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Muñoz MC, Febrero B, Abellán M, Hernández AM, Rodríguez JM. Differences between Patients with Sporadic and Familial Pheochromocytoma-Is It Possible to Avoid Genetic Testing in Certain Patients? Biomedicines 2024; 12:1352. [PMID: 38927559 PMCID: PMC11202019 DOI: 10.3390/biomedicines12061352] [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: 05/09/2024] [Revised: 06/03/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Pheochromocytoma (PHEO) is a rare neuroendocrine tumour with a strong genetic link, which therefore may modify its clinical behaviour and prognosis. The aim of the study is to evaluate the epidemiological and clinical differences between patients with sporadic and familial PHEO, as well as the specific differences in the index cases. METHODS A retrospective analysis of 136 patients in a tertiary hospital (1984-2021). Epidemiological, clinical, and histological variables were analysed. STATISTICS SPSS 28.0 software was used. Univariate and multivariate logistic regression analyses were performed. p < 0.05 was considered statistically significant. RESULTS 64.71% of the cases (n = 88) presented a genetic mutation (familial cases). Additionally, 32.39% (n = 23) corresponded to index cases and the rest to screening cases. The main differences between patients with familial and sporadic PHEO were age (OR = 0.93 (0.89-0.97)), blood pressure-related symptoms (OR = 0.22 (0.06-0.89)), bilaterality (OR = 15.49 (3.76-63.84)), and size (OR = 0.70 (0.54-0.92)). Among patients with sporadic PHEO and index cases, only bilaterality was significant (OR = 13.53 (1.24-144.34)). CONCLUSIONS Patients with familial PHEO diagnosed by screening differ from sporadic cases in terms of age, clinical features, and size. However, patients with sporadic PHEO only differ from index cases by a lower presence of bilaterality, which reaffirms the importance of genetic screening of patients with PHEO and their relatives.
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Affiliation(s)
- María Consuelo Muñoz
- Service of Endocrinology and Nutrition, Hospital Comarcal del Noroeste, 30400 Murcia, Spain;
| | - Beatriz Febrero
- Endocrine Surgery Unit, General and Digestive Surgery Service, Hospital Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (M.A.); (J.M.R.)
- Department of Surgery, University of Murcia, 30120 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria Pascual Parrilla (IMIB_Pascual Parrilla), 30120 Murcia, Spain
| | - Miriam Abellán
- Endocrine Surgery Unit, General and Digestive Surgery Service, Hospital Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (M.A.); (J.M.R.)
- Department of Surgery, University of Murcia, 30120 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria Pascual Parrilla (IMIB_Pascual Parrilla), 30120 Murcia, Spain
| | - Antonio Miguel Hernández
- Service of Endocrinology and Nutrition, Hospital Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
- Department of Medicine, University of Murcia, 30120 Murcia, Spain
| | - José Manuel Rodríguez
- Endocrine Surgery Unit, General and Digestive Surgery Service, Hospital Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (M.A.); (J.M.R.)
- Department of Surgery, University of Murcia, 30120 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria Pascual Parrilla (IMIB_Pascual Parrilla), 30120 Murcia, Spain
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Kaplinsky A, Halperin R, Shlomai G, Tirosh A. Role of epigenetic regulation on catecholamine synthesis in pheochromocytoma and paraganglioma. Cancer 2024. [PMID: 38872410 DOI: 10.1002/cncr.35426] [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: 02/10/2024] [Revised: 04/27/2024] [Accepted: 05/14/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Pheochromocytomas and paragangliomas (PPGLs) typically secrete catecholamines and their metabolites (metanephrines [MN] and normetanephrine [NMN]). Catecholamines are synthesized by several enzymes: phenylalanine hydroxylase (encoded by PAH), tyrosine hydroxylase (TH), aromatic L-amino acid decarboxylase (DDC), dopamine β-hydroxylase (DBH), and phenylethanolamine N-methyltransferase (PNMT). MN/NMN secretion varies between anatomical and molecular subgroups. The aim of this study was to assess the correlation between DNA methylation of catecholamine synthesis genes and MN/NMN secretion. METHODS Gene promoter methylation of PAH, TH, AADC, DBH, and PNMT were extracted and calculated based on publicly available data. Comparisons and correlation analysis were performed between MN ± NMN (MN/NMN), NMN only, and neither/unknown secretion patterns. Methylation levels and MN/NMN patterns were compared by three genetic alteration subgroups: pseudohypoxia (PH), kinase signaling (KS), and others. RESULTS A total of 178 cases were included. Methylation of PAH CpGs negatively correlated with probability for MN/NMN secretion (p < .05 for all CpGs) and positively with NMN-only secretion. NMN-only secreting tumors had significantly higher promoter methylation of PAH, DBH, and PNMT compared with MN/NMN-secreting tumors. MN/NMN-secreting PPGLs had mainly KS alterations (52.1%), whereas NMN-only PPGLs had PH alterations (41.9%). PPGLs in the PH versus KS group had gene promoter hypermethylation of PAH (p = .002), DBH (p = .02), and PNMT (p = .003). CONCLUSIONS Promoter methylation of genes encoding catecholamine synthesis enzymes is strongly and inversely correlated with MN/NMN patterns in PPGLs. KS and PH-related tumors have distinct methylation patterns. These results imply that methylation is a key regulatory mechanism of catecholamine synthesis in PPGLs.
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Affiliation(s)
- Anna Kaplinsky
- Cancer Center, Ramat Gan, Israel
- Tel Aviv University Faculty of Medicine, Tel-Aviv, Israel
| | - Reut Halperin
- Tel Aviv University Faculty of Medicine, Tel-Aviv, Israel
- Division of Endocrinology, Metabolism, and Diabetes, ENTIRE - Endocrine Neoplasia Translational Research Center, Ramat Gan, Israel
| | - Gadi Shlomai
- Tel Aviv University Faculty of Medicine, Tel-Aviv, Israel
- Internal Medicine D Ward, Sheba Medical Center, Ramat Gan, Israel
| | - Amit Tirosh
- Division of Endocrinology, Metabolism, and Diabetes, ENTIRE - Endocrine Neoplasia Translational Research Center, Ramat Gan, Israel
- Internal Medicine D Ward, Sheba Medical Center, Ramat Gan, Israel
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Stawarz K, Durzynska M, Galazka A, Paszkowska M, Bienkowska-Pluta K, Zwolinski J, Tysarowski A, Kwiatkowska E, Podgorska A. Two sisters diagnosed with familial paraganglioma syndrome type 1 (FPGL1) and multiple endocrine neoplasia type 2A (MEN2A). World J Surg Oncol 2024; 22:139. [PMID: 38802890 PMCID: PMC11129478 DOI: 10.1186/s12957-024-03418-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND In clinical practice, genetic testing has become standard for many cancerous diseases. While a diagnosis of a single hereditary syndrome is not uncommon, the coexistence of two genetic diseases, even with partially common symptoms, remains unusual. Therefore, targeted next-generation sequencing (NGS), along with genetic consultation and imaging studies, is essential for every patient with confirmed paraganglioma. In this report, we present two sisters diagnosed with multiple endocrine neoplasia type 2 (MEN2A) and familial paraganglioma syndrome type 1 (FPGL1). CASE PRESENTATION After presenting to the clinic with neck tumors persisting for several months, both patients underwent tumor removal procedures following imaging and laboratory studies. Pathological reports confirmed the diagnosis of paragangliomas. Subsequently, genetic testing, including NGS, revealed a mutation in the rearranged during transfection (RET) gene: the heterozygous change (c.2410G > A), (p.Val804Met), and a variant of the succinate dehydrogenase complex subunit D (SDHD) gene: (c.64 C > T), (p.Arg22Ter). Subsequently, thyroidectomy procedures were scheduled in both cases. CONCLUSION To the best of our knowledge, this is the first report presenting these two mutations in two related patients, resulting in distinctive genetic syndromes with similar manifestations. This underscores that although infrequent, multiple hereditary disorders may co-occur in the same individual.
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Affiliation(s)
- Katarzyna Stawarz
- Head and Neck Cancer Department, Maria Sklodowska-Curie National Research Institute of Oncology, ul. W.K.Roentgen 5, Warsaw, 502-781, Poland.
| | - Monika Durzynska
- Department of Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, ul. W.K.Roentgen 5, Warsaw, 502-781, Poland
| | - Adam Galazka
- Head and Neck Cancer Department, Maria Sklodowska-Curie National Research Institute of Oncology, ul. W.K.Roentgen 5, Warsaw, 502-781, Poland
| | - Monika Paszkowska
- Head and Neck Cancer Department, Maria Sklodowska-Curie National Research Institute of Oncology, ul. W.K.Roentgen 5, Warsaw, 502-781, Poland
| | - Karolina Bienkowska-Pluta
- Head and Neck Cancer Department, Maria Sklodowska-Curie National Research Institute of Oncology, ul. W.K.Roentgen 5, Warsaw, 502-781, Poland
| | - Jakub Zwolinski
- Head and Neck Cancer Department, Maria Sklodowska-Curie National Research Institute of Oncology, ul. W.K.Roentgen 5, Warsaw, 502-781, Poland
| | - Andrzej Tysarowski
- Department of Genetics and Molecular Cancer Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, ul. W.K.Roentgen 5, Warsaw, 502-781, Poland
| | - Ewa Kwiatkowska
- Department of Genetics and Molecular Cancer Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, ul. W.K.Roentgen 5, Warsaw, 502-781, Poland
| | - Agnieszka Podgorska
- Department of Genetics and Molecular Cancer Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, ul. W.K.Roentgen 5, Warsaw, 502-781, Poland
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Hao Y, Li X, Xie J, He W, Wang C, Sun F. Case report: Rare case of a preoperatively diagnosed spermatic cord paraganglioma and literature review. Front Oncol 2024; 14:1373727. [PMID: 38680861 PMCID: PMC11047120 DOI: 10.3389/fonc.2024.1373727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
Paraganglioma (PGL) is rare, and PGL that arises from the urogenital system is even rarer. Here we report a case of PGL in spermatic cord and review the relevant literatures. We encountered a 15-year-old boy with a history of hypertension for almost 2 years, accompanied with headache and palpitations. His serum and urine catecholamines were elevated, but no adrenal lesions were detected, suggesting the existence of PGL. Upon physical examination, a painless nodule adherent to the spermatic cord in the right scrotum was found. A systemic Ga68 DOTATATE PET-CT was then performed, and it revealed a mass with high DOTATATE uptake in the right scrotum. The CT, MRI, and ultrasound images showed the abundant blood supply to the tumor. Based on the above-mentioned imaging and biochemical information, a diagnosis of PGL was made prior to surgery. After 2 weeks of preparation with Cardura, an open surgery was performed to remove the tumor together with the right testis and right epididymis. The blood pressure increased to 180/100 mmHg when the tumor was touched intraoperatively and decreased to 90/55 mmHg after the tumor was removed. Post-operative pathology confirmed our diagnosis of PGL originating from the spermatic cord. Immunohistochemical (IHC) staining showed SDHB (+), CgA (+), synaptophysin (+), GATA3 (+), CD56 (+), sertoli cells S-100 (+), and Ki67 (5%). Genetic testing revealed a missense mutation in the SDHA gene. Only 16 cases of spermatic cord PGL have been reported to date. Although it is easy to diagnose by histology and IHC examinations, preoperative diagnosis is quite important as it can actually reduce intraoperative complications.
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Affiliation(s)
- Yining Hao
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiuci Li
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Xie
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei He
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenghe Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fukang Sun
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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White JA, Rodriguez J, Kandadai J, Kardas E, Chohan F, Michel G. Increased anxiety and emotional lability in a patient with SDHB gene mutation paraganglioma: a call to multidisciplinary approach. Endocrine 2024; 83:349-352. [PMID: 37821692 DOI: 10.1007/s12020-023-03555-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
Paragangliomas are neuroendocrine tumors that have the potential to secrete catecholamines. They have been linked to genetic mutations in the mitochondrial succinate dehydrogenase (SDH) complex. Patients can experience both physical symptoms and psychiatric symptoms like anxiety, depression, and psychosis. These symptoms can occur as paroxysmal episodes with periods of increased catecholamine secretion. We describe a patient with SDHB gene mutation, who has been diagnosed with a jugular paraganglioma, and was brought to the hospital under Baker Act for threats made online. Since diagnosis this patient has been experiencing both anxiety and post-traumatic stress disorder (PTSD). The patient and a family member report increased emotional lability, and the patient reports multiple daily episodes of anxiousness. This case outlines the connection between paragangliomas and psychiatric symptoms, the impact they can have on patients' daily lives, and the importance of addressing the possibility of these symptoms and establishing a multispecialty healthcare team at the time of diagnosis.
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Affiliation(s)
- Joseph Allen White
- Ross University School of Medicine, Two Mile Hill St. Michael, Bridgetown, BB11093, Barbados.
| | - James Rodriguez
- Ross University School of Medicine, Two Mile Hill St. Michael, Bridgetown, BB11093, Barbados
| | - Jagan Kandadai
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, 3200 S University Dr, Davie, FL, 33328, USA
| | - Einas Kardas
- The Faculty of Medicine of Damascus University, G748+VRH, Damascus, Syria
| | - Farrah Chohan
- Larkin Community Hospital, Department of Internal Medicine, 7031 SW 62nd Ave, South Miami, FL, 33143, USA
| | - George Michel
- Larkin Community Hospital, Department of Internal Medicine, 7031 SW 62nd Ave, South Miami, FL, 33143, USA
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Ceccato GHW, Borba LAB. Jugular Foramen Paragangliomas. Adv Tech Stand Neurosurg 2024; 49:201-229. [PMID: 38700686 DOI: 10.1007/978-3-031-42398-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Paragangliomas are the most common tumors at jugular foramen and pose a great surgical challenge. Careful clinical history and physical examination must be performed to adequately evaluate neurological deficits and its chronologic evolution, also to delineate an overview of the patient performance status. Complete imaging evaluation including MRI and CT scans should be performed, and angiography is a must to depict tumor blood supply and sigmoid sinus/internal jugular vein patency. Screening for multifocal paragangliomas is advisable, with a whole-body imaging. Laboratory investigation of endocrine function of the tumor is necessary, and adrenergic tumors may be associated with synchronous lesions. Preoperative prepare with alpha-blockage is advisable in norepinephrine/epinephrine-secreting tumors; however, it is not advisable in exclusively dopamine-secreting neoplasms. Best surgical candidates are young otherwise healthy patients with smaller lesions; however, treatment should be individualized each case. Variations of infratemporal fossa approach are employed depending on extensions of the mass. Regarding facial nerve management, we avoid to expose or reroute it if there is preoperative function preservation and prefer to work around facial canal in way of a fallopian bridge technique. If there is preoperative facial nerve compromise, the mastoid segment of the nerve is exposed, and it may be grafted if invaded or just decompressed. A key point is to preserve the anteromedial wall of internal jugular vein if there is preoperative preservation of lower cranial nerves. Careful multilayer closure is essential to avoid at most cerebrospinal fluid leakage. Residual tumors may be reoperated if growing and presenting mass effect or be candidate for adjuvant stereotactic radiosurgery.
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Affiliation(s)
- Guilherme H W Ceccato
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, PR, Brazil
| | - Luis A B Borba
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, PR, Brazil
- Department of Neurosurgery, Federal University of Paraná, Curitiba, PR, Brazil
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Tănăsescu MD, Popescu Ș, Mincă A, Isac T, Suliman E, Grigorie MM, Suliman E, Stăniloaie D, Timofte D, Ionescu D. Paragangliomas and Anemia: Literature Review and Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1925. [PMID: 38003974 PMCID: PMC10673208 DOI: 10.3390/medicina59111925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023]
Abstract
Paragangliomas are rare neuroendocrine tumors that arise from the extra-adrenal autonomic paraganglia, i.e., small organs consisting mainly of neuroendocrine cells that are derived from the embryonic neural crest and have the ability to secrete catecholamines. Paragangliomas can derive from either parasympathetic or sympathetic paraganglia. Most of the parasympathetic ganglia-derived paragangliomas are nonfunctional, and symptoms result from mass effect. Conversely, the sympathetic paragangliomas are functional and produce catecholamine. Although such patients could have symptoms similar to pheochromocytoma, mass effect symptoms, or non-specific symptoms, being benign tumors, they can also present with anemia, specifically iron-deficiency anemia. Considering that neoplastic pathology is chronically accompanied by moderate, normochromic, normocytic anemia, association between paragangliomas that are mostly benign but with a potential degree of malignancy and anemia is not as frequent as expected, with only 12 cases reported in the literature. We report a case of a 54-year-old female patient diagnosed with a paraganglioma of the carotid glomus accompanied by severe normochromic, normocytic anemia, which reached normal limits after excision of the paraganglioma.
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Affiliation(s)
- Maria-Daniela Tănăsescu
- Department 1 of Medical Semiology, Discipline of Medical Semiology and Nephrology, Bucharest Emergency University Hospital, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Dionisie Lupu Street, No. 37, Sector 2, 020021 Bucharest, Romania; (M.-D.T.); (D.I.)
- Department of Nephrology, Bucharest Emergency University Hospital, 050098 Bucharest, Romania;
| | - Ștefan Popescu
- Department of Nephrology, Bucharest Emergency University Hospital, 050098 Bucharest, Romania;
| | - Alexandru Mincă
- Department 1 of Medical Semiology, Discipline of Medical Semiology and Nephrology, Bucharest Emergency University Hospital, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Dionisie Lupu Street, No. 37, Sector 2, 020021 Bucharest, Romania; (M.-D.T.); (D.I.)
| | - Teodora Isac
- Department 2 of Internal Medicine, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Emel Suliman
- Department 10 of General Surgery, Discipline of Surgery I, Bucharest Emergency University Hospital, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.S.); (D.S.)
| | - Maria Mihaela Grigorie
- Department 3 of Dentistry III, Discipline of Endodontics, Faculty of Dentistry, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Emine Suliman
- Department 3 of Complementary Sciences, Discipline of Medical Informatics and Biostatistics, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Daniel Stăniloaie
- Department 10 of General Surgery, Discipline of Surgery I, Bucharest Emergency University Hospital, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.S.); (D.S.)
- 21st Department of General Surgery, Bucharest Emergency University Hospital, 050098 Bucharest, Romania
| | - Delia Timofte
- Department of Dialysis, Bucharest Emergency University Hospital, 050098 Bucharest, Romania;
| | - Dorin Ionescu
- Department 1 of Medical Semiology, Discipline of Medical Semiology and Nephrology, Bucharest Emergency University Hospital, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Dionisie Lupu Street, No. 37, Sector 2, 020021 Bucharest, Romania; (M.-D.T.); (D.I.)
- Department of Nephrology, Bucharest Emergency University Hospital, 050098 Bucharest, Romania;
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Felemovicius A, Min EA, Eimer M. A patient with elevated troponin but no coronary artery disease. JAAPA 2023; 36:45-48. [PMID: 37493992 DOI: 10.1097/01.jaa.0000944648.90049.d3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
- Alexandra Felemovicius
- At the time this article was written, Alexandra Felemovicius was a student in the PA program at Northwestern University in Chicago, Ill. Elana A. Min is an associate professor and director of clinical education in the PA program at Northwestern University. Micah Eimer practices cardiology at Northwestern University's Feinberg School of Medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Li C, Li J, Han C, Wang T, Zhang L, Wang Z, Wang T, Xu L, Qi G, Qin G, Li X, Zheng L. Novel and recurrent genetic variants of VHL, SDHB, and RET genes in Chinese pheochromocytoma and paraganglioma patients. Front Genet 2023; 14:959989. [PMID: 36936415 PMCID: PMC10020357 DOI: 10.3389/fgene.2023.959989] [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: 07/21/2022] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
Background: Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors arising from chromaffin cells in the adrenal medulla and extra-adrenal ganglia, respectively. The study was aimed to investigate the clinical and genetic characteristics of 22 individuals from six families. Methods: The medical records of six PPGL probands who presented to our hospital between 2016 and 2021 were retrospectively studied. DNA isolated from the probands was analyzed using whole exome sequencing. The identified genetic variants were confirmed by Sanger sequencing and undergone bioinformatic analysis. Results: Six different genetic variants in the six probands were identified, respectively, of which three were novel. A novel von Hippel-Lindau (VHL) variant, c.602T>C (p.L201P), in exon 3 was found. Two novel genetic variants in SDHB (succinate dehydrogenases subunit B), c.423 + 1 G>T and c.662A>G (p.D221G), were identified. Two recurrent genetic variants of VHL, c.C284G (p.P95R) and c.558_560AGAdel (p.186Edel), and one in RET (ret proto-oncogene), c.1901G>A (p.C634Y), were also found. The ClinVar accession number for the present variants are SCV002028348, and SCV002028352 to SCV002028361. Conclusion: Genetic variants in VHL, SDHB and RET were identified in Chinese PPGL patients, which contributed to the knowledge of the genetic etiology and clinical outcome of these tumors.
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Affiliation(s)
- Chong Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingyi Li
- Department of Plastic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Han
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ting Wang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lixia Zhang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhifang Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tingting Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lijun Xu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guangzhao Qi
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Guangzhao Qi, ; Xialian Li, ; Lili Zheng,
| | - Guijun Qin
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xialian Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Guangzhao Qi, ; Xialian Li, ; Lili Zheng,
| | - Lili Zheng
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Guangzhao Qi, ; Xialian Li, ; Lili Zheng,
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Liu Z, Yue R, Sun C, Wang J. Case report: Bilateral carotid body tumors with a concomitant skull-base paraganglioma. Front Oncol 2023; 13:1120152. [PMID: 37025587 PMCID: PMC10072277 DOI: 10.3389/fonc.2023.1120152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/07/2023] [Indexed: 04/08/2023] Open
Abstract
Background Bilateral carotid body tumors with a concomitant skull-base paraganglioma are extremely rare, of which only one case has been reported in the literature to date. Case presentation We present the case of a 35-year-old male with 1 year of hypertension and high levels of dopamine and 3-methoxytyramine. Magnetic resonance imaging (MRI) scans demonstrated three separate masses at the left middle cranial fossa floor and bilateral carotid bifurcation. Genetic testing showed succinate dehydrogenase complex subunit D mutation. The patient underwent the resection of the left skull base mass. Histopathology and immunohistochemistry confirmed the presence of a skull-base paraganglioma. Conclusions Succinate dehydrogenase complex subunit D mutation-associated bilateral carotid body tumors with a concomitant skull-base paraganglioma accompanied by abnormal dopamine and hypertension are extremely rare, which not only provides ideas for considering the association of gene mutations, biochemical abnormalities and clinical symptoms but also provides an expanded diagnostic spectrum for paraganglioma in atypical locations.
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Affiliation(s)
- Zhixuan Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Ruimin Yue
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Cuiyun Sun
- Department of Neuropathology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Junping Wang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Junping Wang,
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Razack R, Butt JL, Coetzee L, Hostein I, Croce S, De Wet DR, McCluggage WG. Cervical Small Cell Variant of Paraganglioma With Sarcomatous Transformation: Report of a Unique Case. Int J Gynecol Pathol 2022; 41:370-377. [PMID: 34570014 DOI: 10.1097/pgp.0000000000000823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a unique primary cervical neoplasm in a 44-yr-old woman which we believe, based on the morphology and immunophenotype, represents an extremely unusual small cell variant of paraganglioma. This represents the first report of a primary cervical paraganglioma. Following chemoradiation treatment, the tumor underwent malignant transformation into an S100 and SOX10 positive sarcoma, morphologically and immunohistochemically resembling a malignant peripheral nerve sheath tumor, which we believe represents a sarcoma derived from the sustentacular cells of the paraganglioma. Mutational analysis detected a nonsense mutation of NF1 gene in the sarcoma. This further supports the diagnosis as both somatic and germline NF1 mutations have been associated with paragangliomas and malignant peripheral nerve sheath tumors. Targeted RNA sequencing (ARCHER, expanded sarcoma panel) covering many known genes implicated in sarcoma development, did not reveal any other molecular alteration (fusion or internal tandem duplication).
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12
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Dai B, He J, Zhu X, Xie Z, Zhang C, Zhou X, Yang Z, Wang J. An Analysis of Computed Tomography Imaging Features and Predictive Factors for Postoperative Recurrence and Metastasis of Abdominal Paragangliomas. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8638588. [PMID: 35280711 PMCID: PMC8885278 DOI: 10.1155/2022/8638588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 11/17/2022]
Abstract
Methods We studied 51 abdominal PGL patients at the First Affiliated Hospital of Bengbu Medical College, Tongde Hospital, and Sir Run Shaw Hospital, Hangzhou, Zhejiang Province, China, from June 2009 to May 2019. Thereafter, the clinical research data, tumor biomarkers, and CT features were compared between the aggressive PGLs and the nonaggressive PGLs using independent-samples t-tests and chi-square tests. Results Of the 51 cases, 43 were benign and 8 had malignant tendencies. Postoperative recurrence and metastasis were more likely to occur when the tumor diameter was >8 cm or/and the enhancement degree was not obvious. Clinical symptoms, tumor markers, sex, age, and CT image characteristics including morphology, presence of cystic degeneration, "pointed peach" sign, calcification, hemorrhage, enlarged lymph nodes, and peritumor and intratumor blood vessels were not significantly different between the two groups (p > 0.05). Conclusion Our findings suggest that CT features, including size >8 cm and enhancement degree, could provide important evidence to assess risk factors for aggressive PGLs.
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Affiliation(s)
- Bailing Dai
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Jie He
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiandi Zhu
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zongyu Xie
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Cui Zhang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xiaoli Zhou
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zhao Yang
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Jian Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
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13
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Chupin AV, Verdikhanov NI, Golovyuk AL. [Modern conceptions on neck paragangliomas]. Khirurgiia (Mosk) 2022:64-70. [PMID: 35775846 DOI: 10.17116/hirurgia202207164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neck paragangliomas are orphan diseases with incidence 1:30 000-1:100 000. Life expectancy is poor in patients with distant metastasis (5-year overall survival 11.8%), whereas 5-year overall survival in patients with regional metastasis is 76.8-82.4%. Meanwhile, there is still no any reliable tool for prediction of malignant potential of paraganglioma. Above-mentioned data indicate an importance of early diagnosis and timely treatment of neck paragangliomas. Total resection of tumor in ablastic conditions is a gold standard of treatment. However, surgery is associated with a high risk of neurovascular complications and requires multidisciplinary approach. Nevertheless, new knowledge dedicated to different aspects of pathogenesis of neck paraganglioma, diagnosis and treatment arise every year. This review is devoted to modern data on neck paragangliomas.
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Affiliation(s)
- A V Chupin
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - N I Verdikhanov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A L Golovyuk
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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14
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Dhillon N, Baniak N, Nosib S. Hypertensive crisis precatheter ablation for resistant atrial fibrillation: a case of undiagnosed bilateral pheochromocytomas. BMJ Case Rep 2021; 14:e244484. [PMID: 34716146 PMCID: PMC8559091 DOI: 10.1136/bcr-2021-244484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 11/03/2022] Open
Abstract
A 63-year-old man with hypertension was referred for catheter ablation of persistent atrial fibrillation. He was diagnosed with paroxysmal atrial fibrillation approximately 6 years prior. Over the previous 12 months, his atrial fibrillation had become persistent despite medication optimisation for rate control and elective cardioversion. Sinus rhythm was restored briefly. The decision was made to pursue catheter ablation and isolation of the pulmonary veins. On anaesthetic induction, the patient suffered from a hypertensive crisis. The procedure was aborted, and the patient was admitted to hospital for investigations of secondary hypertension. Ultimately, the patient was diagnosed with bilateral pheochromocytomas. This case outlines the diagnostic challenges and cardiac comorbidities associated with bilateral pheochromocytomas.
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Affiliation(s)
- Nina Dhillon
- Internal Medicine, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Nick Baniak
- Pathology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Shravan Nosib
- Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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15
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Liu Z, Ma J, Jimenez C, Zhang M. Pheochromocytoma: A Clinicopathologic and Molecular Study of 390 Cases From a Single Center. Am J Surg Pathol 2021; 45:1155-1165. [PMID: 34280940 DOI: 10.1097/pas.0000000000001768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pheochromocytomas are rare neuroendocrine tumors arising from chromaffin cells in the adrenal medulla. They may occur sporadically or in the context of hereditary syndromes. All pheochromocytomas are considered to have malignant potential (defined as risk of metastasis, not local invasion). The use of grading systems with incorporated clinical and histopathologic parameters can help but not definitively predict the metastatic potential of pheochromocytomas. The recent discovery of susceptibility genes provided new insights into the pathogenesis and introduced additional approaches to estimate the metastatic risk of pheochromocytoma. However, the prevalence of these genetic signatures in pheochromocytomas has yet to be fully addressed. Therefore, in the present study, we retrospectively reviewed cases of pheochromocytoma from 1980 to 2018 in the archives of our institution. Three hundred ninety cases were identified, and their clinicopathologic characteristics and genetic statuses were analyzed. About 25% of the cases had metastases, which were more common in older patients (median, 49 y) than in younger ones. Univariate and multivariate analyses revealed that older age, Hispanic ethnicity, metastasis, and large primary tumor size were markedly associated with poor overall survival. In contrast, family history of pheochromocytoma, lack of symptoms, and bilateral adrenal involvement were associated with better survival. About 37% of the pheochromocytomas were associated with inherited syndromes. About 52% of tested patients had pathogenic mutations of pheochromocytoma susceptibility genes. Of these, succinate dehydrogenase B gene mutation had the strongest association with metastasis. These data support that genetic testing should be offered to all patients with pheochromocytoma.
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Affiliation(s)
| | | | - Camilo Jimenez
- Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX
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16
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Kanber Y, Pusztaszeri M, Auger M. Immunocytochemistry for diagnostic cytopathology-A practical guide. Cytopathology 2021; 32:562-587. [PMID: 34033162 DOI: 10.1111/cyt.12993] [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: 01/12/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
Cytological specimens, which are obtained by minimally invasive methods, are an excellent source of diagnostic material. Sometimes they are the only material available for diagnosis as well as for prognostic/predictive markers. When cytomorphology is not straightforward, ancillary tests may be required for a definitive diagnosis to guide clinical management. Immunocytochemistry (ICC) is the most common and practical ancillary tool used to reach a diagnosis when cytomorphology is equivocal, to differentiate entities with overlapping morphological features, and to determine the cell lineage and the site of origin of a metastatic neoplasm. Numerous immunomarkers are available, and some are expressed in multiple neoplasms. To rule out entities within a differential diagnosis, the use of more than one marker, sometimes panels, is necessary. ICC panels for diagnostic purposes should be customised based on the clinical context and cytomorphology, and the markers should be used judiciously to preserve material for additional tests for targeted therapies in the appropriate setting. This review offers a practical guide for the use of ICC for diagnostic cytopathology, covering the most commonly encountered non-hematolymphoid diagnostic scenarios in various body sites.
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Affiliation(s)
- Yonca Kanber
- Department of Pathology, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Marc Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Manon Auger
- Department of Pathology, McGill University Health Center, McGill University, Montreal, QC, Canada
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17
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Jia Y, Yan Y, Lu M, Kirkpatrick IDC. Paraganglioma with highly malignant potential involving the rib - Case report and review of the literature. Radiol Case Rep 2021; 16:1845-1850. [PMID: 34093930 PMCID: PMC8165291 DOI: 10.1016/j.radcr.2021.04.039] [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: 04/11/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Paragangliomas are rare neuroendocrine tumors arising from paraganglion cells in sympathetic or parasympathetic chains, which may develop in the abdomen, chest, skull base, and neck. As paragangliomas have a wide range of imaging features, the diagnosis often requires tissue sampling. We present a unique case of a paraganglioma which originally presented as a rib tumor. A 64-year-old male with right flank pain for 2 months’ was referred for a noncontrast renal colic CT. He was found to have a 3.7 × 3.5 cm soft tissue mass invading the left posterior 9th rib and paraspinal muscle. This was fluorodeoxyglucose F 18, (18F-FDG) avid, with no other distant metabolic activity. He underwent ultrasound-guided core biopsy which revealed a diagnosis of paraganglioma. A right thoracotomy with chest wall resection of 8, 9, and 10 ribs were subsequently performed. The tumor was removed along with a small portion of adherent lung. The tumor was positive for CD56, synaptophysin and chromogranin. S-100 highlighted occasional sustentacular cells, consistent with a pathologic diagnosis of a paraganglioma. The patient remains symptom free for 6 months’ after the operation. Our case highlights that, when paragangliomas occur within the chest wall, they may present as a rib tumor and can mimic metastasis, myeloma or other primary neoplastic etiologies originating from ribs. Both imaging and pathologic diagnosis can be challenging.
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Affiliation(s)
- Yong Jia
- Department of Pathology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A1R9, Canada
| | - Yi Yan
- Department of Radiology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A1R9, Canada
| | - Miao Lu
- Department of Pathology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3A1R9, Canada
| | - Iain D C Kirkpatrick
- Department of Diagnostic Radiology, University of Manitoba, Room O2055, St Boniface General Hospital, 409 Tache Avenue, Winnipeg, MB R2H 2A6, Canada
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Management of functioning pediatric adrenal tumors. J Pediatr Surg 2021; 56:768-771. [PMID: 32972741 DOI: 10.1016/j.jpedsurg.2020.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/30/2020] [Accepted: 08/21/2020] [Indexed: 11/21/2022]
Abstract
AIM The aim of this study is to present our experience in the management of hormonally active adrenal tumors in children. MATERIAL AND METHODS We did a retrospective chart review of all children with hormonally active adrenal tumors evaluated at the endocrinology clinic and operated at our institution between 1983 and 2019. RESULTS There were 75 patients included in the study, 58 with adrenocortical tumors (ACTs) and 17 with pheochromocytomas (PCCs). Within the group of patients with ACTs, there were 41 females and 17 males. The mean age was 58.3 (SD: 87.9; range: 9-211) months. The clinical manifestation of the tumor's hormonal activity was virilization in 37 cases, Cushing syndrome in 5, and mixed in 16. A positive family history was present in 11 patients (18.9%). The mean tumor size was 48.2 (SD: 22.4; range: 7-120) mm. The pathological diagnosis was adenoma in 42 cases, carcinoma in 15 cases, and macronodular hyperplasia in 1. Median follow-up was 192 (range: 50-290) months. Tumor recurrence occurred in 6 patients (10.3%), and there were three disease-related deaths (5%). Within the group of patients with PCCs, there were 11 males and 6 females. The mean age was 146.7 (SD: 71.2; range: 60-216) months. A positive family history was present in 7 patients (41.2%). The mean tumor size was 36.6 (SD: 16.7; range: 7-120) mm. The pheochromocytoma was classified as benign in 15 cases and as malignant in 2. During a median follow-up of 180 (range: 127-300) months, recurrence was observed in 6 cases (35.3%) and disease-related death in 1 case (5.9%). CONCLUSIONS Proper diagnosis and management at our referral center were associated with a high cure rate, even in cases of malignant tumors. Familial surveillance is highly recommended. LEVEL OF EVIDENCE Level IV.
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19
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Mahon SM. Hereditary Neuroendocrine Tumors: Providing Comprehensive Care for Individuals Who Have a Germline Pathogenic Variant Associated With Paragangliomas and Pheochromocytomas. Clin J Oncol Nurs 2021; 25:137-141. [PMID: 33739340 DOI: 10.1188/21.cjon.137-141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Both paragangliomas and pheochromocytomas can be associated with germline pathogenic variants. Although these neuroendocrine tumors are relatively rare, the identification of patients and families with germline risk enables the implementation of surveillance programs to decrease the morbidity and mortality associated with these tumors. Individuals with germline risk require lifelong screening, which is implemented as early as age 5 years. In addition to ensuring that surveillance protocols are implemented, nurses provide education about symptoms that require prompt evaluation.
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20
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Germline Pathogenic Variants Identified by Targeted Next-Generation Sequencing of Susceptibility Genes in Pheochromocytoma and Paraganglioma. J Kidney Cancer VHL 2021; 8:19-24. [PMID: 33777662 PMCID: PMC7969383 DOI: 10.15586/jkcvhl.v8i1.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/28/2021] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate germline variant frequencies of pheochromocytoma and paraganglioma targeted susceptibility genes with next-generation sequencing method. Germline DNA from 75 cases were evaluated with targeted next-generation sequencing on an Illumina NextSeq550 instrument. KIF1B, RET, SDHB, SDHD, TMEM127, and VHL genes were included in the study, and Sanger sequencing was used for verifying the variants. The pathogenic/likely pathogenic variants were in the VHL, RET, SDHB, and SDHD genes, and the diagnosis rate was 24% in this study. Three different novel pathogenic variants were determined in five cases. This is the first study from Turkey, evaluating germline susceptibility genes of pheochromocytoma and paraganglioma with a detection rate of 24% and three novel variants. All patients with pheochromocytoma and paraganglioma need clinical genetic testing with expanded targeted gene panels for higher diagnosis rates.
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21
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Papathomas TG, Suurd DPD, Pacak K, Tischler AS, Vriens MR, Lam AK, de Krijger RR. What Have We Learned from Molecular Biology of Paragangliomas and Pheochromocytomas? Endocr Pathol 2021; 32:134-153. [PMID: 33433885 DOI: 10.1007/s12022-020-09658-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/13/2022]
Abstract
Recent advances in molecular genetics and genomics have led to increased understanding of the aetiopathogenesis of pheochromocytomas and paragangliomas (PPGLs). Thus, pan-genomic studies now provide a comprehensive integrated genomic analysis of PPGLs into distinct molecularly defined subtypes concordant with tumour genotypes. In addition, new embryological discoveries have refined the concept of how normal paraganglia develop, potentially establishing a developmental basis for genotype-phenotype correlations for PPGLs. The challenge for modern pathology is to translate these scientific discoveries into routine practice, which will be based largely on histopathology for the foreseeable future. Here, we review recent progress concerning the cell of origin and molecular pathogenesis of PPGLs, including pathogenetic mechanisms, genetic susceptibility and molecular classification. The current roles and tools of pathologists are considered from a histopathological perspective, including differential diagnoses, genotype-phenotype correlations and the use of immunohistochemistry in identifying hereditary predisposition and validating genetic variants of unknown significance. Current and potential molecular prognosticators are also presented with the hope that predictive molecular biomarkers will be integrated into risk stratification scoring systems to assess the metastatic potential of these intriguing neoplasms and identify potential drug targets.
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Affiliation(s)
- Thomas G Papathomas
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Diederik P D Suurd
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Arthur S Tischler
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston Massachusetts, USA
| | - Menno R Vriens
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alfred K Lam
- School of Medicine, Griffith University, Gold Coast, QLD, Australia.
- Pathology Queensland, Gold Coast University Hospital, Gold Coast, QLD, Australia.
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Ronald R de Krijger
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Zahrarahou F, Miry A, Mirali H, Mahmoudi L, Bennani A, Bouziane M. Diagnosis of a 09 cm pheochromocytoma mistaken to be an intramesenteric pancreatic tumor: Case report complying with the scare guidelines. Int J Surg Case Rep 2020; 80:105198. [PMID: 33500230 PMCID: PMC7982497 DOI: 10.1016/j.ijscr.2020.10.092] [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: 09/27/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/18/2022] Open
Abstract
Pheochromocytoma’s case reports keep showing its diversity in clinical presentation, diagnosis methods treatment and follow up challenges. The diagnosis is basically simple by biomarkers testing, an imaging and challenging when biologically the tumor is silent. Functional imaging should be used to locate the tumor or its metastasis. Preoperative measures should be taken so no major preoperative complications and the main treatment is the tumor complete resection. The malignancy of the pheochromocytoma is not easy to be identified which imposes a lifetime follow up of these patients as metastasis were described even after 40 years after diagnosis.
Introduction Pheochromocytoma is an adrenal medullary tumor of the chromaffin cells first described in 1886, remains an entity not fully discovered that case reports keep showing its diversity in clinical presentation, diagnosis methods treatment and follow up challenges. Case presentation We report the case of a 47 year old woman with complaining from abdominal pain and major weightless with a 09 cm tumor of the body of the pancreas viewed in imaging with no hormonal secretion but high levels of chromogranine A open surgery conducted that revealed the tumor to be located between the adrenal medulla and the Aorta misleading the team between an adrenal tumor or a zuckerkandl body tumor. The hemodynamic changes after manipulation of the tumor and the histopathology confirming the diagnosis of pheochromocytoma. Our main surprise was the aspect of the tumor bombing in the peritoneal cavity firstly thought to be mesenteric tumor; and the stability of the patient with no premedication until the tumor had been manipulated, enlarging the hypothesis about catecholamine secretion of these tumor. Discussion The diagnosis is basically simple when the tumor expresses its catecholamines by biomarkers testing, an imaging. Functional imaging should be used to locate the tumor or its metastasis, the sequence of testing or imaging can vary either it’s a symptomatic tumor or an incidentaloma. Preoperative measures should be taken so no major preoperative complications and the main treatment is the tumor complete resection Conclusion The malignancy of the pheochromocytoma is no near to be reliably identified which imposes a lifetime follow up of these patients as for metastasis were described even after 40 years after diagnosis.
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Affiliation(s)
- Fatima Zahrarahou
- General Surgery Department, Mohamed VI University Hospital, Oujda, Morocco.
| | - Achraf Miry
- General Surgery Department, Mohamed VI University Hospital, Oujda, Morocco.
| | - Houda Mirali
- General Surgery Department, Mohamed VI University Hospital, Oujda, Morocco.
| | - Leila Mahmoudi
- General Surgery Department, Mohamed VI University Hospital, Oujda, Morocco.
| | - Amal Bennani
- General Surgery Department, Mohamed VI University Hospital, Oujda, Morocco
| | - Mohammed Bouziane
- General Surgery Department, Mohamed VI University Hospital, Oujda, Morocco.
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