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Varghese J, Skefos CM, Jimenez C. Metastatic pheochromocytoma and paraganglioma: Integrating tumor biology in clinical practice. Mol Cell Endocrinol 2024; 592:112344. [PMID: 39182716 DOI: 10.1016/j.mce.2024.112344] [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: 05/11/2024] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 08/27/2024]
Abstract
Pheochromocytomas and paragangliomas (PPGL) are rare neuroendocrine tumors derived from chromaffin cells in the autonomic nervous system. Depending on their location, these tumors are capable of excessive catecholamine production, which may lead to uncontrolled hypertension and other life-threatening complications. They are associated with a significant risk of metastatic disease and are often caused by an inherited germline mutation. Although surgery can cure localized disease and lead to remission, treatments for metastatic PPGL (mPPGL)-including chemotherapy, radiopharmaceutical agents, multikinase inhibitors, and immunotherapy used alone or in combination- aim to control tumor growth and limit organ damage. Substantial advances have been made in understanding hereditary and somatic molecular signaling pathways that play a role in tumor growth and metastasis. Treatment options for metastatic disease are rapidly evolving, and this paper aims to provide a brief overview of the management of mPPGL with a focus on therapy options.
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Affiliation(s)
- Jeena Varghese
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Catherine M Skefos
- Clinical Cancer Genetics Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Camilo Jimenez
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Agarwal A, Bathla G, Bhatt A, Murray J, Rao D, Vijay K, Rhyner P, Vibhute P. Molecular Markers in the World Health Organization Classification of Head and Neck Tumors, Fifth Edition. Radiographics 2024; 44:e240037. [PMID: 39356632 DOI: 10.1148/rg.240037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
The past decade has seen exponential advancements in molecular markers and the genetics of tumors, recognizing the limitations of conventional histopathology for grading, classification, and prognostication. Such advances have resulted in changes to classification systems, for example, with the incorporation of objective molecular and genetic information into the 2021 World Health Organization (WHO) classification of central nervous system tumors. The fifth edition of the WHO classification of head and neck tumors (HN5) (beta online version, 2022) also introduced major changes based on molecular markers, including additions, deletions, and reclassifications of entities, with the idea of being more objective and standardized. These changes are highly relevant to therapy decisions, prognosis, and clinical research and for patients with resistant diseases to explore options in clinical trials. The HN5, for the first time, included a radiologist as a member of the writing team to incorporate pertinent imaging findings into the classification. It is important for the radiologist, as an integral part of the multidisciplinary team, to be up to date about these changes for a better understanding of tumor biology, to integrate this into their clinical practice, and to provide more value in their interpretations. The authors provide a basic understanding of pathology and genetics for the radiologist, highlighting the molecular changes in epithelial (including squamous cell) and nonepithelial tumors of the head and neck. The authors also highlight newly recognized and reclassified tumor entities and provide a brief discussion on the genetic tumor syndromes. ©RSNA, 2024 Supplemental material is available for this article. See the invited commentary by Junn and Baugnon in this issue.
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Affiliation(s)
- Amit Agarwal
- From the Departments of Radiology (A.A., A.B., J.M., D.R., P.R.) and Neuroradiology (P.V.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; Department of Radiology, Mayo Clinic, Rochester, Minn (G.B.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.V.)
| | - Girish Bathla
- From the Departments of Radiology (A.A., A.B., J.M., D.R., P.R.) and Neuroradiology (P.V.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; Department of Radiology, Mayo Clinic, Rochester, Minn (G.B.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.V.)
| | - Alok Bhatt
- From the Departments of Radiology (A.A., A.B., J.M., D.R., P.R.) and Neuroradiology (P.V.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; Department of Radiology, Mayo Clinic, Rochester, Minn (G.B.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.V.)
| | - John Murray
- From the Departments of Radiology (A.A., A.B., J.M., D.R., P.R.) and Neuroradiology (P.V.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; Department of Radiology, Mayo Clinic, Rochester, Minn (G.B.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.V.)
| | - Dinesh Rao
- From the Departments of Radiology (A.A., A.B., J.M., D.R., P.R.) and Neuroradiology (P.V.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; Department of Radiology, Mayo Clinic, Rochester, Minn (G.B.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.V.)
| | - Kanupriya Vijay
- From the Departments of Radiology (A.A., A.B., J.M., D.R., P.R.) and Neuroradiology (P.V.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; Department of Radiology, Mayo Clinic, Rochester, Minn (G.B.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.V.)
| | - Patricia Rhyner
- From the Departments of Radiology (A.A., A.B., J.M., D.R., P.R.) and Neuroradiology (P.V.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; Department of Radiology, Mayo Clinic, Rochester, Minn (G.B.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.V.)
| | - Prasanna Vibhute
- From the Departments of Radiology (A.A., A.B., J.M., D.R., P.R.) and Neuroradiology (P.V.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; Department of Radiology, Mayo Clinic, Rochester, Minn (G.B.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.V.)
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Ghayee HK, Costa KA, Xu Y, Hatch HM, Rodriguez M, Straight SC, Bustamante M, Yu F, Smagulova F, Bowden JA, Tevosian SG. Polyamine Pathway Inhibitor DENSPM Suppresses Lipid Metabolism in Pheochromocytoma Cell Line. Int J Mol Sci 2024; 25:10029. [PMID: 39337514 PMCID: PMC11432427 DOI: 10.3390/ijms251810029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/10/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
Pheochromocytomas (PCCs) are tumors arising from chromaffin cells in the adrenal medulla, and paragangliomas (PGLs) are tumors derived from extra-adrenal sympathetic or parasympathetic paraganglia; these tumors are collectively referred to as PPGL cancer. Treatment for PPGL primarily involves surgical removal of the tumor, and only limited options are available for treatment of the disease once it becomes metastatic. Human carriers of the heterozygous mutations in the succinate dehydrogenase subunit B (SDHB) gene are susceptible to the development of PPGL. A physiologically relevant PCC patient-derived cell line hPheo1 was developed, and SDHB_KD cells carrying a stable short hairpin knockdown of SDHB were derived from it. An untargeted metabolomic approach uncovered an overactive polyamine pathway in the SDHB_KD cells that was subsequently fully validated in a large set of human SDHB-mutant PPGL tumor samples. We previously reported that treatment with the polyamine metabolism inhibitor N1,N11-diethylnorspermine (DENSPM) drastically inhibited growth of these PCC-derived cells in culture as well as in xenograft mouse models. Here we explored the mechanisms underlying DENSPM action in hPheo1 and SDHB_KD cells. Specifically, by performing an RNAseq analysis, we have identified gene expression changes associated with DENSPM treatment that broadly interfere with all aspects of lipid metabolism, including fatty acid (FA) synthesis, desaturation, and import/uptake. Furthermore, by performing an untargeted lipidomic liquid chromatography-mass spectrometry (LC/MS)-based analysis we uncovered specific groups of lipids that are dramatically reduced as a result of DENSPM treatment. Specifically, the bulk of plasmanyl ether lipid species that have been recently reported as the major determinants of cancer cell fate are notably decreased. In summary, this work suggests an intersection between active polyamine and lipid pathways in PCC cells.
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Affiliation(s)
- Hans K. Ghayee
- Department of Medicine, Division of Endocrinology, College of Medicine, University of Florida and Malcom Randall VA Medical Center, Gainesville, FL 32608, USA; (Y.X.); (M.B.)
| | - Kaylie A. Costa
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 03610, USA; (K.A.C.); (H.M.H.); (M.R.); (S.C.S.); (J.A.B.)
| | - Yiling Xu
- Department of Medicine, Division of Endocrinology, College of Medicine, University of Florida and Malcom Randall VA Medical Center, Gainesville, FL 32608, USA; (Y.X.); (M.B.)
| | - Heather M. Hatch
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 03610, USA; (K.A.C.); (H.M.H.); (M.R.); (S.C.S.); (J.A.B.)
| | - Mateo Rodriguez
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 03610, USA; (K.A.C.); (H.M.H.); (M.R.); (S.C.S.); (J.A.B.)
| | - Shelby C. Straight
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 03610, USA; (K.A.C.); (H.M.H.); (M.R.); (S.C.S.); (J.A.B.)
| | - Marian Bustamante
- Department of Medicine, Division of Endocrinology, College of Medicine, University of Florida and Malcom Randall VA Medical Center, Gainesville, FL 32608, USA; (Y.X.); (M.B.)
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 03610, USA; (K.A.C.); (H.M.H.); (M.R.); (S.C.S.); (J.A.B.)
| | - Fahong Yu
- The Interdisciplinary Center for Biotechnology Research, University of Florida, Gainesville, FL 32610, USA;
| | - Fatima Smagulova
- Université de Rennes, EHESP, Inserm, Irset (Institut de Recherche en Santé, Environnement et Travail), Campus Sante de Villejean—UMR_S 1085, F-35000 Rennes, France;
| | - John A. Bowden
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 03610, USA; (K.A.C.); (H.M.H.); (M.R.); (S.C.S.); (J.A.B.)
| | - Sergei G. Tevosian
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 03610, USA; (K.A.C.); (H.M.H.); (M.R.); (S.C.S.); (J.A.B.)
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Cardot-Bauters C, Vantyghem MC, Do Cao C, Desailloud R, Joubert M, Coppin L, Odou MF, Pigny P. Genetic predisposition to pheochromocytoma and paraganglioma: 21 years of experience in the field. ANNALES D'ENDOCRINOLOGIE 2024; 85:276-283. [PMID: 38815921 DOI: 10.1016/j.ando.2024.05.024] [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: 02/05/2024] [Revised: 04/20/2024] [Accepted: 05/04/2024] [Indexed: 06/01/2024]
Abstract
CONTEXT Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors with high heritability, justifying systematic genetic screening for a germline variant in one of the twenty predisposing genes described to date. PURPOSE To describe the experience of one endocrine oncogenetic laboratory over a period of 21 years (2001-2022), from the beginning of PPGL genotyping with Sanger sequencing in 2001 to the implementation of next-generation sequencing (NGS). METHOD The activity database of an academic oncogenetic laboratory was searched to extract patients/relatives identified with a pathogenic variant/likely pathogenic variant (PV/LPV) over a period of 21 years. Clinical and genetic data were compared. RESULTS In total, 606 index cases with PPGL and 444 relatives were genotyped. Genotyping of index cases was performed by Sanger sequencing and gene deletion analysis in 327 cases and by NGS in 279. Germline PV/LPV spanning 10 genes was identified in 165 index cases (27.2%). Several recurrent PV/LPVs in SDHx were observed in non-related index cases, the most frequent being SDHD, c.170-1G>T (n=28). This subgroup showed great phenotypic variability both between and within families in terms of both tumor location and number. Four patients (1.1%) with PV/LPV in SDHx had 3PA (Pituitary Adenoma and pheochromocytoma/paraganglioma) syndrome. 258 relatives (58.1%) had inherited a PV/LPV in one driver gene. The rate of PV/LPV carriers who were symptomatic at first imaging evaluation was 32%, but varied between<20% in SDHB and SDHC and >50% in SDHD, VHL and MAX. CONCLUSION Our experience confirmed previously established genotype-phenotype correlations, but also highlights atypical clinical presentations, even for the same genetic variant. These data must be taken into account for optimal patient follow-up and management.
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Affiliation(s)
- Catherine Cardot-Bauters
- Service d'endocrinologie, diabétologie-métabolisme, hôpital Claude-Huriez, CHU, 59037 Lille cedex, France
| | - Marie-Christine Vantyghem
- Service d'endocrinologie, diabétologie-métabolisme, hôpital Claude-Huriez, CHU, 59037 Lille cedex, France
| | - Christine Do Cao
- Service d'endocrinologie, diabétologie-métabolisme, hôpital Claude-Huriez, CHU, 59037 Lille cedex, France
| | - Rachel Desailloud
- Service d'endocrinologie-diabétologie, nutrition, hôpital Sud nord, CHU, 80054 Amiens cedex 1, France
| | - Michael Joubert
- Service d'endocrinologie, CHU Côte de Nacre, 14000 Caen cedex, France
| | - Lucie Coppin
- Laboratoire de biochimie « hormonologie-métabolisme-nutrition-oncologie », UF oncogénétique moléculaire, laboratoire de biologie médicale de référence, CHU de Lille, 59037 Lille cedex, France; Inserm UMR 1277, CANTHER, université de Lille, 59045 Lille cedex, France
| | - Marie-Francoise Odou
- Laboratoire de biochimie « hormonologie-métabolisme-nutrition-oncologie », UF oncogénétique moléculaire, laboratoire de biologie médicale de référence, CHU de Lille, 59037 Lille cedex, France; Inserm, CHU Lille, U1286 - Infinite, université de Lille, 59045 Lille cedex, France
| | - Pascal Pigny
- Laboratoire de biochimie « hormonologie-métabolisme-nutrition-oncologie », UF oncogénétique moléculaire, laboratoire de biologie médicale de référence, CHU de Lille, 59037 Lille cedex, France; Inserm UMR 1277, CANTHER, université de Lille, 59045 Lille cedex, France.
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Bozic Antic I, Djurisic I, Nikolic S. Adrenal Cysts: To Operate or Not to Operate? J Clin Med 2024; 13:846. [PMID: 38337539 PMCID: PMC10856713 DOI: 10.3390/jcm13030846] [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: 12/17/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Adrenal cysts are uncommon and usually asymptomatic, and therefore are usually incidentally discovered adrenal lesions. They have a broad pathohistological spectrum that includes pseudocysts and endothelial (vascular), parasitic, and epithelial (mesothelial) cysts. Although most adrenal cysts are benign and hormonally non-functional lesions, some can have ambiguous imaging appearances and mimic malignant adrenal neoplasms. On the other hand, the actual malignant neoplasms could undergo cystic transformation. Additionally, immune cell infiltrations, thrombosis, or haemorrhage seen in sepsis can frequently cause adrenal cyst development, raising a question about the possible connection between severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and adrenal cystic lesions. Due to the disease's rarity, the likelihood of malignancy, and the lack of specific guidelines, the management of adrenal cysts is always challenging especially in a young person. This review discusses the important diagnostic and the current treatment possibilities for adrenal cystic lesions. Aiming to emphasize clinical dilemmas and help clinicians navigate the challenges when encountering a patient with an adrenal cyst in everyday practice, we based our review on a practical question-answer framework centred around the case of a young woman with an incidentally discovered large adrenal cyst.
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Affiliation(s)
- Ivana Bozic Antic
- Department of Endocrinology, Euromedik General Hospital, 11000 Belgrade, Serbia
- Faculty of Dentistry Pancevo, University Business Academy, 21000 Novi Sad, Serbia
| | - Igor Djurisic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia
| | - Srdjan Nikolic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Alzahrani AS, Bin Nafisah A, Alswailem M, Moria Y, Poprawski D, Al-Hindi H, Pacak K. An aggressive cabergoline-resistant, temozolomide-responsive macroprolactinoma due to a germline SDHB pathogenic variant in the absence of paraganglioma or pheochromocytoma. Front Endocrinol (Lausanne) 2023; 14:1273093. [PMID: 38152133 PMCID: PMC10751293 DOI: 10.3389/fendo.2023.1273093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/24/2023] [Indexed: 12/29/2023] Open
Abstract
Context Germline succinate dehydrogenase subunit B (SDHB) pathogenic variants are characteristic of familial paraganglioma (PGL) syndrome type 4. This syndrome frequently presents with abdominal PGL and has high tendency for locally aggressive behavior and distant metastasis. The vast majority of pituitary adenomas (PAs) are sporadic. However, PAs can be part of a number of familial tumor syndromes such as multiple endocrine neoplasia type 1 (MEN 1) or more rarely in association with pheochromocytoma and PGL (referred to as 3P syndrome). Only a limited number of PAs in association with SDHB-related PGL has been reported and the vast majority occurred subsequently or simultaneously with pheochromocytoma/PGL (collectively abbreviated as PPGL). In this report, we describe a young patient who had a giant pituitary macroprolactinoma resistant to large doses of cabergoline (CBG) and external beam radiotherapy (XRT). The patient did not have personal history of PPGL but was found to carry a germline SDHB pathogenic variant. Case report A 38-year-old woman presented with headache, visual disturbances and galactorrhea and was found to have a 34-mm macroprolactinoma. She was treated with CBG 3-4 mg per week but PA continued to grow and caused significant cranial pressure symptoms. She underwent two transsphenoidal surgeries with rapid tumor recurrence after each one. She received XRT but PA continued to grow. She was finally treated with temozolomide with excellent response. Whole exome and subsequent Sanger sequencing confirmed that she has a pathogenic monoallelic SDHB mutation (NM_003000:c.C343T, p.R115*). PA tissue showed loss of heterozygosity for the same mutation and absent SDHB immunostaining confirming the pathogenic role of this SDHB mutation. Conclusion Germline SDHB mutations can rarely cause PA in the absence of PPGL. They should be considered as a possible cause of aggressiveness and resistance to dopamine agonists in similar cases.
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Affiliation(s)
- Ali S. Alzahrani
- Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulghani Bin Nafisah
- Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Meshael Alswailem
- Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Yosra Moria
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Dagmara Poprawski
- Oncology Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Hindi Al-Hindi
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States
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