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Daniels AB, Chang EY, Chew EY, Gombos DS, Gorin MB, Shields CL, Wiley HE. Consensus Guidelines for Ocular Surveillance of von Hippel-Lindau Disease. Ophthalmology 2024; 131:622-633. [PMID: 38092079 DOI: 10.1016/j.ophtha.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 03/21/2024] Open
Abstract
PURPOSE To develop guidelines for ocular surveillance and early intervention for individuals with von Hippel-Lindau (VHL) disease. DESIGN Systematic review of the literature. PARTICIPANTS Expert panel of retina specialists and ocular oncologists. METHODS A consortium of experts on clinical management of all-organ aspects of VHL disease was convened. Working groups with expertise in organ-specific features of VHL disease were tasked with development of evidence-based guidelines for each organ system. The ophthalmology subcommittee formulated questions for consideration and performed a systematic literature review. Evidence was graded for topic quality and relevance and the strength of each recommendation, and guideline recommendations were developed. RESULTS The quality of evidence was limited, and no controlled clinical trial data were available. Consensus guidelines included: (1) individuals with known or suspected VHL disease should undergo periodic ocular screening (evidence type, III; evidence strength, C; degree of consensus, 2A); (2) patients at risk of VHL disease, including first-degree relatives of patients with known VHL disease, or any patient with single or multifocal retinal hemangioblastomas (RHs), should undergo genetic testing for pathologic VHL disease gene variants as part of an appropriate medical evaluation (III/C/2A); (3) ocular screening should begin within 12 months after birth and continue throughout life (III/C/2A); (4) ocular screening should occur approximately every 6 to 12 months until 30 years of age and then at least yearly thereafter (III/C-D/2A); (5) ocular screening should be performed before a planned pregnancy and every 6 to 12 months during pregnancy (IV/D/2A); (6) ultra-widefield color fundus photography may be helpful in certain circumstances to monitor RHs, and ultra-widefield fluorescein angiography may be helpful in certain circumstances to detect small RHs (IV/D/2A); (7) patients should be managed, whenever possible, by those with subspecialty training, with experience with VHL disease or RHs, or with both and ideally within the context of a multidisciplinary center capable of providing multiorgan surveillance and access to genetic testing (IV/D/2A); (8) extramacular or extrapapillary RHs should be treated promptly (III/C/2A). CONCLUSIONS Based on available evidence from observational studies, broad agreement was reached for a strategy of lifelong surveillance and early treatment for ocular VHL disease. These guidelines were endorsed by the VHL Alliance and the International Society of Ocular Oncology and were approved by the American Academy of Ophthalmology Board of Trustees. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Anthony B Daniels
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.
| | | | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland
| | - Dan S Gombos
- Section of Ophthalmology, Department of Head & Neck Surgery, Division of Surgery, University of Texas-MD Anderson Cancer Center, Houston, Texas
| | - Michael B Gorin
- Jules Stein Eye Institute, University of California-Los Angeles School of Medicine, Los Angeles, California
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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Grimes JM, Gershkovich A, Bogomolny D, Marr BP. TWO CASES OF VON HIPPEL-LINDAU SYNDROME-ASSOCIATED RETINAL HEMANGIOBLASTOMA TREATED WITH BELZUTIFAN. Retin Cases Brief Rep 2024; 18:319-322. [PMID: 36730578 DOI: 10.1097/icb.0000000000001376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To describe two cases of retinal hemangioblastoma regression following treatment with belzutifan in patients with von Hippel-Lindau syndrome. METHODS Clinical information was extracted from the charts and tumor imaging of two patients with von Hippel-Lindau-associated retinal hemangioblastoma. RESULTS In Case 1, a 40-year-old man was treated with belzutifan for spine hemangioblastomas after diagnosis of a 2.0 × 2.0 × 1.3 mm left-eye retinal hemangioblastoma temporal to the macula associated with intraretinal edema, subretinal fluid, and mild retinal traction. In Case 2, a 66-year-old woman presented with a right eye 2.0 × 1.5 × 1.3 mm juxtapapillary lesion with subretinal fluid, intraretinal fluid, and nasal traction, and a 4.0 × 3.5 × 1.1 mm inferior midperiphery lesion with subretinal fluid, intraretinal fluid, and active exudation. She was treated for 2.5 years with belzutifan for renal cell carcinoma on the National Institutes of Health trial. The patient in case 1 demonstrated a 10% reduction in largest tumor diameter and 8% reduction in thickness, along with improving subretinal fluid, intraretinal edema, and retinal traction, after 4 weeks of treatment. After 2.5 years of treatment, the patient in Case 2 demonstrated similar margins of her now fibrotic-appearing juxtapapillary lesion with a 45% reduction in thickness, along with resolved subretinal fluid and greatly improved intraretinal fluid and traction. The inferior lesion demonstrated 12.5% reduction in largest diameter, 36% reduction in thickness, and was without active subretinal fluid or exudation. Neither patient demonstrated new lesions while on treatment. CONCLUSION Belzutifan is a promising treatment for retinal hemangioblastoma with the potential for both rapid and sustained tumor regression.
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Affiliation(s)
- Joseph M Grimes
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
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Mustafi D, Huang J, Ting MA, Waligorski N, Stacey AW, Huang LC. Successful Treatment Response of a Juxtapapillary Retinal Capillary Hemangioblastoma Due to von Hippel-Lindau Syndrome with Belzutifan in a Pediatric Patient. Retina 2024; 44:e31-e33. [PMID: 38100768 PMCID: PMC11039381 DOI: 10.1097/iae.0000000000003973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Affiliation(s)
- Debarshi Mustafi
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington
- Department of Ophthalmology and Roger and Karalis Johnson Retina Center, University of Washington, Seattle, Washington
- Brotman Baty Institute for Precision Medicine, Seattle, Washington
| | - Johnson Huang
- Department of Ophthalmology and Roger and Karalis Johnson Retina Center, University of Washington, Seattle, Washington
| | - Michelle A Ting
- Division of Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington; and
| | - Natalie Waligorski
- Department of Genetics, Seattle Children's Hospital, Seattle, Washington
| | - Andrew W Stacey
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington
- Department of Ophthalmology and Roger and Karalis Johnson Retina Center, University of Washington, Seattle, Washington
| | - Laura C Huang
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington
- Department of Ophthalmology and Roger and Karalis Johnson Retina Center, University of Washington, Seattle, Washington
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Yoo KH, Park DJ, Marianayagam NJ, Gu X, Pollom EL, Soltys SG, Chang SD, Meola A. Stereotactic Radiosurgery for Cranial and Spinal Hemangioblastomas: A Single-Institution Retrospective Series. Neurosurgery 2024; 94:630-642. [PMID: 37967154 DOI: 10.1227/neu.0000000000002728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/27/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Stereotactic radiosurgery (SRS) has been an attractive treatment modality for both cranial and spinal hemangioblastomas, especially for multiple lesions commonly associated with von Hippel-Lindau (VHL) disease. This study aims to provide the largest long-term analysis of treatment efficacy and adverse effects of SRS for cranial and spinal hemangioblastomas at a single institution. METHODS We evaluated the clinical and radiological outcomes of patients with hemangioblastomas treated with CyberKnife SRS at our institute from 1998 to 2022. The follow-up data were available for 135 hemangioblastomas in 35 patients. Twenty-eight patients had 123 hemangioblastomas associated with VHL, and 7 had 12 sporadic hemangioblastomas. The median age was 36 years, and the median tumor volume accounted for 0.4 cc. The SRS was administered with the median single-fraction equivalent dose of 18 Gy to the 77% median isodose line. RESULTS At a median follow-up of 57 months (range: 3-260), only 20 (16.2%) of the VHL-associated and 1 (8.3%) sporadic hemangioblastomas progressed. The 5-year local tumor control rate was 91.3% for all hemangioblastomas, 91.7% among the sporadic lesions, and 92.9% in patients with VHL. SRS improved tumor-associated symptoms of 98 (74.8%) of 131 symptomatic hemangioblastomas, including headache, neck pain, dizziness, visual disturbances, dysesthesia, ataxia, motor impairment, seizures, and dysphagia. Two patients developed radiation necrosis (5.7%), and 1 of them required surgical resection. CONCLUSION SRS is a safe and effective treatment option for patients with hemangioblastomas in critical locations, such as the brainstem, cervicomedullary junction, and spinal cord, and in patients with multiple hemangioblastomas associated with VHL disease.
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Affiliation(s)
- Kelly H Yoo
- Department of Neurosurgery, Stanford University School of Medicine, Stanford , California , USA
| | - David J Park
- Department of Neurosurgery, Stanford University School of Medicine, Stanford , California , USA
| | - Neelan J Marianayagam
- Department of Neurosurgery, Stanford University School of Medicine, Stanford , California , USA
| | - Xuejun Gu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford , California , USA
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford , California , USA
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford , California , USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford , California , USA
| | - Antonio Meola
- Department of Neurosurgery, Stanford University School of Medicine, Stanford , California , USA
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Малиевский ОА, Малиевская РИ, Малиевский ВА, Тюльпаков АН. [Preclinical diagnostics of von Hippel-Lindau syndrome in a child]. Probl Endokrinol (Mosk) 2024; 70:100-104. [PMID: 38433546 PMCID: PMC10926248 DOI: 10.14341/probl13280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/17/2023] [Accepted: 07/28/2023] [Indexed: 03/05/2024]
Abstract
The description of the child aged 5 months with the von Hippel-Lindau syndrome without any manifestations of this syndrome is presented. The reason for the molecular genetic examination was the presence of cases of this syndrome in the family (mother and sister). The heterozygous variant c.355T>C p.F119L was found in the VHL gene. An objective examination revealed no pathology. A comprehensive laboratory and instrumental examination aimed at searching for components of the von Hippel-Lindau syndrome, including a blood test for metanephrines and normetanephrines, ultrasound of the abdominal organs, examination of the fundus, also did not reveal any abnormalities. Given the results of molecular genetic diagnosis, the child remains under observation and will undergo regular examinations to identify components of the von Hippel-Lindau syndrome, including blood/urine tests for normetanephrines.
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Affiliation(s)
| | | | | | - А. Н. Тюльпаков
- Медико-генетический научный центр имени академика Н.П. Бочкова; Российская детская клиническая больница
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Kenessey I, Patócs A, Dobozi M, Nagy P, Polgár C. [The epidemiology of primary brain malignancies]. Magy Onkol 2023; 67:279-287. [PMID: 38109507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/18/2023] [Indexed: 12/20/2023]
Abstract
The occurrence of central nervous system malignancies is relatively low; however, these tumors exhibit poor prognosis and a high mortality rate. On epidemiological grounds, Hungary was placed in the last third among European countries: in the last decade annually 750 to 1000 new cases were diagnosed and the number of deaths was between 550 and 690, without any apparent trends. Age distribution analyses revealed childhood peak and a higher peak at around 65 years of age. Histologically, heterogeneity was apparent, but at least half of the cases were glioblastomas. The exact etiology of adulthood brain tumors is mostly unknown. Among environmental exposures the effect of ionizing radiation was confirmed, the identification of other potential risk factors requires further examinations. 7-10 percent of brain tumors were hereditary tumor syndromes (Li-Fraumeni, neurofibromatosis, sclerosis tuberosa, von Hippel-Lindau, Gorlin- Goltz). Therefore, genetic testing is recommended for families where the diagnosis of brain tumor is suspected.
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Affiliation(s)
- István Kenessey
- Nemzeti Tumorbiológiai Laboratórium, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Attila Patócs
- Nemzeti Tumorbiológiai Laboratórium, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Mária Dobozi
- Nemzeti Tumorbiológiai Laboratórium, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Péter Nagy
- Nemzeti Tumorbiológiai Laboratórium, Országos Onkológiai Intézet, Budapest, Hungary.
| | - Csaba Polgár
- Nemzeti Tumorbiológiai Laboratórium, Országos Onkológiai Intézet, Budapest, Hungary.
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Lopes-Pinto M, Lacerda-Nobre E, Marques P, Bugalho MJ. Long-term surveillance of a Von Hippel-Lindau disease pituitary stalk hemangioblastoma. Minerva Endocrinol (Torino) 2023; 48:473-474. [PMID: 37166401 DOI: 10.23736/s2724-6507.23.03885-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Mariana Lopes-Pinto
- Department of Endocrinology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal -
| | - Ema Lacerda-Nobre
- Department of Endocrinology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Pedro Marques
- Department of Endocrinology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Maria João Bugalho
- Department of Endocrinology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
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Cabrera-Montes J, Aguirre DT, Viñas-López J, Lorente-Herraiz L, Recio-Poveda L, Albiñana V, Pérez-Pérez J, Botella LM, Cuesta AM. Mutation in Chek2 triggers von Hippel-Lindau hemangioblastoma growth. Acta Neurochir (Wien) 2023; 165:4241-4251. [PMID: 37843608 PMCID: PMC10739370 DOI: 10.1007/s00701-023-05825-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Von Hippel-Lindau (VHL) is a rare inherited disease mainly characterized by the growth of tumours, predominantly hemangioblastomas (Hbs) in the CNS and retina, and renal carcinomas. The natural history of VHL disease is variable, differing in the age of onset and its penetrance, even among relatives. Unfortunately, sometimes VHL shows more severe than average: the onset starts in adolescence, and surgeries are required almost every year. In these cases, the factor that triggers the appearance and growth of Hbs usually remains unknown, although additional mutations are suspected. METHODS We present the case of a VHL patient whose first surgery was at 13 years of age. Then, along his next 8 years, he has undergone 5 surgeries for resection of 10 CNS Hbs. To clarify this severe VHL condition, DNA from a CNS Hb and white blood cells (WBC) was sequenced using next-generation sequencing technology. RESULTS Massive DNA sequencing of the WBC (germ line) revealed a pathogenic mutation in CHEK2 and the complete loss of a VHL allele (both tumour suppressors). Moreover, in the tumour sample, several mutations, in BRAF1 and PTPN11 were found. Familiar segregation studies showed that CHEK2 mutation was in the maternal lineage, while VHL was inherited by paternal lineage. CONCLUSIONS Finally, clinical history correlated to the different genotypes in the family, concluding that the severity of these VHL manifestations are due to both, VHL-and-CHEK2 mutations. This case report aims to notice the importance of deeper genetic analyses, in inherited rare diseases, to uncover non-expected mutations.
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Affiliation(s)
- Jorge Cabrera-Montes
- Department of Neurosurgery, Sanitary Investigation Institute - Fundación Jiménez Diaz (IIS-FJD), Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Daniel T Aguirre
- Department of Neurosurgery, Sanitary Investigation Institute - Fundación Jiménez Diaz (IIS-FJD), Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | | | - Laura Lorente-Herraiz
- Department of Molecular Biomedicine, Center for Biological Research Margarita Salas, CIB-CSIC, Madrid, Spain
- Rare Diseases Networking Biomedical Research Centre (CIBERER), Unit, 707, Madrid, Spain
| | - Lucía Recio-Poveda
- Department of Molecular Biomedicine, Center for Biological Research Margarita Salas, CIB-CSIC, Madrid, Spain
- Rare Diseases Networking Biomedical Research Centre (CIBERER), Unit, 707, Madrid, Spain
| | - Virginia Albiñana
- Department of Molecular Biomedicine, Center for Biological Research Margarita Salas, CIB-CSIC, Madrid, Spain
- Rare Diseases Networking Biomedical Research Centre (CIBERER), Unit, 707, Madrid, Spain
| | | | - Luisa M Botella
- Department of Molecular Biomedicine, Center for Biological Research Margarita Salas, CIB-CSIC, Madrid, Spain.
- Rare Diseases Networking Biomedical Research Centre (CIBERER), Unit, 707, Madrid, Spain.
| | - Angel M Cuesta
- Rare Diseases Networking Biomedical Research Centre (CIBERER), Unit, 707, Madrid, Spain.
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain.
- Health Research Institute of the Clínico San Carlos Hospital (IdISSC), Madrid, Spain.
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Elbeltagy M, Abbassy M. Neurofibromatosis type1, type 2, tuberous sclerosis and Von Hippel-Lindau disease. Childs Nerv Syst 2023; 39:2791-2806. [PMID: 37819506 DOI: 10.1007/s00381-023-06160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/16/2023] [Indexed: 10/13/2023]
Abstract
Neurocutaneous syndromes (also known as phakomatoses) are heterogenous group of disorders that involve derivatives of the neuroectoderm. Each disease has diagnostic and pathognomonic criteria, once identified, thorough clinical examination to the patient and the family members should be done. Magnetic resonance imaging (MRI) is used to study the pathognomonic findings withing the CNS (Evans et al. in Am J Med Genet A 152A:327-332, 2010). This chapter includes the 4 most common syndromes faced by neurosurgeons and neurologists; neurofibromatosis types 1 and 2, tuberous sclerosis and Von Hippel-Lindau disease. Each syndrome has specific genetic anomaly that involves a tumor suppressor gene and the loss of inhibition of specific pathways. The result is a spectrum of cutaneous manifestations and neoplasms.
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Affiliation(s)
- M Elbeltagy
- Department of Neurosurgery, Cairo University, 1 University Street, Giza Governorate, 12613, Egypt.
- Department of Neurosurgery, Children's Cancer Hospital Egypt, Sekat Hadid Al Mahger, Zeinhom, El Sayeda Zeinab, Cairo Governorate, 4260102, Egypt.
| | - M Abbassy
- Department of Neurosurgery, Children's Cancer Hospital Egypt, Sekat Hadid Al Mahger, Zeinhom, El Sayeda Zeinab, Cairo Governorate, 4260102, Egypt
- Department of Neurosurgery, Alexandria University, 22 El-Gaish Rd, Al Azaritah WA Ash Shatebi, Bab Sharqi, Alexandria Governorate, 5424041, Egypt
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11
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Idler J, Turkoglu O, Patek K, Stuart S, Taskin B, Sivaswamy L, Whitten A. Neurocutaneous Disorders in Pregnancy. Obstet Gynecol Surv 2023; 78:606-619. [PMID: 37976316 DOI: 10.1097/ogx.0000000000001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Importance Neurocutaneous disorders have significant implications for care of the pregnant patient. As neurocutaneous disorders are uncommon, obstetricians may be unfamiliar with these disorders and with recommendations for appropriate care of this population. Objective This review aims to summarize existing literature on the interaction between neurocutaneous disorders and pregnancy and to provide a guide for physicians caring for an affected patient. Evidence Acquisition A PubMed, MEDLINE, and Google Scholar search was carried out with a broad range of combinations of the medical subject headings (MeSH) terms "pregnancy," "Sturge -Weber," "Neurofibromatosis Type 1," "neurofibromatosis type 2," "von Hippel Lindau," "Tuberous Sclerosis," "neurocutaneous disorder," "treatment," "congenital malformations," "neurodevelopmental defects," "miscarriage," "breastfeeding," "autoimmune," "pathophysiology," and "management." References of included articles were searched to identify any articles that may have been missed after the above method was used. Results Neurocutaneous disorders are associated with increased pregnancy-associated maternal and fetal/neonatal morbidity, largely surrounding hypertensive disorders, epilepsy, and medication exposure. Some features of neurocutaneous disorders may be worsened or accelerated by pregnancy. Neurocutaneous disorders can often be diagnosed prenatally. Therefore, directed assessment should be offered to affected individuals with a personal or family history of a neurocutaneous disorder. Conclusion and Relevance Patients affected by neurocutaneous disorders who are pregnant or planning for future pregnancy should be carefully followed by a multidisciplinary team, which could include maternal-fetal medicine, neurology, and anesthesia, as well as other relevant subspecialists. Additional research is required regarding optimal counseling and management of these patients.
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Affiliation(s)
- Jay Idler
- Maternal Fetal Medicine Specialist, Allegheny Health Network, Pittsburgh, PA; Assistant Professor, Drexel College of Medicine, Philadelphia, PA
| | | | | | - Sean Stuart
- Obstetrics and Gynecology Resident, William Beaumont University Hospital, Corewell Health, Royal Oak
| | - Birce Taskin
- Child Neurologist, Pediatric Neurology Department, Children's Hospital of Michigan, Wayne State University, Detroit
| | - Lalitha Sivaswamy
- Child Neurologist, Pediatric Neurology Department, Children's Hospital of Michigan, Wayne State University, Detroit
| | - Amy Whitten
- Maternal Fetal Medicine Fellow; Maternal Fetal Medicine Specialist and Associate Professor, William Beaumont University Hospital, Corewell Health, Royal Oak, MI
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Daniels AB, Tirosh A, Huntoon K, Mehta GU, Spiess PE, Friedman DL, Waguespack SG, Kilkelly JE, Rednam S, Pruthi S, Jonasch EA, Baum L, Chahoud J. Guidelines for surveillance of patients with von Hippel-Lindau disease: Consensus statement of the International VHL Surveillance Guidelines Consortium and VHL Alliance. Cancer 2023; 129:2927-2940. [PMID: 37337409 DOI: 10.1002/cncr.34896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 06/21/2023]
Abstract
Von Hippel‐Lindau disease is a rare inherited cancer‐predisposition syndrome. The authors report the updated recommendations for the multiorgan surveillance protocols.
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Affiliation(s)
- Anthony B Daniels
- Division of Ocular Oncology and Pathology, Department of Ophthalmology & Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amit Tirosh
- Neuroendocrine Tumors Service, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kristin Huntoon
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Tennessee, USA
| | | | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Debra L Friedman
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Texas, USA
| | - Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jill E Kilkelly
- Division of Pediatric Anesthesia, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Surya Rednam
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Sumit Pruthi
- Division of Pediatric Neuroradiology, Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric A Jonasch
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Laura Baum
- Division of Hematology/Oncology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jad Chahoud
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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13
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Deng B, Liu C. Two tests of peripheral blood by standard methods were negative for Von Hippel-Lindau mutations: A case report. Asian J Surg 2023; 46:4101-4102. [PMID: 37147258 DOI: 10.1016/j.asjsur.2023.04.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Von Hippel-Lindau disease (VHL) is an autosomal dominant, inherited syndrome with variants in the VHL gene causing predisposition to multi-organ benign and malignant neoplasms. Approximately 95-100% of individuals with clinical VHL receive a positive result when they undergo standard genetic testing on DNA extracted from blood. Here, we present the case of an individual with a clinical diagnosis of VHL disease where peripheral blood DNA analysis did not detect a VHL variant. CASE PRESENTATION Our patient is a-38-year-old male whose chief complaints are right shoulder and back pain for almost a year. Cranial Magnetic Resonance Imaging (MRI) showed multiple space occupying lesions in cerebellar hemisphere. Spine MRI showed the formation of intraspinal cavities in cervical 5 to thoracic 10 plane, enhanced lesions in the thoracic 8 vertebral plane. Abdominal MRI showed very weakly enhanced nodules on the left kidney and multiple cystic lesions of pancreas. Our case, without a family history, fulfilled clinical criteria for VHL but initially received negative germline VHL results through multigene panel testing on DNA extracted from peripheral blood leukocytes. One year later, the second peripheral blood send for germline molecular genetic testing was also negative. CONCLUSION Although the patient tested negative for the classic VHL gene, the possibility of somatic mosaicism could not be ruled out. Instead of repeating classic testing, next-generation sequencing, multi-tissue analysis or/and genetic testing of offspring is an efficient tool to identify VHL mosaic mutation.
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Affiliation(s)
- Bing Deng
- Department of Neurosurgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Chunguang Liu
- Department of Emergency, Da Ping Hospital, Army Military Medical University, Chongqing, 400042, China.
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14
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Bond E, Yashar B, Else T, Osborne J, Marvin M. Disclosure of genetic risk to dating partners among young adults with von Hippel-Lindau disease. Fam Cancer 2023; 22:203-215. [PMID: 35984582 DOI: 10.1007/s10689-022-00311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
Individuals with genetic disease face unique challenges related to navigating dating relationships. While previous studies have explored the impact of hereditary breast and ovarian cancer syndrome on dating, research investigating psychosocial implications for young adults with early-onset multi-organ tumor predisposition syndromes such as von Hippel-Lindau disease (VHL) is scarce. This study assessed young adults' attitudes towards dating and decisions related to disclosing a diagnosis of VHL to a dating partner. Twenty-six young adults with VHL participated in semi-structured interviews exploring this issue, using a guide informed by the literature in consultation with providers and an individual with VHL. Interviews were coded with a primarily deductive approach using codes derived from the literature, with inductive coding employed for perspectives unique to VHL. Our results support previous findings that genetic disease contributes to fear of rejection due to decreased desirability. However, participants report that partners' reactions to VHL uniquely exacerbate this concern due to unfamiliarity with VHL and a perception that it is exceptionally serious, leading to different strategies in disclosure. While many cited negative reactions from partners, participants also described how disclosure can strengthen relationships by deepening trust. Participants discussed a desire for healthcare providers to offer support in this context and described the benefit of speaking with peers about their dating experiences and approaches to disclosure. Our findings provide insight into the diverse needs of young adults with VHL as they approach romantic relationships and decision-making regarding disclosure and highlight the importance of patient-centered support from providers and patient organizations.
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Affiliation(s)
- Elysa Bond
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA.
- Department of Medicine, Division of Hematology, Oncology, and Cell Therapy, Rush University Medical Center, Chicago, IL, USA.
| | - Beverly Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Tobias Else
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Jenae Osborne
- Department of Internal Medicine, Division of Genetic Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Monica Marvin
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, Division of Genetic Medicine, University of Michigan, Ann Arbor, MI, USA
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15
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Jayarajah U, Balagobi B, Thanusan V, Gunasekara D, Abeygunasekera AM. Management of Renal Malignancies in Von Hippel-Lindau Syndrome: Lessons Learned from a Series of Six Patients from Sri Lanka. Saudi J Kidney Dis Transpl 2023; 34:187-190. [PMID: 38146729 DOI: 10.4103/1319-2442.391898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
Management of renal malignancies in Von Hippel-Lindau (VHL) is challenging. We present six patients [mean age = 35.1 years (range: 24-54), males = 5] with VHL syndrome with multiple bilateral renal malignancies and the lessons learned during their management. The number of tumors at the time of presentation ranged from 1 to 6, while the number of new lesions varied from 1 to 3. Different combinations of radical nephrectomy (n = 2), partial nephrectomy (n = 7), and focal therapy (n = 6) were used appropriately. Median follow-up was 36 months (range: 12-72). Two patients developed new lesions which were managed with focal therapy. Nephron-sparing approaches are successful even in bilateral, multifocal, large, and recurring renal tumors associated with VHL. Awareness about the availability of efficacious surgical and minimally invasive measures would reduce psychosocial problems faced by patients and their families due to the social stigma associated with malignancies running in a family and burden of renal replacement therapy.
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Affiliation(s)
- Umesh Jayarajah
- Department of Urology, Colombo South Teaching Hospital, Dehiwala, Western Province, Sri Lanka
| | - Balasingam Balagobi
- Department of Urology, Colombo South Teaching Hospital, Dehiwala, Western Province, Sri Lanka
| | | | - Densil Gunasekara
- Department of Radiology, Colombo South Teaching Hospital, Dehiwala, Western Province, Sri Lanka
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16
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Vigaru V, Müntener D, Kuchynka J. [A Surgically Treated Depression]. Praxis (Bern 1994) 2023; 112:235-238. [PMID: 36919322 DOI: 10.1024/1661-8157/a004007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
A Surgically Treated Depression Abstract. We present a 64-year-old patient with an unclear deterioration of her general condition due to a suspected depression. Despite antidepressive treatment, her condition further deteriorated. The CT/MRI of the skull showed a cerebellar tumor as well as a hydrocephalus obstructivus. Together with tumor staging, the histology, which revealed a hemangioblastoma, led to the diagnosis of VHL syndrome. Patients with VHL syndrome and their families should be included in a screening program, unless molecular genetic testing has ruled out the disease.
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Affiliation(s)
- Valentina Vigaru
- 1 Klinik für Geriatrie, Rheumatologie und Rehabilitation, Kantonsspital Schaffhausen, Schaffhausen, Schweiz
| | - Dominik Müntener
- Klinik für Innere Medizin, Neurologie, Kantonsspital Schaffhausen, Schaffhausen, Schweiz
| | - Jan Kuchynka
- 1 Klinik für Geriatrie, Rheumatologie und Rehabilitation, Kantonsspital Schaffhausen, Schaffhausen, Schweiz
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17
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D Arican C, Sancaktep SIV, Bayar G. Renal cell carcinoma, synchronous pheochromocytoma and papillary urothelial neoplasm with low Malignant Potential. Ann Ital Chir 2022; 11:S2239253X22037963. [PMID: 36259433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIM This case report descraes a patient who was diagnosed with both clear cell renal carcinoma and pheochromocytoma of the surrenal glands. MATERIALS AND METODS Ultrasonographic imaging examination, magnetic resonance imaging and thorax computed tomography performed with IV contrast scan techniques were used to diagnose and examine the mass. RESULTS The patient was diagnosed with a mass in his kidney and clear cell renal cell carcinoma. There was a casual pheochromocytoma in the surrenal gland at the same time. In addition, histopathological examination revealed a papillary urothelial neoplasm of low malignant potential (PUNLMP). DISCUSSION It is interesting in this case that the patient did not have any other complaints other than left side pain due to the mass in the kidney. It is notable that there were no clinical or radiological findings that may be compatible with the diagnosis of pheochromocytoma in this case. CONCLUSION This study reports a significant result that there was cooccurrence of pheochromocytoma (PC) and clear cell renal cell carcinoma along with VHL disease. KEY WORDS Clear cell carcinoma, Pheochromocytoma, Von Hippel-Lindau.
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18
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Abedalthagafi M. Commentary: Von Hippel-Lindau disease: A clinical and scientific review. Eur J Hum Genet 2022; 30:1103-1104. [PMID: 36221028 PMCID: PMC9553946 DOI: 10.1038/s41431-022-01172-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/27/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Malak Abedalthagafi
- Genomics Research Department, King Fahad Medical City, Riyadh, Saudi Arabia.
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19
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Vibert R, Lahlou-Laforêt K, Samadi M, Krivosic V, Blanc T, Amar L, Burnichon N, Abadie C, Richard S, Gimenez-Roqueplo AP. Minors at risk of von Hippel-Lindau disease: 10 years' experience of predictive genetic testing and follow-up adherence. Eur J Hum Genet 2022; 30:1171-1177. [PMID: 35918537 PMCID: PMC9553881 DOI: 10.1038/s41431-022-01157-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/08/2022] [Accepted: 07/13/2022] [Indexed: 12/15/2022] Open
Abstract
Von Hippel-Lindau (VHL) disease is one of the most common cancer predisposition syndromes. Penetrance is high with around 20% of children presenting detectable and curable manifestations of the disease at 15 years old. VHL predictive genetic testing (PGT) is recommended during childhood from age 5 years in France. Insufficient compliance to surveillance of VHL pathogenic variant (PV) carriers is associated with severe outcome. PGT experienced by children and their parents is probably critical in influencing future acceptance of the result and adherence to surveillance. We conducted a retrospective study on minors tested (aged 5 to 16 years old) from 2010 to 2020, in a multidisciplinary oncogenetics consultation which follows a 3-step protocol based on psychological familial support. The objectives were to assess the adherence to follow-up within the National Expert Center for inherited predispositions to renal tumors (PREDIR) network of VHL PV carriers and its benefit through tumor detection and medical interventions. A VHL PGT was carried out in 34 children. Among the 16 children diagnosed as VHL PV carriers addressed to the PREDIR network, none had discontinued surveillance after a median of 41 months. Follow-up examinations detected 11 tumors in 6 children, 4 have been surgically treated. All had a favorable outcome. Our data suggest that a specific and adapted procedure for PGT in at-risk VHL children as well as a follow-up, organized within a specialized expert network, fosters a complete adherence to the surveillance protocol and thus lead to a favorable clinical outcome.
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Affiliation(s)
- Roseline Vibert
- Département de Médecine Génomique des Tumeurs et Cancers/UF Oncogénétique Tumeurs et Cancers Rares, AP-HP, Hôpital européen Georges Pompidou, F-75015, Paris, France
| | - Khadija Lahlou-Laforêt
- Université Paris Cité, AP-HP, Hôpital Européen Georges Pompidou, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, F-75015, Paris, France
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
| | - Maryam Samadi
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
| | - Valérie Krivosic
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
- Service d'Ophtalmologie, AP-HP, Hôpital Lariboisière, F-75010, Paris, France
| | - Thomas Blanc
- Service de Chirurgie Viscérale et Urologie Pédiatrique, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France
| | - Laurence Amar
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
- Service d'Hypertension Artérielle, AP-HP, Hôpital européen Georges Pompidou, F-75015, Paris, France
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
| | - Nelly Burnichon
- Département de Médecine Génomique des Tumeurs et Cancers/UF Oncogénétique Tumeurs et Cancers Rares, AP-HP, Hôpital européen Georges Pompidou, F-75015, Paris, France
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
| | - Caroline Abadie
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
- Unité d'Oncogénétique, Institut de Cancérologie de l'Ouest, F-44800, Saint-Herblain, France
| | - Stéphane Richard
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
- EPHE, PSL Université, 75015 Paris, and CNRS UMR 9019, Gustave Roussy, Université Paris-Saclay, 94800, Villejuif, France
| | - Anne-Paule Gimenez-Roqueplo
- Département de Médecine Génomique des Tumeurs et Cancers/UF Oncogénétique Tumeurs et Cancers Rares, AP-HP, Hôpital européen Georges Pompidou, F-75015, Paris, France.
- Réseau National pour Cancers Rares de l'Adulte PREDIR labellisé par l'Institut National du Cancer (INCa), AP-HP, Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France.
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France.
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20
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Schönbach EM, Trichonas G. JUXTAPAPILLARY CAPILLARY RETINAL ANGIOMA AND EPIRETINAL MEMBRANE MANAGEMENT IN A MONOCULAR PATIENT WITH VON HIPPEL-LINDAU SYNDROME. Retin Cases Brief Rep 2022; 16:520-522. [PMID: 32541428 DOI: 10.1097/icb.0000000000001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To report a case of von Hippel-Lindau syndrome in a monocular patient with progressive vision loss due to a juxtapapillary capillary retinal angioma and an epiretinal membrane (ERM) formation. PATIENT We describe a 37-year-old white male patient with von Hippel-Lindau syndrome who presented for retinal evaluation. The right eye was blind with no light perception vision. The left eye had a best-corrected visual acuity of 20/30 and exhibited a peripheral capillary hemangioblastoma at 12 o'clock and a juxtapapillary capillary hemangioma with an ERM covering the fovea. The patient underwent two sessions of fluorescein-potentiated argon laser treatment to the peripheral capillary hemangioblastoma with initial stabilization of vision. After 18 months of follow-up, the ERM contracted causing decline in vision to 20/50. Intravitreal injection of bevacizumab was given without improvement in vision or distortion. Twenty-five-gauge pars plana vitrectomy with ERM peeling and internal limiting membrane removal was performed with immediate improvement in vision and distortion. CONCLUSION This case suggests that pars plana vitrectomy is a reasonable treatment option for vision loss due to a juxtapapillary capillary retinal angioma and ERM formation.
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Affiliation(s)
- Etienne M Schönbach
- Department of Ophthalmology, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio
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21
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Fujii Y, Nishisho T, Tezuka F, Iwanami A, Yamashita K, Toki S, Morimoto M, Sugiura K, Sakai T, Maeda T, Sairyo K. Hemangioblastoma of the Cauda Equina : A Case Report and Review of the Literature. J Med Invest 2022; 69:312-315. [PMID: 36244787 DOI: 10.2152/jmi.69.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Introduction : Hemangioblastoma in the spine mainly occurs at the cervical and thoracic levels and is often associated with von Hippel-Lindau (VHL) syndrome. Here, we reported a quite rare case of spinal sporadic hemangioblastoma arising from the cauda equina. Case presentation : A 66-year-old woman presented with a 5-year history of low back and leg pain. Imaging revealed a hypervascular intradural extramedullary tumor in the lumbar region. Preoperative angiography helped to identify the feeding arteries and draining vein, and so facilitated subsequent tumor resection. The pain was dramatically improved but weakness of the left tibialis anterior and left extensor hallucis longus muscles persisted. Discussion : We reported a rare case of spinal hemangioblastoma arising from the cauda equina. Preoperative angiography may be useful for diagnosis and understanding of the anatomy of feeding veins. J. Med. Invest. 69 : 312-315, August, 2022.
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Affiliation(s)
- Yugen Fujii
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Toshihiko Nishisho
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Akio Iwanami
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
- Department of Orthopaedic Surgery, Spine Center, Koga Hospital, Koga, Ibaraki, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Shunichi Toki
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Masatoshi Morimoto
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Kosuke Sugiura
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Toru Maeda
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
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22
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Bolaños GA, Raimondo M, Corral JE. Pancreatic Cysts in Von Hippel-Lindau. J Gen Intern Med 2022; 37:241. [PMID: 34704208 PMCID: PMC8738799 DOI: 10.1007/s11606-021-07202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 10/04/2021] [Indexed: 01/03/2023]
Affiliation(s)
| | - Massimo Raimondo
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL USA
| | - Juan E. Corral
- Division of Gastroenterology and Hepatology, Presbyterian Healthcare Services, Albuquerque, NM USA
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23
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Ahmad S, Naber MR, Giles RH, Valk GD, van Leeuwaarde RS. Diagnostic and management strategies for pNETs in Von Hippel-Lindau: a systematic review. Endocr Relat Cancer 2021; 28:151-160. [PMID: 33512331 DOI: 10.1530/erc-20-0469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/15/2021] [Indexed: 11/08/2022]
Abstract
Pancreatic neuroendocrine tumors (pNETs) in Von Hippel-Lindau (VHL) disease have a relatively good prognosis. However, a subset of pNETs metastasize and significantly contribute to VHL-related mortality. Evidence-based guidelines are needed for timely detection, management and intervention of these tumors. However, the value of several diagnostic tools is controversial, and evidence-based management strategies are lacking. This systematic review aims to update current literature on diagnostic and management strategies of pNETs in VHL and proposes evidence-based recommendations. The databases of PubMed/Medline, Embase and Web of Science were systematically searched to identify relevant studies. Studies were screened independently and cross-checked by two authors to assess eligibility for inclusion. Eighty-four articles were eligible for full text reading, and thirteen were critically appraised using the modified Quality Assessment of Diagnostic Accuracy Studies or modified Quality in Prognostic Studies tool. Six studies assessed the diagnostic value of imaging modalities, five focused on the optimal timing for surgical intervention, and one article studied the growth rate of pNETs. Quality of the available evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluations tool. Studies recommended CT or MRI as the primary screening modalities for pNETs. For detection of metastases, 68Gallium-DOTATATE/TOC PET/CT is advised. For pNETs <2 cm a watch-and-wait approach is recommended, while for pNETs ≥2.5 cm surgical resection is advised. Due to limited data, no strong recommendations on surveillance could be proposed.
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Affiliation(s)
- Saya Ahmad
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Myrthe R Naber
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rachel S van Leeuwaarde
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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24
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Strowd RE, Plotkin SR. Familial Nervous System Tumor Syndromes. ACTA ACUST UNITED AC 2020; 26:1523-1552. [PMID: 33273171 DOI: 10.1212/con.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Although sporadic primary neoplasms account for the majority of nervous system tumors, familial nervous system tumor syndromes are important and clinically relevant conditions for the neurologist to understand. This article reviews common inherited nervous system tumor syndromes including neurofibromatosis type 1, neurofibromatosis type 2, schwannomatosis, tuberous sclerosis complex, and von Hippel-Lindau syndrome. The epidemiology, genetics, approach to diagnosis, neurologic and nonneurologic manifestations, and management options are reviewed. RECENT FINDINGS Awareness of the more common and clinically relevant familial nervous system tumor syndromes is important. These conditions teach us about the underlying biology that drives tumor development in the central and peripheral nervous systems including peripheral nerve sheath tumors (eg, neurofibroma, schwannoma), meningioma, vestibular schwannoma, subependymal giant cell astrocytoma, and hemangioblastoma. Knowledge of the clinical manifestations ensures that the neurologist will be able to diagnose these conditions, recommend appropriate surveillance, refer to specialists, and support optimal management. Important discoveries in the role of the underlying genetics have contributed to the launch of several novel drug trials for these tumors, which are changing therapeutic options for patients. SUMMARY Familial nervous system tumor syndromes are uncommon conditions that require specialized surveillance and management strategies. Coordination across a multidisciplinary team that includes neurologists, neuro-oncologists, radiologists, neurosurgeons, radiation oncologists, otolaryngologists, pathologists, neuropsychologists, physical medicine and rehabilitation specialists, and geneticists is necessary for the optimal treatment of these patients.
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25
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Anderson S. Volatile Hypertensive Crisis Secondary to Pheochromocytoma: A Case Report of von Hippel-Lindau Syndrome. J Pediatr Health Care 2020; 34:264-272. [PMID: 32143938 DOI: 10.1016/j.pedhc.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/24/2019] [Accepted: 01/09/2020] [Indexed: 11/29/2022]
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26
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Patel D, Phay JE, Yen TWF, Dickson PV, Wang TS, Garcia R, Yang AD, Solórzano CC, Kim LT. Update on Pheochromocytoma and Paraganglioma from the SSO Endocrine/Head and Neck Disease-Site Work Group. Part 1 of 2: Advances in Pathogenesis and Diagnosis of Pheochromocytoma and Paraganglioma. Ann Surg Oncol 2020; 27:1329-1337. [PMID: 32112212 PMCID: PMC8655649 DOI: 10.1245/s10434-020-08220-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Indexed: 08/02/2023]
Abstract
This first part of a two-part review of pheochromocytoma and paragangliomas (PPGLs) addresses clinical presentation, diagnosis, management, treatment, and outcomes. In this first part, the epidemiology, prevalence, genetic etiology, clinical presentation, and biochemical and radiologic workup are discussed. In particular, recent advances in the genetics underlying PPGLs and the recommendation for genetic testing of all patients with PPGL are emphasized. Finally, the newer imaging methods for evaluating of PPGLs are discussed and highlighted.
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Affiliation(s)
- Dhaval Patel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - John E Phay
- Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Tina W F Yen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paxton V Dickson
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Roberto Garcia
- Division of Surgical Oncology, National Cancer Institute of Panama/Paitilla Medical Center, Panama City, Panama
| | - Anthony D Yang
- Division of Surgical Oncology, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carmen C Solórzano
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University, Nashville, TN, USA
| | - Lawrence T Kim
- Division of Surgical Oncology and Endocrine Surgery, University of North Carolina, Chapel Hill, NC, USA
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Carlo MI, Hakimi AA, Stewart GD, Bratslavsky G, Brugarolas J, Chen YB, Linehan WM, Maher ER, Merino MJ, Offit K, Reuter VE, Shuch B, Coleman JA. Familial Kidney Cancer: Implications of New Syndromes and Molecular Insights. Eur Urol 2019; 76:754-764. [PMID: 31326218 PMCID: PMC7673107 DOI: 10.1016/j.eururo.2019.06.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/12/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT Hereditary cases account for about 5% of all cases of renal cell carcinoma (RCC). With advances in next-generation sequencing, several new hereditary syndromes have been described in the last few years. OBJECTIVE To review and summarise the recent preclinical and clinical literature in hereditary renal cancer. EVIDENCE ACQUISITION A systematic review of the literature was performed in November 2018 using PubMed and OMIM databases, with an emphasis on kidney cancer, genetics and genomics, clinical criteria, and management. EVIDENCE SYNTHESIS Several autosomal dominant hereditary RCC syndromes have been described, including those related to germline pathogenic variants in VHL, MET, FH, TSC1/TSC2, FLCN, SDHA/B/C/D, BAP1, CDC73, and MITF. Clinical spectrum of SDH, BAP1, and MITF is still being defined, although these appear to be associated with a lower incidence of RCC. FH and likely BAP1 RCC are associated with more aggressive disease. Preclinical and clinical studies show that using systemic therapy that exploits specific genetic pathways is a promising strategy. CONCLUSIONS There are several well-described hereditary RCC syndromes, as well as recently identified ones, for which the full clinical spectrum is yet to be defined. In the new era of precision medicine, identification of these syndromes may play an important role in management and systemic treatment selection. PATIENT SUMMARY This review covers updates in the diagnosis and management of familial kidney cancer syndromes. We describe updates in testing and management of the most common syndromes such as von Hippel-Lindau, and hereditary leiomyomatosis and renal cell carcinoma. We also provide insights into recently described familial kidney cancer syndromes.
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Affiliation(s)
- Maria I Carlo
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - A Ari Hakimi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | | | | | - Ying-Bei Chen
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - W Marston Linehan
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eamonn R Maher
- Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre, and Cancer Research UK Cambridge Cenre, Cambridge, UK
| | - Maria J Merino
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Brian Shuch
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Thanos A, Ozturk T, Faia LJ, Capone A. Spontaneous Hyaloidal Contraction and Complex Retinal Detachment in a Patient With Von Hippel-Lindau Syndrome. Ophthalmic Surg Lasers Imaging Retina 2019; 50:238-241. [PMID: 30998246 DOI: 10.3928/23258160-20190401-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/02/2018] [Indexed: 11/20/2022]
Abstract
The authors present an interventional case report of a patient with von Hippel-Lindau (VHL) syndrome who developed simultaneous exudative and combined tractional, rhegmatogenous, and exudative retinal detachment (RD) in the right and left eyes, respectively, following uneventful cryotherapy application of retinal capillary hemangioblastoma (RCH). After pars plana vitrectomy combined with encircling scleral buckling with radial element placement and silicone oil injection, complete retinal reattachment was achieved. The exudative RD of the fellow eye was managed initially with intense topical corticosteroid treatment and subsequent placement of a radial scleral buckle due to the presence of clinically apparent traction. Both eyes remained stable after successful surgical interventions, and long-term follow-up revealed no evidence of recurrent disease. The authors conclude that rapid worsening of vitreoretinal traction and exudation are complications that can occur after treatment of RCH in patients with VHL syndrome leading to complex retinal detachments. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:238-241.].
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Sussman I. 65 YEARS OF THE DOUBLE HELIX: Could Watson and Crick have envisioned the true impact of their discovery? Endocr Relat Cancer 2018; 25:E9-E11. [PMID: 29980643 DOI: 10.1530/erc-18-0156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 11/08/2022]
Abstract
Landmark scientific findings are applauded. However, at the time of discovery, the future impact that these types of new knowledge might have on patients is not foreseen. This article discusses how unraveling the structure of DNA has advanced medical treatment, particularly for patients with rare diseases. In addition, each new scientific discovery brings with it the emotion of hope for improved diagnosis and treatment, as well as enhanced outcomes and increased longevity for patients facing a life-long disease.
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Mendenhall WM, Suárez C, Skálová A, Strojan P, Triantafyllou A, Devaney KO, Williams MD, Rinaldo A, Ferlito A. Current Treatment of Endolymphatic Sac Tumor of the Temporal Bone. Adv Ther 2018; 35:887-898. [PMID: 29923043 DOI: 10.1007/s12325-018-0730-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Indexed: 01/10/2023]
Abstract
An endolymphatic sac tumor (ELST) is a rare, indolent but locally aggressive tumor arising in the posterior petrous ridge. Patients present with sensorineural hearing loss and tinnitus. As the tumor progresses, patients may experience vertigo, ataxia, facial nerve paresis, pain and otorrhea. Most patients present in their 4th or 5th decade with a wide age range. Patients with von Hippel-Lindau disease have an increased likelihood of developing ELST. Histologically, ELST is a low-grade adenocarcinoma. As it progresses, it destroys bone and extends into adjacent tissues. The likelihood of regional or distant metastases is remote. The optimal treatment is resection with negative margins. Patients with positive margins, gross residual disease, or unresectable tumor are treated with radiotherapy or radiosurgery. Late recurrences are common, so long follow-up is necessary to assess efficacy. The likelihood of cure depends on tumor extent and is probably in the range of 50-75%.
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Affiliation(s)
- William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Carlos Suárez
- Instituto de Investigacion Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Alena Skálová
- Department of Pathology, Faculty of Medicine in Plzen, Charles University in Prague, Plzeň, Czech Republic
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Asterios Triantafyllou
- Department of Pathology, Liverpool Clinical Laboratories, University of Liverpool, Liverpool, UK
| | | | - Michelle D Williams
- Department of Pathology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Raboudi M, Khiari R, Dridi M, Taktak T, Ghozzi S, Ben Rais N. Von hippel lindau disease revealed by bilateral renal tumor. Tunis Med 2018; 96:462-464. [PMID: 30430496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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32
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Figlus M, Kaczorowska B, Jaskólski DJ, Kępczyński Ł. [Von Hippel-Lindau syndrome - a case report]. Pol Merkur Lekarski 2018; 44:248-252. [PMID: 29813043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Von Hippel-Lindau disease (vHL, familial cerebello-retinal angiomatosis) is a rare genetic autosomal dominant disorder associated with predisposition to vascular tumors. Mutations of VHL tumor suppressor gene, located on chromosome 3p25-26, are responsible for clinical manifestation of the disease. The VHL gene product encodes VHL protein, which is responsible for HIF-1 (hypoxia-inducible factor-1) dependent cell cycle regulation and cellular pathways mediated by VEGF, PDGF, TGF-α, EPO. The mechanism substantiates the hypoxia dependent vascular tumor growth caused by loss of wild-type VHL protein. The clinical spectrum of vHL syndrome includes multiple tumors of various localization and low histologic grade, often bilateral. The most typical for the syndrome are: hemangioblastoma of central nervous system (typically posterior fossa or medulla), retinal hemangioblastoma, renal cell carcinoma and pheochromocytoma. The aim of the case report is to remind the typical clinical manifestation of von Hippel- Lindau syndrome, update the diagnostic criteria, recommended diagnostic and follow up methods.
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Affiliation(s)
- Małgorzata Figlus
- Department of Neurology and Stroke, Medical University of Lodz, University Clinical Hospital, Lodz, Poland
| | - Beata Kaczorowska
- Department of Neurology and Stroke, Medical University of Lodz, University Clinical Hospital, Lodz, Poland
| | - Dariusz J Jaskólski
- Department of Neurosurgery and Neurooncology, Medical University of Lodz, University Hospital, Lodz, Poland
| | - Łukasz Kępczyński
- Molecular Biology Unit, Department of Internal Diseases and Nephrodiabetology, Medical University of Lodz, University Clinical Hospital , Lodz, Poland
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Abstract
Hemangioblastomas are rare vascularized central nervous system tumors, which can occur sporadically or be associated with von Hippel Lindau Syndrome. The pathogenesis of hemangioblastomas in von Hippel Lindau Syndrome is proposed to involve a pseudohypoxic intracellular state induced by dysregulation of hypoxia inducible factor alpha due to the absence of von Hippel Lindau protein complex mediated destruction. Dysregulation of fumarate hydratase, a tricarboxylic acid cycle enzyme, occurs in Hereditary Leiomyomatosis and Renal Cell Cancer Syndrome due to germline fumarate hydratase gene mutations, and also results in oncogenesis via hypoxia inducible factor alpha dysregulation. We present a case study of hemangioblastoma occurrence in a Hereditary Leiomyomatosis and Renal Cell Cancer Syndrome patient and propose it as possible evidence of a phenotypic overlap between von Hippel Lindau and Hereditary Leiomyomatosis and Renal Cell Cancer Syndromes due to their overlapping role in the biochemical regulation of hypoxia inducible factor alpha.
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Affiliation(s)
- Eryn Dow
- Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Australia.
| | - Ingrid M Winship
- Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
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Campos Polo R, Rubio Sánchez C, García Guisado DM, Díaz Luque MJ. BIlateral juxtapapillary retinal capillary haemangioma: Usefulness of aflibercept in the management of its complications. Arch Soc Esp Oftalmol 2017; 92:477-480. [PMID: 28651811 DOI: 10.1016/j.oftal.2016.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 12/17/2016] [Accepted: 12/27/2016] [Indexed: 06/07/2023]
Abstract
CASE REPORT A 45 year-old man with a history of adrenal phaeochromocytoma presented with a subretinal juxtapapillary haemorrhage on his left eye and a small asymptomatic vascular tumour in the contralateral eye. With the mentioned findings, the patient was diagnosed with bilateral retinal capillary haemangioma in the context of a von Hippel Lindau disease. Intravitreal aflibercept was prescribed, with a good outcome of the disease. DISCUSSION Many treatments have been proposed for the management of juxtapapillary retinal capillary haemangioma with variable results. Intravitreal aflibercept can be a useful treatment with a good safety profile.
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Affiliation(s)
- R Campos Polo
- Servicio de Oftalmología, Hospital Virgen del Puerto, Plasencia (Cáceres), España.
| | - C Rubio Sánchez
- Servicio de Oftalmología, Hospital Virgen del Puerto, Plasencia (Cáceres), España
| | - D M García Guisado
- Servicio de Oftalmología, Hospital Virgen del Puerto, Plasencia (Cáceres), España
| | - M J Díaz Luque
- Servicio de Oftalmología, Hospital Virgen del Puerto, Plasencia (Cáceres), España
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Koniusz J, Dąbkowski K, Buczek K, Gomółka A, Starzyńska T. [Gastroenterological manifestations of von Hippel-Lindau disease - a case report]. Pol Merkur Lekarski 2017; 43:66-68. [PMID: 28875972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Gastrointestinal organs are involved in the course of von Hippel Lindau disease. Typically pancreas in von Hippel Lindau syndrome is a site of cystic and solid tumors. Differential diagnosis of pancreatic lesions includes benign lesions (cysts, serous cystic adenomas), potentially malignant (neuroendocrine) and malignant tumors(metastases).In this work we present a patient with VHL syndrome with pancreatic cysts and neuroendocrine tumor.
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Affiliation(s)
- Joanna Koniusz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland; Department of General, Vascular and Transplantation Surgery, Marie Curie Hospital, Szczecin, Poland
| | - Krzysztof Dąbkowski
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Buczek
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Aleksandra Gomółka
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Teresa Starzyńska
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
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Koniusz J, Dąbkowski K, Buczek K, Gomółka A, Starzyńska T. [Gastroenterological manifestations of von Hippel-Lindau disease]. Pol Merkur Lekarski 2017; 43:53-55. [PMID: 28875969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Von Hippel-Lindau disease is rare autosomal dominant disorder that results from mutation of VHL gene. Typical manifestations of this syndrome include haemangioblastomas of retina, cerebellum and spinal cord, endolymphatic sac tumors, clear cell cancer and kidney cysts, pheochromocytoma, pancreatic cysts and neuroendocrine tumors. The differential diagnosis of pancreatic lesions in patients with von Hippel Lindau syndrome plays an important role. The pancreas in VHL disease is not only site of benign lesions (cysts, serous systic adenomas) but also of potentially malignant (neuroendocrine) and malignant tumors(metastases).The gastroenterological manifestations can be the first symptoms of von Hippel-Lindau disease.
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Affiliation(s)
- Joanna Koniusz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland; Department of General, Vascular and Transplantation Surgery, Marie Curie Hospital, Szczecin, Poland
| | - Krzysztof Dąbkowski
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Buczek
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Aleksandra Gomółka
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Teresa Starzyńska
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
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Elborgy E, Pulido JS. Posterior Pole and Peripheral Retinal Fibrovascular Proliferation in von Hippel Lindau Disease. Asia Pac J Ophthalmol (Phila) 2017; 6:256-260. [PMID: 28558182 DOI: 10.22608/apo.2016205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/17/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To report the occurrence of fibrovascular proliferation (FVP) in the retina in von Hippel-lindau (VHl) patients and its association with prior treatment. DESIGN A retrospective study. METHODS A retrospective study of 101 VHL patients. Fundus photos were available for 28 patients. FVP was classified into peripheral and posterior pole. RESULTS All 28 patients had retinal capillary hemangioblastomas (RCH) in 1 or both eyes; 15 patients were found to have FVP (group A), whereas 13 patients did not (group B). Mean age of patients in group A was 35 ± 11.3 years and 36.6 ± 13.8 in group B (P = 0.74). In group A, 27 eyes had RCH; 21 (77.77%) had FVP. In group B, 19 eyes had RCH. The number of treated eyes was significantly higher in group A (81.48%) than group B (42.1%) (P = 0.007). In group A, FVP was noted in the posterior pole in 9 eyes, in the periphery in 5 eyes, and 7 eyes developed both posterior pole and peripheral FVP. CONCLUSIONS FVP can occur in the peripheral retina and in the posterior pole. There is a significant association between prior treatment of RCH and the occurrence of FVP.
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Affiliation(s)
- Ebrahim Elborgy
- Research Institute of Ophthalmology, Giza, Egypt
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
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Abstract
RATIONALE Von Hippel-Lindau (VHL) disease is a rare inherited, autosomal-dominant syndrome caused by heterozygous germline mutations in the VHL gene. VHL patients are prone to develop benign and malignant tumors and cysts in multiple organ systems involving kidneys, pancreas and central nervous system (CNS). The varied and complex clinical manifestations and radiological findings of VHL are of interest. PATIENT CONCERNS We report a 38-year-old woman with a ten-year history of VHL disease involving both pancreas and biliary system. To the best of our knowledge, direct involvement of the biliary system in VHL disease has never been reported. DIAGNOSES The diagnosis was established via computed tomography scan and was confirmed by genetic testing. INTERVENTIONS The patient chose to receive conservative treatment and was followed up by magnetic resonance cholangiopancreatography and magnetic resonance imaging examination. OUTCOMES Renal angiomas and cysts were found during follow-up and there were no evidence of malignant change of the pancreas and biliary system. LESSONS We described the first case of VHL-associated choledochal cysts and may present new visceral manifestations of VHL disease. Gastroenterologists should be aware of the clinical presentations of this rare disease for early detection of its life-threatening manifestations.
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Affiliation(s)
- Xu-Ting Zhi
- Department of General Surgery, Qilu Hospital, Shandong University
| | - Qi-Yu Bo
- Department of Operating Room, Qilu Hospital, Shandong University
| | - Feng Zhao
- Department of General Surgery, Qihe County Hospital of Traditional Chinese Medicine, Jinan, China
| | - Dong Sun
- Department of General Surgery, Qilu Hospital, Shandong University
| | - Tao Li
- Department of General Surgery, Qilu Hospital, Shandong University
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Kakkar A, Sharma MC, Yadav R, Panwar R, Mathur SR, Iyer VK, Sahni P. Pancreatic mixed serous neuroendocrine neoplasm with clear cells leading to diagnosis of von Hippel Lindau disease. Pathol Res Pract 2016; 212:747-50. [PMID: 27161305 DOI: 10.1016/j.prp.2016.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/22/2016] [Accepted: 04/26/2016] [Indexed: 02/08/2023]
Abstract
Mixed serous neuroendocrine neoplasms are extremely rare tumors that are usually seen in female patients and are often associated with von Hippel Lindau (VHL) disease. We describe the case of a 38-year-old male who presented with complaints of anorexia, weight loss, and abdominal pain. CT abdomen showed a mass in the head of the pancreas, multiple small nodules in the body of pancreas, and bilateral adrenal masses. Fine needle aspiration cytology (FNAC) from the mass showed features of a neuroendocrine tumor, with many of the cells demonstrating abundant clear cytoplasm. Histopathological examination of the pancreaticoduodenectomy specimen showed a mixed serous neuroendocrine neoplasm with two components viz. serous cystadenoma and neuroendocrine tumor (NET) World Health Organization (WHO) grade 2. In addition, he was diagnosed to have bilateral pheochromocytomas and a paraganglioma. The synchronicity of these tumors suggested the possibility of VHL disease. Thus, identification of a NET with clear cells or of a mixed serous neuroendocrine neoplasm should raise suspicion of VHL disease. In a mixed tumor, FNAC may identify only one of the two components. Thorough processing of all pancreatic serous tumors for pathological examination is recommended, as NET may occur as a small nodule within the serous cystadenoma.
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Affiliation(s)
- Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Rajni Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rajesh Panwar
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sandeep R Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Venkateswaran K Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Peush Sahni
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
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Páleníková P, Adamcová M, Šturdík I, Ftáčniková B, Copáková L, Payer J. [Von Hippel-Lindau syndrome - two sides of the same coin]. Vnitr Lek 2016; 62:1004-1008. [PMID: 28139130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Von Hippel-Lindau syndrome (VHL) is a rare genetic disease. Its incidence is 1 : 36,000, there is the familial occurrence in 80 % of cases , the remaining cases are de novo mutations. The disease is caused by the highly penetrant mutations in the VHL gene (3p25.3) and is characterized by the occurrence of benign and malignant neoplasms. The most common VHL tumors are the tumors of the retina, brain and spinal hemangioblastomas, renal cell carcinoma, pheochromocytoma, endolymfatic sac tumors and pancreatic tumors and cysts. The mean age of the VHL patients during the diagnosis is 20-40 years. The diagnosis can be confirmed by a positive family history and the presence of one of the typical tumor. In case of no family history, the diagnosis has to be assessed by the presence of the multiple tumors. The clinical signs and prognosis of VHL depend on the location and extent of the tumors. The life expectancy is 50 years. The most common causes of death are complications of the renal cancer and the brain tumors. The treatment requires a multidisciplinary collaboration through the whole life of patients. This 2 cases report we demonstrate the differences among the patients with de novo mutations disease and the patient with familial incidence.Key words: pheochromocytoma - renal cell carcinoma - von Hippel-Lindau syndrome.
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41
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Bočková E, Pánková S. [Hemangioblastoma cerebellum during pregnancy]. Ceska Gynekol 2016; 81:295-299. [PMID: 27882753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Authors describe a case of woman in the age of 27 years, 36th+0 week of pregnancy, who was hospitalized for headache and vomittin. Magnestic resonance showed the cystic expansion in the left hemisphere of cerebellum with the overpressure in the IV. ventricle and wiht the beginning obstructive hydrocephalus. STUDY TYPE Case report. SETTING Hospital of Uherské Hradiště, Inc., Gynecology and Maternity Department. METHOD Own observation.
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Divers R, Wellbery C. Family History, Social Media, and a Diagnostic Surprise. Am Fam Physician 2015; 92:980. [PMID: 26760412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Junaid M, Ur Rashid M, Afsheen A, Tahir A, Ahmad M, Kalsoom A. VON HIPPEL LINDAU SYNDROME AND SURVEILLANCE: A FIVE YEAR FOLLOW UP CASE REPORT. J Ayub Med Coll Abbottabad 2015; 27:930-932. [PMID: 27004355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Von Hipple Lindau disease is a rare genetic autosomal dominant disorder, characterized by formation of tumors and fluid-filled cysts (sacs) in multiple organs of the body, which also carry a potential for malignancy. We are reporting a case of a young 20 years old female who presented to our department with von Hipple Lindau disease.
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Lou LH, Shen H, Lin J, Yan YW, Peng Y, Lu JH, Xu Q, Jiang HQ. T-cell lymphoma with von Hippel-Lindau disease: a rare case report and review of literature. Int J Clin Exp Pathol 2015; 8:5837-5843. [PMID: 26191306 PMCID: PMC4503177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/26/2015] [Indexed: 06/04/2023]
Abstract
von Hippel-Lindau disease (VHLD) comprises a series of complicated clinical manifestations. We hereby described a unique case of co-existing T-cell lymphoma (TCL) and confirmed VHLD. The symptoms in this 42-year-old male included fever and pancytopenia. Overall tests and examination made an infectious process unlikely. The results of bone marrow biopsy confirmed the diagnosis. The purposes we described this case were to probe into the relationship between TCL and VHLD, which was not mentioned in previously literature. Combination of clinical, radiological, immunophenotypic, pathological, and genetic data plays an important role in improving the rate of diagnosis, particularly in the challenge for diagnosis of T cell non-Hodgkin lymphoma.
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Affiliation(s)
- Li-Hong Lou
- International Medical Care Center, Shanghai General Hospital, Shanghai Jiao Tong University Shanghai 200080, China
| | - Hua Shen
- International Medical Care Center, Shanghai General Hospital, Shanghai Jiao Tong University Shanghai 200080, China
| | - Jun Lin
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University Shanghai 200080, China
| | - Yi-Wen Yan
- International Medical Care Center, Shanghai General Hospital, Shanghai Jiao Tong University Shanghai 200080, China
| | - Yan Peng
- International Medical Care Center, Shanghai General Hospital, Shanghai Jiao Tong University Shanghai 200080, China
| | - Jian-Hong Lu
- International Medical Care Center, Shanghai General Hospital, Shanghai Jiao Tong University Shanghai 200080, China
| | - Qu Xu
- International Medical Care Center, Shanghai General Hospital, Shanghai Jiao Tong University Shanghai 200080, China
| | - Hai-Qiong Jiang
- International Medical Care Center, Shanghai General Hospital, Shanghai Jiao Tong University Shanghai 200080, China
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Zhang M, Wang J, Jiang J, Zhan X, Ling Y, Lu Z, Guo J, Gao X. Von Hippel-Lindau disease type 2 in a Chinese family with a VHL p.W88X truncation. Endocrine 2015; 48:83-8. [PMID: 25069792 DOI: 10.1007/s12020-014-0368-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 07/16/2014] [Indexed: 12/18/2022]
Abstract
Von Hippel-Lindau (VHL) disease is an autosomal dominant syndrome caused by germline mutations in the synonymous VHL gene encoding a tumor suppressor. Affected individuals are susceptible to various benign and malignant tumors. Based on the phenotypes, VHL disease is classified as type 1 and type 2. Here, we describe a Chinese family diagnosed as VHL disease type 2, with different metabolic status of tumors on FDG PET-CT. Genetic analysis revealed a germline c.264G>A point mutation, resulting in premature termination at codon 88 (p.W88X). This pedigree represents a rare link between p.W88X nonsense mutation (genotype) and VHL disease type 2 (phenotype), which has not been previously described. This is also the first nonsense mutation to manifest as VHL disease type 2 in ethnic Chinese. We also reviewed the literature and provided an outline of mutations associated with VHL disease in China.
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Affiliation(s)
- Min Zhang
- Department of Endocrinology and Metabolism, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
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Gläsker S, Lonser RR, Okamoto H, Li J, Jaffee H, Oldfield EH, Zhuang Z, Vortmeyer AO. Proteomic profiling – A novel method for differential diagnosis? Cancer Biol Ther 2014; 6:343-5. [PMID: 17471020 DOI: 10.4161/cbt.6.3.3673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Tumors with identical phenotype can have markedly different biologic behavior. The differentiation between hemangioblastoma, a benign vascular brain tumor, and renal cell carcinoma (RCC), a malignant tumor that can metastasize to the brain, is a well-known pathological quandary. We report a 59-year-old female with von Hippel-Lindau disease and known RCC. She presented with a cystic cerebellar tumor that had typical MRI appearance of a hemangioblastoma. Progressive symptoms led to surgical intervention. The histology included features consistent with either hemangioblastoma with epitheloid phenotype or atypical RCC metastasis mimicking hemangioblastoma. The discrepancy between the benign clinical course and the histologic phenotype could not be clearly resolved using conventional clinical techniques. We used proteomic profiling to clarify this diagnostic dilemma. We compared the proteomic expression pattern of the unknown lesion with the patterns of three typical hemangioblastomas and three typical RCCs by using selective tissue microdissection combined with two-dimensional proteomic profiling and protein sequencing. The results clearly indicated a protein profile consistent with RCC. Proteomics may complement pathological evaluation and characterization of tumors in the future. Furthermore, these results show that metastasis of malignant RCC is not necessarily equivalent to aggressive growth patterns.
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Affiliation(s)
- Sven Gläsker
- Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Zhang C, Yang AI, Vasconcelos L, Moon S, Yang C, Nesvick CL, Saidkhodjaeva L, Abdullaev Z, Pack SD, Ghosh A, Chittiboina P, Heiss JD, Zhuang Z, Quezado MM, Zaghloul KA. Von hippel-lindau disease associated pulmonary carcinoid with cranial metastasis. J Clin Endocrinol Metab 2014; 99:2633-6. [PMID: 24878057 PMCID: PMC4121022 DOI: 10.1210/jc.2014-1732] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT Carcinoids have rarely been described in von Hippel-Lindau (VHL) disease. OBJECTIVE We describe the first reported case of a patient with VHL who developed a pulmonary carcinoid that subsequently metastasized to a pre-existent cranial hemangioblastoma. RESULTS Histological and immunohistochemical features of the metastatic lesion were similar to the primary carcinoid. Both lesions demonstrated heterozygous VHL gene deletions with fluorescence in situ hybridization analysis. CONCLUSIONS This case provides direct molecular genetic evidence of an association between VHL and carcinoids.
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Affiliation(s)
- Chao Zhang
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke (C.Z., A.I.Y., C.Y., C.L.N., P.C., J.D.H., Z.Z., K.A.Z.), and Laboratory of Pathology, National Cancer Institute (L.V., S.M., L.S., Z.A., S.D.P., A.G., M.M.Q.), National Institutes of Health, Bethesda, Maryland 20892; and Department of Orthopedics (C.Z.), Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, China
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Yang X, Liu XS, Fang Y, Zhang XH, Zhang YK. Endolymphatic sac tumor with von Hippel-Lindau disease: report of a case with atypical pathology of endolymphatic sac tumor. Int J Clin Exp Pathol 2014; 7:2609-2614. [PMID: 24966975 PMCID: PMC4069932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 03/25/2014] [Indexed: 06/03/2023]
Abstract
The authors described a case of a patient with co-existing endolymphatic sac tumor (ELST) and hemangioblastoma in the posterior cranial fossa, which belonged to a subtype of Von Hippel-Lindau (VHL) disease confirmed by the test of VHL-gene. The signs in this 42-year-old female included intermittent headache and dizziness. Imaging revealed a giant mass in the right cerebellopontine angle (CPA) region and another lesion in the left cerebellar hemisphere. The results of biopsy after two operations confirmed the diagnosis respectively. Both of the tumors were resected totally. Nevertheless, we had to confess the misdiagnosis as vascular tumor instead of ELST at the initial diagnosis because of the rarity of ELST associated with atypical histological characteristics. The purposes we reported this case were to describe the atypical pathological feature of ELST and the mutation of germline VHL not mentioned in previously literature, furthermore, to foster understanding of ELSTs with the avoidance of the similar misdiagnosis as far as possible in future.
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Affiliation(s)
- Xiang Yang
- Department of Neurosurgery, West China Hospital of Sichuan University No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Xue-Song Liu
- Department of Neurosurgery, West China Hospital of Sichuan University No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Yuan Fang
- Department of Neurosurgery, West China Hospital of Sichuan University No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Xiu-Hui Zhang
- Department of Pathology, West China Hospital of Sichuan University No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Yue-Kang Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China
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O' Brien FJ, Danapal M, Jairam S, Lalani AK, Cunningham J, Morrin M, McNally S, Donovan MG, Little D, Tuthill A, Conlon PJ. Manifestations of Von Hippel Lindau syndrome: a retrospective national review. QJM 2014; 107:291-6. [PMID: 24352051 DOI: 10.1093/qjmed/hct249] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Von Hippel Lindau (VHL) disease is a syndrome that is defined by variety of tumours such as cerebellar haemangioblastomas, renal cell carcinomas, phaeochromocytomas, pancreatic adenomas and ear, nose and throat (ENT) adenomas. This disease is often genetic and inherited in an autosomal dominant fashion, and can present in childhood, adolescence or adult life. This study describes the presentation, natural history and manifestations of patients attending our institutions with this condition. We aim to highlight the importance of screening in diagnosing the manifestations of VHL. METHODS A retrospective review was performed on all patients diagnosed with VHL and coded as such by the national Hospital Inpatient Enquiry Scheme at Beaumont Hospital Dublin and Cork University Hospital. This was performed over a 20 years period between 1989 and 2009. Age, sex, mode of presentation, presence or absence of end stage kidney disease and genotype were documented. Presence or absence of the characteristic tumours of VHL was also recorded, as were the initial presenting features of these tumours. RESULTS Thirty-six patients were diagnosed with VHL. These patients ranged from 18 to 78 years old. Three patients were members of the Irish travelling community. The most frequent mode of presentation was altered neurological signs (40%), with a significant proportion presenting with haematuria (23%). Patients diagnosed prior to 1995 were more likely to have presented with significant complications of VHL, while those diagnosed after this time were more likely to have been diagnosed via screening. Genetic testing was performed on 17 patients; those who did not have genetic testing performed were more likely to have been diagnosed prior to the era of genetic testing. Thirty-one patients had received screening for complications of VHL including renal cell carcinomas, central nervous system (CNS) haemangioblastomas and phaeochromocytomas. The patients who did not receive any screening presented with neurological symptoms. CONCLUSION Beaumont Hospital Dublin and Cork University Hospital are tertiary referral centres for nephrology, urology and neurosurgery and deals with a significant proportion of patients diagnosed with VHL in Ireland. This study highlights the significant burden of this illness and emphasizes the importance of screening for these renal/CNS and ENT complications. This study also highlights the importance of family screening in diagnosing this condition.
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Affiliation(s)
- F J O' Brien
- Department of Nephrology, Beaumont Hospital, Dublin 9, Ireland.
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Hafidi Z, Handor H, Laghmari M, Naciri K, Belhadj O, Dadoudi R. [Optic disc traction associated with an hemangioblastoma in Von Hippel-Lindau disease]. J Fr Ophtalmol 2014; 37:426-7. [PMID: 24656692 DOI: 10.1016/j.jfo.2013.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 04/26/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Z Hafidi
- Service d'ophtalmologie A de l'hôpital des spécialités, université Mohammed V Souissi, centre hospitalier universitaire, hay irfane, Rabat, Maroc.
| | - H Handor
- Service d'ophtalmologie A de l'hôpital des spécialités, université Mohammed V Souissi, centre hospitalier universitaire, hay irfane, Rabat, Maroc
| | - M Laghmari
- Service d'ophtalmologie A de l'hôpital des spécialités, université Mohammed V Souissi, centre hospitalier universitaire, hay irfane, Rabat, Maroc
| | - K Naciri
- Service d'ophtalmologie A de l'hôpital des spécialités, université Mohammed V Souissi, centre hospitalier universitaire, hay irfane, Rabat, Maroc
| | - O Belhadj
- Service d'ophtalmologie A de l'hôpital des spécialités, université Mohammed V Souissi, centre hospitalier universitaire, hay irfane, Rabat, Maroc
| | - R Dadoudi
- Service d'ophtalmologie A de l'hôpital des spécialités, université Mohammed V Souissi, centre hospitalier universitaire, hay irfane, Rabat, Maroc
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