalmology Clinic, İzmir, Turkey
| | - Aslı Ece Solmaz
- Ege University Faculty of Medicine, Department of Medical Genetics, İzmir, Turkey
| | - Zafer Öztaş
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Emine Deniz Eğrilmez
- Katip Çelebi University Atatürk Training and Research Hospital, Ophthalmology Clinic, İzmir, Turkey
| | - Şeyda Uğurlu
- Katip Çelebi University Atatürk Training and Research Hospital, Ophthalmology Clinic, İzmir, Turkey
| | - Tahir Atik
- Ege University Faculty of Medicine, Department of Pediatrics, İzmir, Turkey
| | - Filiz Afrashi
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
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Abbott AB, Knickelbein JE, Wiley HE, Chew EY, Wong WT. Ocular von Hippel-Lindau Disease – clinical characteristics and future directions. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1224652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Pierscianek D, Wolf S, Keyvani K, El Hindy N, Stein KP, Sandalcioglu IE, Sure U, Mueller O, Zhu Y. Study of angiogenic signaling pathways in hemangioblastoma. Neuropathology 2016; 37:3-11. [PMID: 27388534 DOI: 10.1111/neup.12316] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/16/2016] [Accepted: 05/22/2016] [Indexed: 01/30/2023]
Abstract
Hemangioblastoma (HB) is mainly located in the brain and the spinal cord. The tumor is composed of two major components, namely neoplastic stromal cells and abundant microvessels. Thus, hyper-vascularization is the hallmark of this tumor. Despite the identification of germline and/or epigenetic mutations of Von Hippel Lindau (VHL) gene as an important pathogenic mechanism of HB, little is known about the molecular signaling involved in this highly vascularized tumor. The present study investigated the key players of multiple angiogenic signaling pathways including VEGF/VEGFR2, EphB4/EphrinB2, SDF1α/CXCR4 and Notch/Dll4 pathways in surgical specimens of 22 HB. The expression of key angiogenic factors was detected by RT2 -PCR and Western blot. Immunofluorescent staining revealed the cellular localization of these proteins. We demonstrated a massive upregulation of mRNA levels of VEGF and VEGFR2, CXCR4 and SDF1α, EphB4 and EphrinB2, as well as the main components of Dll4-Notch signaling in HB. An increase in the protein expression of VEGF, CXCR4 and the core-components of Dll4-Notch signaling was associated with an activation of Akt and Erk1/2 and accompanied by an elevated expression of PCNA. Immuofluorescent staining revealed the expression of VEGF and CXCR4 in endothelial cells as well as in tumor cells. Dll4 protein was predominantly found in tumor cells, whereas EphB4 immunoreactivity was exclusively detected in endothelial cells. We conclude that multiple key angiogenic pathways were activated in HB, which may synergistically contribute to the abundant vascularization in this tumor. Identification of these aberrant pathways provides potential targets for a possible future application of anti-angiogenic therapy for this tumor, particularly when a total surgical resection becomes difficult due to the localization or multiplicity of the tumor.
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Affiliation(s)
| | - Stefanie Wolf
- Department of Neurosurgery, Universitatsklinikum Essen, Germany
| | - Kathy Keyvani
- Institute of Neuropathology, University Hospital Essen, Essen, Germany
| | | | - Klaus-Peter Stein
- Department of Neurosurgery, KRH Hospital Nordstadt, Hannover, Germany
| | | | - Ulrich Sure
- Department of Neurosurgery, Universitatsklinikum Essen, Germany
| | - Oliver Mueller
- Department of Neurosurgery, Universitatsklinikum Essen, Germany
| | - Yuan Zhu
- Department of Neurosurgery, Universitatsklinikum Essen, Germany
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13
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Chen S, Chew EY, Chan CC. Pathology characteristics of ocular von Hippel-Lindau disease with neovascularization of the iris and cornea: a case report. J Med Case Rep 2015; 9:66. [PMID: 25885645 PMCID: PMC4389714 DOI: 10.1186/s13256-015-0539-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/30/2015] [Indexed: 12/05/2022] Open
Abstract
Introduction Retinal hemangioblastoma is one of the most common tumors in von Hippel-Lindau disease. In addition to the classical pathological characteristics of von Hippel-Lindau disease, we report, for what we believe to be the first time, a severe and rare ocular complication characterized by neovascularization in the cornea and iris. Case presentation A 41-year-old white man with a long history of retinal hemangioblastoma presented with neovascularization of his iris and cornea as well as corneal perforation. His right eye was blind and painful, leading to a decision of enucleation. On microscopy, the enucleated eye showed neovascularization of the cornea and iris. The cornea was perforated with an expulsive hemorrhage and extruding intraocular contents, including the retina. A large retinal hemangioblastoma was located at the posterior pole adjacent to the optic nerve head. The tumor was mainly composed of large cells with foamy cytoplasm. Bone formation was also present. Conclusion Our pathology findings were consistent with previously described features of retinal hemangioblastoma. The present case is unusual because of the co-existing neovascularization in the iris and cornea, which may have led to corneal perforation and vision loss.
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Affiliation(s)
- Shida Chen
- Immunopathology Section, Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD, USA. .,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Emily Y Chew
- Division of Epidemiology and Clinical Research, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Chi-Chao Chan
- Immunopathology Section, Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
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Abstract
von Hippel-Lindau (VHL) disease is an inheritable condition with an incidence of 1 in 36000 live births. Individuals with VHL develop benign and malignant tumors including retinal and central nervous system hemangioblastomas, clear cell renal cell carcinomas (RCC), pheochromocytomas, pancreatic neuroendocrine tumors and endolymphatic sac tumors (ELSTs). VHL is caused by germline loss of function of the VHL gene on one allele at chromosome 3p25-26. A somatic "second hit" event leads to the loss of the other allele and tumor formation. Loss of VHL function in cells leads to increased expression and stabilization of hypoxia inducible factor (HIF). VHL protein/HIF pathway has been implicated in tumorigenesis for hemangioblastomas, RCC and other VHL tumors. Clinical examination, imaging, and genetic testing for VHL mutations confirm VHL disease. Management of VHL disease largely consists of surgical resection of symptomatic tumors (hemangioblastomas), tumors prone to metastasize (RCC larger than 3cm), or tumors causing hormonal symptoms (pheochromocytomas). Despite advances in early diagnosis and management of VHL disease, life expectancy for VHL patients remains low at 40-52 years. Secondary effects from VHL manifestations are mitigated by routine surveillance and early detection. In this chapter, we summarize the current state of knowledge in VHL disease.
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Affiliation(s)
- Prashant Chittiboina
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
| | - Russell R Lonser
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA
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