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Schuhmacher P, Kim E, Hahn F, Sekula P, Jilg CA, Leiber C, Neumann HP, Schultze-Seemann W, Walz G, Zschiedrich S. Growth characteristics and therapeutic decision markers in von Hippel-Lindau disease patients with renal cell carcinoma. Orphanet J Rare Dis 2019; 14:235. [PMID: 31661010 PMCID: PMC6819544 DOI: 10.1186/s13023-019-1206-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 09/21/2019] [Indexed: 11/19/2022] Open
Abstract
Background Von Hippel-Lindau (VHL) disease is a multi-systemic hereditary disease associated with several benign and malignant tumor entities, including clear cell renal cell carcinoma (ccRCC). Since ccRCCs grow slowly, nephron sparing surgery is typically performed at a tumor diameter of 3–4 cm before the tumor metastasizes. However, in the case of recurrent disease, repeated surgical intervention can impair renal function. Therefore, it is crucial to optimize the timing for surgical interventions through a better understanding of the growth kinetics of ccRCCs in VHL. We investigated tumor growth kinetics and modern volumetric assessment to guide future therapeutic decisions. Results The prevalence of ccRCC was 28% in a cohort of 510 VHL patients. Of 144 patients with ccRCC, 41 were followed with serial imaging which identified 102 renal tumors, which exhibited heterogeneous growth kinetics. ccRCCs grew at an average absolute growth rate of 0.287 cm/year, an average relative growth rate [(lnV1-lnV0)/(t1-t0)] of 0.42% and an average volume doubling time of 27.15 months. Women had a faster relative growth rate than men. Age and specific mutations did not influence tumor growth. Because of the tumor heterogeneity, we developed an additional cut-off volume of 40 cm3 for surgical intervention. Conclusions Tumor heterogeneity and differences in growth kinetics is suggestive of a state of transient tumor dormancy in ccRCCs of VHL patients. The relative growth rate has not been previously described in other studies. Volumetric assessment as an additional parameter for surgical intervention could be a useful clinical tool and needs further investigation.
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Affiliation(s)
- Patrick Schuhmacher
- Department of Nephrology and Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Emily Kim
- Department of Radiation Oncology, Medical Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Peggy Sekula
- Institute of Genetic Epidemiology, Medical Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cordula Annette Jilg
- Department of Urology, Medical Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Leiber
- Department of Urology, Medical Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hartmut P Neumann
- Department of Nephrology and Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Wolfgang Schultze-Seemann
- Department of Urology, Medical Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerd Walz
- Department of Nephrology and Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Stefan Zschiedrich
- Department of Nephrology and Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Solav S, Bhandari R. Fluorodeoxyglucose positron emission tomography-computed tomography scan in von Hippel-Lindau syndrome: A case report and review of literature. Indian J Nucl Med 2012; 27:119-21. [PMID: 23723586 PMCID: PMC3665139 DOI: 10.4103/0972-3919.110711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Von Hippel-Lindau (VHL) syndrome is a hereditary autosomal dominant disorder caused by defective tumor suppression gene at 3p25-p26. The gene for VHL disease is found on chromosome 3, and is inherited in a dominant fashion. The VHL gene is a tumor suppressor gene. This means that its role in a normal cell is to stop the uncontrolled growth and proliferation. It is characterized by abnormal growth of blood vessels. It strikes the eyes, central nervous system, kidneys, endocrine glands, etc. It predisposes the patient to retinal angiomas, central nervous system hemangioblastoma, renal cell carcinoma (RCC), pheochromocytomas, islet cell tumor of the pancreas, endolymphatic sac tumors, renal, pancreatic, epididymal cysts. We present a case of familial VHL syndrome whose Fluorine 18-fluorodeoxyglucose positron emission tomography-computed tomography scan was truly positive for adrenal pheochromocytoma but was falsely negative for RCC. Review of literature related to this entity is made.
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Affiliation(s)
- Shrikant Solav
- Spect Lab, Nuclear Medicine Services, Kothrud, Pune, Maharashtra, India
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Joly D, Méjean A, Corréas JM, Timsit MO, Verkarre V, Deveaux S, Landais P, Grünfeld JP, Richard S. Progress in Nephron Sparing Therapy for Renal Cell Carcinoma and von Hippel-Lindau Disease. J Urol 2011; 185:2056-60. [DOI: 10.1016/j.juro.2011.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Dominique Joly
- Faculté de Médicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut National de la Santé et de la Recherche Médicale U845, Hôpital Necker-Enfants Malades, Paris, France
- Centre de Référence Cancers Rares Institut National du Cancer, Prédispositions héréditaires au cancer du rein de l'adulte, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Arnaud Méjean
- Faculté de Médicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service d'Urologie, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence Cancers Rares Institut National du Cancer, Prédispositions héréditaires au cancer du rein de l'adulte, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Jean-Michel Corréas
- Faculté de Médicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Radiologie, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence Cancers Rares Institut National du Cancer, Prédispositions héréditaires au cancer du rein de l'adulte, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Marc-Olivier Timsit
- Faculté de Médicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service d'Urologie, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence Cancers Rares Institut National du Cancer, Prédispositions héréditaires au cancer du rein de l'adulte, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Virginie Verkarre
- Service d'Anatomie Pathologique, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence Cancers Rares Institut National du Cancer, Prédispositions héréditaires au cancer du rein de l'adulte, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Sophie Deveaux
- Centre de Référence Cancers Rares Institut National du Cancer, Prédispositions héréditaires au cancer du rein de l'adulte, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Paul Landais
- Faculté de Médicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Biostatistique (EA 4067), Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Pierre Grünfeld
- Faculté de Médicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Richard
- Faculté de Médicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence Cancers Rares Institut National du Cancer, Prédispositions héréditaires au cancer du rein de l'adulte, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
- Génétique Oncologique Ecole Pratique des Hautes Etudes, Institut National de la Santé et de la Recherche Médicale U753, Institut de cancérologie Gustave Roussy Villejuif, Le Kremlin-Bicêtre, France
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Kim WT, Ham WS, Ju HJ, Lee JS, Lee JS, Choi YD. Clinical characteristics of renal cell carcinoma in Korean patients with von Hippel-Lindau disease compared to sporadic bilateral or multifocal renal cell carcinoma. J Korean Med Sci 2009; 24:1145-9. [PMID: 19949673 PMCID: PMC2775865 DOI: 10.3346/jkms.2009.24.6.1145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 01/20/2009] [Indexed: 12/02/2022] Open
Abstract
This study was done to analyze the clinical characteristics of renal cell carcinoma (RCC) in Korean patients with von Hippel-Lindau (VHL) disease. Between January 1996 and July 2008, 1,514 patients were diagnosed with RCC and 24 patients were diagnosed with VHL disease at our institute. We analyzed the clinical characteristics of the 24 patients diagnosed with VHL. The mean age of patients with VHL was 39.2+/-12.6 yr; the mean age of patients with both VHL and RCC was 42.5+/-10.3 yr. Among the 24 patients with VHL, 7 patients had retinal angiomas, 11 had RCC, 16 had renal lesions, 18 had pancreatic lesions and 21 had cerebellar hemangioblastomas. There was no significant difference between survival rates of patients with VHL alone and those with VHL and RCC. However, cancer-specific survival rates were significantly different between patients with both VHL and RCC and patients with sporadic bilateral or multifocal RCC. In our Korean study, the incidence of RCC in patients with VHL disease is 45.8% and the incidence of VHL disease in patients with RCC is 0.73%. Due to the low overall incidence of VHL in Korea, extended multi-institutional studies are needed to establish the true characteristics of VHL disease.
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Affiliation(s)
- Won Tae Kim
- Department of Urology & Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Renal cell carcinoma metastasis to focal nodular hyperplasia focus on liver in a patient with Von Hippel-Lindau disease. Am J Med Sci 2009; 338:159-60. [PMID: 19581795 DOI: 10.1097/maj.0b013e3181a02b2b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Von Hippel-Lindau disease is an autosomal dominant disorder occurring in 1 of 36,000 births and associated with various tumors and cysts in the central nervous system and other visceral organs. At present, metastasis from renal cell carcinoma (RCC) and neurologic complications are the most common causes of death from Von Hippel-Lindau disease. We report a case of Von Hippel-Lindau disease diagnosed during a screening and was found to have metastasis of RCC to a focal nodular hyperplasia lesion on the liver. In the literature, misdiagnosis of benign liver lesions as metastases of RCC has been reported, but there has not been a case reported to have a metastasis of RCC within a benign liver lesion. To our knowledge, this is the first case of RCC metastasis to a benign lesion of the liver.
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Kim WT, Ham WS, Park SJ, Kim SW, Lee JS, Lee JS, Ju HJ, Choi YD. Clinical Characteristics of Renal Cell Carcinoma in Korean Patients with von Hippel-Lindau Disease. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.10.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Won Tae Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Ham
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Jin Park
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Woon Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jin sung Lee
- Department of Clinical Genetics, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sun Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jeong Ju
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Ploussard G, Droupy S, Ferlicot S, Ples R, Rocher L, Richard S, Benoit G. Local recurrence after nephron-sparing surgery in von Hippel-Lindau disease. Urology 2007; 70:435-9. [PMID: 17905091 DOI: 10.1016/j.urology.2007.04.040] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 03/09/2007] [Accepted: 04/27/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the risks of local recurrence and repeat surgery after nephron-sparing surgery (NSS) in von Hippel-Lindau (VHL) disease to propose a therapeutic strategy to patients. METHODS A total of 21 patients with VHL disease and renal tumors were followed up from February 1987 to August 2005. Surgical resection of all tumors was chosen when the largest tumor exceeded a diameter of 30 mm. RESULTS Of the 21 patients, 18 underwent surgery at a mean age of 38.5 years (range 24 to 69). The median follow-up of the series was 100 months. Of the 17 patients treated by NSS, 8 developed a recurrence. The mean time to local recurrence was 53 +/- 38.8 months (range 10 to 115), and the recurrence tumors grew at a stable mean rate of 0.34 +/- 0.32 cm/yr (range 0.1 to 1.08). Repeat NSS was performed on the same kidney in 2 cases and eight recurrences were kept under surveillance. The disease-specific survival rate was 93.8% at 10 years. The local recurrence rate was 45.6% at 5 years and 83.7% at 10 years. The overall repeat surgery rate was 23.1% at 5 years and 63.4% at 10 years. No metastasis or chronic renal insufficiency was observed in patients undergoing NSS only. CONCLUSIONS Five years after NSS, the risk of developing new tumors in the same kidney and the overall risk of repeat surgery was about 50% and 25%, respectively. However, the strategy of elective NSS and close surveillance preserved renal function without increasing the risk of metastasis.
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Affiliation(s)
- Guillaume Ploussard
- Department of Urology, APHP, Bicêtre Hospital, University of Paris-Sud, Le Kremlin-Bicêtre, France.
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Hes FJ, Höppener JW, Luijt RBVD, Lips CJ. Von hippel-lindau disease. Hered Cancer Clin Pract 2005; 3:171-8. [PMID: 20223044 PMCID: PMC2837060 DOI: 10.1186/1897-4287-3-4-171] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2005] [Accepted: 11/10/2005] [Indexed: 11/10/2022] Open
Abstract
A germline mutation in the Von-Hippel Lindau (VHL) gene predisposes carriers to development of abundantly vascularised tumours in the retina, cerebellum, spine, kidney, adrenal gland and pancreas. Most VHL patients die from the consequences of cerebellar haemangioblastoma or renal cell carcinoma. The VHL gene is a tumour suppressor gene and is involved in angiogenesis by regulation of the activity of hypoxia-inducible factor 1-alpha (HIF1-alpha). Clinical diagnosis of VHL can be confirmed by molecular genetic analysis of the VHL gene, which is informative in virtually all VHL families. A patient with (suspicion for) VHL is an indication for genetic counselling and periodical examination.
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Affiliation(s)
- Frederik J Hes
- Leiden University Medical Center, Center for Human and Clinical Genetics, Leiden.
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Ansari MS, Gupta NP, Kumar P. von Hippel-Lindau disease with bilateral multiple renal cell carcinoma managed by right radical nephrectomy and left repeat partial nephrectomy. Int Urol Nephrol 2004; 35:471-3. [PMID: 15198146 DOI: 10.1023/b:urol.0000025633.40416.57] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
von Hippel-Lindau (VHL) disease is an autosomal dominant disorder characterized by cysts and cystadenoma in the kidney, pancreas and epididymis and angiomas of the central nervous system and retina as well as renal cell carcinoma (RCC), phaeochromocytoma, islet tumors of the pancreas, and endolympatic sac tumors. VHL for its multicentric-characteristic and bilateralism often puts the surgeon in challenging situation. We present a case of VHL with bilateral RCC and retinal angiomas managed with right radical nephrectomy and left repeat partial nephrectomy.
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Affiliation(s)
- M S Ansari
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029, India
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Abstract
The role of nephron sparing surgery in patients with a solitary kidney, bilateral kidney tumors or an impaired renal function has been widely accepted. Partial nephrectomy in patients with a normal contralateral kidney is still under discussion. Nevertheless, more and more surgeons perform nephron sparing surgery in these patients with good results. From historical comparisons there seems to be no statistically significant difference in five-year survival between radical nephrectomy and nephron sparing surgery when the tumor diameter is four centimeters or less. The most common problem is the risk of tumor recurrence due to the multifocality. However, multifocality is more frequent than kidney recurrence, questioning the spontaneous evolution of satellite lesions. Further investigations are necessary to optimize patient selection. Therefore, a randomized prospective multicenter study with long-term follow-up might add to the excellent results published by several authors during the last two years in order to confirm that nephron sparing surgery is an excellent alternative to radical nephrectomy in small asymptomatic renal cell carcinoma.
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Affiliation(s)
- H Van Poppel
- Department of Urology, University Hospital Gasthuisberg, Catholic University of Leuven, Belgium.
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