Bausch B, Malinoc A, Maruschke L, Offergeld C, Gläsker S, Rischke H C, Brauckhoff M, Boedeker C C, Neumann H P H
Abteilung Innere Medizin II, Gastroenterologie, Hepatologie, Endokrinologie und Infektiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland.
Chirurg. 2012 Jun;83(6):511-8. doi: 10.1007/s00104-011-2191-8.
About one third of all patients with a pheochromocytoma are carriers of germ line mutations of 1 of the 10 susceptibility genes. Thus, these patients can be diagnosed and classified with specific tumor syndromes. This group is composed of the entities of multiple endocrine neoplasia type 2 (MEN2) due to mutations in the RET gene, von Hippel-Lindau disease (VHL, VHL gene), the paraganglioma syndromes types 1-4 (PGL1-4) due to mutations of the genes SDHD, SDHAF2, SDHC, SDHB, neurofibromatosis type 1 (NF1) due to mutations of the NF1 gene and familial pheochromocytoma syndromes due to mutations of the SDHA, TMEM127 and MAX genes. Patients with hereditary pheochromocytomas run a lifelong risk of relapse of pheochromocytoma. In addition extraparaganglial tumors are frequent and include medullary thyroid carcinoma in MEN2 or renal cancer or neuroendocrine pancreatic cancer as well as hemangioblastomas of the retina and the central nervous system in VHL. Furthermore, renal cancer may be associated with PGL4 and PGL3. In conclusion, molecular genetic screening is essential for the diagnosis of pheochromocytoma-associated cancer syndromes and is thus the cornerstone for successful lifelong preventive medicine of such patients and their relatives.
约三分之一的嗜铬细胞瘤患者是10种易感基因中1种基因的种系突变携带者。因此,这些患者可根据特定的肿瘤综合征进行诊断和分类。该组包括由于RET基因突变导致的2型多发性内分泌肿瘤(MEN2)、冯·希佩尔-林道病(VHL,VHL基因)、由于SDHD、SDHAF2、SDHC、SDHB基因突变导致的1-4型副神经节瘤综合征(PGL1-4)、由于NF1基因突变导致的1型神经纤维瘤病(NF1)以及由于SDHA、TMEM127和MAX基因突变导致的家族性嗜铬细胞瘤综合征。遗传性嗜铬细胞瘤患者终生都有嗜铬细胞瘤复发的风险。此外,神经节外肿瘤很常见,包括MEN2中的甲状腺髓样癌、肾癌或神经内分泌胰腺癌,以及VHL中的视网膜和中枢神经系统血管母细胞瘤。此外,肾癌可能与PGL4和PGL3相关。总之,分子遗传学筛查对于嗜铬细胞瘤相关癌症综合征的诊断至关重要,因此是此类患者及其亲属成功进行终生预防医学的基石。