Von Hippel-Lindau syndrome from the urologist and oncologist perspective — literature review
Abstract
Von Hippel-Lindau (VHL) syndrome is a rare genetic disorder characterized by multiple retinal and cerebellar hemangioblastomas that tend to occur in a familial setting. The pattern of inheritance is autosomal dominant. Patients with VHL syndrome have an increased risk of clear cell renal cell carcinoma (ccRCC) as well as pancreatic and testicular cysts and cystadenomas. Tumors associated with VHL syndrome manifest at a young age. This article presents diagnostic methods and discusses the treatment approaches for this syndrome based on a global literature review.
Keywords: von Hippel-Lindau syndromefamiliar angiomatosis of the retina and cerebellumclear cell renal cell carcinomapolycystic kidney disease
References
- Wein AJ, Kavoussi LR, Novick AC, et al. Campbell-Walsh Urology, 10th Edition. Elsevier, 2012 .
- Martins R, Bugalho MJ. Paragangliomas/Pheochromocytomas: clinically oriented genetic testing. Int J Endocrinol. 2014; 2014: 794187.
- Ang SO, Chen H, Hirota K, et al. Disruption of oxygen homeostasis underlies congenital Chuvash polycythemia. Nat Genet. 2002; 32(4): 614–621.
- Maher ER, Neumann HPh, Richard S. von Hippel-Lindau disease: a clinical and scientific review. Eur J Hum Genet. 2011; 19(6): 617–623.
- Lonser R, Glenn G, Walther M, et al. von Hippel-Lindau disease. Lancet. 2003; 361(9374): 2059–2067.
- Bender BU, Eng C, Olschewski M, et al. VHL c.505 T>C mutation confers a high age related penetrance but no increased overall mortality. J Med Genet. 2001; 38(8): 508–514.
- Louise M Binderup M, Smerdel M, Borgwadt L, et al. von Hippel-Lindau disease: Updated guideline for diagnosis and surveillance. Eur J Med Genet. 2022; 65(8): 104538.
- Pastore Y, Jedlickova K, Guan Y, et al. Mutations of von Hippel-Lindau Tumor-Suppressor Gene and Congenital Polycythemia. Am J Hum Genet. 2003; 73(2): 412–419.
- Lorenzo FR, Yang C, Ng Tang Fui M, et al. A novel EPAS1/HIF2A germline mutation in a congenital polycythemia with paraganglioma. J Mol Med (Berl). 2013; 91(4): 507–512.
- Maher ER, Neumann HPh, Richard S. von Hippel-Lindau disease: a clinical and scientific review. Eur J Hum Genet. 2011; 19(6): 617–623.
- Lenders J, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet. 2005; 366(9486): 665–675.
- Andersen KF, Altaf R, Krarup-Hansen A, et al. Malignant pheochromocytomas and paragangliomas - the importance of a multidisciplinary approach. Cancer Treat Rev. 2011; 37(2): 111–119.
- Parenti G, Zampetti B, Rapizzi E, et al. Updated and new perspectives on diagnosis, prognosis, and therapy of malignant pheochromocytoma/paraganglioma. J Oncol. 2012; 2012: 872713.
- Gimm O, DeMicco C, Perren A, et al. Malignant pheochromocytomas and paragangliomas: a diagnostic challenge. Langenbecks Arch Surg. 2012; 397(2): 155–177.
- Neumann HP, Berger DP, Sigmund G, et al. Pheochromocytomas, Multiple Endocrine Neoplasia Type 2, and von Hippel-Lindau Disease. N Engl J Med. 1994; 331(22): 1535–1535.
- Beitner MM, Winship I, Drummond KJ. Neurosurgical considerations in von Hippel-Lindau disease. J Clin Neurosci. 2011; 18(2): 171–180.
- Barontini M, Dahia P. VHL Disease. Best Practice & Research Clinical Endocrinology & Metabolism. 2010; 24(3): 401–413.
- Richard S, Gardie B, Couvé S, et al. Von Hippel-Lindau: how a rare disease illuminates cancer biology. Semin Cancer Biol. 2013; 23(1): 26–37.
- Bader HL, Hsu T. Systemic VHL gene functions and the VHL disease. FEBS Lett. 2012; 586(11): 1562–1569.
- Jilg CA, Neumann HP, Gläsker S, et al. Growth kinetics in von Hippel-Lindau-associated renal cell carcinoma. Urol Int. 2012; 88(1): 71–78.
- Shuin T, Yamasaki I, Tamura K, et al. Von Hippel-Lindau disease: molecular pathological basis, clinical criteria, genetic testing, clinical features of tumors and treatment. Jpn J Clin Oncol. 2006; 36(6): 337–343.
- Beck O, Fassbender WJ, Beyer P, et al. Pheochromocytoma in childhood: implication for further diagnostic procedures. Acta Paediatr. 2004; 93(12): 1630–1634.
- Vaganovs P, Bokums K, Miklaševics E, et al. Von hippel-lindau syndrome: diagnosis and management of hemangioblastoma and pheochromocytoma. Case Rep Urol. 2013; 2013: 624096.
- Hasani-Ranjbar S, Amoli MM, Ebrahim-Habibi A, et al. Mutation screening of VHL gene in a family with malignant bilateral pheochromocytoma: from isolated familial pheochromocytoma to von Hippel-Lindau disease. Fam Cancer. 2009; 8(4): 465–471.
- Tootee A, Hasani-Ranjbar S. Von hippel-lindau disease: a new approach to an old problem. Int J Endocrinol Metab. 2012; 10(4): 619–624.
- Leung RS, Biswas SV, Duncan M, et al. Imaging features of von Hippel-Lindau disease. Radiographics. 2008; 28(1): 65–79; quiz 323.
- Ong KR, Woodward ER, Killick P, et al. Genotype-phenotype correlations in von Hippel-Lindau disease. Hum Mutat. 2007; 28(2): 143–149.
- Chou A, Toon C, Pickett J, et al. von Hippel-Lindau Syndrome. Frontiers of Hormone Research. 2013: 30–49.
- Zhou B, Wang J, Liu S, et al. Hemangioblastoma Instead of Renal Cell Carcinoma Plays a Major Role in the Unfavorable Overall Survival of Von Hippel-Lindau Disease Patients. Front Oncol. 2019; 9: 1037.
- Hampel H, Bennett RL, Buchanan A, et al. Guideline Development Group, American College of Medical Genetics and Genomics Professional Practice and Guidelines Committee and National Society of Genetic Counselors Practice Guidelines Committee. A practice guideline from the American College of Medical Genetics and Genomics and the National Society of Genetic Counselors: referral indications for cancer predisposition assessment. Genet Med. 2015; 17(1): 70–87.
- Binderup ML, Bisgaard ML, Harbud V, et al. Danish vHL Coordination Group. Von Hippel-Lindau disease (vHL). National clinical guideline for diagnosis and surveillance in Denmark. 3rd edition. Dan Med J. 2013; 60(12): B4763.
- MELMON KL, ROSEN SW. LINDAU'S DISEASE. REVIEW OF THE LITERATURE AND STUDY OF A LARGE KINDRED. Am J Med. 1964; 36: 595–617.
- Maher ER, Neumann HPh, Richard S. von Hippel-Lindau disease: a clinical and scientific review. Eur J Hum Genet. 2011; 19(6): 617–623.
- Nordstrom-O'Brien M, van der Luijt RB, van Rooijen E, et al. Genetic analysis of von Hippel-Lindau disease. Hum Mutat. 2010; 31(5): 521–537.
- Choyke PL, Glenn GM, Walther MM, et al. von Hippel-Lindau disease: genetic, clinical, and imaging features. Radiology. 1995; 194(3): 629–642.
- Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2022 Update. Eur Urol. 2022; 82(4): 399–410.
- Ploussard G, Droupy S, Ferlicot S, et al. Local recurrence after nephron-sparing surgery in von Hippel-Lindau disease. Urology. 2007; 70(3): 435–439.
- Kunath F, Schmidt S, Krabbe LM, et al. Partial nephrectomy versus radical nephrectomy for clinical localised renal masses. Cochrane Database Syst Rev. 2017; 5(5): CD012045.
- Metelo AM, Noonan H, Iliopoulos O. HIF2a inhibitors for the treatment of VHL disease. Oncotarget. 2015; 6(27): 23036–23037.
- Watts D, Gaete D, Rodriguez D, et al. Hypoxia Pathway Proteins are Master Regulators of Erythropoiesis. Int J Mol Sci. 2020; 21(21).
- Suárez C, Vieito M, Valdivia A, et al. Selective HIF2A Inhibitors in the Management of Clear Cell Renal Cancer and Von Hippel-Lindau-Disease-Associated Tumors. Med Sci (Basel). 2023; 11(3).
- Jonasch E, Iliopoulos O, Rathmell W, et al. LITESPARK-004 (MK-6482-004) phase 2 study of belzutifan, an oral hypoxia-inducible factor 2α inhibitor (HIF-2α), for von Hippel-Lindau (VHL) disease: Update with more than two years of follow-up data. J Clin Oncol. 2022; 40(16_suppl): 4546–4546.
- McDermott DF, Choueiri TK, Bauer TM, et al. 656MO Phase II study of belzutifan (MK-6482), an oral hypoxia-inducible factor 2α (HIF-2α) inhibitor, plus cabozantinib for treatment of advanced clear cell renal cell carcinoma (ccRCC). Ann Oncol. 2021; 32: S681.
- Weight CJ, Mulders PF, Pantuck AJ, et al. The Role of Adrenalectomy in Renal Cancer. Eur Urol Focus. 2016; 1(3): 251–257.
- Umbreit EC, McIntosh AG, Suk-Ouichai C, et al. The current role of cytoreductive nephrectomy for metastatic renal cell carcinoma. Indian J Urol. 2021; 37(1): 13–19.
- Hsieh JJ, Purdue MP, Signoretti S, et al. Renal cell carcinoma. Nat Rev Dis Primers. 2017; 3: 17009.
- Powles T, Albiges L, Bex A, et al. ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Renal cell carcinoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2024; 35(8): 692–706.
- Motzer R, Hutson T, Cella D, et al. Pazopanib versus Sunitinib in Metastatic Renal-Cell Carcinoma. N Engl J Med. 2013; 369(8): 722–731.
- Motzer R, Nosov D, Eisen T, et al. Tivozanib Versus Sorafenib As Initial Targeted Therapy for Patients With Metastatic Renal Cell Carcinoma: Results From a Phase III Trial. J Clin Oncol. 2013; 31(30): 3791–3799.
- Choueiri T, Powles T, Albiges L, et al. Cabozantinib plus Nivolumab and Ipilimumab in Renal-Cell Carcinoma. N Engl J Med. 2023; 388(19): 1767–1778.
- Grande E, Alonso-Gordoa T, Reig O, et al. Results from the INMUNOSUN-SOGUG trial: a prospective phase II study of sunitinib as a second-line therapy in patients with metastatic renal cell carcinoma after immune checkpoint-based combination therapy. ESMO Open. 2022; 7(2): 100463.
- Albiges L, Powles T, Sharma A. CaboPoint: interim results from a phase 2 study of cabozantinib after checkpoint inhibitor (CPI) therapy in patients with advanced renal cell carcinoma (RCC). J Clin Oncol. 2023; 41: 606.
- Lee CH, Shah A, Rasco D, et al. Lenvatinib plus pembrolizumab in patients with either treatment-naive or previously treated metastatic renal cell carcinoma (Study 111/KEYNOTE-146): a phase 1b/2 study. Lancet Oncol. 2021; 22(7): 946–958.
- Albiges L, Rini BI, Peltola K, et al. LBA88 Belzutifan versus everolimus in participants (pts) with previously treated advanced clear cell renal cell carcinoma (ccRCC): Randomized open-label phase III LITESPARK-005 study. Ann Oncol. 2023; 34: S1329–S1330.
- Spyropoulou D, Tsiganos P, Dimitrakopoulos FI, et al. Radiotherapy and Renal Cell Carcinoma: A Continuing Saga. In Vivo. 2021; 35(3): 1365–1377.
- Lonser RR, Weil RJ, Wanebo JE, et al. Surgical management of spinal cord hemangioblastomas in patients with von Hippel-Lindau disease. J Neurosurg. 2003; 98(1): 106–116.
- Chang SD, Meisel JA, Hancock SL, et al. Treatment of hemangioblastomas in von Hippel-Lindau disease with linear accelerator-based radiosurgery. Neurosurgery. 1998; 43(1): 28–34; discussion 34.
- Singh AD, Nouri M, Shields CL, et al. Treatment of retinal capillary hemangioma. Ophthalmology. 2002; 109(10): 1799–1806.
- Wong WT, Liang KJ, Hammel K, et al. Intravitreal ranibizumab therapy for retinal capillary hemangioblastoma related to von Hippel-Lindau disease. Ophthalmology. 2008; 115(11): 1957–1964.
- Kim HJ, Hagan M, Butman JA, et al. Surgical resection of endolymphatic sac tumors in von Hippel-Lindau disease: findings, results, and indications. Laryngoscope. 2013; 123(2): 477–483.
- Adapted from the VHL Family Alliance - VHL handbook. 9 Alliance VHL. The VHL handbook - What you need to know about VHL. 6th. International edition. Boston, MA, VHL Alliance 2020.
- Mourão JL, Borella LF, Duarte JÁ, et al. Imaging manifestations of von Hippel-Lindau disease: an illustrated guide focusing on the central nervous system. Radiol Bras. 2022; 55(3): 188–192.