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Tamang OY, Dahal P, Paudel S, Upadhyaya RP, Dawadi K, Shrestha A, Parajuli S. Von Hippel Lindau Disease with central nervous system and multiple visceral manifestations: A case report. Radiol Case Rep 2023; 18:4357-4362. [PMID: 37823048 PMCID: PMC10562168 DOI: 10.1016/j.radcr.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 10/13/2023] Open
Abstract
Von Hippel-Lindau (VHL) disease is an autosomal-dominant syndrome caused by mutations in the VHL gene, located on the short arm of chromosome 3. Patients with VHL are likely to manifest with a spectrum of multiple benign and malignant tumors involving various organ systems. We present a case of a 28-year-old female without a remarkable family history who presented with complaints of hematuria and abdominal discomfort. Initial laboratory investigations confirmed hematuria. Subsequent abdominal computed tomography scan revealed heterogeneous enhancing solid mass in bilateral kidneys, avidly enhancing mass in the right adrenal gland, bilateral simple renal cortical cysts, and a pancreatic cyst. With a provisional diagnosis of VHL disease, an MRI of the brain and spine was performed, which showed the presence of a cerebellar hemangioblastoma. Her catecholamine and vanillylmandelic acid levels were in the normal range not in line with pheochromocytoma. The patient then underwent bilateral partial renal nephrectomy and right adrenalectomy. Histopathologic examination reported clear renal cell carcinoma and pheochromocytoma of the right adrenal gland mass. Molecular genetic testing confirmed the presence of VHL disease.
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Affiliation(s)
- Ongden Yonjen Tamang
- Department of Radiology and Imaging, Grande International Hospital, Kathmandu, Nepal
| | - Prajwal Dahal
- Department of Radiology and Imaging, Grande International Hospital, Kathmandu, Nepal
| | - Sharma Paudel
- Department of Radiology and Imaging, Tribhuvan University Teaching Hospital and Grande International Hospital, Kathmandu, Nepal
| | | | - Kapil Dawadi
- Department of Radiology and Imaging, Grande International Hospital, Kathmandu, Nepal
| | - Ashish Shrestha
- Department of Radiology and Imaging, Grande International Hospital, Kathmandu, Nepal
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A Case of Von Hippel-Lindau Disease with Bilateral Pheochromocytoma and Ectopic Hypersecretion of Intact Parathyroid Hormone in an Adolescent Girl. Case Rep Endocrinol 2020; 2020:8824640. [PMID: 32832168 PMCID: PMC7428957 DOI: 10.1155/2020/8824640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/18/2022] Open
Abstract
Von Hippel-Lindau disease is an autosomal dominant inherited syndrome predisposing to a variety of highly vascularised tumors in different organs. Although bilateral pheochromocytoma was reported in patients with von Hippel-Lindau disease, the coexistence of primary hyperparathyroidism is not a common condition. We report an observation of a primary hyperparathyroidism secondary to an ectopic secretion of intact parathyroid hormone in a 17-year-old girl with von Hippel-Lindau disease and bilateral pheochromocytoma. She presented with a newly diagnosed diabetes mellitus and a severe arterial hypertension. Blood tests disclosed hypercalcemia with increased intact PTH level. Cervical ultrasound and sestamibi scintigraphy were normal. Twenty-four-hour urinary normetanephrine level was highly elevated pointing to a catecholamine-secreting tumor. The abdominal computed tomography showed bilateral adrenal masses. MIBG scintigraphy exhibited a high accumulation of the tracer in both adrenal tumors. Genetic testing revealed a mutation of the VHL gene. The patient underwent a bilateral adrenalectomy. The postoperative outcome was marked by normalization of blood pressure, blood glucose, calcium, and PTH levels. In our case, the elevation of intact PTH and its spontaneous normalization after surgical treatment of pheochromocytomas confirms its ectopic secretion.
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Yaghobi Joybari A, Azadeh P. Von Hippel-Lindau Disease With Multi-Organ Involvement: A Case Report and 8-Year Clinical Course With Follow-Up. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1220-1224. [PMID: 29146893 PMCID: PMC5701459 DOI: 10.12659/ajcr.907356] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient: Female, 31 Final Diagnosis: Von Hippel-Lindau disease Symptoms: Abdominal pain Medication: — Clinical Procedure: Splenectomy Specialty: Oncology
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Affiliation(s)
- Ali Yaghobi Joybari
- Department of Radiation Oncology, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Payam Azadeh
- Department of Radiation Oncology, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
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Arıcan P, Okudan Tekin B, Naldöken S, Şefizade R, Berker D. A Family with Von Hippel-Lindau Syndrome: The Findings of Indium-111 Somatostatin Receptor Scintigraphy, Iodine-123 Metaiodobenzylguanidine Scintigraphy and Single Photon Emission Computerized Tomography. Mol Imaging Radionucl Ther 2017; 26:38-42. [PMID: 28291009 PMCID: PMC5350504 DOI: 10.4274/mirt.70894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Von Hippel-Lindau syndrome (VHLS) is an autosomal dominant hereditary familial disorder characterized by development of malignant and benign neoplasms. Differential diagnosis of the adrenal and pancreatic masses are difficult in patients with VHLS. Iodine-123 metaiodobenzylguanidine (I-123 MIBG) and indium-111 somatostatin receptor scintigraphies (In-111 SRS) have important roles in the differential diagnosis of adrenal and pancreatic masses in those patients. In this case report, we present the findings of I-123 MIBG single-photon emission computerized tomography (SPECT/CT) and In-111 SRS SPECT/CT in three members of a family with VHLS. In case 1, a residual neuroendocrine tumor (NET) was detected in the head of pancreas on In-111 SRS SPECT/CT images. In case 2 and 3, I-123 MIBG SPECT/CT confirmed the adrenal masses as pheochromocytoma, and the extra-adrenal mass as NET, before surgery. We thought that In-111 SRS and I-123 MIBG scan might be helpful in the routine work up of VHLS patients for diagnostic and therapeutic purposes. Hybrid SPECT/CT system may improve diagnostic accuracy of planar images since it assesses morphologic and functional information together.
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Affiliation(s)
- Pelin Arıcan
- Ankara Numune Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey Phone: +90 542 286 75 75 E-mail:
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Abstract
von Hippel-Lindau (VHL) disease is an autosomal dominant disorder caused by heterozygous mutations in the VHL tumor suppressor gene that is characterized by the occurrence of multiple endocrine and nonendocrine lesions. This review focuses on the endocrine manifestations of VHL disease. Pancreatic neuroendocrine proliferations (ductuloinsular complexes, islet dysplasia, endocrine microadenoma, and neuroendocrine tumors), pheochromocytomas, and extra-adrenal paragangliomas are important endocrine manifestations of VHL disease. They frequently display characteristic clinical, biochemical, and histopathologic features that, although not pathognomonic, can be helpful in suggesting VHL disease as the underlying etiology and distinguishing these tumors from sporadic cases. Recent improvements in treatment and outcomes of renal cell carcinomas have allowed pancreatic neuroendocrine tumors to emerge as a significant source of metastatic disease, making the accurate recognition and classification of these neoplasms by the pathologist of utmost importance to determine prognosis, treatment, and follow-up strategies for affected patients.
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Affiliation(s)
- Clarissa Cassol
- From the Department of Pathology, University Health Network, Toronto, Ontario, Canada, and the Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
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Sankaredja J, Brac B, Thines L, Baroncini M, Zairi F, Cardot-Bauters C, Lejeune JP. [Epidemiology, treatment and follow-up of central nervous system hemangioblastomas in von Hippel-Lindau disease]. Rev Neurol (Paris) 2014; 170:288-96. [PMID: 24680832 DOI: 10.1016/j.neurol.2013.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 12/07/2013] [Accepted: 12/20/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Central nervous system (CNS) hemangioblastomas (HGB) are rare vascular tumors. The goal of this study was to analyze their epidemiology, treatment and prognosis in association with von Hippel-Lindau (VHL) disease. METHODS We retrospectively reviewed a series of patients treated in our department for a CNS HGB with VHL disease between 1996 and 2008. We analyzed pre- and postoperative clinical and radiological characteristics, number of visceral lesions (fundoscopy, abdomino-pelvian CT, metanephrines), clinical course (modified Rankin Scale and McCormick scale) and late prognosis (Kaplan-Meier survival curves). RESULTS We studied 19 cases (sex-ratio 0.9, mean age 36). The mean time to diagnosis was 61days. The main symptom was intracranial hypertension for cerebellar lesions (7/15) and a sensitive-motor deficit for medulla oblongata (2/5) or spinal lesions (5/11). Preferred locations were cerebellum (15/31), often nodulo-cystic appearance, followed by spinal cord (11/31), frequently coming with adjacent syringomyelia. Multiple locations and visceral lesions were found in two-third of the cases. Surgical removal was complete in more than three-quarter of the cases. Mean follow-up duration was 9years. Postoperative mortality rate was 16%. In cerebellar and medulla oblongata locations together, final mRS was ≤1 in 17 of the 20 cases. In spinal cord locations, final McCormick score was ≤2 in all the cases. After delayed follow-up, about two-third of patients experienced recurrence or new progressive CNS lesions. CONCLUSION HGB are rare CNS tumors. VHL disease should be considered when an HGB is diagnosed before 30, is located at the spinal cord, comes with multiple other CNS lesions or with typical peripheral lesions. Microsurgical removal is the gold standard treatment and can offer good functional results.
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Affiliation(s)
- J Sankaredja
- Clinique de neurochirurgie, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU de Lille, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France
| | - B Brac
- Faculté de médecine de Lille, université Lille 2 (Option Initiation à la Rédaction d'Article), 1, place de Verdun, 59000 Lille, France
| | - L Thines
- Clinique de neurochirurgie, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU de Lille, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France; Faculté de médecine de Lille, université Lille 2 (Option Initiation à la Rédaction d'Article), 1, place de Verdun, 59000 Lille, France.
| | - M Baroncini
- Clinique de neurochirurgie, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU de Lille, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France
| | - F Zairi
- Clinique de neurochirurgie, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU de Lille, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France
| | - C Cardot-Bauters
- Service de médecine interne et d'endocrinologie, hôpital Huriez, CHRU de Lille, université Lille Nord-de-France, 1, place de Verdun, 59000 Lille, France
| | - J-P Lejeune
- Clinique de neurochirurgie, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU de Lille, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France
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Gkaliagkousi E, Erlic Z, Petidis K, Semertzidis P, Doumas M, Zamboulis C, Neumann HPH, Douma S. Neurofibromatosis type 1: should we screen for other genetic syndromes? A case report of co-existence with multiple endocrine neoplasia 2A. Eur J Clin Invest 2009; 39:828-32. [PMID: 19558618 DOI: 10.1111/j.1365-2362.2009.02174.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND NF 1 is a genetic disorder with an autosomal dominant pattern of inheritence. It is associated with neoplastic disorders mainly derived from the neural seath. However, the co-existence of NF1 with the full spectrum of MEN 2A has rarely been reported. The aim of the study was to investigate the presence of secondary neoplasias in a patient with diagnosed NF1, and in particular the presence of hyperparathyroidism and the possible co-existence with another pheochromocytoma-related syndrome. METHODS We report a case of a 70 years old female patient who had NF1. The patient was referred to our center and was diagnosed with an isolated pheochromocytoma of the right adrenal gland for which she underwent right adrenalectomy. We further investigated for the presence of another pheochromocytoma-related syndrome and in particular for the presence of hyperparathyroidism and medullary thyroid cancer. Molecular screening for germline mutations of the genes NF1, RET and VHL has also been performed. RESULTS The patient was further diagnosed with hyperparathyroidism and medullary thyroid cancer, having the full spectrum of the clinical picture of the MEN2A syndrome. The genetic testing revealed the germline mutation for NF1 but not for the RET proto-oncogene which is generally found in MEN2A cases. CONCLUSION To our knowledge this is a rare case of co-existence of two pheochromocytoma-related genetic syndromes, and generates the question of whether all patients with these syndromes should undergo a thorough clinical and laboratory investigation for the possibility of another co-existing pheochromocytoma-related genetic syndrome.
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Affiliation(s)
- E Gkaliagkousi
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Renal involvement in tuberous sclerosis complex and von Hippel-Lindau disease: shared disease mechanisms? Nat Rev Nephrol 2009; 5:143-56. [PMID: 19240728 DOI: 10.1038/ncpneph1032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 11/28/2008] [Indexed: 12/29/2022]
Abstract
Tuberous sclerosis complex and von Hippel-Lindau disease are distinct autosomal dominant tumor suppressor syndromes that can exhibit similar renal phenotypes and seem to share some signaling pathway components. Similarities exist in the current clinical management of, and the newly identified potential therapeutic approaches for, these conditions. This Review summarizes the pathophysiologic and therapeutic overlap between tuberous sclerosis complex and von Hippel-Lindau disease and highlights the results of recent drug trials in these settings.
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Hussein MR. Central nervous system capillary haemangioblastoma: the pathologist's viewpoint. Int J Exp Pathol 2007; 88:311-24. [PMID: 17877533 PMCID: PMC2517334 DOI: 10.1111/j.1365-2613.2007.00535.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 03/24/2007] [Indexed: 12/12/2022] Open
Abstract
Haemangioblastomas are rare neoplasms of uncertain histogenesis. They represent 1.5-2.5% of intracranial tumours. While the cerebellum is by far the most frequent site, these lesions also tend to occur in the medulla and spinal cord. Most haemangioblastomas are sporadic but up to one quarter are associated with Von Hippel-Lindau disease (VHL). Although a fairly good number of haemangioblastomas were reported, a lack of side-by-side analysis of these reports has resulted in tentative conclusions that merely offer a first glimpse at their clinicopathologic diversity and histogenesis. To remedy this issue, this study presents a literature review concerning these lesions. Medline literature including both relevant monographs and clinicopathological case series. Haemangioblastomas occur either as a part of VHL disease (25-30%, inherited mutation of VHL gene on 3p25-26 chromosome) or as sporadic tumours (often with somatic mutation of VHL gene). They have diverse clinicopathologic presentations with cerebellar lesions having a better prognosis than their brainstem counterparts. Immunostaining is important for separation of haemangioblastomas from other tumours with similar histology. The rich vascularity of haemangioblastomas is due to overexpression of vascular endothelial growth factors. Moreover, 'stromal' cells represent the neoplastic cells of haemangioblastomas and are capable of forming blood islands with extramedullary haematopoiesis.
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Affiliation(s)
- Mahmoud R Hussein
- Department of Pathology, Faculty of Medicine, Assuit University, Assuit University Hospitals, Assuit, Egypt.
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