1
|
Tekin B, Erickson LA, Gupta S. von Hippel-Lindau disease-related neoplasia with an emphasis on renal manifestations. Semin Diagn Pathol 2024; 41:20-27. [PMID: 37980175 DOI: 10.1053/j.semdp.2023.11.003] [Citation(s) in RCA: 1] [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: 06/20/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
von Hippel-Lindau (VHL) disease is characterized by biallelic inactivation of the VHL gene leading to abnormal or absent VHL protein function, and constitutive activation of hypoxia-inducible factors (HIF) that leads to pro-tumorigenic signaling. Individuals with VHL disease develop numerous cysts and tumors involving multiple organs including the kidneys, central nervous system, endolymphatic sac, lungs, pancreatobiliary system, adrenal glands, epididymis, and/or broad ligament. On histologic examination, these lesions show morphologic overlap as they are frequently characterized by cells with clear cytoplasm and prominent vascularity. In addition to distinguishing non-renal tumors from metastatic clear cell renal cell carcinoma, understanding site-specific histopathologic and immunophenotypic features of these tumors has several applications. This includes distinguishing VHL-related tumors from those that arise sporadically and lack VHL gene alterations, guiding further genetic workup, and helping distinguish between different genetic predisposition syndromes. In this context, immunohistochemical studies for markers such as paired box 8 (PAX-8), carbonic anhydrase 9 (CA9), and glucose transporter 1 (GLUT-1) have an important role in routine clinical practice and represent cost-effective diagnostic tools. The recent development of targeted therapeutics directed against HIF-mediated signaling represents a significant milestone in the management of VHL disease and highlights the importance of accurately diagnosing and characterizing the wide spectrum of VHL disease-associated lesions.
Collapse
Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA
| | - Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA.
| |
Collapse
|
2
|
Characterization of Microscopic Multicellular Foci in Grossly Normal Renal Parenchyma of Von Hippel-Lindau Kidney. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121725. [PMID: 36556926 PMCID: PMC9782033 DOI: 10.3390/medicina58121725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/06/2022] [Accepted: 11/16/2022] [Indexed: 11/26/2022]
Abstract
Background and Objectives: This study aims to describe the earliest renal lesions in patients with von Hippel-Lindau (VHL) disease, especially the multicellular microscopic pathologic events, to get information into the genesis of renal neoplasms in this condition. Materials and Methods: Multicellular events were identified, and 3dimensional reconstruction was performed in grossly normal kidney parenchyma from VHL disease patients by using H&E-stained slides previously prepared. Results: The lesions were measured and the volume of clusters was calculated. Immunohistochemistry was performed for downstream HIF-target protein carbonic anhydrase 9 (CAIX) as well as CD34 for assessment of angiogenesis. We divided lesions into four types according to lesion height/size. The number of lesions was markedly decreased from lesion 1 (smallest) to lesion 2, then from lesions 2 to 3, and again from lesion 3 to 4. Distribution was highly consistent in the four cases, and the same decrement pattern was seen in all blocks studied. The volumes of clusters were measured and divided into three categories according to their volume. The most frequent pathologic event in VHL kidneys was category 1 (smallest volume), then category 2, and then category 3. Conclusion: We demonstrate that tracking histologic and morphologic changes in 3 dimensions of multicellular microscopic pathologic events enabled us to confirm a protracted sequence of events from smaller to larger cellular amplification events in VHL kidney.
Collapse
|
3
|
Cinque A, Minnei R, Floris M, Trevisani F. The Clinical and Molecular Features in the VHL Renal Cancers; Close or Distant Relatives with Sporadic Clear Cell Renal Cell Carcinoma? Cancers (Basel) 2022; 14:5352. [PMID: 36358771 PMCID: PMC9657498 DOI: 10.3390/cancers14215352] [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: 10/15/2022] [Accepted: 10/27/2022] [Indexed: 11/24/2022] Open
Abstract
Von Hippel-Lindau (VHL) disease is an autosomal dominant inherited cancer syndrome caused by germline mutations in the VHL tumor suppressor gene, characterized by the susceptibility to a wide array of benign and malign neoplasms, including clear-cell renal cell carcinoma. Moreover, VHL somatic inactivation is a crucial molecular event also in sporadic ccRCCs tumorigenesis. While systemic biomarkers in the VHL syndrome do not currently play a role in clinical practice, a new promising class of predictive biomarkers, microRNAs, has been increasingly studied. Lots of pan-genomic studies have deeply investigated the possible biological role of microRNAs in the development and progression of sporadic ccRCC; however, few studies have investigated the miRNA profile in VHL patients. Our review summarize all the new insights related to clinical and molecular features in VHL renal cancers, with a particular focus on the overlap with sporadic ccRCC.
Collapse
Affiliation(s)
- Alessandra Cinque
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Roberto Minnei
- Nephrology, Dialysis, and Transplantation, G. Brotzu Hospital, University of Cagliari, 09134 Cagliari, Italy
| | - Matteo Floris
- Nephrology, Dialysis, and Transplantation, G. Brotzu Hospital, University of Cagliari, 09134 Cagliari, Italy
| | - Francesco Trevisani
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
- Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
- Unit of Urology, San Raffaele Scientific Institute, 20132 Milan, Italy
| |
Collapse
|
4
|
Shi L, Wang M, Li H, You P. MicroRNAs in Body Fluids: A More Promising Biomarker for Clear Cell Renal Cell Carcinoma. Cancer Manag Res 2021; 13:7663-7675. [PMID: 34675663 PMCID: PMC8502019 DOI: 10.2147/cmar.s330881] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/15/2021] [Indexed: 12/24/2022] Open
Abstract
Renal cell carcinoma (RCC) is the second most common cancer of the urinary system, accounting for approximately 10–15% of kidney cancers in the world. Clear cell renal cell carcinoma (ccRCC) is the most common RCC subtype with the highest mortality. Surgical resection or puncture of tumor tissue is still an important clinical treatment and diagnosis of ccRCC, but its high recurrence rate and poor prognosis often lead to the short survival period of patients. Hence, the development of novel molecular biomarkers is of great clinical importance. miRNAs are endogenous non-coding small RNAs with a length of 19–24 nt. A growing number of studies have reported that miRNAs, as proto-oncogenes or tumor suppressor genes, play a key role in the development of ccRCC and might be effective diagnostic and prognostic biomarkers. In addition, miRNAs can also predict the efficacy of treatment drug, thus improving the accuracy of clinical medication. Furthermore, non-invasive detection of miRNAs or extracellular vesicles (EV) in body fluids has better convenience and repeatability, which shows remarkable advantages compared with tissue detection. In this review, we summarized the typical miRNAs reported in recent years and place emphasis on evaluating miRNAs in different body fluids to provide reference for the clinical diagnosis and prognosis of ccRCC in the future.
Collapse
Affiliation(s)
- Lei Shi
- Hubei Key Laboratory of Resources and Chemistry of Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei, People's Republic of China
| | - Mengheng Wang
- Hubei Key Laboratory of Resources and Chemistry of Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei, People's Republic of China
| | - Haiping Li
- Hubei Key Laboratory of Resources and Chemistry of Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei, People's Republic of China
| | - Pengtao You
- Hubei Key Laboratory of Resources and Chemistry of Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei, People's Republic of China
| |
Collapse
|
5
|
Wessendorf J, König A, Heers H, Mahnken AH. Repeat Percutaneous Radiofrequency Ablation of T1 Renal Cell Carcinomas is Safe in Patients with Von Hippel-Lindau Disease. Cardiovasc Intervent Radiol 2021; 44:2022-2025. [PMID: 34414496 PMCID: PMC8626382 DOI: 10.1007/s00270-021-02935-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/22/2021] [Indexed: 01/20/2023]
Abstract
Purpose Patients with Von Hippel-Lindau disease often develop multifocal, metachronous renal cell carcinomas which require therapy. The purpose of this retrospective single-center study is to evaluate the outcomes of radiofrequency ablation (RFA) in the treatment of renal cell carcinomas in patients with Von Hippel-Lindau disease. Materials and Methods 9 patients (4 male, 5 female, 47.9 ± 10.7 y/o) with Von Hippel-Lindau disease underwent 18 CT-guided percutaneous RFA procedures for the treatment 21 renal cell carcinomas (largest diameter: 32.9 ± 8.6 mm, cT1a: 16, cT1b: 5). Seven patients were previously treated either by partial or radical nephrectomy. Technical success, effectiveness, safety, progression-free survival, overall survival and tumor characteristics were analyzed. Results All RFA procedures were technically successful without major complications. There were 5 minor complications. No residual or recurrent tumor was seen in the ablation zone during a follow-up of 34.0 ± 18.1 months (0–58 months). No patient required dialysis during follow-up. One patient died after 63 months after the first treatment due to complications from a cerebellar hemangioblastoma. No endpoint was reached for overall or progression-free survival. Conclusions The results from this limited case series suggest that RFA of RCCs in patients with VHL is a safe and effective therapy, which can preserve sufficient renal function even after renal surgery.
Collapse
Affiliation(s)
- Joel Wessendorf
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, D, Philipps University Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Alexander König
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, D, Philipps University Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Hendrik Heers
- Department of Urology, Marburg University Hospital, D, Baldingerstrasse, 35043, Marburg, Germany
| | - Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, D, Philipps University Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| |
Collapse
|
6
|
Gläsker S, Vergauwen E, Koch CA, Kutikov A, Vortmeyer AO. Von Hippel-Lindau Disease: Current Challenges and Future Prospects. Onco Targets Ther 2020; 13:5669-5690. [PMID: 32606780 PMCID: PMC7305855 DOI: 10.2147/ott.s190753] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/20/2020] [Indexed: 12/13/2022] Open
Abstract
Understanding of molecular mechanisms of tumor growth has an increasing impact on the development of diagnostics and targeted therapy of human neoplasia. In this review, we summarize the current knowledge on molecular mechanisms and their clinical implications in von Hippel-Lindau (VHL) disease. This autosomal dominant tumor syndrome usually manifests in young adulthood and predisposes affected patients to the development of benign and malignant tumors of different organ systems mainly including the nervous system and internal organs. A consequent screening and timely preventive treatment of lesions are crucial for patients affected by VHL disease. Surgical indications and treatment have been evaluated and optimized over many years. In the last decade, pharmacological therapies have been evolving, but are largely still at an experimental stage. Effective pharmacological therapy as well as detection of biomarkers is based on the understanding of the molecular basis of disease. The molecular basis of von Hippel-Lindau disease is the loss of function of the VHL protein and subsequent accumulation of hypoxia-inducible factor with downstream effects on cellular metabolism and differentiation. Organs affected by VHL disease may develop frank tumors. More characteristically, however, they reveal multiple separate microscopic foci of neoplastic cell proliferation. The exact mechanisms of tumorigenesis in VHL disease are, however, still not entirely understood and knowledge on biomarkers and targeted therapy is scarce.
Collapse
Affiliation(s)
- Sven Gläsker
- Neurosurgical Practise Lake Constance, Singen (Hohentwiel), Germany.,Department of Neurosurgery, VUB University Medical Center Brussels, Brussels, Belgium
| | - Evelynn Vergauwen
- Department of Neurosurgery, VUB University Medical Center Brussels, Brussels, Belgium.,Department of Neurology, University Hospital Antwerp, Antwerp, Belgium
| | | | | | - Alexander O Vortmeyer
- Department of Pathology, Indiana University-Purdue University, Indianapolis, IN, USA
| |
Collapse
|
7
|
Abstract
A heightened understanding of hereditary renal cancer syndromes and their molecular basis has led to an increased awareness and recognition of these renal neoplasms by pathologists. Because a diagnosis of hereditary renal cell carcinoma has a profound impact on the patient and family members, when and how to raise such a suspicion via pathologic assessment has become an important yet very challenging task. This review discusses key clinicopathologic, immunohistochemical, and genetic characteristics of hereditary renal cancer syndromes, and important differential diagnostic challenges, emphasizing recent pathologic and molecular advances.
Collapse
Affiliation(s)
- Yu-Ching Peng
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Ying-Bei Chen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| |
Collapse
|
8
|
Bonsib SM. Urologic Diseases Germane to the Medical Renal Biopsy: Review of a Large Diagnostic Experience in the Context of the Renal Architecture and Its Environs. Adv Anat Pathol 2018; 25:333-352. [PMID: 30036201 PMCID: PMC6086223 DOI: 10.1097/pap.0000000000000199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The kidney is one of the most complicated organs in development and is susceptible to more types of diseases than other organs. The disease spectrum includes developmental and cystic diseases, involvement by systemic diseases, iatrogenic complications, ascending infections and urinary tract obstruction, and neoplastic diseases. The diagnosis of kidney disease is unique involving 2 subspecialties, urologic pathology and renal pathology. Both renal and urologic pathologists employ the renal biopsy as a diagnostic modality. However, urologic pathologists commonly have a generous specimen in the form of a nephrectomy or partial nephrectomy while a renal pathologist requires ancillary modalities of immunofluorescence and electron microscopy. The 2 subspecialties differ in the disease spectrum they diagnose. This separation is not absolute as diseases of one subspecialty not infrequently appear in the diagnostic materials of the other. The presence of medical renal diseases in a nephrectomy specimen is well described and recommendations for reporting these findings have been formalized. However, urologic diseases appearing in a medical renal biopsy have received less attention. This review attempts to fill that gap by first reviewing the perirenal anatomy to illustrate why inadvertent biopsy of adjacent organs occurs and determine its incidence in renal biopsies followed by a discussion of gross anatomic features relevant to the microscopic domain of the medical renal biopsy. Unsuspected neoplasms and renal cysts and cystic kidney diseases will then be discussed as they create a diagnostic challenge for the renal pathologist who often has limited training and experience in these diseases.
Collapse
|
9
|
Ganeshan D, Menias CO, Pickhardt PJ, Sandrasegaran K, Lubner MG, Ramalingam P, Bhalla S. Tumors in von Hippel–Lindau Syndrome: From Head to Toe—Comprehensive State-of-the-Art Review. Radiographics 2018; 38:849-866. [DOI: 10.1148/rg.2018170156] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
|
10
|
Abstract
von Hippel-Lindau (VHL) disease is an autosomal-dominant, hereditary, multisystem neoplasia syndrome with increased susceptibility to several benign and malignant tumors. VHL occurs in about 1 in 36,000 live births and is associated with germline mutation of the VHL tumor suppressor gene on the short arm of chromosome 3. VHL disease exhibits diverse genotype and phenotype correlations, exhibits variable intrafamilial and interfamilial expressivity, and can manifest with benign and malignant tumors of the central nervous system, kidneys, adrenals, pancreas, and reproductive organs. Imaging and management of this entity are therefore multidisciplinary. An overview of VHL disease is presented.
Collapse
|
11
|
Abstract
Renal cell carcinomas associated with syndromes of a heritable nature account for about 4% of all renal cell carcinomas. They are characterized by an earlier age of onset, and are often multicentric and bilateral. Some of these patients may fit into well-characterized kidney cancer syndromes, while many more may have a genetic component that is not fully recognized or understood. The presence of extrarenal clinical features may suggest a specific renal tumor susceptibility syndrome. Moreover, each syndrome is associated with specific renal pathology findings. Recognition of individuals and families with a high risk of renal neoplasia is important so that surveillance for renal tumors may be initiated. This manuscript reviews the clinical, pathological, and molecular features of hereditary renal cell carcinoma syndromes with emphasis on the morphologic features of these tumors and the molecular mechanisms of hereditary renal tumorigenesis.
Collapse
|
12
|
Seeger-Nukpezah T, Geynisman DM, Nikonova AS, Benzing T, Golemis EA. The hallmarks of cancer: relevance to the pathogenesis of polycystic kidney disease. Nat Rev Nephrol 2015; 11:515-34. [PMID: 25870008 PMCID: PMC5902186 DOI: 10.1038/nrneph.2015.46] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a progressive inherited disorder in which renal tissue is gradually replaced with fluid-filled cysts, giving rise to chronic kidney disease (CKD) and progressive loss of renal function. ADPKD is also associated with liver ductal cysts, hypertension, chronic pain and extra-renal problems such as cerebral aneurysms. Intriguingly, improved understanding of the signalling and pathological derangements characteristic of ADPKD has revealed marked similarities to those of solid tumours, even though the gross presentation of tumours and the greater morbidity and mortality associated with tumour invasion and metastasis would initially suggest entirely different disease processes. The commonalities between ADPKD and cancer are provocative, particularly in the context of recent preclinical and clinical studies of ADPKD that have shown promise with drugs that were originally developed for cancer. The potential therapeutic benefit of such repurposing has led us to review in detail the pathological features of ADPKD through the lens of the defined, classic hallmarks of cancer. In addition, we have evaluated features typical of ADPKD, and determined whether evidence supports the presence of such features in cancer cells. This analysis, which places pathological processes in the context of defined signalling pathways and approved signalling inhibitors, highlights potential avenues for further research and therapeutic exploitation in both diseases.
Collapse
Affiliation(s)
- Tamina Seeger-Nukpezah
- Department I of Internal Medicine and Centre for Integrated Oncology, University of Cologne, Kerpenerstrasse 62, D-50937 Cologne, Germany
| | - Daniel M Geynisman
- Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - Anna S Nikonova
- Department of Developmental Therapeutics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - Thomas Benzing
- Department II of Internal Medicine and Centre for Molecular Medicine Cologne, University of Cologne, Kerpenerstrasse 62, D-50937 Cologne, Germany
| | - Erica A Golemis
- Department of Developmental Therapeutics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| |
Collapse
|
13
|
|
14
|
Hereditary syndromes with associated renal neoplasia: a practical guide to histologic recognition in renal tumor resection specimens. Adv Anat Pathol 2013; 20:245-63. [PMID: 23752087 DOI: 10.1097/pap.0b013e318299b7c6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Many hereditary tumor syndromes are associated with neoplasms of the kidney. It is becoming increasingly well recognized that a given familial tumor syndrome may be very heterogenous in clinical appearance and that unrecognized patients may present initially for the treatment of a renal mass. It is therefore important for surgical pathologists to be aware of the specific gross and microscopic findings in the kidney that suggest a possible syndromic association. In this review, we detail the histologic features of syndromic-associated renal neoplasms, describe the presence of characteristic changes in the background renal parenchyma, and provide an update on associated extrarenal manifestations for each of the following syndromes: von Hippel-Lindau disease, hereditary papillary renal cell carcinoma (RCC), hereditary leiomyomatosis-RCC, Birt-Hogg-Dubé syndrome, tuberous sclerosis complex, germline succinate dehydrogenase mutation, hereditary nonpolyposis colorectal cancer syndrome, hyperparathyroidism-jaw tumor syndrome, PTEN hamartoma syndrome, constitutional chromosome 3 translocation, and familial nonsyndromic clear cell RCC. We also include a synopsis of renal medullary carcinoma because of its association with hereditary hemoglobinopathies.
Collapse
|
15
|
Park BK, Kim CK, Park SY, Shen SH. Percutaneous radiofrequency ablation of renal cell carcinomas in patients with von Hippel Lindau disease: indications, techniques, complications, and outcomes. Acta Radiol 2013; 54:418-27. [PMID: 23446745 DOI: 10.1177/0284185113475441] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Renal cell carcinoma (RCC) in patients with von Hippel Lindau (VHL) disease tends to be multifocal, bilateral, and recur or develop new tumors after removal. These characteristics make treating hereditary RCCs difficult for urologists or radiologists compared to treating a sporadic RCC. Radiofrequency ablation (RFA) is a minimally-invasive treatment for small hereditary RCCs associated with a low complication rate and a minimal decrease in renal function. No RFA guidelines have been established about what to treat and when and how to ablate RCCs in patients with VHL disease. Besides, reports on complications and treatment outcomes in this patient group are rare. The purpose of this review is to discuss the indications, techniques, complications, and outcomes of RFA in treating RCC in patients with VHL disease.
Collapse
Affiliation(s)
- Byung Kwan Park
- The Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Kyo Kim
- The Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Yoon Park
- The Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shu-Huei Shen
- The Department of Radiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
| |
Collapse
|
16
|
Capitanio JF, Mazza E, Motta M, Mortini P, Reni M. Mechanisms, indications and results of salvage systemic therapy for sporadic and von Hippel–Lindau related hemangioblastomas of the central nervous system. Crit Rev Oncol Hematol 2013; 86:69-84. [DOI: 10.1016/j.critrevonc.2012.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 09/20/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022] Open
|
17
|
Jilg CA, Neumann HP, Gläsker S, Schäfer O, Ardelt PU, Schwardt M, Schultze-Seemann W. Growth kinetics in von Hippel-Lindau-associated renal cell carcinoma. Urol Int 2011; 88:71-8. [PMID: 22156657 DOI: 10.1159/000333348] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 09/19/2011] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the growth kinetics of renal cell carcinoma (RCC) in von Hippel-Lindau (VHL) disease in a large trial by CT/MRI scan. VHL disease is a multisystemic disorder predisposing to renal cysts and cancer. There is a general assumption that VHL-associated RCC presents slower growth rates than sporadic RCC. PATIENTS AND METHODS We describe growth kinetics of 96 renal tumours in 64 VHL patients with analysed germline mutation (54/64 treated, 10/64 active surveillance) over a mean follow-up of 54.9 months. We calculated tumour volume, growth rate, multiplication of tumour volume per year and overall, as well as tumour volume doubling time. RESULTS The mean growth rate of 96 tumours was 4.4 mm/year (SD 3.2, median 4.1 mm/year), mean volume doubling time was 25.7 months (SD 20.2, median 22.2 months). We saw a median 1.4-fold increase in tumour volume per year. At treatment time point, VHL kidneys comprised 39% tumour and 15.7% cyst volume fraction. We saw no correlation between tumour size and growth parameters. CONCLUSION VHL-associated RCC show large variances in tumour growth behaviour. Compared to the literature, in our study the growth rates (mm/year) of RCC in VHL disease did not differ from those of sporadic RCC. Fast tumour growth increases the risk for metastases.
Collapse
Affiliation(s)
- C A Jilg
- Department of Urology, Albert Ludwigs University of Freiburg, Freiburg, Germany. Cordula.Jilg @ uniklinik-freiburg.de
| | | | | | | | | | | | | |
Collapse
|
18
|
The non-neoplastic kidney in tumor nephrectomy specimens: what can it show and what is important? Adv Anat Pathol 2010; 17:235-50. [PMID: 20574169 DOI: 10.1097/pap.0b013e3181e3c02d] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Surgical nephrectomy is a procedure that has been performed for nearly 100 years. In the presence of a normal contralateral kidney, such as in a renal transplant donor or child with Wilms tumor, it is a benign procedure without deleterious consequences on the remaining kidney. However, many adults and some children postnephrectomy will develop chronic kidney disease. The non-neoplastic kidney in tumor resections may harbor a large number of developmental and acquired diseases predictive of this outcome or that convey other medically significant information. Examination of the non-neoplastic kidney is a fertile opportunity to identify these unsuspected conditions that may ultimately dictate the subsequent clinical course and influence the medical care provided. This review discusses the consequences of unilateral and partial nephrectomy, and illustrates many conditions that may be encountered in the non-neoplastic cortex with a discussion of their clinical implications.
Collapse
|
19
|
VHL-gene deletion in single renal tubular epithelial cells and renal tubular cysts: further evidence for a cyst-dependent progression pathway of clear cell renal carcinoma in von Hippel-Lindau disease. Am J Surg Pathol 2010; 34:806-15. [PMID: 20431476 DOI: 10.1097/pas.0b013e3181ddf54d] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inheritance of a mutant allele of the von Hippel-Lindau tumor suppressor gene predisposes affected individuals to develop renal cysts and clear cell renal cell carcinoma. Von Hippel-Lindau gene inactivation in single renal tubular cells has indirectly been showed by immunohistochemical staining for the hypoxia-inducible factor alpha target gene product carbonic anhydrase IX. In this study we were able to show von Hippel-Lindau gene deletion in carbonic anhydrase IX positive nonneoplastic renal tubular cells, in epithelial cells lining renal cysts and in a clear cell renal cell carcinoma of a von Hippel-Lindau patient. This was carried out by means of laser confocal microscopy and immunohistochemistry in combination with fluorescence in situ hybridization. Carbonic anhydrase IX negative normal renal tubular cells carried no von Hippel-Lindau gene deletion. Furthermore, recent studies have indicated that the von Hippel-Lindau gene product is necessary for the maintenance of primary cilia stability in renal epithelial cells and that disruption of the cilia structure by von Hippel-Lindau gene inactivation induces renal cyst formation. In our study, we show a significant shortening of primary cilia in epithelial cells lining renal cysts, whereas, single tubular cells with a von Hippel-Lindau gene deletion display to a far lesser extent signs of cilia shortening. Our in vivo results support a model in which renal cysts represent precursor lesions for clear cell renal cell carcinoma and arise from single renal tubular epithelial cells owing to von Hippel-Lindau gene deletion.
Collapse
|
20
|
Drosophila von Hippel-Lindau tumor suppressor gene function in epithelial tubule morphogenesis. Mol Cell Biol 2010; 30:3779-94. [PMID: 20516215 DOI: 10.1128/mcb.01578-09] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Mutations in the human von Hippel-Lindau (VHL) gene are the cause of VHL disease that displays multiple benign and malignant tumors. The VHL gene has been shown to regulate angiogenic potential and glycolic metabolism via its E3 ubiquitin ligase function against the alpha subunit of hypoxia-inducible factor (HIF-alpha). However, many HIF-independent functions of VHL have been identified. Recent evidence also indicates that the canonical function cannot fully explain the VHL mutant cell phenotypes, although it is still unclear how many of these noncanonical functions relate to the pathophysiological processes because of a lack of tractable genetic systems. Here, we report the first genomic mutant phenotype of Drosophila melanogaster VHL (dVHL) in the epithelial tubule network, the trachea, and show that dVHL regulates branch migration and lumen formation via its endocytic function. The endocytic function regulates the surface level of the chemotactic signaling receptor Breathless and promotes clearing of the lumen matrix during maturation of the tracheal tubes. Importantly, the regulatory function in tubular morphogenesis is conserved in the mammalian system, as conditional knockout of Vhl in mouse kidney also resulted in similar cell motility and lumen phenotypes.
Collapse
|
21
|
Park BK, Kim CK. Percutaneous Radio Frequency Ablation of Renal Tumors in Patients With von Hippel-Lindau Disease: Preliminary Results. J Urol 2010; 183:1703-7. [DOI: 10.1016/j.juro.2010.01.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Byung Kwan Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
22
|
Kim JJ, Rini BI, Hansel DE. Von Hippel Lindau syndrome. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2010; 685:228-49. [PMID: 20687511 DOI: 10.1007/978-1-4419-6448-9_22] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Von Hippel-Lindau syndrome (VHLS) is an autosomal dominant familial cancer syndrome arising from germ-line inactivation of the VHL gene on the short arm of chromosome 3. VHLS manifests in a myriad of hyper-vascular tumors of both benign and malignant nature. Incidence of VHLS is roughly 1 in 36,000 live births and has over 90% penetrance by the age of 65. Improved understanding of the natural history and biology of VHLS has led to the introduction of screening protocols, early interventions and improved treatments, all of which resulted in a substantially improved prognosis for this disease. Further details regardingvariegated molecular pathways and mechanisms ofVHLS are emerging with the subsequent advent of novel treatment protocols that are currently in clinical trials.
Collapse
Affiliation(s)
- Jenny J Kim
- Cleveland Clinic, Taussig Cancer Institute, Celveland, Ohio 44195, USA
| | | | | |
Collapse
|
23
|
Abstract
The past two decades have witnessed recognition of several new types of renal cell carcinoma, each with distinct cytogenetic abnormalities. Included are several genetic and acquired cystic kidney diseases associated with development of renal cell carcinoma, the topic of this review. The risk in patients with autosomal dominant polycystic kidney disease is not accurately known but may be slightly increased. The risk for patients with von Hippel-Lindau disease is substantial, and death from renal cancer is common. For patients with tuberous sclerosis complex, the challenge is recognition of the occasional malignancy arising in a field of many benign tumors. Patients with end-stage kidney disease and acquired cystic kidney disease may develop a variety of renal cell carcinoma types. Progress in understanding the molecular basis of renal cyst formation and neoplastic disease has fostered development of targeted therapies that now hold promise for a group of neoplasms whose cure was traditionally dependent on surgical approaches.
Collapse
Affiliation(s)
- Stephen M Bonsib
- Department of Pathology, LSU Health Sciences Center, Shreveport, LA 71130-3932, USA.
| |
Collapse
|
24
|
Thoma CR, Toso A, Gutbrodt KL, Reggi SP, Frew IJ, Schraml P, Hergovich A, Moch H, Meraldi P, Krek W. VHL loss causes spindle misorientation and chromosome instability. Nat Cell Biol 2009; 11:994-1001. [PMID: 19620968 DOI: 10.1038/ncb1912] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 04/09/2009] [Indexed: 12/15/2022]
|
25
|
Luu VD, Boysen G, Struckmann K, Casagrande S, von Teichman A, Wild PJ, Sulser T, Schraml P, Moch H. Loss of VHL and Hypoxia Provokes PAX2 Up-Regulation in Clear Cell Renal Cell Carcinoma. Clin Cancer Res 2009; 15:3297-304. [DOI: 10.1158/1078-0432.ccr-08-2779] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
26
|
Reed AB, Parekh DJ. Surgical Management of von Hippel-Lindau Disease: Urologic Considerations. Surg Oncol Clin N Am 2009; 18:157-74, x. [DOI: 10.1016/j.soc.2008.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
27
|
Frew IJ, Thoma CR, Georgiev S, Minola A, Hitz M, Montani M, Moch H, Krek W. pVHL and PTEN tumour suppressor proteins cooperatively suppress kidney cyst formation. EMBO J 2008; 27:1747-57. [PMID: 18497742 DOI: 10.1038/emboj.2008.96] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 04/23/2008] [Indexed: 12/13/2022] Open
Abstract
In patients with von Hippel-Lindau (VHL) disease, renal cysts and clear cell renal cell carcinoma (ccRCC) arise from renal tubular epithelial cells containing biallelic inactivation of the VHL tumour suppressor gene. However, it is presumed that formation of renal cysts and their conversion to ccRCC involve additional genetic changes at other loci. Here, we show that cystic lesions in the kidneys of patients with VHL disease also demonstrate activation of the phosphatidylinositol-3-kinase (PI3K) pathway. Strikingly, combined conditional inactivation of Vhlh and the Pten tumour suppressor gene, which normally antagonises PI3K signalling, in the mouse kidney, elicits cyst formation after short latency, whereas inactivation of either tumour suppressor gene alone failed to produce such a phenotype. Interestingly, cells lining these cysts frequently lack a primary cilium, a microtubule-based cellular antenna important for suppression of uncontrolled kidney epithelial cell proliferation and cyst formation. Our results support a model in which the PTEN tumour suppressor protein cooperates with pVHL to suppress cyst development in the kidney.
Collapse
Affiliation(s)
- Ian J Frew
- Institute of Cell Biology, ETH Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Frew IJ, Krek W. Multitasking by pVHL in tumour suppression. Curr Opin Cell Biol 2007; 19:685-90. [PMID: 18006292 DOI: 10.1016/j.ceb.2007.10.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 10/03/2007] [Indexed: 12/31/2022]
Abstract
Functional inactivation of the von Hippel-Lindau (VHL) tumour suppressor gene product, pVHL, leads to cancer in humans. It is widely accepted that pVHL functions to destabilise hypoxia inducible factor alpha (HIFalpha) subunits, key effectors of the hypoxia signalling pathway. However, growing evidence indicates that tumour suppression by pVHL also involves the control of a wide variety of HIFalpha-independent processes including microtubule dynamics, primary cilium maintenance, cell proliferation, neuronal apoptosis, extracellular matrix deposition and responses to DNA damage. Moreover, it is becoming apparent that tumour initiation requires not only VHL mutation but also the alteration of additional cooperating cancer pathways. These studies are beginning to provide insights into the signalling networks involving pVHL that normally control diverse cellular processes and how disruption of these networks leads to tumour formation.
Collapse
Affiliation(s)
- Ian J Frew
- Institute of Cell Biology, ETH Zurich, 8093 Zurich, Switzerland
| | | |
Collapse
|
29
|
Thoma CR, Frew IJ, Hoerner CR, Montani M, Moch H, Krek W. pVHL and GSK3beta are components of a primary cilium-maintenance signalling network. Nat Cell Biol 2007; 9:588-95. [PMID: 17450132 DOI: 10.1038/ncb1579] [Citation(s) in RCA: 193] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 03/27/2007] [Indexed: 12/29/2022]
Abstract
Defects in the structure or function of the primary cilium, an antennae-like structure whose functional integrity has been linked to the suppression of uncontrolled kidney epithelial cell proliferation, are a common feature of genetic disorders characterized by kidney cysts. However, the mechanisms by which primary cilia are maintained remain poorly defined. von Hippel-Lindau (VHL) disease is characterized by the development of premalignant renal cysts and arises because of functional inactivation of the VHL tumour suppressor gene product, pVHL. Here, we show that pVHL and glycogen synthase kinase (GSK)3beta are key components of an interlinked signalling pathway that maintains the primary cilium. Although inactivation of either pVHL or GSK3beta alone did not affect cilia maintenance, their combined inactivation leads to loss of cilia. In VHL patients, GSK3beta is subjected to inhibitory phosphorylation in renal cysts, but not in early VHL mutant lesions, and these cysts exhibit reduced frequencies of primary cilia. We propose that pVHL and GSK3beta function together in a ciliary-maintenance signalling network, disruption of which enhances the vulnerability of cells to lose their cilia, thereby promoting cyst formation.
Collapse
Affiliation(s)
- Claudio R Thoma
- Institute of Cell Biology, ETH Zurich, 8093 Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
30
|
Rankin EB, Tomaszewski JE, Haase VH. Renal cyst development in mice with conditional inactivation of the von Hippel-Lindau tumor suppressor. Cancer Res 2006; 66:2576-83. [PMID: 16510575 PMCID: PMC3514875 DOI: 10.1158/0008-5472.can-05-3241] [Citation(s) in RCA: 287] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Inactivation of the von Hippel-Lindau tumor suppressor, pVHL, is associated with both hereditary and sporadic renal cysts and renal cell carcinoma, which are commonly thought to arise from the renal proximal tubule. pVHL regulates the protein stability of hypoxia-inducible factor (HIF)-alpha subunits and loss of pVHL function leads to HIF stabilization. The role of HIF in the development of VHL-associated renal lesions remains to be determined. To investigate the functional consequences of pVHL inactivation and the role of HIF signaling in renal epithelial cells, we used the phosphoenolpyruvate carboxykinase (PEPCK) promoter to generate transgenic mice in which Cre-recombinase is expressed in the renal proximal tubule and in hepatocytes. We found that conditional inactivation of VHL in PEPCK-Cre mutants resulted in renal cyst development that was associated with increased erythropoietin levels and polycythemia. Increased expression of the HIF target gene erythropoietin was limited to the liver, whereas expression of carbonic anhydrase 9 and multidrug resistance gene 1 was up-regulated in the renal cortex of mutant mice. Inactivation of the HIF-alpha binding partner, arylhydrocarbon receptor nuclear translocator (Arnt), but not Hif-1alpha, suppressed the development of renal cysts. Here, we present the first mouse model of VHL-associated renal disease that will provide a basis for further genetic studies to define the molecular events that are required for the progression of VHL-associated renal cysts to clear cell renal cell carcinoma.
Collapse
Affiliation(s)
- Erinn B. Rankin
- Department of Medicine and Cell and Molecular Biology Graduate Group, Program in Cell Growth and Cancer
| | - John E. Tomaszewski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Volker H. Haase
- Department of Medicine and Cell and Molecular Biology Graduate Group, Program in Cell Growth and Cancer
| |
Collapse
|
31
|
Truong LD, Krishnan B, Shen SS. Intraoperative pathology consultation for kidney and urinary bladder specimens. Arch Pathol Lab Med 2006; 129:1585-601. [PMID: 16329731 DOI: 10.5858/2005-129-1585-ipcfka] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Intraoperative pathology consultation for kidney and urinary bladder specimens is relatively infrequent. Scant literature is devoted to this topic. OBJECTIVE The clinical indications and diagnostic usefulness and pitfalls of intraoperative pathology consultation of kidney and urinary bladder specimens will be reviewed, based on literature and personally encountered cases. DATA SOURCES The indications for intraoperative pathology consultation for renal lesions included (1) surgical margins in partial nephrectomy specimens, (2) solid renal mass in unusual clinical or radiologic settings, (3) synchronous renal and extrarenal masses, (4) cystic renal lesions, (5) ureteral surgical margin for transitional cell carcinoma, (6) multiple renal masses, (7) solid mass in a diffusely cystic kidney, and (8) evaluation of renal injury. The indications for urinary bladder included (1) status of the surgical margins, (2) diagnosis of bladder tumor biopsy, (3) diagnosis of extravesical tumors with vesical extension, (4) diagnosis of extravesical mass, including pelvic lymph nodes encountered during cystectomy, and (5) status of bladder neck margin during radical prostatectomy for cancer. The frequent problematic areas for the kidney included misdiagnosis or incorrect classification of cystic tumors or spindle cell tumors, and confusion of clear cell renal cell carcinoma with inflammatory lesions. The problematic areas for urinary bladder included the differential diagnoses of high-grade dysplasia/carcinoma in situ with reactive changes at the ureteral or urethral surgical margins. CONCLUSIONS Distinctive indications and diagnostic pitfalls are recognized for intraoperative consultation of renal or urinary bladder lesions. Awareness of the pertinent problems should improve diagnostic accuracy and facilitate the proper management of these lesions.
Collapse
Affiliation(s)
- Luan D Truong
- Department of Pathology, The Methodist Hospital, Baylor College of Medicine, Houston, Texas, USA.
| | | | | |
Collapse
|
32
|
Kim KA, Choi JW, Park CM, Lee CH, Lee JH, Yoon DK, Seol HY. Unusual renal cell carcinomas: a pictorial essay. ACTA ACUST UNITED AC 2005; 31:154-63. [PMID: 16333698 DOI: 10.1007/s00261-005-0382-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Renal cell carcinoma (RCC) is the most common solid renal neoplasm. Clear cell (conventional) carcinoma is the most common pathologic subtype of RCC. Usually RCC is a hypervascular, solid, solitary mass with contour bulging. However, RCC can manifest different features according to the pathologic tumor subtypes. Preoperative diagnosis of cyst-associated RCC is very difficult, especially in cases of RCC originating in a cyst. Multiple or bilateral presentation of RCC occurs in fewer than 5% of cases. In addition, RCCs may demonstrate unusual findings such as infiltrative growth mimicking transitional cell carcinoma, fatty component mimicking angiomyolipoma, severe perinephric infiltration, and extensive calcifications mimicking inflammation or other tumor. RCCs can be associated with hereditary diseases such as von Hippel-Lindau disease. Familiarity with these radiologic features of unusual RCCs can help ensure correct diagnosis and proper management.
Collapse
Affiliation(s)
- K A Kim
- Department of Radiology, Korea University Guro Hospital, 97 Gurodong-Gil, Guro-Ku, Seoul 152-703, Korea
| | | | | | | | | | | | | |
Collapse
|
33
|
Lee YS, Vortmeyer AO, Lubensky IA, Vogel TW, Ikejiri B, Ferlicot S, Benoît G, Giraud S, Oldfield EH, Linehan WM, Teh BT, Richard S, Zhuang Z. Coexpression of Erythropoietin and Erythropoietin Receptor in Von Hippel-Lindau Disease–Associated Renal Cysts and Renal Cell Carcinoma. Clin Cancer Res 2005. [DOI: 10.1158/1078-0432.1059.11.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Von Hippel-Lindau (VHL) disease is characterized by multiple tumors in specific target organs. The tumors at different sites share distinct morphologic and genetic characteristics but their cell of origin is unknown. We show that VHL disease–associated renal clear cell carcinomas (RCC) consistently coexpress erythropoietin (Epo) and Epo receptor (EpoR). In addition, coexpression of Epo and EpoR is detected in many renal cysts, providing further evidence that renal cysts are potential precursors for RCC. In conjunction with VHL gene deficiency, coexpression of Epo and EpoR in renal cysts and tumors may reflect a developmental arrest in immature mesenchymal cells. Such arrest may lead to autocrine stimulation, cell proliferation, and renal tumor development, similar to tumorigenesis of VHL disease–associated hemangioblastomas.
Collapse
Affiliation(s)
- Youn-Soo Lee
- 1Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke and
| | | | - Irina A. Lubensky
- 1Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke and
| | - Timothy W.A. Vogel
- 1Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke and
| | - Barbara Ikejiri
- 1Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke and
| | | | - Gérard Benoît
- 4Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Sophie Giraud
- 5Laboratoire de Génétique Oncologique EPHE-UMR 8125,Villejuif, France
- 7Genetic Laboratory, Hôpital Édouard Herriot, Lyon, France; and
| | - Edward H. Oldfield
- 1Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke and
| | - W. Marston Linehan
- 2Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland
| | - Bin T. Teh
- 8Van Andel Research Institute, Grand Rapids, Michigan
| | - Stéphane Richard
- 4Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
- 5Laboratoire de Génétique Oncologique EPHE-UMR 8125,Villejuif, France
- 6Service de Néphrologie, Hôpital Necker, Paris, France
| | - Zhengping Zhuang
- 1Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke and
| |
Collapse
|
34
|
Abascal Junquera JM, Esquena Fernández S, Martos Calvo R, Ramírez Sevilla C, Serrallach Orejas F, Id M'Hammed Y, Trilla Herrera E, Murio E, de Torres I, Morote Robles J. [Von Hippel-Lindau disease: atypical presentation]. Actas Urol Esp 2004; 28:138-40. [PMID: 15074063 DOI: 10.1016/s0210-4806(04)73053-3] [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: 10/27/2022]
Abstract
OBJECTIVE To describe an atypical presentation of von Hippel-Lindau disease. MATERIAL AND METHODS We present the clinical, diagnostic and treatment of the urological signs of this disease, which has overcoat a neurological management, in a young man with familiar history of it. CONCLUSIONS The basic knowledge of the von Hippel-Lindau disease is important for the urologist because the urological signs of it, are common and they make up one of the most important causes of morbility and mortality.
Collapse
|
35
|
Truong LD, Choi YJ, Shen SS, Ayala G, Amato R, Krishnan B. Renal cystic neoplasms and renal neoplasms associated with cystic renal diseases: pathogenetic and molecular links. Adv Anat Pathol 2003; 10:135-59. [PMID: 12717117 DOI: 10.1097/00125480-200305000-00003] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Cystic renal neoplasms represent an isolated cystic mass not accompanied by cystic change of the renal parenchyma. Although cystic change may be seen in any type of renal neoplasm, a few (i.e., cystic renal cell carcinoma, cystic nephroma, cystic partially differentiated nephroblastoma, mixed epithelial and stromal tumor) are characterized by constant cystic change that may involve the entire tumor. Cystic kidney disease is characterized by cystic change, which usually involves the kidneys in a bilateral and diffuse pattern, does not create a discreet mass, and is due to hereditary or developmental conditions. Some of the cystic kidney diseases are not known to give rise to renal neoplasm; others such as autosomal polycystic kidney disease or multicystic dysplastic kidney may fortuitously coexist with renal neoplasms. Three conditions (acquired cystic kidney disease, tuberous sclerosis, and von Hippel-Lindau disease) are associated with renal neoplasms with such a high frequency that they are considered preneoplastic. This article reviews the differential diagnoses among cystic neoplasms. It also focuses on the underlying genetic and molecular mechanisms for the relationship between cystic renal diseases and renal neoplasms.
Collapse
Affiliation(s)
- Luan D Truong
- Departments of Pathology, Baylor College of Medicine, The Methodist Hospital, Houston, Texas 77030, U.S.A.
| | | | | | | | | | | |
Collapse
|
36
|
Izzedine H, Bodaghi B, Launay-Vacher V, Deray G. Eye and kidney: from clinical findings to genetic explanations. J Am Soc Nephrol 2003; 14:516-29. [PMID: 12538754 DOI: 10.1097/01.asn.0000051705.97966.ad] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Hassane Izzedine
- Nephrology and Ophthalmology Departments, Pitie-Salpetriere Hospital, Paris, France.
| | | | | | | |
Collapse
|
37
|
|
38
|
Affiliation(s)
- D Gauthier
- Massachusetts Eye and Ear Infirmary, Boston 02114, USA
| | | | | |
Collapse
|
39
|
|
40
|
|
41
|
Pathology of kidney tumors. ACTA ACUST UNITED AC 2001. [PMID: 21318786 DOI: 10.1385/1-59259-144-2:035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
The classification of epithelial tumors of the kidney has undergone considerable change in the last two decades. Systems based on cytoplasmic characteristics and cytogenetic analysis have expanded our understanding of this group of tumors. These new, nontraditional systems have led to the development of a more clinically significant pathological classification (1,2). Although many questions remain unanswered and debate continues concerning the validity of these proposals, research studies on epithelial neoplasms of the kidney must take these advances into consideration. Scientific studies of any type should incorporate information regarding the type of tumor(s) included in the study group. This chapter briefly reviews the accepted subtypes of renal epithelial neoplasms, with a focus on the morphological features that distinguish them.
Collapse
|
42
|
Paraf F, Chauveau D, Chrétien Y, Richard S, Grünfeld JP, Droz D. Renal lesions in von Hippel-Lindau disease: immunohistochemical expression of nephron differentiation molecules, adhesion molecules and apoptosis proteins. Histopathology 2000; 36:457-65. [PMID: 10792488 DOI: 10.1046/j.1365-2559.2000.00857.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS Renal lesions in von Hippel-Lindau disease comprise clear cell simple cysts, atypical cysts and carcinomas. Although histological and molecular studies suggest that cystic lesions may represent precursors of carcinomas, there is no detailed phenotypic evidence of their relationship. METHODS AND RESULTS To investigate such a possible relationship between cystic lesions and solid carcinomas, we studied the pathological and immunohistochemical features of 328 lesions of 33 kidneys originating from 23 patients with von Hippel-Lindau disease, using a panel of antibodies directed against cytoskeleton proteins, cell surface proteins, integrin subunits, adhesion molecules, lectins, and apoptosis and proliferation markers. Solid carcinomas (n = 175) were all of clear cell type and mostly nuclear grade 1. Cystic lesions (n = 138) consisted of cystic clear cell carcinomas (n = 15), atypical cysts (n = 20) and simple cysts (n = 103). Clear cells of the simple cysts, atypical cysts and solid carcinomas coexpressed cytokeratins (CK8, CK19) and vimentin, and expressed a similar pattern of tubular markers (CD24, tetraglonolobus), integrin subunits (alpha3, alpha5, alpha6, alphav, beta1) and cell adhesion molecules (ICAM 1, VCAM 1). In all lesions studied, proliferation rate (MIB1 index) was low, and apoptosis marker expression (fragmented DNA, p53, bcl-2) inconspicuous. CONCLUSIONS Phenotypic alterations found in solid renal cell carcinomas are already present in simple and atypical renal cysts of von Hippel-Lindau disease.
Collapse
Affiliation(s)
- F Paraf
- Laboratoire de Pathologie Rénale; Service de Néphrologie, Hôptal Necker, Paris, France
| | | | | | | | | | | |
Collapse
|
43
|
Miyazaki T, Yamashita Y, Yoshimatsu S, Tsuchigame T, Takahashi M. Renal cell carcinomas in von Hippel-Lindau disease; tumor detection and management. Comput Med Imaging Graph 2000; 24:105-13. [PMID: 10767590 DOI: 10.1016/s0895-6111(00)00004-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Twenty-seven renal cell carcinomas (RCCs) found in one family affected with von Hippel-Lindau disease were examined using ultrasound (US), CT, MRI and angiography. The sensitivity of the tumor detection using different imaging modalities was evaluated by macroscopic pathology (solid or cystic) and size (exceeding 2cm in diameter or not). In 18 of the RCC's exceeding 2cm in diameter (eight solid and ten cystic), all lesions were detected on US, CT, and MRI. However, on angiography, solid RCCs were detected in 88%, and cystic RCCs were detected in 60%. In nine RCCs less than 2cm in diameter (seven solid and two cystic), solid RCCs were detected in 86% on US, 86% on CT, 80% on MRI, and 43% on angiography, but cystic RCCs were detected in 50% on only CT and MRI. From the pathologic correlation, even renal simple cystic lesions in VHL are considered premalignant lesions and they had better be removed if the residual renal function after surgery is preserved. In case of the observation, they should be followed carefully using thin slice thickness dynamic CT to discover the wall irregularity, septation and irregular contour.
Collapse
MESH Headings
- Adult
- Aged
- Angiography, Digital Subtraction
- Carcinoma, Renal Cell/diagnosis
- Carcinoma, Renal Cell/diagnostic imaging
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/surgery
- Contrast Media
- Diagnostic Imaging
- Female
- Follow-Up Studies
- Gadolinium DTPA
- Humans
- Kidney Diseases, Cystic/diagnosis
- Kidney Diseases, Cystic/diagnostic imaging
- Kidney Diseases, Cystic/pathology
- Kidney Diseases, Cystic/surgery
- Kidney Neoplasms/diagnosis
- Kidney Neoplasms/diagnostic imaging
- Kidney Neoplasms/genetics
- Kidney Neoplasms/pathology
- Kidney Neoplasms/surgery
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Nephrectomy
- Precancerous Conditions/diagnosis
- Sensitivity and Specificity
- Tomography, X-Ray Computed
- Ultrasonography
- von Hippel-Lindau Disease/genetics
Collapse
Affiliation(s)
- T Miyazaki
- Department of Radiology, Kumamoto Red Cross Hospital, 2-1-1, Nagamine Minami Kumamoto, Japan
| | | | | | | | | |
Collapse
|
44
|
Abstract
An autosomal dominant tumor predisposition syndrome, von Hippel-Lindau disease (VHL) is characterized by the presence of benign and malignant tumors. Hallmark lesions include retinal angiomas, hemangioblastomas of the cerebellum and spinal cord, and renal cell carcinomas. Affected persons may also have angiomatous or cystic lesions of the kidneys, pancreas, and epididymis, as well as adrenal pheochromocytomas. In this article, we discuss the clinical features and diagnostic criteria for this clinically underdiagnosed condition. An update on recent findings regarding the molecular genetics of VHL is provided, including a discussion of the evolving understanding of genotype-phenotype correlations. Understanding the molecular and functional aspects of this condition will lead to the development of strategies for the management and treatment of inherited and sporadic VHL-associated tumors.
Collapse
Affiliation(s)
- V Couch
- Department of Medical Genetics, Mayo Clinic Rochester, Minn. 55905, USA
| | | | | | | |
Collapse
|
45
|
Tsui KH, Shvarts O, Laifer-Narin S, Belldegrun AS. Current Status of Partial Nephrectomy in the Management of Kidney Cancer. Cancer Control 1999; 6:560-570. [PMID: 10756387 DOI: 10.1177/107327489900600602] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: The technique of partial nephrectomy for managing renal cancers is well recognized, but guidelines regarding indications for its use are not generally accepted. METHODS: The authors review the indications for partial nephrectomy in various clinical situations, and they include their own experience to clarify the utility of the technique. RESULTS: Intraoperative renal ultrasound and helical computed tomography can assist the surgeon in technical decisions. Partial nephrectomy is considered when nephrectomy would render the patient anephric and dependent on dialysis. CONCLUSIONS: The technical and operative advances in partial nephrectomy make the approach increasingly attractive for patients with kidney cancer in a variety of clinical circumstances.
Collapse
|
46
|
Abstract
The incidence of renal carcinoma has increased in the United States over the last two decades. An increased rate of detection of incidental tumors and a variety of exogenous risk factors may be responsible for this increase. Pathologic stage and nuclear grade remain the most important and practical prognostic features, however, the specific tumor type has emerged as important as the cytogenetic validation of recent renal carcinoma classification. Proliferation markers, DNA ploidy, and morphometry have powerful predictive value but are handicapped by cost and complexity. The search continues for molecules of diagnostic and prognostic utility that may also impact invasive and metastatic capability for this group of neoplasms whose course is principally determined by the completeness of the original resection.
Collapse
Affiliation(s)
- S M Bonsib
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, USA
| |
Collapse
|
47
|
Walther MM, Choyke PL, Glenn G, Lyne JC, Rayford W, Venzon D, Linehan WM. Renal cancer in families with hereditary renal cancer: prospective analysis of a tumor size threshold for renal parenchymal sparing surgery. J Urol 1999; 161:1475-9. [PMID: 10210376 DOI: 10.1016/s0022-5347(05)68930-6] [Citation(s) in RCA: 153] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE Patients with hereditary forms of renal cancer are at risk for new tumors and metastases. Renal parenchymal sparing surgery has been performed to preserve renal function and quality of life, and prevent metastases. We evaluated a 3 cm. threshold for performing renal parenchymal sparing surgery in patients with von Hippel-Lindau disease and hereditary papillary renal cancer. MATERIALS AND METHODS Patients with von Hippel-Lindau disease or hereditary papillary renal cancer and renal cancer were identified by screening affected kindred and by kindred history. Patients with small tumors were followed with serial imaging studies until the largest renal tumor was 3 cm., when renal parenchymal sparing surgery was performed. Renal tumors greater than 3 cm. were resected without delay. Parenchymal sparing techniques were used when possible in each group. RESULTS The 3 cm. surgical threshold was evaluated in 52 patients with von Hippel-Lindau disease (group 1) at a median followup of 60 months (range 6 to 205). None of these patients had metastatic disease and none has required renal transplantation or dialysis. In 44 patients with von Hippel-Lindau disease (group 2) renal tumors larger than 3 cm. developed. Median followup from the initial radiological diagnosis of renal cancer in this group was 66.5 months (range 0 to 321). Patients in group 1 underwent parenchymal sparing surgery instead of nephrectomy more frequently than those in group 2 (46 of 48 operations or 96% versus 45 of 72 or 63%, Fisher's exact test p <0.0001). In contrast to patients in group 1, metastatic renal cancer developed in 11 of the 44 in group 2 (25%) (Fisher's exact test p <0.0001). A total of 23 patients with hereditary papillary renal cancer were also identified. Median followup in these cases was 44 months (range 0 to 237). Ten patients had tumors less than 3 cm. No patient with tumors less than 3 cm. and 2 of the 13 (15%) with larger tumors had metastases. CONCLUSIONS Using a 3 cm. renal tumor diameter as an indication for renal surgery no patient with renal cancer and von Hippel-Lindau disease or hereditary papillary renal cancer had metastatic disease regardless of the number of tumors. Using a lesion size of 3 cm. as a threshold for performing renal parenchymal sparing surgery may help to prevent metastatic disease, unnecessary renal damage due to frequent surgery and renal dialysis or transplantation.
Collapse
Affiliation(s)
- M M Walther
- Urologic Oncology Branch, Department of Radiology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | | | | | | | | |
Collapse
|
48
|
|
49
|
Hes FJ, Slootweg PJ, van Vroonhoven TJ, Hené RJ, Feldberg MA, Zewald RA, Ploos van Amstel JK, Höppener JW, Pearson PL, Lips CJ. Management of renal cell carcinoma in von Hippel-Lindau disease. Eur J Clin Invest 1999; 29:68-75. [PMID: 10092992 DOI: 10.1046/j.1365-2362.1999.00402.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND An evaluation of nephron-sparing surgery (NSS) or radical nephrectomy (RN) for treating renal cell carcinoma (RCC) in patients with von Hippel-Lindau disease (VHL) was carried out. METHODS Between 1976 and 1997, 10 patients with RCC from four VHL families, of whom seven were from one family, were studied by clinical and histopathological examination. Before 1991, three patients were treated using RN, and thereafter five patients were treated using NSS. Two patients were not operated on. RESULTS RCCs in our patients showed a slow growth rate (on average 0.3 cm year-1), and asymptomatic patients presented with tumours of low-grade malignancy. In all patients, tumours were surrounded by a fibrous pseudocapsule. In 5 out of 17 tumours, pseudocapsular invasion was observed, and three of these five tumours broke through the pseudocapsule. To date, these patients have not shown a less favourable outcome than those without pseudocapsular involvement by tumour growth. Multicentricity of RCC was relatively low (4.6 lesions per kidney). In two of the three RN patients, only a single satellite lesion, in the direct vicinity of a RCC, was found in one kidney. Six tumours (1.8-5.5 cm) were enucleated by NSS. During a mean follow-up of 30 months, renal function in these patients was well preserved. CONCLUSIONS In our patients, RCCs grew slowly, were of low grade, had a dense fibrous pseudocapsule and were thus good candidates for NSS.
Collapse
Affiliation(s)
- F J Hes
- Department of Internal Medicine, University Hospital, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
NEUMANN HARTMUTP, BENDER BERNHARDU, BERGER DIETMARP, LAUBENBERGER JORG, SCHULTZE-SEEMANN WOLFGANG, WETTERAUER ULRICH, FERSTL FRANZJOSEF, HERBST EBERHARDW, SCHWARZKOPF GEORG, HES FREDERIKJ, LIPS J. M. CORNELIS, LAMIELL JAMESM, MASEK OTAKAR, RIEGLER PETER, MUELLER BARBARA, GLAVAC DAMJAN, BRAUCH HILTRUD. PREVALENCE, MORPHOLOGY AND BIOLOGY OF RENAL CELL CARCINOMA IN VON HIPPEL-LINDAU DISEASE COMPARED TO SPORADIC RENAL CELL CARCINOMA. J Urol 1998. [DOI: 10.1016/s0022-5347(01)62509-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- HARTMUT P.H. NEUMANN
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - BERNHARD U. BENDER
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - DIETMAR P. BERGER
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - JORG LAUBENBERGER
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - WOLFGANG SCHULTZE-SEEMANN
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - ULRICH WETTERAUER
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - FRANZ JOSEF FERSTL
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - EBERHARD W. HERBST
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - GEORG SCHWARZKOPF
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - FREDERIK J. HES
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - CORNELIS LIPS J. M.
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - JAMES M. LAMIELL
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - OTAKAR MASEK
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - PETER RIEGLER
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - BARBARA MUELLER
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - DAMJAN GLAVAC
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| | - HILTRUD BRAUCH
- From the Departments of Medicine, Radiology, Urology and Pathology, Albert-Ludwigs-Universitat, Freiburg and Laboratory of Oncology, Department of Gynecology, University of Hamburg, Hamburg, Germany, Department of Medicine, University Hospital Utrecht, The Netherlands, United States Army Medical Department Center and School, Fort Sam Houston, Texas, Department of Radiology, Community Hospital, Zlin, Czech Republic, Department of Nephrology, Community Hospital, Bolzano, Italy, and Institute of
| |
Collapse
|