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Erschienen in: Current Hypertension Reports 6/2010

01.12.2010

Genetic Testing for Pheochromocytoma

verfasst von: David Karasek, Zdenek Frysak, Karel Pacak

Erschienen in: Current Hypertension Reports | Ausgabe 6/2010

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Abstract

Pheochromocytomas (PHEOs) and paragangliomas (PGLs) are rare, catecholamine-producing tumors that are usually sporadic. However, about 30% of these tumors have been identified as being of inherited origin. To date, nine genes have been confirmed as participating in PHEO or PGL tumorigenesis. Germline mutations were found in 100% of syndromic cases and in about 90% of patients with positive familial history. In nonsyndromic patients with apparently sporadic tumors, genetic mutations have been found in up to 27%, and genetic testing is now recommended for all patients with PHEOs and PGLs. Patients with syndromic lesions, a positive family history, or both should be tested for the appertaining gene. Recent discoveries have shown that the order of tested genes in nonsyndromic, nonfamilial cases can be based on histologic evaluation, location, and the biochemical phenotype of PHEOs and PGLs—the “rule of three.” Identification of a gene mutation may lead to early diagnosis and treatment, regular surveillance, and a better prognosis for patients and their relatives.
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Zurück zum Zitat •• Ricketts CJ, Forman JR, Rattenberry E, et al.: Tumor risks and genotype-phenotype-proteotype analysis in 358 patients with germline mutations in SDHB and SDHD. Hum Mutat 2010, 31:41–51. Authors assessed 358 patients with SDHB (n = 295) and SDHD (n = 63) mutations. At age 60 years, the risk of head and neck PGL in SDHB mutation carriers was 29% and the risk of PHEO was 52%; in SDHD mutation carriers, the risks were and 71% and 29%, respectively. Risks of malignant PHEO and renal tumors (14% at age 70 years) were higher in SDHB mutation carriers. No clear genotype-phenotype correlations were detected for SDHB mutations. CrossRefPubMed •• Ricketts CJ, Forman JR, Rattenberry E, et al.: Tumor risks and genotype-phenotype-proteotype analysis in 358 patients with germline mutations in SDHB and SDHD. Hum Mutat 2010, 31:41–51. Authors assessed 358 patients with SDHB (n = 295) and SDHD (n = 63) mutations. At age 60 years, the risk of head and neck PGL in SDHB mutation carriers was 29% and the risk of PHEO was 52%; in SDHD mutation carriers, the risks were and 71% and 29%, respectively. Risks of malignant PHEO and renal tumors (14% at age 70 years) were higher in SDHB mutation carriers. No clear genotype-phenotype correlations were detected for SDHB mutations. CrossRefPubMed
45.
Zurück zum Zitat •• Gill AJ, Benn DE, Chou A, et al.: Immunohistochemistry for SDHB triages genetic testing of SDHB, SDHC, and SDHD in paraganglioma-pheochromocytoma syndromes. Hum Pathol 2010, 41:805–814. These authors defined positive, weak diffuse, and negative immunohistochemistry staining for SDHB. All 12 SDH mutated tumors (6 SDHB, 5 SDHD, and 1 SDHC) showed weak diffuse or negative staining, whereas 9 of 10 tumors with known mutations of VHL, RET, or NF1 showed positive staining. One VHL-associated tumor showed weak diffuse staining; one PGL with no known SDH mutation but clinical features suggesting familial disease was negative, and one showed weak diffuse staining. Completely absent staining is more commonly found with SDHB mutation, whereas weak diffuse staining often occurs with SDHD mutation. CrossRefPubMed •• Gill AJ, Benn DE, Chou A, et al.: Immunohistochemistry for SDHB triages genetic testing of SDHB, SDHC, and SDHD in paraganglioma-pheochromocytoma syndromes. Hum Pathol 2010, 41:805–814. These authors defined positive, weak diffuse, and negative immunohistochemistry staining for SDHB. All 12 SDH mutated tumors (6 SDHB, 5 SDHD, and 1 SDHC) showed weak diffuse or negative staining, whereas 9 of 10 tumors with known mutations of VHL, RET, or NF1 showed positive staining. One VHL-associated tumor showed weak diffuse staining; one PGL with no known SDH mutation but clinical features suggesting familial disease was negative, and one showed weak diffuse staining. Completely absent staining is more commonly found with SDHB mutation, whereas weak diffuse staining often occurs with SDHD mutation. CrossRefPubMed
46.
Zurück zum Zitat •• van Nederveen FH, Gaal J, Favier J, et al.: An immunohistochemical procedure to detect patients with paraganglioma and phaeochromocytoma with germline SDHB, SDHC, or SDHD gene mutations: a retrospective and prospective analysis. Lancet Oncol 2009, 10:764–771. Immunohistochemistry for SDHB was done on 220 tumors. SDHB protein expression was absent in all 102 PHEOs and PGLs with an SDHB, SDHC, or SDHD mutation, but was present in all 65 tumors related to MEN 2, VHL, and NF1. Of the 53 PHEOs or PGLs with no syndromic germline mutation, 47 (89%) showed SDHB expression. The SDHB immunohistochemistry was 100% sensitive (95% CI, 87%–100%) in detecting the presence of an SDH mutation in the prospective series, and 84% specific (95% CI, 60%–97%). CrossRefPubMed •• van Nederveen FH, Gaal J, Favier J, et al.: An immunohistochemical procedure to detect patients with paraganglioma and phaeochromocytoma with germline SDHB, SDHC, or SDHD gene mutations: a retrospective and prospective analysis. Lancet Oncol 2009, 10:764–771. Immunohistochemistry for SDHB was done on 220 tumors. SDHB protein expression was absent in all 102 PHEOs and PGLs with an SDHB, SDHC, or SDHD mutation, but was present in all 65 tumors related to MEN 2, VHL, and NF1. Of the 53 PHEOs or PGLs with no syndromic germline mutation, 47 (89%) showed SDHB expression. The SDHB immunohistochemistry was 100% sensitive (95% CI, 87%–100%) in detecting the presence of an SDH mutation in the prospective series, and 84% specific (95% CI, 60%–97%). CrossRefPubMed
47.
Zurück zum Zitat •• Cascón A, Pita G, Burnichon N, et al.: Genetics of pheochromocytoma and paraganglioma in Spanish patients. J Clin Endocrinol Metab 2009, 94:1701–1705. This study analyzed 237 nonrelated probands for the major susceptibility genes: VHL, RET, SDHB, SDHC, and SDHD. All syndromic probands were genetically diagnosed with a mutation affecting either RET or VHL. A total of 79.1% of patients presenting with nonsyndromic familial antecedents and 18.4% of those with apparently sporadic presentation were found to carry a mutation in one of the susceptibility genes. CrossRefPubMed •• Cascón A, Pita G, Burnichon N, et al.: Genetics of pheochromocytoma and paraganglioma in Spanish patients. J Clin Endocrinol Metab 2009, 94:1701–1705. This study analyzed 237 nonrelated probands for the major susceptibility genes: VHL, RET, SDHB, SDHC, and SDHD. All syndromic probands were genetically diagnosed with a mutation affecting either RET or VHL. A total of 79.1% of patients presenting with nonsyndromic familial antecedents and 18.4% of those with apparently sporadic presentation were found to carry a mutation in one of the susceptibility genes. CrossRefPubMed
48.
Zurück zum Zitat •• Erlic Z, Rybicki L, Peczkowska M, et al.: Clinical predictors and algorithm for the genetic diagnosis of pheochromocytoma patients. Clin Cancer Res 2009, 15:6378–6385. Of 989 apparently nonsyndromic PHEOs, 187 (19%) harbored germline mutations. Predictors for the presence of mutation were estimated: age less than 45 years, multiple PHEOs, extra-adrenal location, and previous head-and-neck PGL. CrossRefPubMed •• Erlic Z, Rybicki L, Peczkowska M, et al.: Clinical predictors and algorithm for the genetic diagnosis of pheochromocytoma patients. Clin Cancer Res 2009, 15:6378–6385. Of 989 apparently nonsyndromic PHEOs, 187 (19%) harbored germline mutations. Predictors for the presence of mutation were estimated: age less than 45 years, multiple PHEOs, extra-adrenal location, and previous head-and-neck PGL. CrossRefPubMed
49.
Zurück zum Zitat Pacak K, Eisenhofer G, Ahlman H, et al.; International Symposium on Pheochromocytoma: Pheochromocytoma: recommendations for clinical practice from the First International Symposium. October 2005. Nat Clin Pract Endocrinol Metab 2007, 3:92–102.CrossRefPubMed Pacak K, Eisenhofer G, Ahlman H, et al.; International Symposium on Pheochromocytoma: Pheochromocytoma: recommendations for clinical practice from the First International Symposium. October 2005. Nat Clin Pract Endocrinol Metab 2007, 3:92–102.CrossRefPubMed
Metadaten
Titel
Genetic Testing for Pheochromocytoma
verfasst von
David Karasek
Zdenek Frysak
Karel Pacak
Publikationsdatum
01.12.2010
Verlag
Current Science Inc.
Erschienen in
Current Hypertension Reports / Ausgabe 6/2010
Print ISSN: 1522-6417
Elektronische ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-010-0151-1

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