A malignant pheochromocytoma in a child with von Hippel-Lindau mutation

Abstract

Pheochromocytoma is a rare neuroendocrine tumor that arises from the chromaffin cells of the sympathetic nervous system. Over one third of pheochromocytomas are associated with germline mutations. We describe a 3 year-old girl with an inherited right adrenal malignant pheochromocytoma, with the mother diagnosed with von Hippel-Lindau syndrome. Genetic tests revealed the presence of the VHL c 244 C>G (p. Arg 82 Gly) heterozygote mutation in the mother, as well as in the child. After 6 months from the complete resection of the tumor, the patient is without any clinical symptoms, with normal blood pressure, normal ophthalmoscopy, no tumor markers and no evidence of tumor on cerebral or abdominal MRI. Lifelong complex follow-up is needed, as it is known that at a later age VHL mutation may cause retinal angiomas, cerebellar and spinal hemangioblastomas, relapsed pheocromocytoma, pancreatic and renal cysts, clear cell renal cell carcinoma and endolymphatic sac tumors.

Keywords: child; malignant pheocromocytoma; von Hippel-Lindau mutation.

Figure 1

Right adrenal tumor.

Figure 2

Example of light microscopy image of sections from the excised tumor showing characteristics of malignant pheochromocytoma (Zellballen with central necrosis), hematoxylin eosin (HE) stain (10X).