title: Hemangioblastomas and neurogenic polyglobulia.
abstract: BACKGROUND
  Neurogenic polyglobulia occurs with central nervous system hemangioblastomas. Among the suggested mechanisms are extramedullary hematopoiesis in the tumor tissue and germline mutations of the von Hippel-Lindau (VHL) tumor suppressor gene.
  
  
  OBJECTIVE
  To determine the frequency and driving mechanisms of polyglobulia in central nervous system hemangioblastomas.
  
  
  METHODS
  We performed a retrospective analysis of pre- and postoperative (at 3 and 12 months) hemoglobin levels in a consecutive series of patients with hemangioblastomas operated on in our institution from 1996 to 2009. We performed molecular genetic analyses for mutations of the VHL tumor suppressor gene.
  
  
  RESULTS
  Preoperative hemoglobin levels were available from 164 patients. The average hemoglobin level (15.2 g/dL in males and 13.1 g/dL in females) was within normal range according to our standards. Of 22 patients with increased preoperative hemoglobin levels (>17 g/dL in males and >15 g/dL in females), 8 presented with pathological hemoglobin (>18.5 g/dL in males and >16.5 g/dL in females) according to World Health Organization criteria. Surgical removal of the hemangioblastoma resulted in a permanent cure of polyglobulia in all patients. Six of the 8 patients with pathological hemoglobin elevation carried a germline mutation of the VHL tumor suppressor gene.
  
  
  CONCLUSIONS
  Neurogenic polyglobulia occurs in a subset of patients with hemangioblastomas. This phenomenon is mostly observed in VHL mutation carriers, but also occurs in patients with sporadic hemangioblastomas. Removal of the tumor results in the permanent cure of polyglobulia. Our observations suggest that polyglobulia is an effect by the tumor itself, either due to paraneoplasia or extramedullary hematopoiesis.
authors: Department of Neurosurgery, Freiburg University Medical Center, Freiburg, Germany. sven.glaesker@uniklinik-freiburg.de
authors: Sven
authors: S
authors: Gläsker
authors: Marie T
authors: MT
authors: Krüger
authors: Jan-Helge
authors: JH
authors: Klingler
authors: Marcin
authors: M
authors: Wlodarski
authors: Julia
authors: J
authors: Klompen
authors: Bawarjan
authors: B
authors: Schatlo
authors: Beate
authors: B
authors: Hippchen
authors: Hartmut P H
authors: HP
authors: Neumann
authors: Vera
authors: V
authors: Van Velthoven
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002528:Cerebellar Neoplasms / Q000097:blood* / Q000235:genetics; D005260:Female; D018095:Germ-Line Mutation; D018325:Hemangioblastoma / Q000097:blood* / Q000235:genetics; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D051794:Von Hippel-Lindau Tumor Suppressor Protein / Q000235:genetics; D055815:Young Adult; D006623:von Hippel-Lindau Disease / Q000097:blood / Q000150:complications / Q000235:genetics
chemical_list: D006454:Hemoglobins; D051794:Von Hippel-Lindau Tumor Suppressor Protein