Unique association of non-functioning pheochromocytoma, ganglioneuroma, adrenal cortical adenoma, hepatic and vertebral hemangiomas in a patient with a new intronic variant in the VHL gene.
We analyzed the clinical, hormonal, immunohistochemical and genetic features in a 69-yr-old Caucasian woman with a very rare "composite and mixed pheochromocytoma". This was characterized by right adrenal pheochromocytoma associated with homolateral ganglioneuroma and controlateral adrenal cortical adenoma. The three tumors, incidentally discovered, proved to be non-functioning (normal secretion of catecholamines and of other neuroendocrine peptides, glucocorticoids, mineralcorticoids and androgens). Accordingly, the patient showed no sign or symptom of endocrine disease. Computed tomography (CT) and magnetic resonance (MR) demonstrated a typical adenomatous lesion on the left adrenal gland with precocious uptake of the radiotracer on radioidine (131I)-norcholesterol adrenal scintigraphy, while the controlateral gland showed hyperdensity on CT, hyperintensity on MR and no uptake at adrenal scintigraphy. In addition, CT and MR revealed a vertebral and two hepatic hemangiomas. The right adrenal gland was surgically removed and, microscopically, pheochromocytoma and ganglioneuroma areas appeared intermixed without a predominant component. The former showed strong immunoreactivity for chromogranin, synaptophysin, vascular endothelial growth factor (VEGF) and CD34, while the latter appeared positive for neuron-specific enolase (NSE) and S-100. Peripheral blood genomic DNA analysis revealed a new intronic variant (5557A > G) in the von Hippel-Lindau gene (VHL) not observed in our control population.
Department of Internal Medicine, University of Pisa, Pisa, Italy. g.bernini@med.unipi.it
G P
GP
Bernini
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A
Moretti
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M
Mannelli
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Ercolino
M
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Bardini
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Caramella
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Taurino
A
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Salvetti
D000306:Adrenal Cortex Neoplasms / Q000235:genetics / Q000473:pathology; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000235:genetics* / Q000473:pathology; D018246:Adrenocortical Adenoma / Q000235:genetics* / Q000473:pathology; D000368:Aged; D004273:DNA, Neoplasm / Q000032:analysis; D005260:Female; D005729:Ganglioneuroma / Q000235:genetics* / Q000473:pathology; D014644:Genetic Variation; D006391:Hemangioma / Q000235:genetics* / Q000473:pathology; D006801:Humans; D007438:Introns / Q000235:genetics; D008113:Liver Neoplasms / Q000235:genetics* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D009378:Neoplasms, Multiple Primary; D010673:Pheochromocytoma / Q000000981:diagnostic imaging / Q000235:genetics* / Q000473:pathology; D011877:Radionuclide Imaging; D013125:Spinal Neoplasms / Q000235:genetics* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D051794:Von Hippel-Lindau Tumor Suppressor Protein / Q000235:genetics*
D004273:DNA, Neoplasm; D051794:Von Hippel-Lindau Tumor Suppressor Protein; C497446:VHL protein, human